Taking picture of patient?

[rkitty198]

Hello all-

A co-worker of mine cared for a minor celebrity and was herself a fan. She wanted a picture with the patient and asked if I wanted to get one too. I declined. She took the picture after the patient was discharged. The patient was dressed and standing outside the room.

After having a very busy day I didnt think much about it. I told another co-worker about myself not "getting a picture" with this patient and then I thought I was glad I didnt choose to, because I didnt think it was right (although it would have been neat to have a picture). The co-worker I told, reported this Nurse to management.

This Nurse had a meeting with management and her job is in jeopardy.

Is this wrong? I personally think it is, but I would never want to get my co-worker into trouble. I feel so bad by saying anything as it is affecting her.

Also this staff member was contacted that evening by this former patient for a bleeding IV site issue at discharge and was instructed to go to the ED (I thought calling 911 would have been better as he was at home). My co-worker met the patient in the ED after she was clocked out and off duty to see how the patient was. Do you think this is inappropriate?

I feel badly for her.

What do you all think?

[tyloo]

Don't beat yourself up. The other nurse you confided to chose to go to management making it an issue. I don't know what her/his intentions were but that was her choice and if the nurse gets terminated for it the person who reported her is going to have to live with that not you! On the other hand the nurse taking the pic is not innocent either. HIPPA has been around for a number of years now that staff should know that you can get terminated if it is violated whether you are a good nurse or not. It is unfortunate that you were involved in this. In the future, and I am sure you will now, mind your P's and Q's around the tattle-tell nurse.

[decembergrad2011, BSN, RN]

Well, you learned a few things from this experience, and I feel like the more important lesson is that the nurse who you told will totally hang you out to dry on a minor mistake.

Do not care for gossips or tattle tells at all. Be straight with your co-workers, it's the best way to garner respect.

[Bortaz, MSN, RN]

It really amazes me how many HIPAA experts we have on this forum that dont even know its not called HIPPA. Who knows. Maybe this picture IS a ******* "HIPPA" violation.

[Old.Timer]

You guys are right. I should have told her about her actions and prevented the entire thing. I feel awful!

She asked me if I wanted to take a picture, I was going to see a patient for a dressing change- it was at the end of the shift- Originally I wanted a picture- didnt have time- then thought it wasnt right- then asked another Nurse their opinion.

She has been an RN for over 25 years and myself 4.5 years. I guess I didnt feel like telling another Nurse with more seniority what to do.

I would have never told management about her decision to take the picture. I was more telling the other RN that I wanted a picture, blah blah, didnt get one, but should you do it, blah blah

I think this RN is great, I have no reason to tattle or hurt her, yet that is what I did.

Very gracious response.

[GHGoonette, BSN, RN]

You guys are right. I should have told her about her actions and prevented the entire thing. I feel awful!

She asked me if I wanted to take a picture, I was going to see a patient for a dressing change- it was at the end of the shift- Originally I wanted a picture- didnt have time- then thought it wasnt right- then asked another Nurse their opinion.

She has been an RN for over 25 years and myself 4.5 years. I guess I didnt feel like telling another Nurse with more seniority what to do.

I would have never told management about her decision to take the picture. I was more telling the other RN that I wanted a picture, blah blah, didnt get one, but should you do it, blah blah

I think this RN is great, I have no reason to tattle or hurt her, yet that is what I did.

Twenty-five years of experience and she couldn't handle this herself??? Nasty. As another post has mentioned, this incident will enable you to be more on your guard with this nurse.

I like your response; I think both you and your friend are still quite young-age makes you a little more blase about "celebrities":)

Please warn your friend, if she is hoping to establish a "personal" relationship with this "celebrity", she may well be setting herself up for a fall-if she hasn't already done so I've met a few in my life, and my warning to her is, be very careful, these guys are not above "using" a willing, attractive youngster. And most of them are married....

But I can't get over this character...25 years experience, and the best thing she can think of doing is sinking another nurse....? very, very nasty.

[Marvie]

Unless that nurse had expressed consent by that patient, the photo was a violation of the person's privacy, along with meeting the same patient in the ER (even if she was off the clock) was also inappropriate (How did she know the person was in the ER??) Unless she was directly caring for the person at that time, it was not right for her to do so. Legality will always win if it ever goes to court, just saying.

[Anisettes, BSN, RN]

Very gracious response.

Very. It's a rare person these days that is able to look at the consequences of an act, take responsibility for it, and admit they made a mistake both privately and in a public forum where they are exposed to the censure of everyone. And without trying in any way to minimize or excuse their actions. Please don't ever lose that capacity. The older you get you'll realize how few of our fellow humans ever had it to begin with. We live and learn.

[rkitty198, BSN, RN]

Thank you.

[cherrybreeze, ADN, RN]

For everyone that has said this photo was a HIPAA violation, please explain exactly why. If this patient was discharged, gave consent, and posed for the photo....what is the infraction? Even if the picture was taken in the hospital (meaning, the background is identifiable)...the patient was obviously OK with it. There is no violation, sorry. People like to throw that term around like crazy, but it has more specific guidelines than this.

I'm not even going to address the meeting in the ER issue, because there are too many details missing about that part. The biggest, in my mind, is what type of IV would bleed that badly after being discharged that it would require even being SEEN?

[Otessa, BSN, RN]

To add more to the story, we have paper charting and have access to the charts until medical records picks up the charts at 9pm after the patient has been discharged.

Management knows about the phone call from celebrity to RN because the RN that told on her was there when the phone call took place and she got so fed up she decided to tell about both situations.

Just playing devils advocate:

What about telling the patient to call 911- if a patient calls the unit bleeding?

Wouldnt that be a better idea then telling them to drive to the ED?

I was there at the time of the phone call (as well as the RN who told) so I did hear the conversation from her end

Back to the picture:

This patient did supposedly give verbal consent.

*Say a patient does give consent, as in this case, what if they are under the influence of narcotics? What then?

Thank you for your opinions.

Call 911 for a bleeding IV?? No

Bleeding groin site? yes

[SnowStar4]

Just curious, why would it be considered a violation if the patient said it was okay to take the picture?

It's just taking advantage of their situation. The patient is in a vulnerable position and may say yes even though they do not want to. If it doesn't help in their care or making them more comfortable it shouldn't be asked.

[tyloo]

here is my response to the above question: hipaa does not go into specifics however it does give generalizations of what is considered phi. specifically hospitals have their own policies that address this. i am not a hipaa guru , thankfully, but i need to stay employed. therefore, i am very paranoid when it comes to disclosure. yes hipaa is a catch all phrase and is thrown around a lot. however, it is also something that gets people fired for being careless with words or actions. people can get fired for being incompetent, tardy, combative to fellow employees, etc, but the one thing that can get a good worker fired is violating this. honestly i believe that a photograph of a patient in the hospital is considered a phi. again that is how i interpret it and you tell me what you think. i do admit i am paranoid because i just think a slip up and it going to the wrong set of ears or eyes gives reason for a termination.

summary of the hipaa privacy rule

summary of the hipaa privacy rule:

protected health information. the privacy rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. the privacy rule calls this information "protected health information (phi)."12

"individually identifiable health information" is information, including demographic data, that relates to:

• the individual's past, present or future physical or mental health or condition,
  
• the provision of health care to the individual, or
  
• the past, present, or future payment for the provision of health care to the individual,
  

and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.13 individually identifiable health information includes many common identifiers (e.g., name, address, birth date, social security number).

the privacy rule excludes from protected health information employment records that a covered entity maintains in its capacity as an employer and education and certain other records subject to, or defined in, the family educational rights and privacy act, 20 u.s.c. 1232g.

authorized uses and disclosures

authorization. a covered entity must obtain the individual's written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the privacy rule.44 a covered entity may not condition treatment, payment, enrollment, or benefits eligibility on an individual granting an authorization, except in limited circumstances.45

an authorization must be written in specific terms. it may allow use and disclosure of protected health information by the covered entity seeking the authorization, or by a third party. examples of disclosures that would require an individual's authorization include disclosures to a life insurer for coverage purposes, disclosures to an employer of the results of a pre-employment physical or lab test, or disclosures to a pharmaceutical firm for their own marketing purposes.

all authorizations must be in plain language, and contain specific information regarding the information to be disclosed or used, the person(s) disclosing and receiving the information, expiration, right to revoke in writing, and other data. the privacy rule contains transition provisions applicable to authorizations and other express legal permissions obtained prior to april 14, 2003.46

regardless of what is stated by hipaa taking a picture of a celebrity while the person was seeking treatment at the hospital is just unprofessional. it is not the same as seeing them in a public place, for instance, the street or restaurant. i don't care if they are pleased to respond to the request. think about it if you just got discharge out of the hospital do you really feel like posing for a photo (with exception to having a baby)? people don't get hospitalized because they feel well it is when they are at their worst.