VA Mid South Healthcare Network (VISN 9)

Issue: Patient A received Patient B's Travel Voucher. The health information on the travel voucher was full name, full SSN, home address. It was outside of VA control more than 48 hours. Update: 04/01/13:Patient B will be sent a letter offering…

Outcome: Staff re-educated on proper handling of PHI.

Issue: A patient admitted on Ward 1-West found a patient list which included his name and as well as other patients on the ward. Other pieces of information on the list included full SSN, diagnosis, diet allergies, weight, patient problems, and…

Outcome: Credit Monitoring letters are ready to be mailed to the Veterans affected by this incident. A redacted copy has been uploaded to this incident.PO has submitted his summary report regarding the fact-finding and the outcome to the Nursing leadership. As…

Issue: On March 25, 2013, the Administrative Officer, Audiology (Nashville Campus), was contacted by Veteran A who stated he received an appointment letter in the mail which belonged to Veteran B. The appointment letter contained Veteran B's name, last four of…

Outcome: 3/27/13 - HIPAA notification letter mailed.Incident due to a human error. Employee has been re-educated on the importance of safeguarding Veteran PII.…

Issue: Patient A received Patient B's lab letter in the mail. The information contained last 4 of SSN, full address and lab results. This was not recovered and was outside of VA control more than 72 hours. It involved one Veteran.…

Outcome: Re-educated employees on proper handling of PHI.

Issue: Prescriptions for two patients were sent to a third patient by mistake. The two patients' names and medication information were compromised. Update: 03/21/13:Two patients will be sent a HIPAA notification letter.…

Outcome: Analysts continues to examine the pharmacy process to try to discover why this error occurred. It appears to be a glitch in the computer system.…

Issue: Veteran A contacted the Privacy Officer (PO) on 03/20/13 to report that he had received another Veteran's records. (Veteran B). The PO asked him if he would mail the information back to the facility to the PO's attention, and he…

Outcome: Service Chief has spoken to employee regarding the importance of checking information be mailed. I indicated to the Chief of HIMS that she needs to insure that they understand and re-training may be needed as this is happening too often.…

Issue: A Veteran called stating that he had received another Veteran's information in the same envelope as his appointment letter. Both Veterans were seen on the same day at a Community Based Outpatient Clinic. The Veteran has to drive 60 miles…

Outcome: Veteran returned the appointment letter on March 21 and a new document was mailed to the right Veteran. He was notified by phone . Privacy Officer prepared the Notification letter and the Acting Director signed on April 10, and mailed…

Issue: Veteran A received Veteran B's appointment letter in the mail. The information on the appointment letter contained full name, last 4 digits of the SSN, and full address. It affected one Veteran and was outside of VA control more than…

Outcome: Re-educated staff on proper mailing of PHI

Issue: On 03/14/13, Veteran A reported the following complaint to the Privacy Officer (Nashville Campus). From 09/05/12-10/10/12, Veteran A was admitted to 7A (Murfreesboro Campus). During this admission, Veteran A stated his Provider completed a Family Medical Leave Act (FLMA) form…

Outcome: 4/4/13 - Upon investigation, the PO found: - On several occasions, the Veteran or his mother (NOK) approached the provider and social worker to request the FMLA form be completed and faxed to the employer (Social Security). Such actions imply…

Issue: Today, 03/14/13, at the Nashville Campus, the Patient Advocate notified the Privacy Officer (PO) of the following incident: Veteran A contacted the Patient Advocate Office and reported that he received medication in the mail which belonged to Veteran B. Veteran…

Outcome: 3/27/13 - Incident due to human error. HIPAA notification letter mailed. PO requests ticket be closed. 4/1/13 - HIPAA notification letter mailed on 3/27/13. Employee involved was re-educated on the importance of checking prescriptions for accuracy before mailing. PO requests…