Video in the Trauma Room
	Date: Fri, 11 Oct 1996 20:49:19 From:[TraumaView@aol.com] Many on these webs use VIDEO recordings in the shock room or the ICU for QA and educational purposes. The following is a must read as it has bearing on your future. A patient was brought to one of the nations busiest trauma centers following a penetrating wound. In the presence of a peace officer the patient alledgedly admitted to a crime or a series of crimes. The peace officer saw the signs about the video recordings and immediately obtained a court supena to obtain the video recording. The trauma coordinator who always distroys the videos after they are viewed in a QA conference within 5 days had already given the video to the chief of trauma who had called the lawyers for the hospital and the medical school. The doctor had been told to lock up the video and not give it to anyone until a request to deny the prosecutors request was sent to the judge. After a brief was prepared by one of the nations best law firms (at great expense) the judge denied the request and mandated the tape. The judge stated that in a criminal case there is NO physician/patient privledge NOR is there any protection from seizing ANY material from a hospital or physician INCLUDING ALL QA material. The judge went on to say that the video material is also NOT protected from even CIVIL seizure should the court want it. The decision was discussed in detail and finally, only the edited portion containing the alledged confession and conversations with the peace officer were given to the prosecutor and judge. (BUT THEY DID GET THIS PIECE). The Hospital administation did not understand the principle underlying the physicians stand and stated up front that the QA tapes should be given to the judge and prosecutor. The origional tape has not yet been distroyed at the instructions of the judge, but is still in the safe of the lawyer of the doctors. THis occurance has far reaching consequences on our QA programs and deserves discussion on all of these boards. Many many more details exist, but only the prinicples which have openly been discussed in the halls and conferences of the hospital are cited here. THe physicians do not know of nor have any opinion as to the guilt or innocence of the patient. The physicians and nurses concerns rest with the QA process and protection under the hospital, JCAHO, and the law. The hospital administration mandates that the nurses and physicians actively participate and sign the QA material so the hospital can get certified by JCAHO. THe nurses and doctors are very near refusing to participate in ANY QA activities as the hospital took the stand that if a judge really wants something, just give it to them.
	Date: Fri, 11 Oct 1996 21:49:56 From: Harvey Louzon [harvey@mcs.net] The hospital attorneys were correct to ignore the physician's hysterical response and to comply with the judges orders. Physicians should not place themselves in the position of obstructing the administration of justice.
	Date: Fri, 11 Oct 1996 22:55:29 From: David Crippen [crippen+@pitt.edu] It is, and has always been my opinion that video taping ANYTHING in a patient care area is fraught with INFINITELY more problems than benefit. I would NEVER allow ANY videotaping of ANYTHING in a patient care area at our facility for ANY reason. A word to the wise is usually sufficient.
	Date: Sat, 12 Oct 1996 01:49:10 From: Todd Kelly [ToddKelly@aol.com] I disagree completely. Although I too want to see criminals put behind bars, the information gained from these tapes for medical educational purposes is too valuable. If these tapes are going to be subpoened by the courts I fear that doctors will refuse to tape at all. Afterall, the only logical next step is that the videos can be used against the treating physician in court.
	Date: Sat, 12 Oct 1996 16:07:42 From: Ed Kelly [eke@med.pitt.edu] Wait a minute. Is this admissable evidence? Did the patient hear and understand his Miranda rights? Was he given an opportunity to confer with his lawyer? Was he even questioned by a police officer, or did he simply say "I shot citizen X" in response to a doctor's questioning? These are important issues because they determine whether the video is a record of the doctors' interview of the patient (confidential and not subject to subpoena) or the police officer's questioning of a suspect (admissable evidence, subject to rules and limitations concerning handling of evidence).
	Date: Mon, 14 Oct 1996 10:00:58 From: Dick Burrows [BURROWS@MED.UND.AC.ZA] Video training may well be useful but it is also something whih is likely to destroy patient confidentiality. However I'm not sure WHAT training if the tapes are destroyed within a few days. There is also an argument which says that social justice is important - more important than any confidential discussion between doctor and patient - indeed the judge could probably subpoena you to give evidence and if you refused he might throw you in porridge. The same goes for your notes. The journalist often faces the same problem but more accurately the priest faes it when he hears a confession of murder. I don't know what the final answer is but I do know that in respect of the trust that is necessary between doctor and patient it is vital to maintain confidentiality. I think under these circumstances it is obviously dangerous to question the means whereby he came by his wounds. It is also likely to be quite irrelevant as surely it is enough surely to know that he has been shot or stabbed or whatever. you shouldn't need to know the why's and the wheretofors in order to treat him.
	Date: Sat, 26 Oct 1996 16:21:27 From: Bartholomew Tortella [tortella@UMDNJ.EDU] I am still unclear as to why the hospital did not appeal the ruling of the first judge. Provision of the tape, albeit edited, seems improper and I would go to the appellate level at least if not above that before I obeyed the court order. Clearly there was not time constraint and an appeal of the original judge's order seem appropriate.
	Date: Sun, 27 Oct 1996 13:44:49 From: Ken Mattox [KMATTOX@aol.com] They did not appeal because the lawyers told them that this was a criminal not civil issue and that they would loose in the long run.
	Date: Wed, 30 Oct 1996 16:37:10 -0500 (EST) From: Bartholomew Tortella [tortella@UMDNJ.EDU] I realize that the mattter was criminal, but the hospital has every right to appeal if they believe the physician-patient relationship was violated. Appeals of jurdge's orders and ruling are commonplace. I believe they got BAD ADVICE from their lawyers. Remember, an opinion from the hospital lawyers is just that, an opinion. The hospital might think about asking for a second opion or the trauma docs might think about retaining their own counsel.