In an August 7, 2026, order denying a patient’s request for a preliminary injunction in Raphael v. Mantei (“Raphael“), a Washington trial court (the “Court”) held that an audio recording created by an ambient artificial intelligence (“AI”) documentation tool was exempt from a patient’s right of access under Washington law because the recording was used for an administrative purpose. The decision is believed to be one of the first rulings in the country to address whether recordings created and processed by AI systems are part of the patient-accessible medical record.
The decision serves as helpful guidance for providers using AI documentation systems, but the reach of the ruling is limited. As a trial court order interpreting Washington law, the ruling is not binding on other courts, does not establish a nationwide rule and does not resolve whether a recording or transcript may be subject to patient right of access under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) or another state’s medical-record, privacy, recording or consent laws. Nor did the Court address whether the recording was lawfully made in the first place, an issue now being litigated in other states. The ruling also came at an early stage of the case and after the provider had already given the patient a copy of the recording, and the Court separately concluded that the patient had not shown a well-grounded fear of invasion of any right or actual and substantial injury. This issue is likely to come before courts more frequently, and future decisions may look to the Washington ruling as persuasive.
Background
The case arises out of a telehealth visit between a patient and physician at a Washington state clinic (the “Clinic”). The Clinic used Nuance Dragon Ambient eXperience (“DAX”) to record the conversation and generate a draft summary. According to the Court’s findings, DAX automatically generates a summary of the visit and inserts it into the patient’s medical record, and the physician can then edit the summary to create the final record. In this case, the physician reviewed the summary after it populated into the chart and added details the summary had omitted. The patient requested the audio recording used by DAX in the generation of the summary; however, the Clinic declined to provide it. The patient, representing herself, then sued in Clark County Superior Court seeking, among other relief, production of the recording. Before the preliminary injunction hearing, the Clinic produced an unaltered copy of the recording to the patient. The patient contended the copy was incomplete, leaving her request for production of the recording as the only issue before the Court. The Court found that the Clinic did not edit the recording and that, because DAX is provided by an outside vendor, the Clinic could access only the recording itself and not the vendor’s cloud metadata or audit logs.
The American Medical Association Litigation Center, Washington State Medical Association and Washington State Hospital Association filed an amicus brief in support of the Clinic. The brief argued that AI recordings should be treated like traditional dictation, handwritten notes and other preliminary tools used by physicians in preparation of the final medical chart.
Court Analysis: The Washington Uniform Health Care Information Act
Patients generally have a right to examine or copy their recorded health care information under RCW 70.02.080, a section of Washington’s Uniform Health Care Information Act. However, access can be denied if the provider reasonably concludes the information “was compiled and is used solely for litigation, quality assurance, peer review, or administrative purposes.” RCW 70.02.090(1)(d).
The Court applied the ordinary meaning of “administrative purpose,” which it described as relating to the internal operation or use of an institution. The Court determined that the underlying recording was within the meaning of administrative purpose because the Clinic was using the recording to assist with preparation of the patient’s written record. The Court’s reasoning focused on how the recording was used, rather than on the physician’s review, although its findings describe a workflow in which the physician reviewed and supplemented the AI-generated summary. Therefore, the underlying recording was exempt from the patient’s access right, highlighting the distinction between the final clinical note and the recording or intermediate materials used to produce the note.
AI as a Documentation Tool
The underlying recording functioned as an intermediate documentation tool rather than the patient’s actual record used to provide care. The amicus brief argued that medical practices have long used preliminary materials, including dictation and handwritten notes, to create the final patient chart. In the amici’s view, ambient AI simply updates that process with new technology and should not change the distinction between the patient-accessible final record and the materials used to create the record.
What the Ruling Does Not Decide
HIPAA right of access. The Washington exception does not control the federal right of access. Under 45 C.F.R. § 164.524, individuals may access protected health information (“PHI”) maintained in a designated record set (“DRS”), which includes medical and billing records and any other records used, in whole or in part, by or for a covered entity to make decisions about individuals. 45 C.F.R. § 164.501. Because HIPAA preempts contrary state law that gives individuals less access to their own PHI (45 C.F.R. §§ 160.202–160.203), a covered entity cannot rely on a state-law exception alone and must separately conclude that the recording falls outside the DRS. A recording that is used only to generate a draft note, is not consulted to make decisions about the patient and is deleted on a short, defined schedule is likely well positioned for that conclusion. The position becomes harder to defend if recordings or transcripts are retained for a longer or indefinite period, made available to clinicians for later reference or used to resolve questions about what occurred during a visit. Because electronic health information under the information blocking rules is defined by reference to the DRS (45 C.F.R. § 171.102), the same analysis drives information blocking risk.
Consent to record. The Court addressed access, not whether the recording was lawfully made. Washington is among the states that generally require the consent of all parties to record a private conversation (RCW 9.73.030), and recording-consent litigation involving ambient AI is already underway. In a proposed class action filed in November 2025, a patient alleges that a California provider used an ambient documentation tool to record exam-room conversations without the all-party consent required by the California Invasion of Privacy Act, disclosed medical information to the vendor without the authorization required by California’s Confidentiality of Medical Information Act and inaccurately documented patient consent in the chart. Those claims remain allegations, but they show that notice, consent and documentation workflows deserve as much attention as record classification.
Litigation holds and vendor retention. The ruling addressed a patient’s statutory access right, not whether recordings are discoverable or must be preserved in litigation. In Raphael, the patient sent a litigation hold demand the day after the visit, and the Clinic placed a hold on her records. Once a claim is reasonably anticipated, a legal hold may require preservation regardless of a routine deletion schedule. Organizations should also confirm where recordings, transcripts and derived data actually reside, because vendor agreements may permit retention beyond the provider’s own schedule or secondary uses such as product improvement. At the September 2026 HIPAA Security conference co-hosted by the HHS Office for Civil Rights (“OCR”) and the National Institute of Standards and Technology, OCR’s Director emphasized that a current risk analysis, defined access controls and an executed business associate agreement should be in place before an AI vendor begins handling electronic PHI.
State AI disclosure laws. A growing number of states require providers to tell patients when AI is used in their care. For example, since January 1, 2026, Texas has required providers to disclose the use of AI in relation to health care services or treatment no later than the date of service. Depending on how an ambient tool is used, those laws may apply in addition to recording-consent requirements.
Practical Takeaways
Health care organizations should not interpret this ruling to mean that all AI recordings are categorically excluded from patient access. The decision does, however, offer a useful framework, and organizations deploying ambient AI should use it as an opportunity to review record classifications, patient-access procedures, retention practices and vendor agreements before a request or dispute arises. Health care organizations using or considering AI documentation tools should:
- Evaluate patient-access obligations separately under federal and state law, including whether recordings, transcripts and AI-generated drafts fall within the regulatory or policy definition of DRS;
- Align retention and deletion practices for AI recordings, transcripts and drafts with their intended use as temporary documentation aids, subject to litigation holds;
- Inventory and categorize the information created by each AI system, including where the vendor stores it;
- Confirm that patient notice and consent workflows satisfy applicable state recording and AI disclosure laws, particularly in all-party consent states, and that consent is documented accurately (including with respect to employees, guests and visitors that may be captured by the records); and
- Review vendor agreements and business associate agreements for retention periods, deletion on request, secondary use (including model training), offshore access, the provider’s ability to retrieve recordings, metadata and audit logs, and cooperation with access requests and litigation holds.
Hall Render will continue to monitor this evolving area of the law as more decisions come to light. If you have questions about ambient AI documentation, patient-access rights, HIPAA compliance or related vendor-contracting considerations, please contact:
- Michael Batt at (317) 977-1417 or mbatt@hallrender.com;
- Stephane Fabus at (414) 721-0904 or sfabus@hallrender.com;
- Emily Beukema at (248) 457-7882 or ebeukema@hallrender.com; or
- Your primary Hall Render contact.
Special thanks to summer associate Matt Moller for his assistance with the preparation of this article.
Hall Render blog posts and articles are provided for educational purposes only and are not intended to constitute legal advice or to establish an attorney-client relationship. Readers should consult with legal counsel to determine how laws or decisions discussed herein apply to their particular circumstances.
