Hospital investigated after improper photo is taken

A Denver hospital is facing strong criticism and threats of a lawsuit after emergency department (ED) staff photographed an unconscious patient’s genitals and left the photo on the man’s digital camera. The hospital already has weathered multiple investigations by the police and state regulators following the incident.

The 35-year-old man had been attacked outside a gay bar and was taken to Denver Health Medical Center with a cracked skull, says hospital spokes-woman Bobbi Barrow. While the man lay unconscious in the ED, two staff members found a digital camera among his personal belongings, Barrow explains. They first viewed the images stored on the camera, seeing that the patient had used the camera at the bar that night, she says.

They then pulled down a sheet to expose the man’s genitals and took a photo before placing the camera with the rest of the man’s belongings. The patient discovered the photo sometime after leaving the hospital.

Hospital admits misdeed

Barrow says the hospital does not deny the incident took place. It represents a breakdown of several fundamental hospital policies, she says. "The digital camera was not immediately placed with his personal belongings, as policy required. There was a time lapse of an hour or more before the camera was put away," Barrow says. "In a very inappropriate and unprofessional action, someone shot a picture of him."

The staff members were a paramedic assigned to the ED, but not involved in transporting the patient to the hospital, and a health care technician.

The incident occurred at about 2:30 a.m. on Feb. 16, 2003, but was not reported to hospital leadership until July 17, 2003, she says. Hospital administrators immediately apologized to the patient in person and by telephone and launched an internal investigation.

Twelve days later, on July 29, the two employees involved with the incident were no longer employed at Denver Health. The hospital also reported the case to the Colorado Department of Public Health and initiated reminder training about patient privacy, management of personal belongings, and professional standards.

"The protocol for securing patient belongings was not adhered to," Barrow says. "Picking up something that belongs to a patient and using it is a major departure from anything expected in the emergency room. And the fact that we violated a patient’s privacy was something we had to follow up on."

The internal investigations determined that all the proper policies already were in place, but that the staff needed reminders about respecting patients, Barrow says. She suggests that risk managers would be well advised to remind staff about patient respect and securing personal property. The other lesson is to respond promptly once such an incident is brought to your attention, Barrow adds. Denver Health leaders are confident that they did everything possible once they were informed, she says.

"The police investigation determined that there was a discussion around the emergency room that night about someone taking a picture, but it was a busy night," so the comments were not brought to the attention of administration at that time, Barrow says. When hospital leaders investigated, interviews suggested that three or four staff members knew about the incident. No one was disciplined for not reporting the incident, Barrow says.

The hospital cooperated with a state of Colorado investigation initiated on behalf of the Centers for Medicaid & Medicare Services, as well as cooperating with a local police investigation.

"The outcome was that we were not cited by the state and the police did not issue any charges," she says. "From our perspective, we took all the appropriate actions as soon as we knew. We behaved responsibly in response to what was clearly, clearly a violation not only of our policy but of the patient’s privacy."

Patient threatens to sue

The incident did not become known publicly until the patient’s attorney, Dan Caplis, JD, released a statement to the media. At that time, he also filed a notice of intent to sue, but Barrow says the hospital has not yet been sued. While Barrow admits that the incident was a clear violation of the patient’s privacy, she relates her surprise that the patient’s attorney released the photo in question to Denver television stations, at least one of which showed the photo during a newscast.

Barrow explains that the public disclosure of the incident came at the same time the hospital was already dealing with another scandal involving emergency staff. She says the two incidents are unrelated. On June 24, 2004, the hospital terminated five paramedics, placed three others on investigatory leave, and disciplined nine more.

"A former employee, after leaving, alleged actions of not only internal harassment of each other, but also some unprofessional treatment of patients by a small group of paramedics," Barrow explains. "We learned through our investigation that there was some substantiation of the allegations, so action was taken."

The internal harassment included anonymous, threatening letters and other issues that created a hostile work environment. Regarding patients, the paramedics were accused of callous and abusive behavior such as making a 96-year-old woman walk to the ambulance instead of carrying her, bullying patients, making vulgar and demeaning comments, and unnecessarily rough and demeaning treatment of patients.

"As a result, Denver Health is doing a review of the paramedic division, taking a closer look at various aspects of the organizational structure," Barrow says. "We have already changed the patient complaint system because we previously had a separate complaint system for the paramedics but sometimes those complaints never made it through to the hospital."

The hospital also now has a policy that requires rounding on patients admitted after transfer by paramedics, seeking feedback on how the paramedics treated them. The hospital also is reminding employees that they can report concerns anonymously through the employee hotline.