Taking pictures to document the injuries that the patient inflicted on herself could be a reasonable step in the provision of medical care. The patient was unable to consent because of self-inflicted wounds, and there is not enough information to know whether delay in taking the pictures could have had an adverse medical outcome for the patient. Therefore, taking the pictures would not be a violation. However, it seems equally clear that sharing the pictures would be a violation. The Privacy Rule dictates minimum access, which means that access to a patient's private health information should be limited to as few people as necessary to administer treatment. There does not seem to be a medical reason for the physician to show the 15 people the pictures of the suicide patient. Therefore, I believe that the patient's confidentiality was violated. However, if the group of 15 people happened to be doctors and staff in the hospital's psychiatric ward, I might have to revisit that conclusion.

The more difficult issue is how I would handle the situation. Under HIPAA, a nurse can be penalized for violating a patient's confidentiality, but there is no mandatory duty to report a violation...

Therefore, I would not be violating any laws by failing to report the violation. In fact, because I would need to release confidential patient information to a reporting agency to report the violation, I might actually be violating the Privacy Rule to do so. Furthermore, while I might want to tell the patient about the violation, the patient is clearly in a state of fragile mental health. I would be concerned that such a revelation might have a negative impact on the patient's health. Therefore, I believe that the appropriate response would be to discuss the incident with the nurse manager and someone in the hospital's administration in order to determine what could be done to prevent the physician from sharing these photos with anyone else.
References

Stewart, M. (2012). What nurses need to know about HIPPA. Retrieved December 10, 2012

from Motlow College Nursing website: www.mscc.edu/nursing/hippa.ppt

U.S. Department of Health and Human Services. (2012). Summary of the HIPAA Privacy Rule.

Retrieved December 10, 2012 from HHS.gov website: http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html