Consent and Forensic Photography

Thank you.

Is there a forum specifically for, or can SANEs share their policies r/t the discussion here? I also have some homework to do. 😐 As sounds like from the more experienced posters, (thank you), I much prefer be informed by their sample policy that is well thought out - and working- than attempt to reinvent the wheel.

Mindy, What Christine said! If destroying evidence that is not wanted by LE then it should be stated in your policy and maybe recommended patient sign acknowledgment form LE does not request evidence and patient is requesting destruction— all should be documented in the record and driven by institution policy.

Barb

Wow, this is great information. I def have some homework to do. Thank you for sharing your practice.

Another general inquiry:

When evidence is created and then destroyed (given the patient declines the medical forensic exam when they become conscious) could this be obstruction of justice? Especially in cases of which are mandated reportables?

Perhaps this is beyond physical/material evidence collection (Swabs, clothes, etc.)

Documentation and photodocumentation is standard and routine for the forensic nurse which enhances patient care and is performed to aide in medical diagnosis and treatment. Once created, can it be destroyed? Another way to phrase this question: Do patients have the autonomy or authority to redact information from their own medical record?

While the nurse is both ethically obligated to the patient… what about the ethical obligation to the safe keeping of the community?

Yes! All good comments and information were provided by Barb and Christine. This is an excellent discussion and point of best practice. Thanks for asking Mindy and starting the discussion.

Hi Mindy~

I will echo much of Barb's info. We do absolutely take photos of findings/injuries on unconscious patients. This occurs all over the hospital (ER, OR, wound care, ICU, OB-GYN, etc) so it is not a "forensic" specific practice. I had a GI scope last year and woke up to the GI doc showing me pics they took of my esophagus with the scope. I also had a hysterectomy earlier this year and woke up to the OB-GYN showing me pics of my endometriosis and cysts. :) So I think we tend to forget this happens in other depts and is not a new practice. Photodocumentation of injuries truly is best practice to show what the finding looked like at the time of assessment. This can be helpful with tracking of wound healing as well.

We do require consent (signed by patient or MDPOA if patient won't regain consciousness) or a court order to release the photos to law enforcement.

We do have photography written into our ED Consent to Treat that all patients sign when entering the hospital (or that is "implied" when they come in unconscious). We also have a hospital FNE policy with a clause written in about photography. If you have other questions, my email is Christine.Foote.Lucero@uchealth.org

Mindy, Our hospital policy on incapacitated care of the patient does allow photos, even ano-genital, but some hospital attorneys may not agree to that. We legislated in Indiana for us to be able to do a MFE on the unconscious patient and it passed. But with the caveat that until we obtained actual consent the photos, kit, and documentation went no where. So either the patient had to wake up and we would inform them of what we did and why, the next of kin would consent OR if the patient died then it comes a coroner's case and they are exempt from HIPAA.

Only then after we do it would the patient sign a letter of acknowledgment that we did the MFE and they would have to sign a consent to release to LE. Same if we could not get ahold of next of kin and we did the exam pending locating the next of kin.

So we not only have legislation providing up civil immunity and giving the provider the ability to do the exam we have our policy to cover us.

Regards,

Barb