VA Midwest Health Care Network (VISN 23)

Issue: Patient's A's wife called in and stated two pages of patients' names, SSNs, account numbers, and account balances somehow got placed in the patient's discharge papers. Patient A visited Endoscopy, 4th floor desk, and Travel. Update: 03/21/13: These were papers…

Outcome: Employee who lost the sheet is no longer printing this paper and is instead looking at the information from his screen. Supervisor was made aware of the incident.

Issue: A Pharmacist gave Veteran A a medication list belonging to Veteran B. Update: 03/19/13:Veteran B will be sent a letter offering credit protection services.…

Outcome: No violation - document was retrieved immediately and destroyed.

Issue: Appointment reminder letter was mailed without an envelope. Veteran's name, address, last 4 of SSN, and name of clinic was viewable. Update: 3/19/13:According to the Privacy Officer, the machine that stuffs letters failed to insert this folded letter in an…

Outcome: The cause of the incident was a rare machine error, but mail room clerk has been educated to watch for letters that may have not been stuffed in envelopes.

Issue: On 03/12/13, a VA employee reported finding a patient's wristband in a waiting area. The wristband contained the patient's full name, full SSN, date of birth. The employee took the wristband and reported it to the VA Police Department who…

Outcome: Unable to determine if came from patient or employee.

Issue: A VA contract provider handed a Veteran his documentation and it had documentation on 3 other Veterans attached. The Veteran realized it was not his information, brought it back to the clinic and reported it. The documentation contained the 3…

Outcome: Required to re-take Privacy training.

Issue: Release of Information (ROI) released a CD with Patient B's information, medical records, SSN, etc. to Patient A The label had the correct patient's information but the contents of the CD had Veteran B's information. This was sent to the…

Outcome: A credit monitoring letter was sent to the individual and the staff member who released the information in error was educated and told to double check the CD content before releasing.

Issue: Received notification from the postal service that an envelope of documents was damaged in transit. Update: 03/08/11:The patient's full SSN was possibly disclosed, so credit protection services will be offered.…

Outcome: Obtained copies from Postal Service. Assured those not retrieved were destroyed. Credit monitoring offered to Veteran.…

Issue: A VA provider was on a Telehealth conference with a patient with the door open into a hallway used by employees and patients. Update: 03/04/13:Patient A will be sent a notification letter.…

Outcome: Provider was educated he must keep the door closed during appointments. Provider was educated he must keep the door closed during appointments.

Issue: A VA Housekeeper found a Motor Vehicle Operator exam certificate on a VA volunteer in a waiting area with a main hallway open to the public. The information contained full name, full social security number, date of birth and information…

Outcome: Volunteer left in waiting area.

Issue: An employee left a patient list for a ward laying in the employee smoking area. Update: 02/25/13:Twelve (12) Veterans will be sent letters offering credit protection services.…

Outcome: To HRMS for action. Employee required to re-take privacy training.