Washington Court Rules Patients Don’t Have Right to AI Scribe Recordings 

A Washington state court has ruled that patients do not have a legal right under state law to access recordings created by ambient AI tools physicians use to draft clinical notes. The American Medical Association (AMA) called the August decision a win for physicians and one of the first U.S. cases to address the increasingly common augmented intelligence (AI) technology, which can reduce time spent taking notes and let physicians focus more attention on patients rather than their computers. 

The decision could provide an early road map for healthcare organizations and courts as they determine whether recordings, transcripts, and other content generated by AI documentation tools should be considered part of the patient-accessible medical record. 

Court Treats AI Recording as a Drafting Tool 

The case, Raphael v. Mantei, centered on patient Gail Renee Raphael’s request for the ambient AI recording of a telehealth visit with her physician at The Vancouver Clinic. During the visit, the clinic’s Nuance DAX system recorded the encounter and used AI to generate a draft summary, which the physician reviewed and edited before finalizing the medical record. 

Raphael argued that the recording should be accessible under Washington’s Uniform Health Care Information Act. The clinic maintained that it was used solely for administrative purposes and therefore qualified for an exception under the law. 

Clark County Superior Court Judge Derek Vanderwood agreed. In an Aug. 7 order, the court found that the DAX recording was used for an administrative purpose and therefore exempt from disclosure. 

The Washington State Medical Association joined the AMA Litigation Center and the Washington State Hospital Association in an amicus brief arguing that ambient AI should be treated similarly to physician dictation, handwritten notes, and other tools traditionally used to prepare medical records. 

The Decision Does Not Apply Nationwide 

The ruling comes from a Washington state trial court and interprets Washington law. It does not establish a nationwide rule that patients cannot access ambient AI recordings. 

However, the AMA describes the ruling as one of the first legal decisions involving ambient AI clinical documentation, which may make its reasoning relevant as similar questions arise elsewhere. 

The key issue is distinguishing the final medical record from the intermediate materials used to create it. Under the court’s reasoning, an AI recording used solely to prepare a clinical note can function like physician dictation rather than automatically becoming part of the patient-accessible medical record. 

What About HIPAA? 

The Washington decision does not determine how every AI recording should be treated under HIPAA. HIPAA generally gives patients access to protected health information in a healthcare organization’s designated record set, which includes medical and billing records and other records used to make decisions about individuals. 

That raises an important question: Is an AI recording or transcript simply a temporary documentation tool, or is it retained and used in a way that could make it part of the designated record set? 

Storing information with an AI vendor does not necessarily place it outside HIPAA’s access requirements. HHS guidance states that patients’ access rights apply to PHI in a designated record set maintained by a business associate on behalf of a covered entity. 

→ Read more about staying HIPAA compliant when using ambient AI tools and working with third party vendors: Ambient AI Scribe & HIPAA Compliance: What Every Healthcare Clinic Needs to Know (2026) 

Access and Consent Are Different Issues 

The case addresses whether a patient can obtain an AI recording after it is created. It does not establish a nationwide standard for when providers must notify patients or obtain consent before using ambient AI. 

Healthcare organizations must consider applicable state recording and privacy laws separately, along with emerging requirements governing healthcare AI. A 2025 AMA Journal of Ethics analysis identified privacy, security, accuracy, and informed consent as concerns surrounding ambient listening technology. 

What Healthcare Organizations Should Do Now 

The ruling does not authorize healthcare organizations nationwide to automatically exclude all AI recordings from patient records. Instead, organizations should: 

• Identify what their AI systems create, including recordings, transcripts, summaries, drafts, and final notes. 
• Determine which information belongs in the HIPAA-designated record set. 
• Establish retention and deletion policies for recordings and intermediate AI content. 
• Review vendor agreements, including data storage, access, retention, and secondary-use provisions. 
• Establish procedures for patient requests for AI recordings and transcripts. 
• Review state consent, recording, privacy, and AI disclosure requirements. 
• Include ambient AI in privacy and security risk assessments. 

As ambient AI adoption expands, healthcare organizations need to know what information their systems create, why it is retained, how it is used, who can access it and what happens to it after the final clinical note is completed. 

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