Watching Fred Wiseman’s Hospital (1970) at the last Docyard screening, as patients at New York’s Metropolitan Hospital bled and vomited their way into our hearts, I kept wondering “How is he filming this?” I loved the film, but I wondered if a document like that could even be made today in an American hospital. In the Q&A, Wiseman talked about the issues of privacy and consent in his movies. Verbal, on-camera consent (as opposed to release forms, which can make people suspicious and nervous) was enough to allow him to film doctors and patients in a public hospital in the late 1960s.
What would you need to get consent to film in a major hospital now? The regulations of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 mean that “patients must give specific authorization for the disclosure of their protected health information,” according to the privacy policy on Massachusetts General Hospital’s website. You have to sign HIPAA forms to let your own family see your medical records, much less let someone make a movie about them, and as the Duke University Medical Center specifies, consent is written, not spoken: “any patient who will be photographed, audio, or videotaped for any reason has to sign a release and that release goes into the patient’s chart.”
Hospitals have their own PR offices. They think about the possible effects of filming in terms of risks to patient privacy and video evidence that might be used in lawsuit – they also use media exposure to try to attract patients and funding. Vanderbilt University Medical Center, the setting for TLC’s “Trauma: Life in the ER,” makes sure to emphasizes the show’s “HIPAA-compliant production process.”
A 2002 study in the Journal of the American Medical Association deals with filming in hospitals. When filming patients, “a priority is to obtain informed consent from an individual with intact decisional capacity under conditions of nonduress.” Doctors are familiar with duress – the author warns: “patients who are severely ill or injured, intoxicated, psychologically disturbed, or experiencing severe pain, anguish, or grief frequently lack capacity to give consent and should not be approached.” 1
By those standards, the best characters in Hospital aren’t qualified to consent to being on camera. Those recommendations aren’t hard-and-fast rules – there are grey areas, like the tactic of filming first, and getting consent later. It seems fair in the context of non-medical filming, since the form gets signed before anyone sees the footage, but technically the details of doctor-patient interactions are private unless otherwise specified, and the camera crew isn’t supposed to be listening in.
I watched an episode of the new ABC documentary show Boston Med, which takes place at Mass General Hospital. Producer Terence Wrong claims Fred Wiseman as an influence2 and the show has some intimate scenes dealing with trauma, surgery, and even the sudden death of a patient. It’s more of a doctor-drama, but the show has some of the same goals as Hospital, showing the day-to-day work of medicine.
There are some big differences in the version of the reality that we see, though, and not just because it’s a different kind of show. There are now cameras everywhere, including the ones that go inside of people to do laparoscopic surgery, but the TV cameras are more tightly controlled. We get to know patients who are getting a heart transplant or giving birth to twins, but a patient who overdosed on crystal meth and a heroin user have to have their faces blurred out. Presumably, neither of them could give consent (both are in emergencies), but while we sympathize with the man from Tennessee with cardiovascular disease, we don’t get a chance to see or get to know the anonymous, drugged, ill people, and we don’t care about them in the way that we care about the patients in Hospital. Since we can’t see their stories, we don’t give them much thought (at least in this episode).
It made me wonder how filmmakers who are trying to work in medical settings now can work within HIPAA rules to give the most honest portraits possible. A tricky logistical challenge.
