VA Southeast Network (VISN 7)

Issue: A Physician left her purse in the front seat of her car and went into Walmart. The Physician returned within 15 minutes but her purse was missing. In addition to patient information already stated, her purse contained her PIV Badge…

Outcome: Chief of Service to discuss incident with staff and reiterate the proper controls and actions. PO will not be given any further information regarding employee who had purse stolen. Credit Protection letters mail today and PO will scan copy of…

Issue: An employee emailed Veterans/patients and included their name and phone number The employee also emailed the messages to himself and another patient. One email to himself contained patient name and last four SSN as well as medications and treatment note.…

Outcome: Findings and supporting documentation reviewed with Service Chief for proper Administrative Action. Outlook access revoked.

Issue: The VA Mail Room typed a 1 when the address was actually 14. The Veteran went to his neighbor who received the package but it could not be located. The package contained a prescription and information concerning the medication. Update:…

Outcome: Privacy Officer discussed incident with mail room informing them of the severity of not being careful with all correspondence, packages, and medications being sent out from the VAMC. The employee with the most experience and time in the mail room…

Issue: On 02/08/12, the Home Based Primary Care (HBPC) Program Manager was notified by the HBPC RN that several locked office desk drawers in the HBPC Nursing and Social Work offices had been broken into at the Medical Center Tower Site.…

Outcome: Training has been provided to the VA staff by the Privacy Officer and immediate supervisor. Additional measures have been put in place to ensure protection of personally protected health information. VA staff that works at the HBPC Clinic have been…

Issue: On 2/2/2012, Veteran A received a reminder by mail of an upcoming Neurology Clinic appointment. The Veteran was surprised to see a second appointment letter, which was intended for another Veteran included in the same envelope. Veteran A contacted the…

Outcome: All Neurology orders and consults and resulting appointment letters will be printed in a central location in the Neurology clinic area. All appointment letters and correspondence under the supervision of the Neurology staff will be hand folded and placed into…

Issue: A Social Worker e-mailed a Supplemental Claim for Compensation to a Veteran. The form included information of another Veteran, including his name, address, social security number, and service connection conditions. The e-mail was sent via Outlook on 1/19/12 at approximately…

Outcome: Employee was verbally counseled and provided further retraining regarding email communication with Veterans by supervisor. Employee is current with privacy training.…

Issue: Veteran A called to report that she received Veteran B's information in correspondence she received from the medical center. The documentation appears to be Veteran B's disability paperwork. Veteran A has agreed to return the documentation to the medical center.…

Outcome: Incident addressed with staff. New filing method established for correspondence in order to prevent similar incidents in the future. Documents returned to the medical center.

Issue: A provider reported to the Privacy Officer (PO) that he had taken video recordings of a patient, with the patients written consent. The provider then sent the video to a private-public educational medical company for educational purposes without the patients…

Outcome: Provider was required to retake Privacy training. Provider has increased his awareness by ongoing training and education.…

Issue: Veteran A called to report a Privacy Incident. He received a reminder by mail of an upcoming Dermatology Surgery appointment. The Veteran was surprised to see a second appointment letter, which was intended for Veteran B included in the same…

Outcome: To prevent an incident such as this from recurring, staff is being re-educated on the need to safeguard patient information.

Issue: Veteran A's caregiver contacted the Dorn VA Medical Center Narcotic Pharmacist. The caregiver informed the Narcotic Pharmacist that UPS could not locate the medication mailed to the Veteran on 12/9/11. According to the caregiver, UPS attempted one delivery and, apparently,…

Outcome: The VA Chief Police, VA Detective, and IG have been notified of this Incident. No updated information to report.…