VA Sunshine Healthcare Network (VISN 8)

Issue: Upon discharge an RN inappropriately disclosed a ward census report to a Veteran. The census report was attached to the Veteran's discharge instructions. 30 full names and full social security numbers were disclosed. Update: 01/14/11:Thirty (30) Veterans will receive a…

Outcome: Provided additional privacy training to employee involved and encouraged all staff to double check the information retrieved off the printers. Supervisor also spoke with employee. Mailed credit monitor letters to 29 Veterans involved in this incident.…

Issue: Veteran A's radiology report was mis-mailed to Veteran B by a clerk in Release of Information. Update: 01/13/11:Veteran A will receive a letter offering credit protection services.…

Outcome: The ROI clerk has been provided additional training by Privacy Office and couseled by supervisor.

Issue: A DOM Technician allegedly provided DOM Resident A with the roster to show him his eligibility for DOM privileges (or lack thereof). The technician failed to secure it and Resident A retained the roster until yesterday, when Resident B (during…

Outcome: The importance of protecting private information of residents who are served in the program was discussed at the Dom Morning Report meeting In addition, the staff is engaged in discussions of observing for areas where private information might be at…

Issue: Veteran A received mail that was intended for Veteran B. The appointment letter included Veteran B's name and partial SSN and clinic information. Update: 01/20/11:Veteran B will receive a letter of notification.…

Outcome: Veteran A will return the mailing to the Privacy Officer. The PO will conduct service level training with appropriate staff.Notification letter mailed to the veteran. Redacted copy sent to IRCT for ticket closure.

Issue: A SF-182 requesting tuition reimbursement to attend a training seminar at a private sector Medical Center in San Juan PR was placed in our facility inter office messenger envelope to go from the service chief to the Chief of Staff…

Outcome: Documents returned to employee and secured. Service Chief aware of incident and staff counseled to take additional precautions with mail sorting.…

Issue: medical records sent via US Postal Service did not reach their destination as requested. Update: 01/18/11:The Veteran will be sent an offer for credit protection services, since SSN was disclosed.…

Outcome: We will resend the medical records as requested by the life insurance underwriter. We can and will now download to a CD rather than paper format. This will be sent UPS rather than US Postal Service, for tracking purposes. In…

Issue: An AOD sent an unencrypted email with 17 Veteran's PHI to an unknown address outside VA. Update: 01/10/11:PO stated only last 4 SSN & full name was in the email. The email has not been recall that I know. We…

Outcome: AOD reminded of Outlook precautions. Additional training provided.…

Issue: Veteran Record reported missing from CLC. Name, SSN, and PHI were included in record. Update: 01/10/11:PO states CLC stands for Community Living Center (Nursing Home). The record has been missing since 03/23/10. The record is still missing. The Veteran will…

Outcome: Privacy Officer advised the Service Chief to create an SOP for the filing of the CLC records and retrain the nurses.

Issue: Nurse reported a missing Veteran's medical record. Record included name, SSN, and PHI. Update: PO state the clinic is the Inpatient Ward 5 A. The record been missing since 10/10/10. The last time someone handled or had possession of the…

Outcome: Extra safeguards have been put in place.

Issue: An Arecibo CBOC Dietitian reported to VA Police that he was a victim of a burglary at his home during the early morning hours. His vehicle was stolen which contained a clipboard with notes from approximately 10 patients. Update: 01/10/11:Ten…

Outcome: The binder was recovered from the stolen car within 2 days and no PHI was lost. All documents from 5 patients were recovered. No credit monitoring notification letters should be sent to Veterans.…