A patient entering a cosmetic surgeon’s office may remove her clothing, disclose fears she has not told her family, submit to anesthesia, reveal pain, expose scars, ask embarrassing questions, or place her body in the hands of strangers. When her privacy is violated, psychological and lasting harm may ensue.
That is why the recent judgment from the Superior Court of Justice in Ontario against Toronto plastic surgeon Dr. Martin Jugenburg deserves attention far beyond cosmetic surgery, privacy law, or Canadian jurisprudence. The court found that his clinic operated 24 surveillance cameras in areas where patients would reasonably expect privacy, including consultation, examination, and operating rooms. The court found negligence, breach of fiduciary duty, and intrusion upon seclusion, awarding $21.5 million in aggregate damages and $1 million in punitive damages.
Patients testified that they felt violated, humiliated, shocked, betrayed, disempowered, and distressed about not knowing where images or videos of them may have ended up. Some described diminished trust in physicians and reluctance to seek medical care afterward. The judgment explicitly discussed medical trauma and the mental health consequences that can follow violations of patient trust, autonomy, informed consent, and privacy in medical settings.
A licensed professional counselor was retained as an expert witness for the defense, testifying to educate the court about medical trauma and the potential psychological and emotional effects of trust betrayal. The judge wrote in his ruling that the expert’s “evidence was informative and relevant to issues relating to intrusion upon seclusion and informed the evidence of the patients who reacted negatively to learning that they had been filmed by Dr. Jugenburg without their knowledge or consent.”
Medical trauma is often misunderstood. It is not limited to catastrophic diagnoses, botched procedures, or near-death experiences. It can arise from the clinical encounter itself when a patient feels trapped, exposed, dismissed, coerced, deceived, or stripped of control. A person may heal physically while remaining psychologically altered by the experience. The body may recover from surgery, but the nervous system remembers the lack of informed consent and lapse in safety standards.
The Toronto judgment also has implications for the expanding litigation involving ambient AI medical scribes, including psychotherapy scribes. These tools are being promoted as solutions to documentation burden and clinician burnout. Used properly, they may help restore attention to the patient rather than the keyboard. But when deployed without explicit, visit-level consent, they risk recreating the same betrayal as undisclosed surveillance.
A psychotherapy session is not a clinical conversation in the ordinary sense. It may contain trauma accounts, suicidal thoughts, marital discord, substance use, shame, sexuality, violence, grief, paranoia, or disclosures that have never before been spoken aloud. The litigation involving note-taking AI therapy scribes alleges that some health systems have captured and transmitted sensitive clinical audio to third-party vendor systems without clear notice or informed consent, raising concerns under wiretapping laws, medical privacy statutes, vendor retention policies, and data-use practices.
The patient’s experience may be traumatic and devastating: I thought I was speaking only to my therapist. I thought this room was safe. I thought I had control over who heard my story. Then I learned someone, or something, else was listening.
The fact that the listener may be an AI tool rather than a person does not negate the betrayal. For some patients, it may intensify it. The imagined audience becomes diffuse and unknowable: a vendor server, a transcription pipeline, a model-training dataset, a quality-improvement archive, a retained audio file, a future subpoena. Even when none of those feared outcomes occurs, uncertainty itself can become part of the injury. Patients may wonder where their words went, who can access them, whether deletion occurs, and whether their most intimate disclosures may one day find a home on the internet.
Medicine must not assume that technological convenience grants permission. Audio recorders and cameras, especially when hidden, alter the dynamics of the encounter. They introduce additional parties, risks, and fears into the life of an individual whose trust may already be fragile, and into a clinician-patient relationship that depends heavily on trust. A further breach can exacerbate anxiety and panic, deepen depression and shame, intensify feelings of vulnerability, and leave patients reluctant to seek care even when they urgently need it.
The lesson is not that cameras, recordings, or AI scribes can never be used in health care. Some uses are clinically justified. Some may improve safety, teaching, quality, and documentation. But the justification must be patient-centered, not institution-centered. The patient must know what is being recorded, why it is being recorded, who will access it, where it will be stored, whether it will be transmitted to a vendor, whether it can be used for training or product improvement, how long it will be retained, whether it can be deleted, and whether refusal to participate will affect care. Patients must be able to say no without consequences.
The Toronto ruling should be a warning to every health system, insurer, private practice, digital health company, and AI vendor that privacy failures are not merely compliance failures. They can be trauma-generating events. They can deepen mistrust in a medical system already struggling to convince patients that it sees them as people rather than revenue units, risk scores, business opportunities, or data sources.
Every member of the health care team should be educated about medical trauma and trauma-informed care. That education should not be reserved for psychiatrists, emergency physicians, pediatricians, or clinicians who work with abuse survivors. It belongs to cosmetic surgery clinics, primary care offices, hospital wards, imaging suites, call centers, insurance operations, and AI implementation committees. Trauma-informed care begins with the recognition that patients may present with preexisting vulnerability and trauma, and the act of providing health care itself can diminish or magnify it.
The wounds of a privacy breach may not appear on an operative report. They may not show up on imaging. They may not be visible at the incision line. But they can remain long after the body has healed. Medicine should know that by now. And after this ruling, it has one less excuse for forgetting.
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of several books on narrative medicine and the fictional series Real Medicine, Unreal Stories. His latest book is Nobody Told Me There’d Be Days Like These: Hard Truths from Physicians—and What They Mean for Medical Practice.
