Rhode Island's largest hospital was fined $150,000 and ordered to take the extraordinary step of installing video cameras in all its operating rooms after it had its fifth wrong-site surgery since 2007, state health officials said Monday.

Rhode Island Hospital, the teaching hospital for Brown University's Alpert Medical School, was fined a second time for wrong-site surgeries, state health director David Gifford said. The hospital also was fined $50,000 after brain surgeons operated on the wrong part of the heads of three patients in 2007. Gifford said his department has issued only two fines — both to Rhode Island Hospital.

Gifford sent a letter and order to hospital CEO Timothy Babineau on Monday.

The latest incident last month involved a patient who was to have surgery on two fingers. Instead, the surgeon performed both operations on the same finger. Under protocols adopted in the medical field, the surgery site should have been marked and the surgical team should have taken a timeout before cutting to ensure they were operating on the right patient, the right part of the patient's body and doing the correct procedure.

Gifford said the surgical team marked the wrist, rather than each finger, and the surgeon did not mark the site himself. The team did not take a timeout before the second surgery. When they discovered the error, they checked with the patient's family to see if they should perform the surgery on the correct finger. When they did the surgery on the correct finger, they also did not do a timeout, something Gifford called "amazing" given that they had just made such a serious error.

The order includes a provision that the hospital must assign a clinical employee who is not part of the surgical team to observe all surgeries at the hospital for at least one year. The person will monitor whether doctors are marking the site to be operated on and taking a time out before operating to ensure they're operating on the proper body part.

It requires the surgeon to be involved in marking the surgical site.

It also gives the hospital 45 days to install video and audio recording equipment in all its operating rooms. Every doctor will be taped performing surgery at least twice every year, although it will be left up to the hospital whether to tell surgeons when they are being monitored, he said.

The purpose is to use it as a monitor and a training tool, he said.

"Professional athletes do it all the time," he said.

Gifford said he had never heard of another state health department ordering a hospital to install video cameras in its operating rooms, something he said surgeons should welcome.

"You know what? They should be open to that. Clearly there's a culture of making mistakes, so if they're hesitant to have someone to look over their shoulder, that says to me that we're doing the right thing," he said.

The hospital will get permission from patients or their families before any recording