Louis Stokes Cleveland VA Medical Center

Issue: A clinic mailed lab results to the wrong patient. The patient mailed the documents back to VA. The cover letter was correct, but the mailing address was another Veteran's address. Both addresses in CPRS are correct, so it is not…

Outcome: 05/28/14: The Incident Resolution Team has determined that one Veteran will be sent a letter offering credit protection services due to full SSN being disclosed.…

Issue: A Veteran called to state they received a reminder letter on another patient. Patient is mailing the letter back to the VA to the PO. Letter contained name and home address. No other details are known at this time.

Outcome: 02/21/14: One Patient will be sent a HIPAA notification letter.…

Issue: Veteran A received the appointment letters of Veterans B and C. The letters were returned by Veteran A's significant other. The two Veterans' name, address, protected health information (PHI) were disclosed.…

Outcome: 02/14/14: The Incident Resolution Team (IRT) determined that Veterans B and C will be sent HIPAA letters of notification based on their protected health information being released.…

Issue: A family member reported that a patient SSN was displayed on a biomed device. The machine display closes after six minutes but the nurse forgot to log off and the SSN was displayed on the ward for the six minutes.…

Outcome: 02/11/14: Patient A will be sent a letter offering credit protection services.…

Issue: The Privacy Officer (PO) performed an internal review of a recently deceased employee and found 2 employees accessed CPRS. Reviewing CPRS the PO did not see any reason for the two employees to access the chart. PO will set up…

Outcome: 02/18/14: One employee accessed the chart without a need to know. One employee was cleared as having a need to know. 02/24/14: The Incident Resolution Team (IRT) determined that this was an inappropriate access. The deceased employee's next of kin…

Issue: Veteran stated employee accessed financial information to determine monthly allowance. Employee asked for sums of money that was within the limits of her monthly allowance.

Outcome: 09/23/14: The Incident Resolution Service Team has determined that the Veteran will be sent a HIPAA notification letter due to Protected Health Information (PHI) being accessed without a need to know.…

Issue: A Community Based Outpatient Clinic (CBOC) Clerk processed a Release of Information (ROI) that the daughter signed and not the patient. It was for current lab results. Patient is elderly but not incompetent and daughter is not POA per chart…

Outcome: 01/16/14: The patient will receive a letter of notification.…

Issue: 2 employees accessed the medical record of another employer without a need to know

Outcome: Data not available.

Issue: A Regional Counsel attorney reported that a provider disclosed patient information to adult protective service and the County Probate court, without appropriate authority.

Outcome: 02/03/14: The patient will be sent a HIPAA notification letter.…

Issue: At 9:00 AM, on 12/29/13, a nurse gave the Privacy Officer (PO) a progress note that Patient A brought in. The note was on Patient B. Patient A stated he had the note for a while but is now bringing…

Outcome: 12/30/13: Patient B will be sent a letter offering credit protection services.…