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Closed circuit television systems are commonplace in most hospitals across the country. However, when one evaluates the implementation of CCTV, one comes away perplexed as to the objectives of such a system. The CCTV systems of many hospitals clearly have the potential of doing more harm than good in terms of liability. It appears that some hospitals have employed the use of a camera system in order to provide the illusion of security. The reality is that many camera systems detract from overall security objectives.
There are instances where camera systems become the tool of plaintiff attorneys. For example, assume your hospital has a CCTV system that surveys a parking structure. Assume the following scenario. A female visitor, upon returning to her car is sexually assaulted in the parking structure within full view of a camera. During the course of the assault, lasting five minutes, there is no security response. There is, however, a videotape of the entire incident. Furthermore, there was no one observing the video monitors because they are locked up in a secure closet. The victim sues the hospital, maintaining the premises had inadequate security. Her attorney, during the discovery process, subpoenas the videotape of the entire incident and uses this evidence against the hospital. The facts of this case are not fictional. Clearly the CCTV system, in this scenario has become a valuable tool of the plaintiff.
What are the lessons in this example?
First, there must be some rationale for a camera system. If the design of the CCTV system is not predicated on a hospital-wide security audit, be prepared to defend the placement of every camera as well as the overall purpose of the system. Second, if you are not monitoring your cameras with a live person, you may be better off with no cameras. The courts seem to support the notion that anyone within the field of view of a camera has a reasonable expectation that the cameras are being monitored and that in the case of an assault, help is on the way.
Cameras have one primary purpose as well as one of two alternative objectives. CCTV systems are primarily meant to be a deterrent to criminal activity. Secondarily, they are placed either for evidentiary purposes or to provide security personnel with expanded surveillance capability. Competent CCTV vendors will often ask the question, "do you want to see bodies or faces?" All night mini marts and banks primarily use cameras for evidentiary reasons (faces). Parking facilities and large shopping centers use cameras to expand the reach of their security force (bodies).
CCTV systems must be integrated as one component of an overall security program. They should be an extension of the security force. When used properly, CCTV can reduce FTEs in the Security Department. Camera systems that are added as an after-thought rather than being the product of a security assessment, will be marginal at best. Let's take a look at the two primary components of a CCTV system, cameras and monitors.
Cameras can be fixed or movable, monochrome or color, auto iris or fixed as well as interior or exterior. Cameras can be mounted in the open or behind smoke colored domes. They can be alarm and/or motion activated. They can be placed in weather resistant or tamper-resistant housings. Cameras placed in the ER, L&D or the Business Office may be there for evidentiary reasons (faces). Cameras placed in parking facilities, hallways and at exits may be there to extend the reach of the security force.
Fixed cameras are less expensive and require much less maintenance than movable cameras. Sometimes two or three fixed cameras can be installed for the same cost as a movable camera (pan, tilt and zoom). Light becomes a critical consideration when using outdoor cameras.
Cameras may also be deployed to extend the medical staff's ability to observe patients and waiting room areas. However, cameras that are placed for this purpose should also be redundantly monitored by the Security Department. What about patient privacy? When this issue come up it is wise to consult with your Legal Department or risk manager. Generally speaking, if patients or staff, for that matter, have a reasonable expectation of privacy, cameras should not be used. It is not unreasonable to use cameras in seclusion rooms located in the Emergency Department or in psychiatric units. The use of CCTV in L&D units, within the common areas, is not unreasonable.
Where most CCTV systems break down in the hospital setting, it is in the area of monitoring. Cameras can be monitored on a ratio of one monitor for every camera (not practical), monitored and a lessor ratio using automated and/or manual switching or monitored on large monitors with screen splitting. All cameras, without exception, should be tied to a video recorder.
The problem with many hospitals is who, if anyone, is watching the monitors. Some hospitals lock the monitors in a room or a closet with no one watching. Some hospitals place the monitors at the main reception desk or in the PBX area. Some hospitals place the monitors in the security central control center.
The obvious resistance to monitoring cameras by a dedicated employee is cost. Recently, there is another alternative, remote-interactive monitoring. There are some companies providing monitoring services to their clients with the ability to speak directly to would-be suspects when caught in the act. With this technology a monitoring company in Los Angeles may monitor the cameras for a hospital in New York City. If this approach helps keep the FTE count down, it may be worth considering. Monitors left unwatched could produce liability costs that exceed the cost of several FTEs. Furthermore, the videotapes produced by those cameras could be used against the hospital in a legal proceeding.
The inherent difficulty in purchasing a CCTV system is that the vendor knows much more about his product than does the buyer. This can lead to overkill as well as poor design. When buying a camera system, it is important to deal with a reputable vendor who will be in business ten years down the road. CCTV systems can be maintenance-intensive. Consider hiring a security consultant to help you through the design and request for proposal process.
If you are considering a CCTV system or upgrading and existing system, first do a needs assessment study. Then develop an RFP (request for proposal) that functionally describes, in plain language, what you expect the system to do. The key is to describe what the system should accomplish. It is not necessary for you to describe how to accomplish your desired objectives. Consider whether you want to own or lease the system. If you are working under a multi-year plan, be sure the system is fully expandable.
Once the system is installed, the Security Department should give the system teeth by responding to any suspicious activity they view on the monitor.
Finally, portable video cameras should also be used to preserve crime scene information as well as data pertaining to accidents. Video or digital imaging is also useful for memorializing suspects detained for security reasons and/or arrested. The use of covert cameras may also be appropriate for specific investigations.
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