| Media Kit | Testimonials | | | Contact Us | Archives


Bloodstain Patterns and Interpretation
By Kenneth S. Passan, RN, BS

Editor's Letter
Championing the Crime Lab, and Separating Fact From Fiction

News & Views
Datebook

 

Capturing More Than the Moment
By Georgia A. Pasqualone, MSN, MSFS, RN, CEN

Recent conversations with emergency department (ED) colleagues have revealed that some healthcare providers are under the misconception that photodocumentation of patient injuries will breach confidentiality. On the contrary, photographs are considered as much a part of the medical record as is the written documentation. Neither gets separated from the record, and the information enclosed within does not get revealed outside the clinical setting until subpoenaed by the legal system.

An elderly woman was brought into the ED from a nursing home with fever of unknown origin. When the patient was prepared for catheterization, the nurse observed massive swelling, contusions and bruises in the patient's perineal area. There were no other injuries on the woman's body. Was this a result of anticoagulation therapy, or was this a situation of elder abuse? The nurse wanted to photodocument the injuries and report her observations to Elder Services, but was discouraged from doing either by the resident on call. The resident was under the impression that photographing the woman's injuries, because they were on her genitalia, would not only be an invasive process, but would also breach her confidentiality.

The truth of the matter is that by not photographing the woman's injuries, healthcare personnel are committing an injustice to this patient. Photodocumentation preserves the injuries that will heal with time. If photodocumentation does not become part of the written record, the patient will lose the impact for adjudication of this potentially abusive situation.

"What do we do with the photographs once we take them?" was the question then asked by the resident. As with all narrative notes, documentation of physical findings, clinical procedures, and diagrams of patient's injuries, photographs are included in the medical record. If a patient is unable to give consent for photography, there is an implied consent, as treatable injuries are considered exigent evidence. In other words, evidence that will eventually vanish or be changed in appearance through healing or treatment is considered exigent and must be captured through photodocumentation in order to complete the record.

A well thought-out policy must therefore be in effect for photodocumentation prior to the arrival of any forensic category of patient. Ideally, photodocumentation should be included in the blanket permission to treat. As with any treatment generated in the ED, the patient always has the option of refusing or declining. If a patient does not want photographs taken of their injuries, they still have that right to refuse.

There will come a day when hospitals and healthcare providers will be sued for not photographing the injuries due to trauma and/or violent crime. This will be an act of neglect on the part of the clinicians. The police have been photodocumenting for many years. Their photographs lend only to the investigative process, though.

Healthcare providers, especially those in the ED, are in the ideal situation for visualizing injuries, recognizing them as evidence, and preserving them for any future litigation. In effect, they are advocating for their patients. The knowledgeable public is becoming more and more aware of the fact that photographs provide a tremendous impact in the courtroom. It is the proactive hospital and the educated healthcare provider with a vision toward the future that not only treats the patient, but also protects his or her civil rights.

Georgia A. Pasqualone MSN, MSFS, RN, CEN, is a clinical forensic nurse specialist in the emergency department and staff development at Winchester Hospital in Winchester, Mass.

Click here to Subscribe


HOT NEWS

09/16/

Study Explores Dental Care Needs of Child Sex Abuse Victims

09/15/

Suicide Among Male Prisoners is Five Times That of the General Population

09/13/

New York Doctor Exposes Inadequacies of Child Protection Agencies in New Book

08/31/

Minnesota Department of Health Report Provides New Insights into Child Maltreatment by Looking at Hospital and Child Protection Data

Illinois Governor Signs Legislation to Make Nursing Homes Safer; New Law Requires Criminal Background Checks for More Employees at Long-term Care Facilities

08/17/

International Conference Seeks Collaboration, Strategies for Violence Prevention

08/03/

Puritan Medical Products Company LLC Introduces a New Forensic Swab

More News

 

 

 

 







related sites

EndoNurse

Infection Control Today

Today's SurgiCenter

Forensictrak