Video Footage of a Patient Encounter Can be Considered Medical Records Under PAIMI Act
In Disability Rights Texas v. Hollis, 103 F.4th 1058 (5th Cir. 2024), Houston Behavioral Healthcare Hospital refused to produce video records for a protection and advocacy (P&A) organization investigation on the basis that it needed to protect the confidentiality of other patients and the video did not constitute a medical record. The United Protection for Individuals with Mental Illness (PAIMI) Act and disclosure was not in violation of the Health Insurance Portability and Accountability Act (HIPAA) under the “as required by law” exception.
Facts of the Case
In August 2021, patient G.S. was involuntarily detained in the Psychiatric Intensive Care Unit at Houston Behavioral Healthcare Hospital (Houston Behavioral). After his discharge, G.S. submitted a complaint to Disability Rights Texas (DRTx), an advocacy organization designed to protect the rights of people with mental illness pursuant to the PAIMI Act (42 U.S.C. § 10801 (2024)). G.S. alleged he was abused at the hospital. He signed a medical record release waiver, and DRTx requested all records from G.S.’s involuntary hospitalization at Houston Behavioral. Although they were compliant with DRTx’s first request, Houston Behavioral refused to provide additional information thereafter, including a request for surveillance video footage of G.S.’s hospitalization. Houston Behavioral claimed that the presence of substance use disorder (SUD) treatment information prohibited them from releasing the video records. In response, DRTx claimed that patient G.S. did not receive SUD treatment during his psychiatric hospitalizations nor was he considered a patient with SUD. DRTx also argued that a patient with SUD would not be identifiable on a video recording. Despite these arguments, Houston Behavioral continued to refuse access to video records, which subsequently led to DRTx’s filing a suit against Roy Hollis, the Chief Executive Officer of Houston Behavioral, and seeking declaratory and permanent injunctive relief. Following a motion hearing in February 2023, the District Court of the Southern District of Texas granted summary judgment allowing DRTx access to limited footage related to G.S.’s allegations. The court denied Mr. Hollis’ motion, after which he appealed.
Ruling and Reasoning
The court of appeals affirmed the district court’s ruling that DRTx has the authority to obtain the video records. The decision was rooted in the plain language and purpose of the PAIMI Act, which grants such authority, and is consistent with HIPAA privacy protections (45 C.F.R. § 164.502 (2024)). The court identified DRTx as a P&A organization, which describes state-designated nonprofits created to protect and advocate for the civil rights of people with disabilities.
The court disagreed with Houston Behavioral’s argument that the video cannot be disclosed because the video is not part of a medical record and other patients may unknowingly be visible, in violation of HIPAA. The court found the language of the PAIMI Act has been consistently read to provide P&A organizations with broad access to records. Therefore, blocking DRTx from the video would hinder the organization’s broad investigative powers, and the court found the plain reading of medical record to include the requested video records.
Houston Behavioral described the consequences of disclosing the video as a violation of HIPAA, which would subject it to penalties. The privacy of an individual’s health records is governed by HIPAA and the Privacy Rule, forbidding disclosure of protected health information (PHI) unless such disclosure is required or authorized by law. The court found that HIPAA is not violated when video records containing third-party patients are released to P&A organizations. The Privacy Rule also permits a covered entity to disclose PHI without the authorization of the individual, to the extent it is required by law and complies with 45 C.F.R. § 164.512(a) (2024).
The court also enforced that Health and Human Services’ longstanding interpretation of the required by law exception reinforces the conclusion that health care providers face no liability under HIPAA when they comply with a P&A organization’s request for access under the P&A acts. In further analyzing the HHS Privacy Rule, the court explained where the release of records is specifically allowed under the PAIMI Act. HIPPA does not bar disclosure based on the “as required by law” exception. Despite the video footage classification of PHI, which HIPAA generally restricts, the required by law exception permits its disclosure. The court found that health care providers may disclose an individual’s PHI without consent, to the extent some disclosure is required by law.
Discussion
Disability Rights Texas v. Hollis has significant implications for forensic psychiatrists, particularly in the realm of access to medical records. Forensic psychiatrists often assess the quality of care provided in institutional settings and rely on comprehensive records to form opinions. The case affirms an expanded understanding of what may be deemed as a medical record. That is, a patient’s medical record is not solely what is entered into the patient’s chart. Although the video was not explicitly considered by health care providers to be part of any individual’s medical record, the recordings did include documentation of a patient in a health care facility and thus are necessary for a P&A group to complete an investigation. Forensic psychiatrists must be aware of what constitutes relevant documentation for forensic evaluations, as the court emphasized that not only traditional medical notes but also video evidence can play a role in determining the facts surrounding a patient’s care and treatment. Although traditional notes record clinician patient encounters, video footage may provide critical information that either corroborates or contradicts other forms of documentation, enhancing the validity of an opinion. This case highlights the role that video records may play in psychiatric evaluations, especially in cases involving allegations of abuse, neglect, or substandard care.
This case also addresses the scope of the required by law HIPAA exception, finding that health information may be disclosed in an instance where other statutory authority requires it, even if that health information involves video of patients who did not consent to its release. This provides clarity for psychiatrists striving to balance protecting third-party patient privacy while fulfilling legal obligations.
- © 2025 American Academy of Psychiatry and the Law
