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"It's not a level playing field," he says.
In their article for JAMA, Geiderman and Larkin examined the AMA's recommendations for filming in hospitals as well the guidelines set by the Joint Commission on Accreditation of Healthcare Organizations, a voluntary organization that is the country's predominant accrediting body for health-care facilities. Both sets of guidelines call for production companies to get informed consent from patients who are filmed, but neither addresses the fact that patients in hospitals are often emotional wrecks.
In the case where consent is not given until after the film is shot (a common occurrence in shows produced in emergency rooms), the commission insists that the hospital keep the tapes until the production company gets consent. If permission isn't given, the tape should be destroyed (the commission acknowledges that before it updated its guidelines it was common for a production company to leave the hospital with footage that had never been consented to). The commission can cite a hospital for breaking the rules and can even pull the facility's accreditation, but they can't undo what's been done.
The AMA's guidelines suggest that the consent form should be explained by a "disinterested third party" and that the consent procedure should clearly outline the patient's right to see and edit the footage -- something that didn't happen to the Walter family. But the AMA is not a regulatory agency, and it can only offer suggestions.
"There's still a lot of license" afforded the production companies, says Larkin. "The guidelines don't have that much teeth in them."
There is a place for filming in hospitals, say Geiderman and Larkin. Because textbooks are often outdated by the time they're published, it's certainly a good idea to allow medical staff to watch certain filmed surgical procedures to learn new techniques. And Larkin applauds the Nova programs on PBS that are often graphic and compelling but provide real education -- not just melodrama.
But he thinks the only thing that will throw cold water on shows like Houston Medical are disinterested viewers or lawsuits from upset subjects.
"There's a reason we don't make Pipers and Cessnas anymore, and it's because of lawsuits," says Larkin.
But longtime Houston media lawyer Bill Ogden says that unless consent was never obtained for footage that was broadcast anyway, production companies usually win when these cases go to court. While Ogden would not comment specifically on the Walter family's situation, he says if anyone approaches a patient in a hospital and asks to film them, the patient needs to take the time to read the entire consent form.
"The best advice I have is don't do anything in a hurry," says Ogden. "Take the time to ask questions and to understand why someone wants the release. If the circumstances are that you do not have time to give it your full focus, do not agree to it."
It's been more than two months since the first episode of Houston Medicalaired. Chad is preparing to go back for his third year of law school. When he's finished, the couple hopes to move back to Dallas, where they first met, and have more children. For now they say they don't go out much -- they'd rather spend time at home with Grant. Shani admits that she's still terrified of germs, although she hopes she's getting better.
"I had a nurse tell me I had to stop," she says. "I was going crazy. It was really hard at first."
Grant is a good baby. He likes to stare at himself in the mirror and laugh. It's an especially poignant pastime for his parents, because Grant and Nathan were identical.
"Some days I cry because I don't have twins anymore," says Shani. "I picture them laying next to one another in their diapers. Or playing soccer or dating or playing tricks because they were identical."
Shani and Chad say they don't know how they will tell Grant about the Houston Medical footage. They do know that they won't give him the option of seeing his brother's final moments until he is at least 18. But Shani worries that the glut of reality shows on TV will desensitize their son to the tragic moments captured on the tapes.
"By the time he grows up, is he not going to care to see a baby die because it's shown so much on TV?" asks Shani.
As for Shani herself, she admits to still tuning in to some of the medical reality programs, although she says it's more like she's policing them.
"If I was a Nielsen family, I wouldn't watch, but I feel so sorry for these people and I wonder what they're telling them," says Shani. "I wonder how they approach these people, and I wonder what they say."
"We're not done with this," adds Chad. "If they renew Houston Medical, what do you think they'll show for old clips? They'll show Shani again."
Why did people watch Houston Medical? Chad and Shani aren't entirely sure. Maybe it was for a good cathartic cry. Maybe it was to have a "thank God that's not me" moment. Sure, a lot of them wiped tears from their eyes when they saw Nathan Walter die. But the Walters were strangers to them, and when the show was done they turned the TV off and the sad feelings passed.