Are surveillance cameras privacy issues in school clinics?

A health services coordinator submitted a question about the use of surveillance cameras in school-based clinics.

She was concerned about surveillance cameras privacy issues on students and staff who seek medical care there.

In addition, the nurse was concerned that RNs working in the clinics were being constantly watched.

One ethical and legal obligation of RNs and school nurses who work with students is protecting their rights of privacy. I wrote about this topic in my blog, “When School Nursing and Student Privacy Laws Clash.”

Which laws apply to student privacy protection?

The 4th Amendment to the United States Constitution prohibits an “unreasonable search or seizure.” If either occurs, a warrant is necessary and based on “probable cause” when a student attends a public school.

The Health Insurance Portability and Privacy Act (HIPAA) and its Privacy Rule does not, in most cases, apply to a school setting — whether elementary or secondary school — because it is not a covered entity.

If it is a covered entity, the records kept about a student’s health information are an “education record” under FERPA and therefore not subject to the HIPAA Privacy Rule.

If a staff member bills Medicaid services for a student under the Individuals With Disabilities in Education Act, for example, that transaction must comply with HIPAA’s rule.

Surveillance cameras privacy issues in schools

According to the National Center for Education Statistics, more than 80% of public schools and more than 94% of high schools in the U.S. used security cameras to monitor students during the 2015-2016 school year.

Their use for these purposes have been upheld and determined not to be an invasion of privacy in locations such as classrooms, hallways and the perimeter of the building, according to National Center for Education Statistics.

Bathrooms and locker rooms — where an expectation of privacy is greater — create constitutional and general invasion of privacy difficulties.

Does school safety require cameras in clinics?

One answer that would justify their presence is the fact the clinic houses medications, including controlled substances, syringes and other healthcare equipment that could be stolen and sold.

The medications and equipment also could be used in an adverse way against students and school personnel if the school was taken over by an intruder.

Even if this were a strong argument for having cameras in school-based clinics, is it strong enough to override a student’s privacy?

How surveillance cameras co-exist with student privacy

Although FERPA does not directly address surveillance cameras privacy issues in the school setting generally or in a school-based clinic, it provides guidelines that can help use them in a responsible way.

The consent should be kept with the student’s education records, especially if the school system is the keeper and maintainer of the surveillance system.

For staff who seek treatment at the clinic, they need to know the policy and provide written, informed consent.

For both groups, the consent should include information as to who or what entities will have access to:

• Any camera footage.
• The roles and responsibilities of those who have access to the cameras.
• How long any footage will be kept.
• How any footage will be destroyed.

What about nursing staff surveillance?

Employers have been using cameras in the workplace for some time, and the courts have upheld their use there. Employer-based rationales include security and risk management.

Employee anxieties with electronic surveillance include a mistrust of the employer’s motives and a reduction in their privacy.