Despite strict privacy laws that govern the sharing of patient information, and policies against obscenity on most mainstream social sites, the Internet enjoys a steady trade in so-called “medical gore”: graphic, bloody images from surgeries, accidents and morgues, passed around YouTube, Imgur and more shadowy sites not for educational or training purposes, but for the macabre titillation of amateurs.

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There are pictures of children with weeping burn wounds. Blood-stained images of dog maulings, shark bites and broken ankles. YouTube videos of graphic rectal surgeries that we’d hesitate to even describe. (In one, the surgeons actually pause the procedure to take a picture around the patients’ prone, unconscious body.)

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The provenance of this material is usually unclear, as is, generally, the identity of the patient. But judging from the fact that many images are clearly taken inside operating rooms — and that, frequently, the patient is unconscious — it would appear that at least some medical gore is produced by doctors, nurses or other health-care workers, perhaps without the patient’s consent.

That is, incidentally, the exact claim in the California case, which was filed last week in Los Angeles County Superior Court. The lawsuit claims that, two and a half years ago, a nurse took a picture of an unnamed patient who had tried to commit suicide by stabbing pencils into her eyes. From there, the nurse allegedly shared the photo with a nephew, who shared it with a friend, who posted it to a gore site. The image is still available on the web and has been viewed, per the suit, nearly 200,000 times.

While the case doesn’t name the site in question, it’s easy to guess at where it could’ve come from: The web boasts any number of dedicated gore forums, from Goregish to That’s Phucked to Best Gore, the Canadian shock site whose owner was charged with “corrupting morals” last year.

Even more generalized forums and social sites have their own sticky, stomach-turning corners: YouTube’s sketchy surgery videos have racked up hundreds of thousands of views, and more than 40,000 people subscribe to Reddit’s /r/gore. Ten months ago, one enterprising user even started a forum exclusively for medical gore — “enjoy the bloody mess,” moderators chirp — though the community hasn’t been terribly active since then.

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“Medical gore is a place for gory pics/videos with some connection to professional medicine,” the forum’s description reads. “From selfies in the ER, to autopsy documentation … We welcome it all.”

It’s unclear, however, if patients welcome being filmed in quite the same way. Surgery release forms may, for instance, include permission to record the procedure. But whether that allows recording on a personal cellphone — or republishing online — is iffy. After all, personally identifiable patient photos are considered protected health information under U.S. law, which means they’re governed by a pretty sweeping privacy code called HIPAA.

A great deal of medical gore, however, seems to come from Asia, the Middle East or elsewhere overseas, where privacy laws may not be as stringent. And even in the U.S., there’s only so much the law can do once pictures have already gone up. In a legal labyrinth also faced by victims of revenge porn, you can’t make a Web site take a non-consensual image down, because it’s protected under the Communications Act — and unless you know exactly who took the picture, you can’t have that person get it taken down, either.

All this makes it easy to see, perhaps, why the California Jane Doe — who is now blind, but studying Braille and receiving psychiatric treatment — fell “back into a depression” when she learned her photo had gone viral.

Meanwhile, the forums rejoice over each new upload.