Risk manager, counsel reduce the media risk
November 1, 2000 5 minutes read
Risk manager, counsel reduce the media risk
While the "Hopkins 24/7" experience may be an extreme way to accommodate the media in a hospital, the Johns Hopkins risk management team suggests that the lessons it learned could be applied on a smaller scale by other institutions.
There is a growing interest in reality programming and documentaries about medical care, so many hospitals may find similar requests for media access to off-limits portions of the hospital. At Hopkins, the risk management implications were addressed by Meg Garrett, RN, MED, JD, the hospital’s senior counsel, and Rick Kidwell, JD, director of risk management. They say that such access does not have to threaten patient confidentiality as long as certain steps are taken to control the situation.
Lengthy discussions with the producers convinced Garrett and Kidwell that the project could be done without abdicating their responsibility to patient and staff confidentiality. But before the camera crews showed up, they put in place a number of protective measures.
The first step was to make sure the actual camera crews were screened carefully before Hopkins allowed them access to the hospital. Each crew member had to undergo a criminal background check and tuberculosis testing; they also had to visit the hospital’s occupational health department for a primer on bloodborne pathogens and other safety concerns. The hospital put the camera crews through training similar to that required of hospital volunteers.
In addition, crew members had to sign a confidentiality agreement stating they would not divulge any information they gained during their stint at Johns Hopkins other than the information that made it to the television screen. The Hopkins staff clearly and firmly explained to the camera crews that they had to stay out of the way during any medical treatment. Their presence could never interfere in the slightest way with treatment. If it did, any staff member was empowered to order them out of the room.
The camera crews used small, handheld video cameras similar to the type used for home movies, so they were considerably less intrusive than a camera crew with a standard news video camera. Initially, crews were given access to the entire hospital except for the psychiatric unit.
"But after the project began, psychiatry complained that they were at a disservice and not able to give their message about mental health," Garrett says. "I was reluctant, but I agreed to let the filming happen there, too. We agreed that they could film only in rooms, never in a hallway. They ended up using film from a group therapy session where all the individuals agreed to be filmed." That agreement led to a powerful segment in the broadcast that followed a young woman with anorexia nervosa.
Here are some of the other rules Hopkins used:
• Any staff member could refuse to participate and be videotaped. To alert the staff about the project, Hopkins sent a letter explaining all the details.
• ABC had to obtain consent from any patient whose image would be used in the program. Hopkins kept a copy of each consent form.
• The production team had to meet with Garrett or Kidwell, and sometimes both, each morning at 11 to discuss how the project was going. At those meetings, they would discuss any concerns that had been raised by the Hopkins staff and hash out any difficulties.
M&M session posed special risks
One bone of contention was the hospital’s morbidity and mortality (M&M) session. ABC wanted to tape the session to show how the doctors critiqued each other and analyzed cases. Many of the physicians, including the chief of surgery, supported the idea, but Garrett and Kidwell had serious misgivings.
"It was a real risk. We had a lot of discussion about that, knowing that it would waive the peer review privilege if the session was aired," says Kidwell. "We decided it was more important that the public knows how this takes place than to preserve the peer review."
Kidwell and Garrett agreed to allow the camera crews into the M&M session, but they urged the physicians to be careful about selecting the cases to discuss on camera. Because the physicians would be giving up a valuable defense for any information revealed at the session, the risk manager suggested they avoid any cases that might result in litigation.
"We made it clear that the physicians had a right to come or not come to that M&M, but we did not have anyone who refused to participate," Garrett says. "What ended up in the broadcast was very fragmented anyway, with just bits and pieces of discussion edited together. It would be very difficult to attribute any of the discussion to a particular case. We haven’t had any claims for the cases discussed in the M&M."
Even with all the precautions, Garrett and Kidwell say they were apprehensive about watching the program when it aired. They did not know ahead of time what vignettes would make the cut and how ABC would portray the Hopkins staff and patients. There were some moments that were very revealing, such as parents dealing with the loss of a child and the doctor who decided to quit because of the heavy workload, but Garrett and Kidwell say they were pleased with the outcome of the special project.
"The feedback has been very positive," Garrett says. "Some people were disappointed that the nurses didn’t get much attention at all, and some said there was too much attention to female physicians in the ER. Mostly people were just upset that they didn’t get on the program."
Everyone’s curious
The risk managers still say they would be wary about allowing access to another television crew, and they caution that the "Hopkins 24/7" project worked only because they were so careful about overseeing the visitors. The Hopkins risk management department is getting a lot of queries about the broadcast, so it offers these suggestions to risk managers considering a similar project, even on a much smaller scale:
• Work only with professional journalists who have a good reputation. Garrett and Kidwell say they were impressed with the attitude shown by the ABC production team, in particular, their respect for the work done at Hopkins and their willingness to work discreetly. The fact that the production team had experience in health care reporting was a plus.
• Establish ground rules before granting any access. Set the boundaries and limitations. No hospital can allow media to have completely unfettered access, so make sure the producers know upfront exactly what is expected.
• Communicate frequently and clearly. Daily meetings are best for any project that goes beyond a single day in the hospital. Deal with any problems in real time, rather than letting them wait.
• Work closely with legal counsel. The risk manager and legal counsel should jointly make many of the decisions about what will and will not be allowed.
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