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HIPAA - MTs being fired for sending wrong carbon copies - Paranoid MT

Posted: May 03, 2010

First of all, let me just say to the people who have already been fired for MISTAKENLY sending the wrong CC I am truly sorry to hear this

My question is, is this a case of SEVERE OVERACTION by the MTSOs or is this the case now according to HIPAA?

So are they saying that because a non-treating MD received a report and everyone in the office, wherever, "SAW" that report that it breaks the Privacy Rule and thus a breach?

So there is no need for a warning to the MT who did that but just grounds for termination immediately?

I'm truly asking these questions.

The way I see it... garbage in, garbage out... - CrankyBeach

[ In Reply To ..]
... and 'perfect' is not in my job description. Not to mention, waaaaay above my pay grade.

For the 3 or 4 of you who haven't noticed, I work for Transcend, one of the big nationals. I worked for TRS before, and then there was a merger.

What we were told at TRS, and we have NOT been told different now that we're Transcend, is to never, EVER guess on ANYTHING, be it a word, a name... or a carbon copy. If the dictator says cc to Dr. Smith, then by golly we type "Dr. Smith" in the cc field and kick it upstairs. It is not up to us to try and figure out which Dr. Smith the dictator means, as we do not have enough information to figure that out.

The important point is that when we work remotely, for a national, we, the MTs in the trenches, are NOT the ones physically printing/faxing/mailing/e-mailing the carbon copies to the designated entities; thus we cannot possibly be held responsible if it goes to the wrong place.

And even if we blatantly typed cc to Dr. Jones when the dictator clearly said cc to Dr. Smith... yes, our employer most certainly should take some corrective action; but for cryin' out loud, the people at the client's end need to exercise some due diligence as well! For example... if the patient is a male and the Dr. Jones we mistakenly said to send a copy to happens to be a gynecologist, anybody with half a brain should catch this. (Oh. Excuse me. I am expecting too much of people. Sorry. My bad.)

And even if we very carefully type what the dictator says, i.e. that's Dr. Jon without an H Smith who practices internal medicine at Smithjones Family Practice at 123 Main Street, Anytown... we still have NO control over the fact that some moron in the file room sticks Dr. Smith's copy into a mailing envelope that happens to be addressed to Dr. Skunk on Swamp Avenue. Or punches in the wrong fax number, and it goes to Dave's Tire Shop instead of Dr. Smith's office.

Even during my long career working locally, except during the times when I was pinch-hitting in the file room, I was not the one physically sending out the copies; and even when I was, I had no way of ensuring that even if it was properly marked and addressed, the post office or the courier would get it into the right hands. I've been on the other end of this as well; I cannot tell you how many pieces of mail I opened that were mis-delivered to our office... and whoa Nellie, I saw that somebody named so-and-so, who could have been my neighbor, or my neighbor's cousin, or anybody at all, was a patient of Dr. Flybynight over on the next street.... Of course, I still considered that to be confidential information, even though I wasn't supposed to have seen it, and I treated it with the same care as I treated information on our own patients. (I also promptly re-addressed it to the correct entity and sent it on, with a little note saying it had been delivered to our office by mistake.)

There just seems to be a dearth of common sense permeating so many sectors of our society; not just our own industry. In too many ways, people are being blamed for things they didn't do, and others are NOT being held responsible for things they DID do. But that's another discussion altogether....

Apologies for the great glob of text.... - CrankyBeach

[ In Reply To ..]
There WERE paragraph marks inserted in there when I typed it! Blame this one on the computer!

you should be writing for a living, not just MTing.... - me

[ In Reply To ..]
...

Why, thank yew :) - CrankyBeach

[ In Reply To ..]
I am actually an aspiring writer of fiction, and if I ever do get published you can be sure I will be tooting my horn all over the net about it! :)

Sending Wrong Carbon Copies - Silly Rabbit

[ In Reply To ..]
They have got to be kidding and these records are processed all over the world. The following notes a grevious security breach. It had nothing to do with sending the cc to the wrong Dr. Smith located on Main Street, New York.

http://www.ashevilletribune.com/archives/Laden-medical%20.html

The problem is - me

[ In Reply To ..]
is that the new laws stipulate that ANY breach of confidentiality MUST be reported to the patient. So Cranky, in your case, that patient whose information you got from the wrong clinic, you would be required by law to inform that patient that you (the unintended reciepent) saw their medical records. That is why the MTSOs are being so uptight about it. When I worked in hospital we basically were held to the same standards, if we breached confidentiality, even once by accident, we were subject to termination (one of my leads was fired because of this).

The MT, if she just puts "Dr. Smith" and 'sends it upstairs' should NOT be held liable if it is sent to the wrong Dr. Smith. No copies should be sent out in that case until the dictating physician or recieving physican specifically clarifies WHICH Dr. Smith it's supposed to go to.

I would have had NO way of notifying a patient of another doctor - CrankyBeach

[ In Reply To ..]
that I had mistakenly seen something pertaining to them, because of mis-directed mail, because unless that person was also OUR patient, I did not have their contact information!

And can you just imagine the can of worms it would open if I went to the phone book.
"Is this Mrs. Jane Smith?"
"Yes."
"This is Cranky at Dr. Snerd's office, and I am by law informing you of a privacy violation that I have perpetrated on you."
"But I don't go to Dr. Snerd."
"I know. We got a piece of mail from Blue F. Cross that was supposed to go to Dr. Snake."
"But I don't go to Dr. Snake either."

You see... there are 17 Mrs. Jane Smiths in the phone book, and I called the wrong one. Oops.

A perfect, albeit fictional, example of the law of unintended consequences....

Exactly - sm

[ In Reply To ..]
I totally agree with you that it is totally overkill. I personally don't give a hoot if another doctor's office accidentally gets my information. I would assume most would be like you and send it on to the correct person, or at the very least trash it. I personally think it should be rewritten so that if the patient information leaves physician offices or hospitals (ie, a laptop is stolen with my information on it), then it should be reported.

love it! - ; )

[ In Reply To ..]
lol

I could be wrong, but - to my understanding...

[ In Reply To ..]
the conditions under which you are compelled to inform the patient involve wholesale breaches in patient data such that the pt's identity and medical record was made "public" (i.e., no longer private). This is different from a breach of confidentiality.

If a cc is sent to the wrong doc, that doc is still a compliant entity. This does not constitute a data breach.

I'm not sure - sm

[ In Reply To ..]
The full text of the new law is here
http://www.ama-assn.org/ama1/pub/upload/mm/399/hipaa-breach-notification-rule.pdf

I THINK you may be right.. but I'm not sure. It may only be for employees or others under the intended doctor's office that are okay to see it.

Someone who has more attention to the details, please read it and translate... I'm a little burned out tonight

WRONG WRONG WRONG! YOU do not notify - ANYONE about ANYTHING!!

[ In Reply To ..]
Notifications - IF they are required (and that question is not a simple one) - are handled by the covered entity's privacy officer or other designee.

NOT YOU, or any other person!!

YES you do - You notify your compliance officer

[ In Reply To ..]
You have to notify your compliance officer of the violation.

That is NOT what the "notification" provisions refer to. - (SM)

[ In Reply To ..]
Let's put aside for the moment the fact that you aren't likely to know about a violation, or why did you permit it to happen in the first place?!

I wish people who haven't studied HIPAA as well as the HITECH provisions of the ARA formally AND thoroughly wouldn't comment on these matters on public forums. The notification provisions (of the law) ONLY spell out how, when and why PATIENTS must be notified of an unauthorized disclosure - and that has nothing whatsoever to do with YOU as a medical transcriptionist. The post that I made was in DIRECT RESPONSE to someone who was saying that THEY were supposed to notify the patient.

I repeat - WRONG, WRONG, WRONG.

That is not what I inteded - me

[ In Reply To ..]
I only meant that the patient needed to be notified, not necessarily by the MT. It would depend on who the responsible person is, a supervisor, a complaince officer, a VP at a company, one way or another the patient would need to be notified if a breech occured under the new law.

My thoughts - Redpen

[ In Reply To ..]
It's just an opinion, but my thinking is that any facility which sends out copies based on a physician's dictated request is asking for trouble.

That's a very, very unsafe practice.

If the physician wants to send copies, let him take HIS copy to HIS office and HE can fax it all over.

The facility at which the dictation is done should not be doing this. Half the time you can't tell what doctors they want to have copies, and the rest of the time they can't remember, either. So, the facility is blindly faxing. I'm sure they're not confirming the fax number every time they fax, either.

We do not allow doctors to have copies faxed to themselves or anyone else. Any time we do fax patient information, we confirm the number with a test page, ensure that someone is standing there waiting for the fax, and then we send the real fax.

Very good point, Redpen... - CrankyBeach

[ In Reply To ..]
... and your suggestion would remove the possible screw-ups one step even further away from the MT.

Again... there is NO FREAKING WAY the MT can be held responsible... unless he or she is the one physically sending the copies out--and even then, once it's out of his/her hands, if it does not reach the proper destination, it's not his/her fault!

Best way to handle copies - properly (sm)

[ In Reply To ..]
That "clerical" problems with copies should exist in these times is simply ridiculous. After all, we're asking a very simple question: "Should this person receive a copy of this patient's report?" - and the solution is equally simple.

1. Each patient should have an authorized distribution list, which would normally include their treating physicians, but in some cases there might be others (such as a guardian ad litem, POAHC, etc.). An electronic copy would then be transmitted ONLY if the recipient is on the list. The information required for distribution such as fax number, email address, etc. would come from that list, not from the report, and would have already been confirmed.

It would be child's play for software to check the requested copies against th distribution list and release those that meet the criteria.

2. If a copy is requested to anyone who is NOT on the patient's distribution list, it would be kicked out into an "exception" pool and dealt with manually according to appropriate protocols.

Great idea! - MTPockets

[ In Reply To ..]
I like that! and like you said, it would be easy enough to implement. Good thinking :-)

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