HospitalInspections.org

Based on facility policy, document review, medical record review, observation and interview, the hospital failed to honor the patient's right to privacy by failing to ensure video monitoring of patients was limited to patients with an existing clinical need for the video monitoring for all patients who were admitted to the COVID 19 unit.

The finding included:

Review of the hospital's policy "Photography and/or Audio/Visual Recording" revealed, "...Video observation of patients may be used in patient care settings where continuous visual observation of the patient and bedside activity is deemed important to provide treatment and a safe environment of care for patients..." There was no documentation the policy noted that video monitoring should be limited to patients with a clinical need or to ensure safety of a patient who was restrained or secluded.

Review of hospital invoices revealed video monitoring was installed on the designated COVID 19 unit on December 17th 2021, January 8 2021 and February 3 2021.

Medical record review revealed Resident #2, #3, #4, #5, #6, #7, #8, #9, #10 and
#11 were admitted as patients to the designated COVID 19 unit.

Observations during the survey revealed at a nurse's station located outside of the designated COVID 19 unit a video monitor observing Patients #2, #3, #4, #5, #6, #7, #8, #9, #10 and #11.

During an interview with Patient #2, the patient stated his right to privacy was being violated.

During an interview with the Chief Nursing Officer (CNO), the CNO was asked what the clinical need was for each patient being the video monitored on the COVID 19 unit and the CNO stated there was not a clinical need. The CNO was asked if the patient or patients' representatives were notified of the video monitoring and the CNO stated if the patient was not confused they would be notified but the hospital is not notifying the patients' representatives at this time.

Refer to A143.

Based on facility policy, medical record review, document review, observation and interview, the hospital failed to maintain the patient's right to privacy by video monitoring the patients in their rooms on the designated COVID-19 unit for 10 of 10 (Patients #2, #3, #4, #5, #6, #7, #8, #9, and #10) sampled patients reviewed on the designated COVID 19 unit.

The findings included:

1. Review of the hospital revised 9/2021 policy "Photography and /or Audio/Visual Recording" revealed, "...It is the policy of Hardin Medical Center to obtain consent prior to photography and/or audio/visual recording of patients/residents made for purposes other than utilization in identification, diagnosis or treatment. Recording or filming of care, treatment, or any services provided to patients/residents can be useful for many purposes, but such recordings or filming are likely to compromise the patient's/resident's privacy and confidentiality...The practice of videotaping a patient/resident in his/her room is also authorized under specific conditions. Hardin Medical Center acknowledges our patient's/resident's privacy; therefore, the facility will obtain informed consent detailing the use of said materials...Video observation of patients may be used in patient care settings where continuous visual observation of the patient and bedside activity is deemed important to provide treatment and a safe environment of care for patients...Video monitors used for such surveillance are located at clinical workstations for viewing by hospital personnel only..."

2. Review of the hospital's Invoice number 1247 issued on December 17, 2020 revealed, "... Labor Installation...Installation, programming and Training-Cameras in Covid wing..."

Review of the hospital's Invoice number 1271 issued on January 8, 2021 revealed, "...Installed wire for cameras on 2nd floor annex [designated Covid unit]..."

Review of the hospital's Invoices number 1388 issued on February 3, 2021 revealed a video communications lease agreement with an outside vendor.

3. Medical record review revealed Patient #2 was admitted to the hospital's designated COVID 19 unit on 12/27/2020 with an diagnosis of COVID-19 and was discharged on 12/30/2020. Patient #2 complained his rights to privacy had been violated by the hospital's video monitoring system.

During an telephone interview on 9/7/2021 at 10:38 AM, Patient #2 stated, "[The Hospital] are violating HIPPA [Health Insurance Portability and Accountability Act] ....there are cameras in the rooms where they can see you 24/7 [twenty four hours a day, seven days a week]".

During an telephone interview on 9/8/2021 at 8:30 AM, Patient #2 was asked if the hospital staff had informed him that they were video monitoring him and Patient #2 stated, "I just knew there was a camera in my room because I could see it, I was sick and I don't remember them telling me about the video..."

4. Medical record review revealed the current patients below remained on the designated COVID 19 unit with video monitoring with no evidence a consent for the video monitoring was obtained per the hospital's policy as follows:
(a). Patient #3 was admitted on 8/26/2021 with an diagnosis of Pneumonia due to COVID-19 virus.
(b). Patient #4 was admitted on 8/27/2021 with an diagnosis of Respiratory Failure with Hypoxia, Pneumonia due to COVID and Severe Sepsis without Septic Shock.
(c). Patient #5 was admitted on 8/29/2021 with an diagnosis of Pneumonia due to COVID-19, Encephalopathy due to COVID, and Thrombocytopenia.
(d). Patient #6 was admitted on 9/1/2021 with an diagnosis of Pneumonia due to COVID-10 virus, Toxic Metabolic Encephalopathy and Myasthenia Gravis.
(e). Patient #7 was admitted on 9/2/2021 with an diagnosis of Pneumonia due to COVID-19 virus.
(f). Patient #8 was admitted on 9/2/2021 with an diagnosis of Pneumonia due to COVID-19 virus, Chronic Renal Failure and Acute Hypoxemic Respiratory Failure.
(g). Patient #9 was admitted on 9/4/2021 with an diagnosis of COVID-19.
(h). Patient #10 was admitted to the facility on 9/6/2021 with the diagnosis of COVID-19.
(i). Patient #11 was admitted to the facility on 9/6/2021 with the diagnosis of COVID-19.

5. Observation on the COVID 19 unit on 9/7/2021 beginning at 2:15 PM revealed a video camera in the upper right corner of Room 240. Observations also revealed a video camera in Room 249 which was on the hospital's Medical Surgical unit.

Observations in Room 239, which was the designated nurses's station for the COVID-19 unit, revealed a video monitor sitting on a table. The following rooms located on the designated COVID 19 unit were being constantly video monitored: 230-A, 232-A, 233-B, 234-A, 235-A 236-A, 237-B, 238-A and 240-A.

Observations at the second nurse's station located outside the designated COVID 19 unit revealed a video monitor placed on the ledge of the nurse's station that was constantly monitoring the following patient's rooms on the designated COVID 19 unit: 230, 232-A, 233-B, 234-A, 235-A 236-A, 237-B, 238-A and 240-A. Observations of this nurse's station also revealed active telemetry monitoring of all the patients on the designated COVID 19 units.

6. During an interview on 9/7/2021 at 2:28 PM, the Chief Nursing Officer (CNO) was asked why there was video monitoring of the designated COVID 19 unit and the CNO stated, "Just for observation the cameras are not recording..."
The CNO was asked why was there also a video camera in the non-designated COVID 19 room 249 and the CNO stated, "...It is there in case we have a High Risk Fall's Patient..."

During an interview on 9/7/2021 at 2:40 PM, with the Director of Maintenance (DOM), the DOM was asked when were the video monitoring cameras were installed in the designated COVID 19 patient rooms and the DOM stated, "...Those in the COVID unit were just installed".
The DOM was asked when was the video monitoring cameras installed in Room 249, a non designated COVID 19 room on the Medical surgical unit and the DOM stated, " I didn't know those rooms had cameras or when they were installed".

During an interview on 9/8/2021 at 10:00 AM, the CNO confirmed the live video camera monitor was constantly monitoring the patients on the designated COVID 19 unit. The CNO was asked how long the video monitoring cameras had been used to monitor the patients on the designated COVID 19 unit and the CNO stated, "I really don't know I guess since the first of the year".

During an interview on 9/8/2021 at 1:15 PM, the CNO and Interim Administrator were asked to provide this surveyor with the clinical need for each patient who was being video monitored and the CNO stated, "...there is not a certain clinical need for each person...it is to look at the COVID patients to see if they take their oxygen off...COVID patients are very confused and we are able to intervene quicker if they take off their 02 [oxygen]...the [patients] oxygen drops very quickly and if they [patients] take the oxygen off it can drop very quickly and very low...Someone is always there monitoring the patient..."
The CNO was asked if the patients and/or the patients representative's were made aware they were being monitored by a camera in their rooms the CNO stated, "Yes unless they are confused..."
The CNO was asked if the patients were confused were the patient representatives made aware the patients were being video monitored and the CNO stated, "...well they cannot have any visitors...we would have to call them, I don't think that is being done..."
The CNO was asked if there was documentation the patients were being made aware of the video monitoring and the CNO stated, "No..."
The CNO was asked if there were physician orders for the video monitoring and the CNO stated, "No.."
The CNO was asked if any of the current patients on the COVID 19 unit were being monitored for a high risk for falls the CNO stated, "...No".
The Interim Administrator stated, "Due to the staffing shortage we brought the COVID patients down to the closed unit [designated COVID 19 unit] on the 2nd floor and in order to monitor those patients more closely the cameras were placed...There are wood doors down here on the 2nd floor so we cannot see the patients with the door closed...The level of confusion goes up with COVID patients..."
The Interim Administrator was asked were there physician orders for the video monitors and the Interim Administrator stated, "...Well it might be."

During a telephone interview on 9/9/2021 beginning at 9:28 AM, the Interim Administrator was asked were all the patient's on the designated COVID 19 unit being monitored by using telemetry monitors in order to monitor the patients' respiratory rate, heart rate, heart rhythm and oxygen saturations and were the alarms on the telemetry monitors set to alarm if the perimeters were not met and the Interim Administrator stated, "...yes I believe so but I will check on that for you..."

During an telephone interview on 9/9/2021 beginning at 10:20 AM, the CNO was asked if the patients on the COVID 19 unit were also being monitored by using telemetry monitors in order to monitor the patients' respiratory rate, heart rate, heart rhythm and oxygen saturations and were the alarms on the telemetry monitors set to alarm if the perimeters were not met and the CNO stated, "Yes".

The hospital failed to ensure the patients' right to personal privacy was honored and not violated by failing to determine if a clinical need existed to video monitor patients, or a need existed to monitor the patient due to being restrained, or secluded to manage violent or self-destructive behaviors for each patient being video monitored on the designated COVID 19 unit. The hospital failed to inform the patient and/or the patients' representatives of the video monitoring and failed to follow their policy of obtaining consent to use video monitoring.