This database was last updated in December 2015 ago and should only be used as a historical snapshot. More recent data on breaches affecting 500 or more people is available at the U.S. Department of Health and Human Services’ Breach Portal.

VA Southwest Health Care Network (VISN 18)

VISN 18 Phoenix, AZ

Mentioned in a privacy incident report created by the U.S. Department of Veterans Affairs on April 24, 2013. Also cited in 228 other reports.


Report ID: PSETS0000088455, U.S. Department of Veterans Affairs

Reported Entity: VISN 18 Phoenix, AZ

Issue:

On 04/24/13, the Pharmacy supervisor reported that Veteran B received one insulin medication for Veteran A in addition to receipt of his/her own insulin medication. Veteran A notified the clinic that they had not received their prescription, who notified the pharmacy. After confirming that the address was correct, the Pharmacy re-mailed Veteran As insulin. Veteran B was contacted. His wife had accepted prescription shipment and placed without review into the refrigerator. Veteran B was not aware that they had another medication. A prepaid UPS label was sent to Veteran B to recover Veteran As prescription and information. Root cause appears to be batch processing of refrigerated meds, both insulin, where label was dual placed on one shipment instead of two. Further notification and investigation, to ensue. Update: 04/24/13:Veteran A will receive a HIPAA letter of notification.05/08/13:This was determined to be non-HITECH reportable by VHA Privacy Office.

Outcome:

Supervisor reports that because of prior actions in this area, new policies had been put in place. This was brought to the employee's awareness. HR involvement for appropriate actions.

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