T.M.I. (Too much information) ? Cameras in the Hospital and the Downsides That Weren’t Meant to Happen
A very angry doctor went rogue this month.
In his “Open Letter to the Public,” he blasted his former employer, San Diego’s Sharp Grossmont Hospital, for aiming secret video cameras on his fellow doctors and staff as well as their patients for nearly a year. Motion-activated, they captured 14,000 or so scenes showing hundreds of women undergoing obstetric and gynecologic surgeries.
Now, the hospital’s accidental release of some of those video clips may constitute an embarrassing privacy breach, currently under investigation.
As reported here May 5, Sharp Grossmont’s goal was to catch whoever was taking sedatives from anesthesia carts and work to curtail their licenses. But former chief of anesthesiology Patrick Sullivan, MD, who is no longer with the hospital, said in his screed — in so many words — that Sharp’s operation was outrageously, morally, and ethically bereft.
Far from being praised for its courage, the 528-bed hospital and the Sharp name are facing a public relations disaster.
“One can only imagine what might be on those video clips,” Sullivan wrote.
Imagine indeed. And that’s what this column is about.
Hospital documents say some of those clips show women “in their most vulnerable state.” Sullivan was less euphemistic. He said they show women in lithotomy or “legs spread apart position, while staff place prep sponges, catheters and instruments inside their genitalia.”
Not exactly prime time material or fodder for YouTube. And let’s hope those videos never get that far.
But hey, this was about nabbing drug diverters, a clear threat to patient safety. Healthcare worker addiction is an insidious and growing national nightmare, sometimes resulting in patients being infected with lethal viruses that may take years to show up or manifest in disease.
Give me the forms. I’d happily consent to record my surgery if it helps zoom in on a diverter. Surely national hospital advocacy organizations would come to Sharp’s defense.
Surprisingly, not so.
The Joint Commission declined to weigh in. The American Hospital Association, punted to the International Association for Healthcare Security and Safety. The IAHSS is “the best source of information. They are experts on this topic,” the AHA said.
“Not Worth the Risk”
Two IAHSS officials I spoke with separately both said this was absolutely the wrong way for Sharp to grapple with missing drugs.
“I’ve learned a lot of lessons the hard way that using covert cameras specifically to try to catch people either stealing or doing criminal activity … is not an appropriate way,” said IAHSS Vice President Ben Scaglione, a 30-year healthcare professional who directs security for the firm G4S in Jupiter, Fla. “It’s just not worth the risk.”
For starters, video surveillance usually doesn’t find what you’re looking for, “but you may find other activities that are inappropriate, maybe not criminal in nature, but then that becomes an ethical issue of what you do with that information,” Scaglione said.
Just imagine other activities those clips might show.
For example, “let’s say a nurse and doctor have ‘relations’ on the OR table, or a doctor drops an instrument, or even a patient falls off the table,” said Scaglione. “Now you’ve recorded an event, which if the jury saw would be very detrimental in a lawsuit, because the patient wasn’t strapped properly and the staff wasn’t paying attention.”
If the lawyer finds out videos were taken, and the hospital discards them, the hospital has destroyed evidence, he said.
John White, president and CEO of Protection Management LLC in Canton, Ohio, and a member of the IAHSS board said, “Quite frankly, if someone were to ask me, ‘Can we do this?’ I would be talking to them about the risk … and looking at another way we can find out who is diverting this drug without going to that point.”
Scaglione, a former hospital risk manager and former hospital security director in New York City, said some states require medical records of infants retained until 2 years after the child becomes of legal age. “Because maybe the child’s head was cut during a C-section, and at 18, you have a scar on your face and feel deformed and sue the hospital.
“So why would (a hospital) put itself in that situation? You’ve ended up recording that gash or that someone dropped the baby.”
Rather than go Sharp’s route of video surveillance for a year, Scaglione said traditional investigative techniques, like interrogation of suspects, “are far more effective and tend to pinpoint the perpetrator.”
“You know, if you’re doing this to catch someone, you have an idea who the person is … so after the first couple of weeks, you need to be thinking to yourself, maybe I need to find another technique.”
Like “interviewing of staff, comparing work schedules with loss events, checking public CCTV cameras to confirm the suspect being on site, checking social media sites, checking card access data, sign in sheets, logs and records on the dispensing or use of anesthetic drugs. And lastly, the interview and drug testing of the suspect. Today we generally jump to terminate employees who are caught abusing substances instead of treating the abuse as an addiction and providing treatment.”
Over the years, he said several hospitals did try to install covert cameras to catch criminal activity. But time after time, “What we were looking for and what we got were so very different, and so problematic, and so illegal — it really became an ethical issue, and it was hard for the hospital to explain how we knew what was going on.”
Credibility, Privacy Issues
“We try to be an ethical industry in security, but we really need to sometimes check ourselves to make sure we’re doing the right thing for the right purpose,” Scaglione said. “When we don’t, you’re seeing here what can happen. The hospital is going to lose credibility, they may lose money as a result of it, certainly doctors aren’t going to be willing to work for that institution or be attracted to that institution out of fear that it’s happening in other areas.”
White, a former police officer for the Oceanside and San Diego City police departments, said he’s never heard of a case like Sharp Grossmont’s. Quite the opposite.
“A lot of hospitals will go out of their way to make sure that the most intimate moments of patient care are not recorded on video,” White said. Monitoring of hospital operations, yes, but not recording them.
That privacy issue seems about to mushroom in other ways. Patients are now upset, saying they never consented to having their surgeries recorded. One patient has now filed a class action lawsuit claiming the surveillance caused her personal injury including “anguish, fright, horror, nervousness, grief, anxiety, worry, shock, humiliation … ” and much more.
Attorney Duane Admire, who represents a doctor accused of taking propofol from surgery carts, told me that as part of discovery, the hospital mistakenly sent him 77 video clips, many of them showing identifiable patients undergoing C-section surgeries. The hospital has apologized.
Admire said that several months ago — before he realized what he had — he sent those same clips to at least one other attorney and his client. Who knows what they might have done with them — intentionally or not — or how many others may still have those clips on their computers?
Sharp Grossmont’s officials have said the video surveillance operations were legit because their admissions agreement has patients “consent to all hospital services rendered … and to the taking of photographs and videos of you for medical treatment, scientific, education, quality improvement, safety, identification or research purposes. … ”
But Scaglione and White disagree that boilerplate consent gives the hospital the right to take pictures of women while they’re undergoing surgery. “That (consent language) is talking about the general surveillance in hallways, stairwells and the elevator, and other public areas,” said Scaglione. “It’s not about putting hidden cameras in areas where you’re trying to catch people stealing things.”
Added White: “There’s an expectation of privacy in some areas; some areas where cameras just don’t go.”
Some hospital and physician leaders must now ask themselves variations of this question: Was all this worth it?
The now-accused doctor continued on at the hospital 10 months after videos allegedly captured him removing drugs, but he kept his staff privileges and left on his own. Although he faces a medical board accusation, he’s still practicing while mounting a plausible defense: that propofol was in short supply and that a lot of doctors grabbed it for emergencies.
Another big reason to not do what Sharp Grossmont did, White said, “is that those videos could, potentially, go out on the internet. And, you don’t know what that camera is going to capture.”
There might be a wide range of emotions in these women’s faces as they meet their newborns — whatever Apgar score they might have — for the first time. And hospital staff doing many things they shouldn’t.
To Sullivan’s point: “One can only imagine.”