VALLEY CHILDREN'S HOSPITAL

Report ID: 7RMY11, California Department of Public Health

Reported Entity: CHILDRENS HOSPITAL CENTRAL CALIFORNIA

Issue:

Based on staff interview, clinical record, and administrative document review, the facility failed to ensure confidential treatment of protected health information (PHI) when:1) On 7/22/13 a utilization clinical review sheet for Patient 1 was faxed to the wrong medical group. (CA00373050)2) On 8/30/13 a Home Care delivery ticket containing information for Patient 2 was attached to equipment delivered to Patient 3. (CA00373405)3) On 9/18/13 a prescription for Patient 4 was given to Patient 5. (CA00371442)4) On 9/20/13 a face sheet for Patient 6 was used on a PowerPoint slide presentation shared with participants from a variety of health plans. (CA00371487)5) On 9/24/13 a utilization clinical review flow sheet for Patient 7 was faxed to a title company. (CA00371824)6) On 10/8/13 a utilization clinical review flow sheet for Patient 8 was faxed to the wrong insurance company. (CA00373396)These failures resulted in unauthorized access to Patients 1, 2, 4, 6, 7, and 8's PHI and the potential for abuse of the PHI.Findings:(CA00373050)1) On 10/18/13 at 1014 a.m., during an interview, the Accreditation Coordinator (AC) stated on October 4, 2013 the Registered Nurse (RN) 1 faxed a utilization clinical review sheet to the wrong insurance group. The error was detected when insurance payment was denied. The AC stated RN 1 did not double check the fax number with the utilization review log to verify the review sheet was being sent to the correct insurance group.The PHI included Patient 1's name, address, birth date, sex, telephone number, account number, and medical record number.The hospital's Policy/Procedure Number PR-1016 dated 08/11 indicated, "it is the policy of [hospital] to respect and protect the privacy rights of patients, their families, employees, and third parties. All information that is deemed confidential by [hospital] and/or by specific legal statutes shall be kept confidential..."(CA00373405)2) On 10/18/13 at 10:25 a.m., during an interview, the AC stated on 8/30/13 the Customer Service Care Representative (CSCR) included Patient 2's home health equipment (medical equipment supplied by the hospital for in-home use after patient is discharged) ticket on equipment that was to be sent to Patient 3's home. The Respiratory Therapist (RT) delivered the equipment to Patient 3 prior to discharge from the hospital. The RT did not compare the ticket attached to the home health equipment to the doctor's order.The PHI included Patient 2's name, address, birth date, telephone number, and medical record number.The hospital Policy/Procedure Number PR-1016 dated 08/11 indicated, "it is the policy of [hospital]to respect and protect the privacy rights of patients, their families, employees, and third parties. All information that is deemed confidential by [hospital] and/or by specific legal statutes shall be kept confidential..."(CA00371442)3) On 10/18/13 at 10:36 a.m., during an interview, the AC stated on 9/18/13 RN 2 gave a prescription for Patient 4 to Patient 5. The AC stated RN 2 felt rushed and did not follow the correct patient identification process.The PHI included Patient 4's name, birth date, sex, address, telephone number, medical record number, and prescribed medication information.The hospital Policy/Procedure Number PR-1016 dated 08/11 indicated, "it is the policy of [hospital]to respect and protect the privacy rights of patients, their families, employees, and third parties. All information that is deemed confidential by [hospital] and/or by specific legal statutes shall be kept confidential..."(CA00371487)4) On 10/18/13 at 10:48 a.m., during an interview, the AC stated on 9/20/13 a face sheet (a hospital document containing patient information) for Patient 6 was used in an educational power point document by Physician Leadership and Development (PL). The AC stated the PL should have verified no real patient names or information were on the document.The PHI included Patient 6's name, birth date, sex, address, telephone number, medical record number, prescribed medication information, medical history, social history, family history, and surgical history.The hospital Policy/Procedure Number PR-1016 dated 08/11 indicated, "it is the policy of [hospital]to respect and protect the privacy rights of patients, their families, employees, and third parties. All information that is deemed confidential by [hospital] and/or by specific legal statutes shall be kept confidential..."(CA00371824)5) On 10/18/13 at 11:01, during an interview, the AC stated on 9/24/13 RN 3 faxed a utilization review flow sheet for Patient 7 to an incorrect fax number. The AC stated RN 3 transposed numbers and did not verify she had the correct fax number.The PHI included Patient 7's name used by the facility, address, birth date, sex, medical record number, account number, and medical history.The hospital Policy/Procedure Number PR-1016 dated 08/11 indicated, "it is the policy of [hospital]to respect and protect the privacy rights of patients, their families, employees, and third parties. All information that is deemed confidential by [hospital] and/or by specific legal statutes shall be kept confidential..."(CA00373396)6) On 10/18/13 at 11:17 a.m., during an interview, the AC stated on 10/8/13 Patient 8's PHI was faxed to the wrong insurance review company. The AC stated RN 4 did not verify the name on the cover sheet against the name on the utilization clinical review sheet prior to faxing it.The PHI breached included Patient 8's name, address, birth date, sex, telephone number, and medical record number.The hospital Policy/Procedure Number PR-1016 dated 08/11 indicated, "it is the policy of [hospital]to respect and protect the privacy rights of patients, their families, employees, and third parties. All information that is deemed confidential by [hospital] and/or by specific legal statutes shall be kept confidential..."

Outcome:

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