PROVIDENCE -- A doctor at Rhode Island Hospital started to operate on the wrong side of an 82-year-old woman's head on Friday, barely four months after a similar incident at the same hospital.

The Health Department today fined the hospital $50,000, noting that this was third wrong-site surgery at the hospital this year, and the fourth in six years -- all involving neurosurgery.

Friday’s surgery occurred at the woman’s bedside. The chief resident performed a procedure to remove blood that had pooled between the patient’s brain and skull on the left side. The resident, a doctor in the final year of neurosurgery training, began drilling a hole on the wrong side, realized the error, and completed the procedure on the correct side, the left.

The patient was in fair condition at the hospital late this afternoon.

The hospital notified the Health Department on Friday, and a Health Department investigation determined that no staff member present during the procedure verified the site as dictated by hospital policy.

“The repeated nature of these events suggests a system and culture problem with patient safety that needs to be addressed,” said a Health Department statement.

The department ordered the hospital to have a fully licensed physician attend every neurosurgical procedure from beginning to end, and to require the operating physician to complete a checklist before starting.

The previous incident, which occurred July 30, involved an emergency procedure in an operating room.

An 86-year-old patient arrived at the hospital emergency room three days after a fall, and was found to have blood between his brain and skull. Neurosurgeon J. Frederick Harrington didn’t check the CT scans to see which side to work on, and instead relied on his memory. Harrington drilled into the wrong side of the patient’s head, realized his error, and immediately operated on the correct side. The patient died a week later.

The hospital said in a statement today: "We have talented, dedicated professionals working hard to provide the best care to our patients, but we clearly need to do more. Our policies and procedures cannot be effective unless every person understands them and follows them to the letter."

The hospital goes on to say that it has begun to insitute a "cultural change" at the hospital. Changes under way included "reevaluating training and policies, continue to look at different safety systems, provide more senior level oversight and further empowering nursing staff to ensure our policies and procedures are followed."

-- With reports from projo.com staff writer Michael P. McKinney