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Jan 30, 2014

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MAMMOTH HOSPITAL

85 SIERRA PARK ROAD PO BOX 660 MAMMOTH LAKES,CA 93546

Cited by the California Department of Public Health for a violation of California’s Health and Safety Code relating to medical privacy during an inspection that began on January 30, 2014. Also cited in 15 other reports.


Report ID: 16PJ11.01, California Department of Public Health

Reported Entity: MAMMOTH HOSPITAL

Issue:

Based on interview, and record review, the facility failed to ensure the confidential treatment of a radiology (x-ray) CD(Compact disc-used to store data images) for Patient B, when it was inadvertently given by the registered nurse (RN) to Patient A upon discharge from the emergency room (ER). This resulted in a breach of Patient B's protected health information (PHI).Findings:On January 30, 2014 at 9:00 AM, the facility privacy officer (FPO) was interviewed regarding a self- report of an x-ray CD being given to the wrong patient on January 2, 2014. The FPO said that both Patients A and B had been admitted and discharged from the ER within minutes of each other on January 2, 2014. Patient A had been seen for a leg injury, and Patient B for a wrist injury. The nurse handed the wrong CD to Patient A, who did not discover the error until a week later, and notified the facility."A review of the cover of the x-ray CD indicated that it contained Patient B's name, date of birth and medical record number. It identified the date, but not the specific type of x-ray that had been taken.During a review of the facility policy and procedure (P&P) titled, "Copying Medical Imaging CDs in the Emergency Department," dated May 2010, the P&P indicated that the registered nurse in the ER was responsible to "burn" (copy) a CD after ensuring they had selected the correct patient and images to copy. The nurse was instructed: "Once the CD has been burned the RN will visually verify that it is the correct patient.When the CD/DVD is given to the patient, the patient will be asked, "Is this your name on this CD/DVD?" The failure of the nurse to follow this procedure resulted in breach of PHI for Patient B.

Outcome:

Deficiency cited by the California Department of Public Health: Patients' Rights

Related Reports:

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