Video Recording in Dental Clinics; Permitted, not Permitted, and Gray Areas
Video Recording in Dental Clinics; Permitted, not Permitted, and Gray Areas
By: Michael W. Davis, DDS?????????????????????????????????????????? 6-11-2024
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Generally, video recording is allowed where people (patients, staff, etc.) do not have a reasonable expectation of privacy. This might include an attached parking lot, the entrance and exit to the dental facility, and public reception area.
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The cameras themselves, as well as printed notification signage, may help deter potential criminal activity and later assist law enforcement if an untoward action has occurred. Nationally and internationally, oral healthcare workers are at an unusually high risk for violence.1
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Dental offices have unfortunately experienced vandalism, arson, burglary, robbery, stalking and harassment of personnel, as well as overt acts of extreme violence from the public. Video recordings may augment deterrence and assist as evidence in any future civil or criminal prosecution. Such taping may also provide exculpatory evidence to help exonerate any potential innocent suspects.
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In Oklahoma City, Oklahoma, a vandal captured on surveillance video damaged property belonging to an Asian-American dentist in 2021.2 The act was apparently part of a larger pattern of vandalism specifically targeting this protected minority class. Earlier in Philadelphia, vandals tagged graffiti on the outsides of dental offices, which was also caught on tape.
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January of 2024 cameras recorded two “suspicious” fires, as reported by the San Luis Obispo (California) Fire Department, which completely destroyed two local dental offices.3 ?Authorities highly suspect arson.4
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In a different incident, a Ventura County, California dentist was caught on video surveillance of committing arson upon two different dental clinics. He subsequently was sentenced to one-year incarceration.5
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April 2024, a Seattle dental facility suffered the burglary of four porcelain dental ovens.6 ?A surveillance camera captured the suspects arrival in a green mini-van and black station wagon get-away vehicle to transport the stolen property. Interestingly, suspects ignored computers and drug medications on the premises, while specifically focused on the dental ovens for alleged theft. Questions were raised if the ovens may have possible use in the illicit drug manufacturing industry, or for resale in the unlicensed and unlawful dental practice trade.
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Two robbers wielding knives in a Brazilian dental office in 2021 were filmed. An armed off-duty police officer heroically thwarted the robbery.7? The footage was dramatic of the officer’s tactical skill and courage. The video not only assisted in the subsequent legal prosecution, but publicly demonstrated the extraordinary value of law enforcement personnel and their essential training and motivation.
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Video cameras both inside and outside a Malaysian dental clinic in 2022, filmed the armed robbery by suspects brandishing a parang (similar to a machete).8 Shortly afterwards, authorities arrested suspects thanks in part to the surveillance evidence.
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A former patient stalked a British dentist for four years.9 The disturbed man was finally arrested by authorities parked outside the dentist’s home at night, while driving a vehicle with false license plates. Seized in the arrest were a loaded crossbow, chloroform, knives, buckets, medical wipes, extra clean cloths, and multiple notebooks, all sealed in polythene sheets.
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The dentist stated, “I didn’t know about the patient sealing the car, his plans to torture me and ensure that there was no DNA.” The doctor added, “He got 16 months, but the police told me he actually probably only served six and then got released. It’s because stalking without violence is a very low-grade sentence.” ?
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“Going equipped to burgle is a criminal offence, but going equipped to murder is not. It wasn’t attempted murder because he didn’t pull a trigger although he did drive to the house.”
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The doctor, when asked to offer advice for other dentists who may find themselves in a similar situation responded, “You have to collect your own evidence. Whether that’s CCTV (closed circuit television) footage or photographs. Document everything because the law will let you down.”
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The perpetrator in the shooting and killing of two Affordable Dentures and Implants dentists in Tyler, Texas, accepted a guilty plea in January 2024.10 The killer will serve a life-sentence for capital murder.
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A bystander in the dental clinic’s parking lot took a photo of the perpetrator’s license plate which was forwarded to law enforcement. No surveillance cameras were onsite. Apparently, the shooter was disgruntled over the quality of dentures fabricated and demanded both a refund and to keep the dentures.
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On February 7, 2024, a New Orleans, Louisiana, dentist was attacked by a knife-wielding former female patient at her place-of-work and suffered a catastrophic eye wound and stabbing to the right side of her neck.11 The dentist will in high probability lose the use of her eye. The suspect is facing charges for attempted second-degree murder and aggravated assault. Undoubtedly, the workplace for dental personnel has become a site for risk of serious violence.
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Where Video Surveillance Unacceptable-
Video cameras are totally unacceptable where people have a reasonable expectation of privacy. This includes restrooms, staff changing areas, and sometimes employee breakrooms.
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Civil legal action was initiated in 2020 against Aspen Dental Management, Inc., and others related to clandestine filming by two video cameras in a staff restroom.12 The two hidden cameras were focused upon the employees’ toilet from different angulations. The alleged perpetrator held a history for deviant activities. However, he was allegedly hired regardless of his past record.
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In 2008, a Texas dentist was convicted for surreptitiously videotaping female employees in a staff changing room.13??? Later in 2014, another Texas dentist and former chairperson of the Texas State Board of Dental Examiners received a 21-day sentence for the clandestine filming of a staff member changing in the employee restroom.14 ?In 2013, a Pickering, Onterio, dentist was charged with unlawful voyeurism, after a hidden camera was discovered in a restroom used by both staff and patients.15
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Surveillance cameras in employee lounges and breakrooms are something of a gray area. Since this is a timeframe when workers are off-the-clock, employees might reasonably expect privacy. However, others may argue that these are common areas and privacy expectations are unreasonable.
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Some video recordings are disallowable for employers, such as recording personnel involved with union discussions. A collection of workers and their identities demonstrated on camera discussing matters such possible violations to state and/or federal statutes like OSHA, HIPAA, or matters before a state regulatory board would also potentially be highly problematic for a dental employer.
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It is one matter to place cameras in an employee breakroom for deterrence of sexual harassment and inappropriate touching. Such cameras might also discover healthcare employees’ consumption of drugs and/or alcohol in the clinical workplace.
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The downside is filming employees in very personal situations. This might include a worker discreetly making the sign of the cross prior to consuming a meal. It might include an employee’s observance of Islamic ritual prayer of salah. It could also involve a worker on their break period reviewing very personal and intimate family photos on a screen device like a Tablet or a laptop computer. Another employee might remove or insert an oral appliance (Essex device, anterior “flipper,” removable partial denture (RPD), or oral obturation appliance).
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While such videotaping may not be illegal, it may be unethical. Some employees may perceive such cameras as an employer’s betrayal of trust and overly intrusive. During this time of healthcare workplace shortages, what employer can afford to generate employee ill-will?
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Cameras in Treatment Rooms
Cameras in patient treatment rooms have become increasingly popular in dentistry. Naturally, since patient identity is exposed, the patient or their legal guardian must agree and sign a release form under HIPAA guidelines. Such video material could be validly utilized for teaching and staff training purposes. Such filming also becomes part of the patient record.
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Video-recording has especially become popular in clinical operatories in which sedation is utilized. A side-effect of numbers of sedation agents is sexual hallucinations.16 ??Patients may incorrectly report an inappropriate sexual activity resulting from the influence of their medication.
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Cameras can go a long way in reassuring patients that untoward activities will not be tolerated, as any offender should be identified. Cameras also may deter doctors and staff from any possible dubious actions, as their identities might be exposed. Security video films can also provide a valuable defense against a patient’s potential false claim.
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Luis Ramos, a dental assistant at a San Diego oral surgery practice was convicted and sentenced to 15-years in prison in 2016.17 ? He molested a total of 13 female victims aged 17-63, while all patients were under influence of general anesthesia. His actions were recorded on videotape, although he went to lengths to hide his criminal behaviors.
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Investigators stated Ramos was a “serial predator.” “He preyed on women who could not defend themselves.” Ramos often positioned his back to security cameras in an attempt to hide his disturbing criminal actions. Once arrested, the perpetrator phoned a co-worker and requested they destroy the tapes.
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On May 17, 2024, a dental assistant was arrested leaving his place of employment at Kidiatric Dental and Orthodontics in Gilbert, Arizona. He was later indicted for sexual abuse of multiple minor children.18-20
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The defendant was tasked with taking x-rays on pediatric dental patients. The youngest patient allegedly molested was four-years old, and most children were sedated. Authorities allegedly hold evidence on the defendant’s cell phone of multiple photos of unclothed children. Yet, the defendant alleged during his initial police interview, that he was monitored by company video surveillance during the time of the reported violations, which would substantiate his innocence.
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?Employer Required and Suggested Actions
·???????? Employees must be advised of video surveillance cameras in the workplace and a written and signed acknowledgement kept in the employee’s file.
·???????? Patients may be advised of video surveillance in the dental clinic with simple signage. If cameras are in the treatment rooms, under federal HIPPA regulations, a written and signed form should be retained in the patient’s record. The recording itself becomes part of the patient record.
·???????? Surveillance audio recordings are not permitted in many jurisdictions, and the statutes may vary considerably in locals where allowed. Consultation with appropriate legal counsel is highly advisable.
·???????? Surveillance cameras must be placed to safeguard exposure of patient protected health information (PHI). Thus, cameras should not face computer monitor screens or capture devices in which patient’s may enter codes for debit or credit cards. If any PHI is captured, HIPAA compliance rules are triggered. This includes written patient consent, limiting personnel with access to data, and data storage issues (e.g., encryption).
·???????? It is highly advisable to consult with a company well-versed in HIPAA compliance prior to installation of video recording devices. Proper camera placement is essential to safeguard PHI, promote safety to healthcare staff and patients, offer possible evidentiary material to law enforcement authorities, and generate potentially exculpatory evidence for innocent persons.
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Conclusion
Readers should be well-aware that the majority of dental facilities desire to be in full compliance with surveillance regulations. Safety and well-being of patients and personnel is considered paramount.
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By stark contrast, an unfortunate collection of dental healthcare clinics brazenly violates statutes. Since regulatory enforcement is frequently remiss, compliance is disincentivized.
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Both video and audio surveillance are conducted within these troubling clinics lacking any notification or acknowledgement by patients or staff. Cameras and sound recorders are hidden and may be smaller than a pencil eraser. Management and/or ownership may not be so focused on voyeurism, but on perhaps more toxic goals.
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Management which may be actively involved with a business model of insurance, Medicaid, or consumer fraud, will desire to identify potential whistleblowers. Such heroic staff will be weeded out.
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Doctors and auxiliary dental workers may desire to act in their patient’s best interest with specialist referrals and clinical treatment plans more in-line with patient needs versus the clinic’s bottom-line production quotas. Such activities supporting patient interests may not be in sympatico with an unhealthy business model based on greed supported by their employer. Deviant dental employers desire to discover such protagonists, to remove them from employment.
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References (accessed 6-9-2024 References #7 and 8 have particularly insightful video footage.)
4.??? https://www.kclu.org/2024-01-28/fire-guts-central-coast-dental-offices-firefighters-say-it-was-arson
15.? https://globalnews.ca/news/1036004/dentist-charged-with-voyeurism-after-camera-found-in-washroom/
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ABOUT THE AUTHOR
Dr.?Michael W. Davis practices general dentistry in New Mexico. He also provides attorney clients with legal expert witness work and consultation. Dr. Davis writes and lectures on matters related to dental laws and ethical conduct.
He can be reached at [email protected] .