MEDICAL PRIVACY: When an Actor Gives You Private Medical Information, But...

[RuthNY]

Here are two hypothetical scenarios for discussion. What would, or did you do, if you were to encounter, or have have encountered these situations? In both situations, the actor in question has NOT revealed the information on a medical emergency form, but comes to you, privately.

1. Your leading lady tells you she has a medical condition that causes seizures. It is possible, although not probable that she might have a seizure onstage during a performance. However, she doesn't want management or the Director to know, because it might affect her ability to be hired in the future, if they know of even a possible medical issue.  What do you do?

2.  A featured player tells you he has a a medical device in his body that could be affected by proximity to equipment that might discharge a magnetic field. You, as stage manager, aren't qualified to analyze all the equipment onstage and assure the actor of his safety, or assure the theatre of the actor's safety. Again, the actor wants his medical information to be kept confidential. What do you do?

[Dart]

I don't think one ever has the right to disclose someone else's medical information. I don't know if it's illegal, but I would be particularly weary if disclosing that information could perhaps ever hinder that person's ability to get a job.

Let's take into account, for the first situation, that every single person is liable to have a seizure basically anywhere, at any time, without warning or a history of seizures. We should, as stage managers and as people, be competent in basic first aid; even better if we know CPR whether we're currently certified or not. Of course we could add a bunch of things to the "should know" list - what to do when someone faints, whether to apply cold or heat to a twisted ankle, how to check for signs of a stroke, and, sure, how to care for someone having a seizure. At least with this actor we have warning, so I'd ask to have an in-depth talk about what to do, what not to do, and how to help. People who often have seizures may not need an ambulance or medical personnel at all, instead just needing space, objects (furniture, props) moved out of their way, and a familiar face once they've come to. (Please, everyone, be aware that the whole tongue-swallowing thing is a myth, and you should never put anything in the mouth of a person having a seizure!) I'd insist upon including a person backstage - ASM, wardrobe, whomever - in that aid conversation so they could get onstage immediately while I handled the house and actors and made my way onstage.

The second situation would worry me legally either way. Again, no right to share someone else's information, but keeping information that could actively endanger the actor would be a liability to the theatre. If I'm not qualified to ensure the actor's safety, who is? Is there an instrument out there that can be used to check for magnetic fields and their safety? I'd probably speak to the PM, TD, sound engineer, and ME and share that an unnamed actor has a medical condition - hopefully the actor would provide me with specifics about the kind of equipment they could not be around - and ask them to double-check all of the equipment used. It might be worth it to ask a doctor for a document explaining the medical device's stats as well.

[lsears]

Good prompt Ruth!

Medical privacy is such a delicate subject, and walking the line between protecting the show and the producer's interests, liability issues and an adult actor's personal choices is always complex.

I've come up against this issue a few times, though not as urgent as the ones Ruth suggested.
-a woman early in her pregnancy but who would be four months pregnant by the time we hit tech and was going to be in a flying set piece in the show
-someone undergoing occasional chemotherapy who told me that the days following treatments there would probably be some side effects visible onstage
-someone four years clean of cancer, so not quite at the official remission point but didn't want to write down anywhere that they had cancer

But honestly, compared to the unexpected things we deal with, injuries that arise mid-process, real life sneaking into the room, etc, any medical issues that are disclosed beforehand are a little easier to deal with.  You have time to think and plan and have those talks about 'what should we be concerned with? what can we do to mitigate the impact this has on the show and your medical condition? what are warning signs things I should be aware of? under what circumstances would you want the rest of the cast to know your condition - do you plan on telling them at some point as you work together?'

[loebtmc]

great questions!

For the first question, this happened once. I called from the booth, so I (discretely) told my ASM to keep eyes open for things like seizures and then had the actor talk w the ASM abt what to look for and what the expectation of best possible action was. We had no issues, but the actor felt safer knowing it was 1) discrete and 2) covered nearby.

I also have had a legally blind actor who chose not to self-identify for casting purposes, and similarly, we kept things on the DL between myself and my ASM. Of course, this was a professional ASM I trusted, but it was vital that someone on deck knew in case of emergency.

In terms of the second - wow, not sure! That's a real challenge, to keep confidentiality while keeping both the actor safe and the theater out of liability. I have some thoughts, for example making sure they spoke w the designers/technicians loading in, since they would know what kind of electro-magnetic fields are involved, but wow. Fascinating conundrum.

[nick_tochelli]

I'm not a doctor. I'm not obligated to follow HIPAA Laws!!!

I always disliked when situations come up like this. If it's important enough I need to keep track of it, it should be important enough you tell your employer so they can confront challenges and be prepared.

Remember, Stage managers are essentially middle management. If either of these actors tell you something, end up being injured or otherwise incapacitated in a manner they mentioned could happen but you didn't tell anyone about it....what does that do for your potential future employment opportunities? At what point do you need to remove yourself as the party who could end up on the receiving end of a law suit? If an actor tells me they have a pacemaker but don't want me to tell anyone about it, i'd probably say it's best that you tell a company manager or producer. It's a legal issue to me. I'd much prefer to not be involved.

[cdavisnyc]

I think it's important to note that it's the performer's responsibility to keep themselves safe, and taking you into their confidence is good judgement on their part, but you are not responsible for anything other than accomodating to the best of your ability and keeping them informed. If you are concerned about liability, keep a diary that will show due diligence. You can ask to disclose information to a company manager.

If a performer cannot be around electromagnetic devices, I would assume that means they have a pacemaker. (If not, it would be good to have more specific info.) Then you can say, "In this venue, there is a microwave in the green room and there are 4 solenoid releases onstage, 30' over your head." (That's just an example - most solenoids may be perfectly safe, and certainly would be at that distance.) Asking the TD and/or crew chief about equipment is a great idea. You don't even have to disclose: "How is the balloon release triggered? Is that a magnetic device? Where is it located?" Take a tour of the venue. In ours, the dimmer rooms are very far away from the stage, but perhaps they are closer in yours. After you have informed the performer where the devices are (and ensuring they are not relocated without your knowledge), it is up to them to maintain their safety.

If a performer is prone to seizures, then having an ASM backstage who knows how to handle a seizure is ideal. Again, the performer can tell you how best to handle a seizure, but it will likely mean just sitting with them until it has passed, keeping them from injuring themselves on nearby objects, and assuring bystanders that all is well. Please don't put anything in their mouth!

I have had performers tell me they had heart issues, epilepsy, panic attacks, were undergoing chemo, and one asked not to be scheduled at certain times so they could attend N/A meetings. I have worked with wardrobe to accomodate a stomach feeding tube and a dialysis pump. I have worked with a diabetic who was still learning to control his levels, and we kept a sandwich nearby to put into his hand if he started to slow down or get brain fog. 

The Red Cross is a great resource for advice on how to handle any issues. I bet if you called your local chapter for advice, they would be happy to offer more qualified advice than mine. Whenever I recertify for CPR & First Aid, I come with a list of questions just like these!

The fact that you have been taken into their confidence is wonderful! And, you probably don't have to tiptoe around anything. If you can find a private place to talk, I bet they will give you more detail about how they manage their particular issue, once they know they are in a judgement-free and confidential zone. If it's something they don't want others to know about, they will feel relieved to have a confidant.

With permission, make a list of pertinent info: medical condition, medications, contact info for Dr, contact info for their partner or parent, etc, that you can keep in a sealed envelope (I keep it in their valuables bag, so it's with their wallet). If necessary, you have the envelope and their ID handy to give it to EMTs to ensure the quickest and best treatment in an emergency. If you don't need it, you hand it back to the performer to give to their next SM or shred it. (I ask everyone to fill out an in-case-of-emergency form, and everyone has sealed envelopes with either volunteered information or blank paper inside, so it's not unusual to have a sealed envelope in your valuables bag.)

The gentleman who I worked with who had heart issues did indeed have an episode, and after his Dr. was contacted, he was fast-tracked through the ER while his Dr. was en-route to the hospital. Information is the stage manager's superpower. A reputation for discretion gets you more information.

Lastly, break the confidence if you feel it's a matter of life & death. Most company managers understand discretion as well. They deal with as much of this stuff as you do.

-Colleen