The National Protocol Adult/Adolescent states that photography is an integral component of the medical forensic examination. Photographs are taken to document injury and other physical findings from the examination. These photographs should meet the facility standards of medical photography. The legal uses of medical photography may include—
Preservation of the appearance of injury
Documentation of evidence found on the patient’s body before it is moved or collected
Future reference or memory aid
Documentation of the details of injury
Permit jurors to see things as they were
Education for nurses and other providers
Case review/peer review
The following considerations need to be central when developing program policies for medical legal photography.
Consent – The patient should always consent to the taking and any release of photographs. It should be clear on the consent form what the photographs can be used for, including teaching and/or peer review.
Storage – Photographic images must be securely stored and backed up. Access must be limited and trackable. Photographs should not be stored on a single computer as there must be concern over possible equipment failure, including the loss of a hard drive.
Release and Transfer of Photographs – SANE programs need to have protocols and procedures in place for the release of photographs. Because of the intimate nature of genital photographs, and the need for medical expertise to interpret the findings present in these photographs, routine release to law enforcement is not a standard practice in many communities. SANE programs need to work with prosecutors to provide protection for these images. Several options can be used to protect genital images from disclosure. First, the program can have a policy that requires the opposing medical expert to meet with the SANE to view and review photographs. Second, a judge can create a protective order that limits how opposing counsel can use the photographs. In all situations, a patient should provide consent prior to release of the photographs. While a program may be required to release photographs when ordered by a judge, the patient should still be notified in order to have an opportunity to challenge the court order if the patient is unwilling to give consent for the release.89
Non-genital photographs also require patient consent for release to law enforcement. Since photo documentation of a physical injury may facilitate immediate arrest of a suspect, some programs routinely release copies of non-genital photographs to law enforcement at the time of the examination. Photographs are part of the medical record and original copies need to be maintained by the SANE program.
While photo documentation is not a required part of the medical forensic examination (and can be declined by the patient), it creates a mechanism for peer review of exam findings. It is the only way that a nurse’s evaluation of an injury can be peer reviewed, an essential part of SANE practice. In cases where pornography is part of the patient’s (child, adolescent, or adult) history or disclosure, the taking of photographs may trigger traumatic memories, in which case, apply a trauma-informed approach. Also, consult risk management about possession and sharing of genital images to make sure federal and state pornography laws are not violated.