(Apr. 28, 2020) On April 6, 2020, Israel’s Ministry of Health (MOH) issued the Camera-Corona Directive (CCD), providing guidelines for the use of cameras in hospital units caring for COVID-19 patients.
According to the CCD, care for coronavirus patients requires rigorous patient monitoring as the condition of such patients can deteriorate rapidly. Their treatment also raises concerns about the infection of medical personnel, which may impact a hospital’s ability to care for its patients, especially as the pandemic is “unlikely to disappear in the near future.” (CCD, “Background.”)
To provide optimal care while minimizing unnecessary contact with medical personnel, the MOH’s directive authorizes the installation and use of cameras in COVID-19 units to enable the provision of care and maintain communication with patients, examine their condition, and monitor those who are in a serious condition or whose condition may worsen rapidly.
The CCD seeks to balance two competing interests¾patients’ rights to privacy, dignity and autonomy in a way that will enable them to obtain optimal medical care versus the need to prevent disproportional harm to the ongoing operation of hospitals by minimizing the infection of medical personnel.
Camera Installation and Operation
The CCD authorizes the use of cameras operated by hospitals under the following conditions:
- Cameras must be installed in a way that minimizes harm to patients’ privacy.
- Cameras may be installed in patients’ rooms and in communal spaces, such as hospital corridors, but not in bathrooms.
- Hospital personnel and patients must be informed of the placement of cameras.
- To the extent possible, one area in the patient’s room should be out of camera range and the patient must be notified of it.
- In general, and in the absence of exceptional circumstances, ICU patients may be video monitored to the extent medically necessary.
- A decision on the need to operate a camera will be made on an individual basis, or for a group of patients similarly situated, based on clinical conditions, the need for monitoring, and the likelihood of a deterioration in their condition. (CCD §§ 5–10.)
The CCD does not apply to video monitoring of patients with lighter symptoms, who are allowed to stay in the community or in hotels designated for patients, or to those under quarantine. (Background & § 2.)
The use of cameras in the patient care setting requires a patient’s express consent or failure to object after having been informed of the planned video monitoring and its purpose, the medical need for it, the manner in which it would be done, “who would be exposed to it,” and the way to stop or block it. (CCD § 11.)
In the event of a patient’s objection, the hospital must find an alternative method, if possible, that does not unnecessarily endanger caregivers or other patients. The rejection of a patient’s request that a camera not be used requires approval by the hospital’s department manager and general counsel, and must be grounded in the conviction that the use of cameras is imperative due to the patient’s condition and need to be monitored, or due to the condition of other patients. Under such circumstances, video monitoring must be limited in duration based on medical need.
A decision to video monitor a patient despite his or her objections when the only reason is the patient’s medical condition and other patients or medical staff are not endangered may also require approval under section 15 of the Patient Rights Act. Among other situations, this section allows the provision of medical care upon the approval of three physicians in circumstances where a patient’s consent cannot be received because of emergency circumstances, including the patient’s poor physical or mental condition. This could apply, for example, to patients whose physical or mental status does not enable them to give informed consent and their guardian’s consent or objection cannot be discerned. (Patient Rights Act, 5756-1996, Sefer HaHukim [Book of Laws (official gazette)] 5756 No. 1591 p. 327, as amended; CCD §§ 11–14.)
Attributes of Video Monitoring
As a general rule, the monitoring of patients by camera may be authorized only when required for medical care. To the extent possible video monitoring may begin only with the patient’s knowledge. Observation is limited to real-time viewing without audio, saving, or recording. If audio is built into the system, it should not be operated continuously, except to the extent necessary to hear a patient in a conversation with a caregiver on an intercom system. (CCD §§ 15–19.)
A patient should be allowed to temporarily and independently discontinue video monitoring at will if they are capable of doing so, or with the assistance of medical staff if assistance is required. The CCD emphasizes that video monitoring devices will not be used for any other purpose (such as questioning, supervision of unusual movements, etc.), but only for monitoring patients and communication with them. (§§ 20–21.)