Sharp Grossmont Hospital has apologized for releasing 14 video clips that included women undergoing obstetric surgery, an error it said constituted a breach of their medical privacy and has led to state and federal agency notification.
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A major San Diego hospital’s yearlong video surveillance of women undergoing surgery to track missing drugs raises questions about hospital operations and security
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“We are very sorry that this error occurred and that the privacy of these patients was breached,” the Sharp Grossmont statement said. The hospital mistakenly released the clips to an attorney representing a doctor the hospital said is seen in the videos taking bottles of sedatives from surgery carts and putting them in his pocket
Hospital spokesman John Cihomsky said Grossmont is trying to identify each patient shown in these clips, and when it does it will notify them of the breach.
Patients, doctors upset
Meanwhile, several women who underwent C-section surgeries to deliver their babies during the course of the hospital’s yearlong video surveillance in its Women’s Health Center say they are horrified they may be among those captured on video. They believe they never gave consent to be on camera during their most private moments with their doctors, while they were giving birth.
One, Melissa Escalera, 34, said she felt “violated.”
Carla Jones, 34, of La Mesa, who delivered her baby by unscheduled C-section, said she is “extremely uncomfortable” knowing her surgery on May 15, 2013, was on video and was viewed by people other than her doctors and nurses.
“If you’re missing drugs, you don’t just pop cameras in a place where women are naked. It’s ridiculous that Sharp thought this was a reasonable way to figure this all out,” Jones said.
Two anesthesiologists who worked at the hospital said they also were upset about the video surveillance.
Dr. Patrick G. Sullivan, former chief of the hospital’s anesthesia department who no longer works at Grossmont, said in an “Open Letter to the Public” Sharp’s operation should prompt “outrage,” and that women whose images were captured on videos “are entitled to damages.” He said Sharp Grossmont, the second largest in the county with 528 licensed beds, “severely violated and betrayed the public trust of East County women and the East County community in general.”
Another Grossmont anesthesiologist, Dr. David R. Diehl, told a medical executive committee on April 10, 2013, that the removal of drugs probably wasn’t theft. “Anesthesia carts are unlocked and physicians often take 1-3 vials for emergencies; these are life and death situations,” according to minutes from that meeting.
Sharp Grossmont launched its surveillance operation with hidden cameras in three operating rooms at its Women’s Health Center on July 17, 2012, to determine why drugs, including the sedative propofol, were missing, Sharp documents say. Seven months later, in February 2013, the videos began to show that an anesthesiologist, Dr. Adam Dorin, was putting bottles of the drugs in his pocket, Sharp documents say. inewsource first reported about the video operation May 5.
The surveillance continued through June 2013, capturing Dorin taking a total of 12 bottles of medications, Sharp documents allege.
Nevertheless, Dorin, 52, continued to provide anesthesia services at the hospital until mid-October, when he resigned. The fact that he was allowed to continue working at the hospital raises questions about why, if hospital leadership believed he was taking, abusing or selling drugs for personal gain, it didn’t act more aggressively to remove him from the staff. It did not relay its concerns or file documents about its investigation with the Medical Board of California until after Dorin left in October for a new job in Palmdale.
“Why didn’t they send Dorin to the (Medical Board of California) immediately?” asked Duane Admire, an attorney who represents Dorin.
Sharp has not answered that question.
Admire said he has had numerous conversations with other doctors and nurses in the hospital who are angry that it conducted surveillance on them without their knowledge. It compromised physicians’ relationships with their patients, he said.
Propofol in short supply
In April 2013, the hospital’s medical executive committee, an independent peer review organization that grants physician staff privileges, suspended Dorin but lifted the suspension the next day after learning that propofol was in short supply, and that many anesthesiologists grabbed it to prepare for emergencies. That was confirmed by Sullivan.
Those drugs were missing because, Sullivan wrote, “there was a year-long local and national shortage of propofol, and Sharp could not procure enough propofol to put patients to sleep in all areas of the hospital.” So anesthesiologists would take the drug from one area to another.
“There were literally times when patients were on the operating table with the surgeon ready, and there was no propofol to put them to sleep,” he wrote.
“Sharp Healthcare and Sharp Grossmont Hospital have severely violated and betrayed the public trust of East County women and the East County Community in general.” –Dr. Patrick G. Sullivan, former Grossmont chief of anesthesiology.
Admire wants to privately review the 14,000 or so video clips taken during the surveillance, saying they will exonerate Dorin by showing many doctors taking drugs just like Dorin did. They also will show Dorin replacing some of the drugs in other carts or using them on patients, Admire said.
Sharp has refused. It said releasing those videos would compromise patient privacy because they show women “exposed,” “under anesthesia,” and “in their most vulnerable state.”
A self-described whistle-blower
Dorin and another doctor who still practices at Sharp Grossmont believe Dorin was targeted for discipline.
Dorin has acknowledged he has been a frequent whistle-blower, and often complained about safety issues at Sharp Grossmont. In 2008, he told the county medical examiner and a reporter for The San Diego Union-Tribune about a hospital error he said resulted in a patient’s death. The case resulted in a family lawsuit against the hospital.
In a phone interview Tuesday, Diehl said he attended that medical executive committee meeting on April 10 because he had learned that “they had set up these cameras, which I was quite upset about because they were like spying.”
Diehl said the story “is not about drug diversion (medical personnel taking medications intended for patients for personal use or gain). The real story was that Michele Tarbet (Grossmont’s former senior vice president and CEO
, who is now deceased) had a vendetta against Dorin. When she found out he was taking the drugs, she used that against him to get rid of him. … She went to great lengths to do that.”
Diehl emphasized that he did not know exactly why Tarbet wanted Dorin off the staff.
In June 2013 the medical executive committee formally admonished Dorin because when he was first asked about the drugs, he denied taking them, and was thought to have lied about it. Admire said Dorin countered that he thought he was being asked if he took drugs outside the hospital, which he had not. The committee stopped far short of curtailing his ability to practice on staff.
Two weeks after Dorin left Sharp, Tarbet sent a letter to the Medical Board of California detailing Dorin’s brief suspension and subsequent admonishment. “Dr. Dorin’s conduct described above was potentially detrimental to patient safety and demonstrated a lack of integrity and honesty,” she wrote.
That got the Medical Board of California’s attention and it launched its own investigation. In January 2014, Sharp sent the medical board a thumb drive containing 12 video clips that the hospital said documented Dorin putting the drugs in his pocket.
77 video clips
Last September, the medical board filed a formal accusation against Dorin, who subsequently hired Admire for his defense.
In reviewing evidence against Dorin, Admire noticed the thumb drive contained multiple clips with “extremely graphic” views of identifiable women undergoing vaginal or abdominal surgery, exactly what Sharp officials said they had not released.
“Of the first four patients that I happened to view before I quit and decided to figure out how best to deal with the problem, (I) discovered that two of the women patients were not under anesthesia — as one of them walked into the operating room, another you can clearly see was adjusting herself and her hair cap etc., and the other two, did seem to be under anesthesia,” Admire said in an e-mail.
In all, Admire said the thumb drive he received from the hospital included about 77 video clips He said he watched about 12 and saw “at least five to six different women having procedures.” Some of the clips may show more than one patient, so it is unclear how many separate patients are visible.
On May 16, hospital spokesman Cihomsky said in an e-mail that the hospital had reported the breach to the California Department of Public Health and will report the breach to the federal Department of Health and Human Services Office for Civil Rights. He said in his statement: “Our intention was to send the attorney only the same video clips that were sent to the California Medical Board in January 2014 that contained no video of patients.”
Hospital might be fined
The California Department of Public Health said on Wednesday that it “is aware of the alleged incident(s)” and is investigating whether the Sharp Grossmont Hospital privacy breach constitutes a violation of the Health Insurance Portability and Accountability Act (HIPAA).
Under state law, the hospital could be penalized up to $25,000 per patient whose medical information was breached, and up to $17,500 per subsequent breach of that patient’s medical information, with a cap of $250,000.
It said the U.S. Department of Health and Human Services also enforces HIPAA violations.
Questions remain about whether the hospital had the right to conduct widespread video surveillance of women undergoing surgery.
Cihomsky insisted the hospital did, because all patients sign the hospital’s Admission Agreement consent form before receiving services. The agreement reads:
“You consent to all hospital services rendered under the general and special instructions of your physician(s), and to the taking of photographs and videos of you for medical treatment, scientific, education, quality improvement, safety, identification or research purposes, at the discretion of the hospital and your caregivers and as permitted by law.”
However, that consent form, Cihomsky said, does not give the hospital permission to release protected health information to outsiders. “We have a separate obligation to keep protected health information confidential,” he wrote in an e-mail. “We should not have shared the information with Mr. Admire.”
Julianne D’Angelo Fellmeth, administrative director for the Center for Public Interest Law and the enforcement monitor for the Medical Board of California, said in an email she’s “not sure if a patient can waive HIPAA and/or other rights via a blanket paragraph contained in an adhesive contract that a patient is likely forced to sign in order to receive treatment.”
“Most of the time, patients are not able to opt out of any of those paragraphs; plus the signature may be under duress due to the patient’s need for hospitalization,” Fellmeth wrote.
Melissa Escalera of Lemon Grove, who delivered her baby by emergency C-section on Sept. 4, 2012, said she was horrified at the idea her surgery was captured on video and is contemplating legal action.
“I feel violated, like my privacy and confidentiality were compromised, and that’s not the feeling you want to have when you go to a hospital to give birth,” Escalera said.
Dorin believes Sharp Grossmont is retaliating against him for being a whistle-blower in 2008 and complaining about other issues at the hospital.
He denies he used or stole drugs from the hospital, or used them for anything other than patients under his care.
In my opion, this points to several problems.
1. Providers do steal patient’s drugs, often for their own use, and yes sometimes to cover for shortages. Both must be monitored/documented in a fashion that is trustworthy. Audio/video is the only tool to come close to doing that.
2. Consent is largely a “just get the signature” task, a box to be checkd. Audio/video of surgery consent will prove if the patient was given enough, all the relivent information to make an informed decision or not.
3. Patients undergoing surgery largely have no clue of the real dangers they face. Short staffing, unqualified staffing, double booking surgeries, not to mention providers stealing patients drugs,
Audio video of operating room should/must be the patient’s right. If the patient is willing to carry all of the burdens if the surgery needlessly go wrong, the the should have the right to not be videoed.
Just remember, 1 in 4 patients will experience botched medical care, 1/2 of those will be serious including death.
The hospital has handled all of this badly, from placing cameras without the patients consent, to allowing others to view the videos. I do not understand why the hospital took so long to notify the medical board or to stop this doctor if they really thought he was stealing drugs…how does this time lapse protect patients? I hope women cancel their C-sections at this hospital and go elsewhere. I know I would.
Superb article. Really solid reporting. Couldn’t agree more with the esteemed doctors Sullivan and Diehl, both seasoned Grossmont Hospital Women’s Center anesthesiologists. If you noted this reporter’s first article 5/5/16, she references a lawsuit the accused doctor filed against the Medical Board in July 2014. I read it. He mentions (two years ago) being scapegoated by CEO Michele Tarbet and alerts the court to “patient privacy violations … by hidden cameras” that should have been recognized by the office of the Attorney General. They missed it, and as a result some “male” security personnel [non-medical person(s) per Dr. Sullivan’s open letter to the public] and who knows who else have been looking over, editing (how do you think they parsed out images of only one doctor out of thousands of video minutes?) and illegally storing illicit naked video clips of unsuspecting female patients for years. This all could have been avoided.
I am a physician, and follower of American medical organizations (and individuals) who look out for gross injustices in the healthcare system, such as AAPS, CPRJ, Mr. Larry Huntoon’s office and others. This scenario here is what these groups might call an extreme version of SHAM PEER REVIEW. Extreme because what this former CEO of SHARP Grossmont Hospital, Ms. Tarbet, did was commit a crime in acting maliciously to inflict harm upon a physician who had already cleared the CEO’s own internal hospital review body without any restrictions on his medical staff privileges many months prior. By sending a letter to a licensing body (the Medical Board) as the head of a hospital, without merit but with full knowledge that she was subjecting the doctor to months or years of harassment and damage, is beyond the pale. This is the action of a very mean-spirited individual. The hospital must take responsibility for her actions. Second, in her 5/5 and 5/19 articles, this reporter did a very thorough job of including all pertinent documents for us to review as discerned readers. This I did. What I found is that the Medical Board falsified its Accusation, wherein it explicitly (and falsely) reads that Doctor Dorin left SHARP Grossmont Hospital while under investigation. This is not true. Doctor Dorin DID NOT leave while under any investigation, but instead stuck it out, fought and won at the hospital Medical Executive Committee level for the explicit reason so that he could avoid any mark on his record. So, why would the Medical Board lie? You tell me. This is a second injustice against this physician, who we also know sued the Medical Board in 2014 (was this payback by the medical board?). Dorin’s lawsuit against the medical board in 2014 clearly states in four different areas of the complaint that the accused doctor was worried he was being targeted by the CEO of the hospital for whistleblower related complaints, and it details concerns over patient privacy violations committed by the hidden cameras that he became aware of toward the end of the hospital’s yearlong videotaping. Why is this important? Because the Medical Board knew about the patient privacy violations for a full two years, courtesy of Dorin’s 2014 lawsuit naming the Medical Board and Attorney General Harris as defendants, and the medical board did nothing. How would you feel if you were violated by some unknown party that was peering into your private medical procedure, only then find out–adding injury to insult– that an official body of the State of California knew about it for years and did nothing to help bring justice to your cause? I would be furious. Doctor Dorin has standing to sue not only SHARP Grossmont Hospital, but also the Medical Board–It’s been done in the State of Texas, which has a very powerful Medical Board, and it can be done here in California. If knee-jerk anti-physician activists think I am pro-physician only, then you are wrong. I am a patient too. My concern about quasi-judicial bodies with enforcement arms and tons of money to spend–like medical boards–is that there’s little data to suggest they are administered in a fashion that actually improves medical care. The really bad apples are easy to spot, but when these boards run amuk there is real danger that they are veering off path and wasting resources that could be applied in other areas. I trust statistics. In this case, Doctor Dorin has a malpractice-free, impressive career that most would envy. I’d trust this guy putting me under anesthesia, and I would demand answers from the hospital and the medical board on what looks like a really messy, poor job, and waste of community resources. And while all of these resources were being wasted, these female patient images remain burned into hard drives on the SHARP Grossmont Hospital–and we should demand detailed answers on who, what, where and when these ‘security personnel’ were watching.
This is how bad the hospital was run back then (I think it has improved, but I totally feel Dr. Sullivan tirade). Some of us worked at the 5565 building across the way (not hospital property). There were doctors who worked at two surgery centers in that building at the time regularly giving anesthesia and their names were not names I see in this article. I know well three of them, and I do not see these doctor names here. That means they are low life in my book for letting an innocent man pay for their crimes. They often “borrowed” propfol vials and other drugs that were in short supply everywhere to use for plastic surgery and other cases and I promise you no person at the surgery center asked any questions. Not the surgeons not the nurses and not the tecks. And not the front office. I am very disappointed that these grown men have not stepped forward and begged for mercy because I promise you the real truth will come out and it will be worse for them. I can’t speak to the rest of it, the vendettas and all that I just do not know. I will say the hospital is very toxic now. Everyone is scared and angry the hospital was so stupid peering into private surgery rooms. If there were cameras in the rooms at these little surgery offices, and who know where else, I am guessing you would see where some of the hospital neostigmine, robinul, proposal, lidocaine and other needed medicines was going then. Shame. Shame. Shame.
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