Readers Respond to Mo. EMT Terminated Over Scene Photos

Chris Drennan, a Mo. EMT with the Adair County Ambulance District, was recently suspended, then terminated, after his department found out that photos he took at the scene of a school bus-ATV accident were posted in an online forum.

The department’s administration cited the 11-year veteran with violations against the Health Insurance Portability and Accountability Act of 1996 and ACAD policies.

After EMS1.com learned of Drennan’s suspension, we asked our readers what they thought about this issue. We posed the question: Do you think the EMT in this case should have been suspended for posting scene photos on the Internet that were approved by the patient’s family and intended for educational purposes?

To read the original article published on EMS1.com, click here.

Editor’s note: Please read the follow up exclusive to this article by JEMS contributing photographer Ray Kemp.

Here are a few of the responses that we received:

What I am concerned about is medics and firefighters on the scene with their personal phones/camera taking shots for personal reasons. That I think is inappropriate. The procedure should be for the service that the EMT/firefighter work for provide a camera and then the service (not individuals) use pictures (with permission) for training purposes internally as well as for outside presentations.

If the photos were taken on personal equipment, then I feel that the medic should be disciplined. Of course, policies should be in place to address the use of personal cameras/cell phones with photo capability during working hours. Not sure if EMS services are aware of the risk and liability of allowing personal cameras and cell phones during work hours. Oh – I can hear the screaming now!!!! Not only am I a paramedic, but my background is in risk management and human resources.

— Loree Allen, NYS Paramedic

Protected health information is only protected until permission is granted for its release. If the pictures and descriptions of an accident are published under permission granted by the patient or agent, there is no violation. It is interesting to note that most people who invoke HIPAA rules don’t have a proper understanding of those rules.

— Lt. Tom Corso, RN, EMT-P, Franklin Park (IL) Fire Department

No, I do not think the EMT should be suspended, due to the fact that the family, the ones we should be protecting, was OK with this doing.

Now, I don’t believe we should not follow procedures and guidelines. Maybe the EMT should have been reprimanded but not taken off of his duties.

— Shakeyta Orr, Medicare/Medicaid Team Lead, American Medical Response

Sounds like this paramedic “crossed the line” when he posted the photos on the Internet. He tried to make the argument that he had the parents’ permission to take the photos, but did he have permission to post them?

If he did not get that permission, he probably violated HIPAA and should probably lose his license and be permanently banned from caring for patients (Adair County is probably also being opened up for legal action because employee probably violated HIPAA). I believe his suspension is justified as he violated basic patient/care giver confidentiality, which even pre-HIPAA medics know to keep sacred.

— Charles Phillips, REMT-P (Ret.), Cooper County, Mo.

As a practicing paramedic myself, with both teenagers and a young son still at home as well, I can see why Mr. Drennan would want to post the pictures as a “learning experience.” Without having all of the details it is hard for one to state what was right or wrong.

When were the pictures taken? Were they taken on the employer’s equipment or on their time? Why was Mr. Drennan there?

If he was there on company time and utilizing company equipment then one would have to believe that the release the parents signed must release the employer as well, not just the photographer. Regardless of what the parents and Mr. Drennan agreed upon, it is crucial to have legal consultation when it comes to releasing patient information.

It is as much the company’s responsibility to protect that information as it is the employee. In this case, it appears that the employee acted on his own with information that he received in course of doing his job. Regardless, of any agreements that Mr. Dennan had with the family, I fully believe that all could have been adverted if he consulted his employer prior to posting the pictures.

— Kevin Haines, EMT/P, Plano, Texas

The EMT obtains written permission from the parents to display the photos specifically for educational purposes and gets suspended......because “maybe” it’s a HIPAA violation. I think perhaps we need to examine all EMS educational conferences across the country who show slides and discuss various disasters and incidents in order to train responders, I’m sure we can find a few HIPAA violations there, and we can suspend all the speakers. While we’re at it, let’s suspend CNN, I’ve seen plenty of wrecked cars and blood on their programs.

We can’t get minimal government support for EMS and first responders, an embarrassment when compared to many other countries, but we sure can suspend our EMTs for trying to educate the public. I think the whole situation is pathetic.

— Jeffrey A. Friederich, MD, Duluth, Minn.

The way I understand this from the article, the EMT had written permission from the boy’s parents to post the photos for educational purposes. HIPAA allows a person to assign rights to another person to see/use health information, which is apparently what happened in this case. Thus, I see no HIPAA violation.

My real question is this, however: How is this different from the news media posting bloody images and video of crash sites all over their websites and the television news shows? When the media does it, it can be very gratuitous, with images of body bags and bloody helmets and such. Depending on how the EMT posted the photos, the text accompanying them, and the overall theme of the website, his presentation was most likely less sensational and more educational than any news show could manage.

— Kate McDonald, EMT-I, Minerva Park VFD, Columbus, Ohio

Unfortunately, this is a prime example of the problems that HIPAA mania has caused EMS. “Officials” who think they understand the rules flip out at anything they deem to be a violation. HIPAA has created bizarre practices to “protect patient information.”

The fact that the EMT went and got permission from the parents should have automatically dropped this case. Numerous entities like MADD, police departments, etc., post accident photos without family permission. Why is EMS exempt? A prime example is the show Cops v. Paramedics. Paramedics violates a person’s privacy and Cops doesn’t?

— Jon Willoughby, Firefighter/NREMT-P, Albuquerque, N.M.

Absolutely, he should be suspended. Not fired. Pictures taken on scene by a responding crew should be considered part of a patient’s chart. If the pictures are to be used, there are ways to go about getting permission through the hospital or EMS system. Just because the parents are ok with it does not give an employee permission to make public what should be considered property of the service.

I know, everyone has a cell phone or digital camera to take a quick pic. It’s still a bad idea. What is also yet to be considered is the emotional impact this may have on friends or other family members. And many people misuse pictures and information from the Internet. This was an emotional decision that is understandable, but still just as bad an idea. Plus, while many people will think this accident was “a real shame,” they also believe it won’t happen to them because they “are safer.”

Start a safety program that will run for years, not just when you’re emotional about it. Injury prevention is the name of the game. But not by posting your latest bloody pics.

— David S. Hoover BA, EMT-P, Hospital Emergency Planner

I think that seeing as how the parents approved of the pictures there is no privacy issue at stake. The paramedic should not have been disciplined unless it was for some breach of duty or protocol of the service he worked for.

— Howard Hicks, NREMTP

Yes. There is no educational value over showing bloody photo’s of victims or patients.

— Jeff Schanhals, Coordinator, Northeast Colorado RETAC

Although Mr. Drennan’s actions may have been motivated by an altruistic purpose (that of warning other young ATV riders while heightening their sense of safety), he failed to secure the permission of his agency. His agency develops internal policies to comply with laws, rules, and regulations. All be it, his actions may not rise to an actual violation of law, he did violate the agency’s internal policy. Let us not forget, he was not there as a photographer or journalist, he was there as an agent of his employer.

Mr. Drennan should have approached his superiors and received written permission to pursue this course of action.

— Nelson Machado, Jr., NYS EMT-P, NREMT-P

With written permission from the parents, no he should not be suspended. Rather, he should be assisted in making this into a presentation to help prevent future occurrences.

— Ricky Ferguson, EMT Instructor

Very interesting “test case” perhaps for our EMS community. While we can’t know all details, one can only share what we think in response to your question.

It’s nothing new for agencies to photograph scene details, for the receiving hospital’s use, for local training, commemorative books, or even personal keepsakes. Some of this will likely continue. We also know how rules have developed to protect patient information, even to the point of being absurd. Yet it’s what agencies and responders must live by. We also know what a Pandora’s box the Internet is, meaning that posted information may be manipulated by others.

It’s commendable to use photos for training/education, and many agencies today use the staged MVA’s to educate students. At least one agency local to me was adamantly opposed to doing the same, for fear of scaring someone. At least in this subject case, the responder sought approval and permission in an attempt to do the right thing.

Unfortunately in our business, one learns that some things still must go up the food chain first, for management to sign off on. It doesn’t matter if we agree or not, they do want to be included. Perhaps this is the rub? While they state it’s being investigated, my concern was the lack of pay during suspension. That’s very unusual in itself, without a history by this person and other infractions. I hope there is a mechanism in place for the responder to recover the lost wages?

— E. Mark Baland, Fire Captain, Irving Texas

I believe that he should not be suspended. He did receive permission from the pt’s parents and so this should not be a HIPAA violation. Employers are taking this new law to the extreme. Any time that a medic does something to either protect a pt or report abuse and are the advocate for that pt, and the employer feels that this has jeopardized either a contract or the company as far as public relations go, they start with this HIPAA stuff. There is too much of a gray area in that law and is very vague for most situations. What should we do? Do we keep everything to ourselves and not educate the public? Do we let abuse continue in nursing homes, in homes or any other place or situation? When and where are we supposed to do these things?

— Maria McCain, NREMT-P, Starkville, MS

To read more reader responses, please click here.