These days cameras are everywhere.  In fact, in the United Kingdom, any person can be seen on camera at least 300 times every day as the devices are everywhere.  Every time you’re on the street, every time you enter a store, restaurant or bank, drive into a public garage … anywhere and everywhere the chances are likely that a camera is looking at you.  And now they are making their way into hospitals around the world.

A recent case in San Diego against Sharp Hospital, Administration put 3 motion detector cameras on their anesthesia medication cart because someone was stealing propofol.  However, the cameras did not shut off when there was no motion and it happened to be in an OB surgical suite where women were having babies by C-section and GYN type surgeries where the patients’ genitalia were exposed.  These patients, some of whom where unconscious, were being videotaped without their knowledge or consent.  The hospital no longer has 3 of the servers with the videos and is unsure if the hard drives were properly erased.  This is scary and a true invasion of privacy as well as a violation of HIPAA. 

There are also ICUs where patients consent to be monitored on video tape called E ICU.  Video cameras are sometimes located in public areas of hospitals and health care facilities.

I think cameras can help … and they can hurt.

The idea of having cameras at the Pyxis is to see who takes medication and whether medication is properly wasted.  This can be helpful to show your properly wasted medication with a witness or it can hurt if you forgot to sign out that you administered the medication.  If your facility does have a camera at the Pyxis, I would recommend that you administer the ordered medication to the patient right away, document that on the MAR and then immediately waste the medication in front of the camera with a witness so there can be no question about you properly deposing of the medication.

Cameras also can be a disservice because they capture images at only one angle and you cannot get the true 3-D picture.  If you go to break up an altercation with patients in a hall, what the video shows will depend at which the camera views the scene.  Or, if you are providing care to a patient on video, it may be misconstrued that you are being rough with a patient.  Things aren’t always as they seem at one angle.  Sometimes you need multiple angles.

I do have concerns about patients’ privacy on video.  I think sometimes facilities will give you a paper and ask you to sign it and most will do as they are told but not bother to read it.

In some respects, cameras can be a blessing and help a person if the footage is kept and sometimes it can be a curse.

What are your thoughts on being videotaped doing your job?

After getting an unfavorable Nursing Board decision, it is unusual for a nurse to appeal the matter to a court.  It is even more unusual for such an appeal to make it all the way to the state Supreme Court.  However, Appellants Christine Mulry Francis and Angela L. Caldwell DeBenedictis did just that.

The facts of this case are very interesting.  Nurses Francis and DeBenedictis were employed in supervisory roles in a Delaware correctional facility where a patient inmate was being administered a very pricey hepatitis C pill costing $1,000 each, and could only be provided in lots of 28.  Because of the high cost of the pills, 2 on-duty nurses (neither Francis or DeBenedictis) were required to count the medications just as if it were a controlled substance.

While performing a count, 1 nurse accidentally tipped over the pills, spilling 12 of them onto the floor.  Both nurses believed the dozen pills, valued en toto at $12,000, should be wasted because the medication had hit the floor, and deposited the medication in the sharps container.

When pharmacy was contacted to provide more of the pills, they hit the roof!  After the pharmacy, a private company, contacted their superiors about the incident, instructions were delivered to supervisory nurse Francis to remove the pills from the sharps container and return them to their original container.  Ms. Francis asked Ms. DeBenedictis to join her as they complied with the order and placed the pills in a paper towel before restoring them for later use.  The patient inmate was never informed of this incident.

When one of the nurses originally involved in the attempted wasting learned that the pills had been retrieved and given to the patient inmate, she reported the matter to the Delaware Division of Professional Regulations.

After an investigation, Francis and DeBenedictis were charged with violating the Nurse Practice Act in “[F]ailing to take appropriate actions to safeguard a patient of incompetent, unethical or illegal health care practice.  Aiding abetting and/or assisting an individual to violate or circumvent any law or duly promulgated rule and regulation intended to guide the conduct of a nurse or other health care provider.  Failing to appropriate action or to follow policies and procedures in the practice situation to safeguard the patient.”

In the hearing, a nurse expert was called who stated that the nurses had a right to rely on the pharmacist to retrieve the medications.  The Hearing Officer “found that disposing of medication that falls on the floor is an accepted standard of the nursing profession and that retrieving those pills from the sharps container … violated the standard of care.” 

The Hearing Officer concluded that both supervisory nurses violated the standard of care and placed their licenses on probation for 90 days as well as requiring them to have continuing education in the areas of pharmacology and nursing ethics.

The nurses appealed to the Superior Court, which set aside the Board’s decision because no harm came to the patient inmate.  Then, upon appeal to the state Supreme Court, its October 2, 2018 ruling was that the Board had been acting properly and the Supreme Court returned the matter to the Board for further recommendations.

I cannot believe the time and expense that must have gone into this case.  It is difficult to appeal these decisions because the Board does have so much discretion.  The nurses in this case should not rely on the directions of pharmacy but need to use their own common sense.  No one would want to ingest medication, which hit the floor and was tossed into a contaminated sharps container.  However, as nurses, none of us wants any action on our licenses, because nursing is part of our identity.

I would like to hear your thoughts, which you are invited to post below, on this interesting case.

Lorie Brown, Nurse Attorney, discusses problems that are the result of a Pyxis audit and how to protect your Nursing License. This includes how it may look like a nurse is diverting medications and making sure you are administering and wasting medication properly so you protect your license.

Nurses always want to be helpful and will share with anyone.  However, there are some instances where silence is golden!

            1.         WORK STATEMENT.  If your supervisor calls you in wanting you to write a statement, be very careful.  Don’t be pressured into writing a statement.  Or, if you want time to think about it first, definitely do so.  When you are pressured into writing a statement, read it and read it again to ensure that it is accurate because it could be used against you, for example, at the Nursing Board.  Remember, silence is golden!

            2.         DEA ENCOUNTER.  If the DEA shows up telling you it’s best not to be associated with the physician for whom you work because he is in trouble, be very cautious.  If they want you to sign a voluntary surrender of your DEA license saying, “You can always get it back later” … realize it is a very bad idea!  They will seem like they are doing you a favor and tell you that it’s in your best interests which likely will be followed by their trying to talk you out of getting an attorney.  Again, silence is golden!

            3.         POLICE INVESTIGATORS.  If the police ask you to come to the station, note that you are going to be videotaped, a fact they may not tell you.  The police will come out looking like 21 Jump Street, all kind, cool and nice to you until you spill your beans.  Then they will turn around and file charges against you.  Silence is golden!

            4.         NURSING BOARD INVESTIGATORS.  If a Nursing Board investigator comes to your home or your work, they will present themselves nicely and say they just want to get your side of things.  Any statements you make against your best interests will be used against you.  Silence is golden!

            5.         OIG/MEDICAID FRAUD CONTROL UNIT INVESTIGATORS.  Like the others, these investigators will be courteous and seem all nice.  Many are former police officers trained to know exactly what to say to get you to spill your guts.

What most nurses probably don’t know is that talking to these investigators could lead to criminal charges.  They all may be friendly and want to talk to you about where you work or where you used to work.  Again, anything you say can and will be used against you.

Moral of this writing, silence is golden!  Anything you say can and will be used against you.  I’ve seen it countless times where nurses, wanting to be helpful, will answer questions which winds up leading them to trouble.  It is always best to tell any of these authorities, from your boss to police officers, that you want to think about the situation and will get back to them. 

Of course, in situations like noted above, it is best to hold your responses to any questions until you get an attorney to protect your interests.