VA Healthcare System (VISN 10)

Issue: NA Update: 02/02/12:Veteran A will be sent a letter offering credit protection services.…

Outcome: Employee was disciplined (Suspended). Volunteer was terminated. Credit Monitoring Letter mailed to victim.…

Issue: Release of Information (ROI) mailed medical records on a deceased patient to life insurance company on January 4, 2012. On January 26, 2012 the alternate Privacy Officer (PO) received the medical records from the USPS with letter stating that the…

Outcome: No fault of VA.

Issue: A ticket was entered on 12/07/11 (SPE 69395) for an employee leaving her own pay stubs in a hallway in Bldg 5 of Brecksville. Reviewing the evidence again today, there were 2 other employees information in the packet. Since the…

Outcome: Credit Monitoring offered and sent. Case turned over to Supervisor of employee who counseled the employee on leaving PHI unsecured.…

Issue: A VA employee was assisting a Veteran who placed his folder on top of a paper that an employee was working on and when the Veteran took his folder he picked up the paper as well (Veteran B's 10-10 EZ).…

Outcome: The supervisor of the employee was contacted and asked to instruct the employee (and others) not to keep working papers on counters or desks when other patients come to them for assistance and to raise awareness with this example.

Issue: A VA employee reported that she left medication profile in the restroom on 7-8 individuals. When she realized this, she returned to the restroom and the documents were no longer there. Update: 1/12/12:Seven (7) Individuals will be receive letters offering…

Outcome: Seven individual's medication profiles were found by an employee and brought to the Privacy Officer's office. Employee received privacy and security counseling on safeguarding patient information. Email sent to all staff as a reminder about transporting patient information in unsecured…

Issue: The Administrative Officer of the Lab called and stated a lab employee disclosed inpatient information on a recently admitted lab employee/patient to another lab employee. Update: 01/01/12:No data breach occurred.01/13/12:Upon additional investigation, it was found that the two employees inappropriately…

Outcome: Credit Monitoring offered and sent. Turned over to Supervisor of Lab for corrective personnel action. Email was sent by Chief of Lab reminding all employees to only access records in the performance of their official duties.…

Issue: The Supervising Nurse emailed the Privacy Officer to notify that she was calling Friday's procedure patients and discovered the discharge instructions for Patient B were mistakenly given to Patient A. The Privacy Officer sent a message asking if anyone called…

Outcome: The supervisor has discussed this with staff. Employees will double check individual information against the medical record before releasing the information.

Issue: The daily patient list for one of the doctors was placed on their desk at 0800 in the morning. When the Doctor arrived the door was unlocked and the patient listing was missing. Update: 12/05/11:The Privcay Officer went to Clemont…

Outcome: The Privacy Officer reviewed the procudures at the facility. The clinic has sound procedures in place on how they provide the daily listing to the physicians. It is still not clear how this was lost.…

Issue: The Risk Manager took a call from Veteran A who claimed that his medical records (demographic info. and problem list) were released to an unidentified Veteran B by clinic staff. The unidentified Veteran B was alleged to have received his…

Outcome: Employee was reprimanded for allowing PHI of one patient to be picked up by another. Also, education was provided and the policy for providing information to Veterans in the clinics was improved. Credit Monitoring offered to affected Veteran. Copy of…

Issue: ROI staff misfaxed a Veterans lab results to a business outside the VA. The business called and reported the incident and notified us that it came through as an electronic fax and was deleted. Update: 11/08/11:One Veteran will be sent…

Outcome: Supervisor reiterated caution when faxing and reviewed process with staff involved. SAL/PO…