Should Hospital Security Officers Carry Narcan?
Two days ago, I was leaving the hospital and I heard the overhead announcement "Code Blue, front entrance to the hospital". Nine times out of ten, this is because someone...
A blog for and about medical directors
Last year, one of the emergency room physicians called me to ask my advice when one of his patients wanted to film himself being sutured and stream it live to Facebook. Today, one of the hospitalists contacted me because a patient wanted to video his hospital encounter for pain management. In the first case, the patient was looking to create “reality TV” for public entertainment. In the latter case, the patient was using the threat of public exposure in order to coerce the physician into prescribing narcotic medications.
The patient was admitted with a medical condition that can cause pain but is almost always associated with abnormal blood tests. In this case, all of the blood tests were normal and there were some suspicious discrepancies in the patient’s history that caused the physician to suspect opioid-seeking behavior on the part of the patient. In the past, we have had patients use all sorts of behaviors to get their physician to prescribe opioids. I’ve had patients threaten to call the State Medical Board about their physician. When his physician refused to prescribe oxycontin, one patient called the medical staff office to report that his physician was intoxicated (we immediately did an alcohol breath test – it was negative). But this was taking coercion to a new level.
It is pretty common for patients to ask to record their visits in the outpatient clinic and the vast majority of the time, it is for very appropriate reasons. Patients often have a hard time remembering all of the information that you’ve given them and they want to be sure that they get their medical instructions right. Sometimes, they have family members who will ask: “What did the doctor say?” and they want to be sure that they get it right. I was taken aback the first time that happened to me but now, I don’t find it intrusive – usually it is a way to improve my patients’ compliance with medical instructions and a way to be sure that everyone in the family hears the same thing. I admit, I am a little more cautious about what I say and how I say it… but then, maybe that is how I should always be.
From a legal standpoint, patients can record their conversations with you, even if they don’t tell you that they are recording you. In Ohio (as in most states), a conversation can be legally recorded as long as one party consents to it. This means that anyone can legally record a conversation with anyone else in secret. Video is treated pretty much the same as audio. The legal case of Smith versus the Cleveland Clinic in 2011 illustrates this. A patient died in the hospital and afterward, the family asked to meet with the hospital medical director and secretly recorded the conversation; the court ruled that the recording was admissible as evidence in the subsequent malpractice case. As the paparazzi will attest, it is perfectly legal to take photographs or videos of anyone as long as you are on public property. Hospitals are generally considered a public place, in this regard.
Police are being pressured into wearing body cameras both because of the fear from some members of the public that the police are being abusive and because of the fear that many police officers feel that they are being inappropriately accused of being abusive. Jeremy Brown, MD, the director of the National Institutes of Health’s Office of Emergency Care Research, proposed that body cams should be standard equipment for emergency department physicians. I’ve been an expert witness for dozens of defense malpractice cases and can’t count the number of times the plaintiff will make an allegation about something totally outlandish that they claimed that the physician said with the astonished dependent physician’s response of “I never said that”.
So what should the physician do? Most of the time, an audio or video recording is a way of improving patient care and can be the physician’s friend, not foe. But this was a pretty unique situation where a patient took advantage of a physician being uncomfortable being filmed in order to pressure the physician into prescribing narcotics. Here are my suggestions:
The world has become a very small and very public place. We are recorded on some surveillance camera or another whenever we walk down a city block. People have their cell phone in holsters ready to draw at the first sign of anything newsworthy on our streets and our public places. When you walk into a grocery store or a bank, your picture has been taken. Like it or not, we are filmed by someone almost every day. The hospital has become no different.
May 31, 2017