"I rushed up because I wanted to run alongside him and just hold his hand and reassure him and say, 'You'll be OK,'" she said. The doctor said no. "That would have been my last chance to even say something to him."

Mr. Chanko was initially alert and awake, and able to respond to questions, medical records show. But he was in bad shape: His pelvis had been broken in several places, as had his left femur. The skin was ripped off his right leg.

Outside the operating room, doctors and nurses could not detect Mr. Chanko's pulse and resuscitated him. In the operating room, he became more unstable, medical records show. Twice more they tried to bring him back. He was pronounced dead at 1:17 a.m.

Dr. Schubl and a social worker walked into the conference room, where the family was waiting, and shut the door.

"I did everything I possibly could," Dr. Schubl told them. "Unfortunately, he did not survive. I am sorry."

The family did not know until the episode was broadcast that a camera was focusing on the closed door of the room where they had gathered and that audio of Dr. Schubl was being recorded.

Afterward, on the episode, Dr. Schubl turned to the camera and said, "Rough day. Rough day."

"It was the last clip before the commercial," Mrs. Chanko said, "or as I put it, 'Watch this man die, now we're going to sell you some detergent.

'"According to PR Week, the public affairs staff at NewYork-Presbyterian contacted Mr. Wrong in 2008, eager to bring one of his shows to the hospital. Mr. Wrong had completed two shows based at Johns Hopkins Hospital in Baltimore and was working on another in Boston.

After three years of trying, production began in 2011 at two campuses of NewYork-Presbyterian: Weill Cornell on the Upper East Side and Columbia University Medical Center in Washington Heights, both in Manhattan (some filming also took place at Lutheran Medical Center in Brooklyn).

But two months into filming the first season, Mr. Wrong later told the Philadelphia Inquirer, "Weill Cornell was just not delivering enough traumas." To capture more drama and action for "NY Med," he said he signed contracts with other emergency rooms and began keeping videographers in NewYork-Presbyterian's emergency room at Weill Cornell 24 hours a day.

Mr. Wrong ended up with thousands of hours of footage, and the luxury of cutting any example that was not perfect, he told Capital New York last year. "You can be shut out of a critical moment that the case lacks emotional resonance without," he said. "I will give you one of those: the 'goodbye' moment, it is the moment where a family says goodbye to their loved one going into surgery. If you don't capture that moment, because a nurse shut the door on your camera's face, you kill that piece. "

Some of the patients and families captured by Mr. Wrong's cameras have no complaints. "I think they were honest in their portrayal of our family and the love that we had and the concerns that any average family would go through when faced with this type of surgery," said Dara van Dijk, whose mother's heart valve operation was featured on the same episode as Mr. Chanko's death. Ms. van Dijk did have one quibble: She was shown falling off a chair while meeting Dr. Oz in the episode. "In a million years, I didn't think that they would show that," she said.

Typically, hospitals have not received money in return for allowing medical reality shows to set up shop, and NewYork-Presbyterian is no exception, an ABC spokeswoman said in an email.

"That was very important to us," said Peggy Slasman, a spokeswoman for Massachusetts General Hospital, which was featured on Mr. Wrong's Boston Med. "This was not entertainment. This was news. We would not have participated if they had said, 'For $20,000 or for $50,000, we will include you in a series.' We're not the marketing department. We processed it in a similar way as we would any request that we would get from the media."

The real payoff for participating hospitals is distinguishing themselves at a time when other forms of promotion are no longer as effective, said Jennifer Coleman, the senior vice president of marketing and public relations for Baylor Scott & White Health, a large hospital system in Texas. Baylor self-produced a reality series about its cancer center and paid to broadcast it on local television.

"Advertising is just so saturated right now," she said. "You put your thumb over anybody's ad and it's just the same. That's what people are trying to break through." By participating in a major network program, she added, "They get that endorsement."

Patients caught up in emergencies are especially vulnerable, posing special issues for reality shows. They may not be conscious or able to speak for themselves; they may be quite literally exposed, as caregivers work to help them. Joel Geiderman, co-chair of the emergency medicine department at Cedars-Sinai Medical Center in Los Angeles and chairman of the ethics committee of the American College of Emergency Physicians, compared it to taping in a store dressing room and only asking for permission later. Patients' loved ones, too, are caught up in the moment, making decisions on the fly.

The emergency physicians group opposes "the filming for public viewing of emergency department patients or staff members except when they can give full informed consent prior to their participation," yet show after show returns to the emergency room, drawn by the life-or-death stakes.

The New York Times Co. was sued for invasion of privacy in the early 2000s, by a group of patients in New Jersey who appeared in "Trauma: Life in the ER," a series produced for Discovery's Learning Channel. One appeals court ruled that the show qualified as news and deserved the same protections under the law. Many of the plaintiffs settled their cases individually, a lawyer for them said.

Mr. Wrong of "NY Med," said by email that he had not been sued over his medical shows before: "We put enormous behind the scenes effort into training our team and working in the medical environment. We have profound respect for the work we witness and the dispensation that allows us to do so."

Some hospital systems—including the New York City Health & Hospitals Corp., which runs the city's 11 public hospitals—were approached about participating in "NY Med" but declined. "It was just going to be very difficult to provide all the access that they wanted," said a hospital corporation spokeswoman, Ana Marengo. "It sounded interesting but it was just too much for us to accommodate really."

The Mayo Clinic, based in Rochester, Minn., regularly works with news crews to highlight medical care and patient stories. But it has insisted on asking patients for permission before they meet the film crews and has turned down requests to film first and seek permission later.

"Clearly I can't comment on whatever happened in some other hospital," said Ginger Plumbo, a Mayo spokeswoman. "I can tell you here, we would not be comfortable with a situation where you're filming patients' situations and then trying to get permission after the fact."

Mr. Chanko's family had already settled a lawsuit against the private sanitation company whose truck backed over him by the time his widow saw the episode of "NY Med" featuring his case.

A couple of hours after watching her husband die on TV, Mrs. Chanko called her daughter-in-law Barbara, a health care ethicist at the U.S. Department of Veterans Affairs in Manhattan. Barbara Chanko remembers standing up in her office and saying, "If this happened, it's got to be stopped." When she watched the episode, she was shocked. "We protect patient privacy in everything we do," she said. "I feel very betrayed by that medical staff for what they did."

The Chankos' son Eric Chanko, a physician who works at a hospital in Ithaca, N.Y., said he, too, struggled to reconcile what he saw on the air with his own work. "They basically did everything that you're taught in medical school not to do," he said.