Thursday, November 13, 2014

Metro Nashville Lost Personal Data on 1,717 Disabled Children

By Walter F. Roche Jr.

Personal data on 1,717 children getting services through a Metro Nashville Health Department program for the disabled has gone missing and the matter has been reported to the U.S. Department of Health and Human Services.
The data, which was contained on nearly 2,000 index cards, has not been recovered though the loss was first discovered in mid-July. The possible data breach was recently posted on an HHS website containing information on health care data breaches affecting more than 500 individuals.
A health department spokesman, Brian Todd, said the cards went missing in the midst of an office relocation and it is believed they were discarded in a landfill.
The cards contained the names, addresses, social security card numbers, birth dates and medical coding numbers for recipients of a program for the disabled.
The 1,717 youths were getting care under a program known as Children's Special Services which provides services to children up to age 21 with chronic illnesses or disability needs. The program, which has income limits, provides funding for such items as medical bills, prescriptions and durable medical equipment.
Todd said that thus far there has been no indication that any personal information was accessed "and we believe they ended up buried under several feet of trash."
He said the information on the cards dated back several years. The loss was discovered on July 24.
Following the discovery of the missing cards, Metro officials contacted the potential victims and offered them a year's worth of identity protection services.
The reporting of health data breaches became mandatory under the same 2009 law which created the federal economic stimulus program. Thus far health care providers have reported possible breaches affecting more than 30 million people.

Monday, November 10, 2014

TN Health Adds Assisted Living Citations to Monthly Reports

By Walter F. Roche Jr.

Tennessee health inspectors recently cited 33 assisted living facilities and fined them a total of $50,250 for a variety of violations including failure to transfer a patient who needed a higher level of care  to an appropriate  facility.
Nearly all the violations were recorded between May and September of this year, according to department officials. 
The listing of assisted living violations was included for the first time in a monthly report issued last month by the state health agency. Tennessee currently has 16,252 licensed assisted living beds.
According to spokeswoman Shelley Walker, the department decided to include citations imposed on health facilities in addition to the usual listing of disciplinary actions against individual health care professionals ranging from physicians to dentists to physical therapists.
Walker said the decision to add health facilities was not a result of increased scrutiny on assisted living facilities, but as part of an effort at increased transparency. Though the citations are being publicized and posted on the internet, residents seeking the actual inspection reports that resulted in those citations must file a request and pay a 15 cent per page fee for copies.
Among the facilities cited were major chains including Elmcroft, a Kentucky based operator, and Emeritus, another national provider with assisted living services at multiple locations.
Five Emeritus facilities made the list as did three run by Elmcroft.
Emeritus, earlier this year merged with Tennessee based Brookdale Senior Living, which also had one of its facilities, Clare Bridge of Cleveland, on the citation list. The $2.8 billion merger closed last summer.
Elmcroft of Lebanon was fined $1,000 after it "failed to identify the need for a higher level of care for a resident who developed an unstageable ulcer."
Also cited were Elmcroft of Halls (Knoxville) which was fined $500 for failing to administer medications ordered by a physician and Elmcroft of Twin Hills (Madison) fined $1,000 for failing to securely store medications and unsanitary dietary conditions.
The Emeritus facilities were fined by amounts ranging from $1,000 to $2,500 for a variety of violations including failing to document proper care plan revisions for a resident with multiple falls, failing to ensure medications were administered by a licensed professional and failure to properly store medications.
Clare Bridge of Cleveland was fined $1,000 for failing to review and revise a patient's care plan.
The largest penalty, $5,500, was imposed on Lafollette Court Assisted Living (Lafollette) for multiple violations including failure to secure medications, failing to maintain resident progress notes and failing to include physician's orders in patient records.
Rose of Sharon's Senior Villa in Chattanooga was cited for allowing the continued stay of a resident who exhibited verbal aggressive behaviours which posed a threat to others." The facility was fined $2,500 for that and other violations including failure to ensure that medications were administered by a  properly licensed professional.
Walker said there are no immediate plans to add state inspectors, who also handle the review of other licensed health facilities such as nursing homes.
"While we have worked hard to fill our vacant positions over the past couple of years we have not recently added any new positions for surveyors," Walker said.

Good morning Wally.
There has been no new or additional effort to look at assisted care living facilities any more closely than ever, and while we have worked hard to fill our vacant positions over the past couple of years we have not recently added any new positions for surveyors.  Our Office of Health Care Facilities has been recommending civil monetary penalties on ACLFs for a number of years.  CMP and consent order information for ACLFs have not been included in the Disciplinary Action Reports in the past because the requirement for issuance of DARs is found under the Health Professionals statutes and does not apply to facilities.  However, the department decided this year to include health care facilities in these reports in an effort to be more transparent.
The facilities that were placed on the DAR for September 2014 were files received after the May 2014 Board for Licensing Health Care Facilities meeting, with the exception of some that were carried over from May.  All of these cases originated from surveys in 2013 and 2014. 
Tennessee currently has 16,252 ACLF beds.  The numbers of ACLFs and ACLF beds in Tennessee has increased in recent years. 

Woody is out at a meeting today and asked me to work on this for you.  I’ve requested the Elmcroft files for you and am looking into your other questions.  I can tell you we currently have 262 ACLFs in Tennessee.  You can pull up the list at

Monday, October 20, 2014

TN State University Cited for Research Missteps

By Walter F. Roche Jr.

Eastern Tennessee State University is notifying some student athletes that they were involved in four research studies that did not go through federally mandated reviews.
The notifications stem from an investigation by the U.S. Department of Health and Human Services into charges that some students involved in ETSU athletic programs may have been coerced or under undue influence to participate in research studies being conducted by graduate students.
In a Sept. 25 letter to William N. Duncan, vice provost for research at the Johnson City institution, HHS bureau director Kristina Borror wrote that some ETSU athletes "might believe that if they do not agree to have the test results used for research purposes, they will not be able to play and will lose their scholarships."
Duncan, in an email response to questions about the investigation wrote, "The investigation is complete and the Office of Human Research Protection has accepted our corrective action plan, including notifying individuals that we were able to contact who had participated in the four studies listed in the letter."
The studies, according to the report, included blood draws and tissue sampling in tests of "various physical performance characteristics."
Duncan added that new procedures have been implemented to ensure continued compliance.
The university official did not respond to questions concerning the number of students involved in the studies or in which athletic programs those students participated.
According to the letter from Borror,  the doctoral students involved in conducting the research are often team coaches,
"If they are taking a course taught by the doctoral student, they might also be concerned that they might receive a lower grade if they don't participate in the research," Borror wrote, adding that OHRP was concerned that enrollment procedures for the studies "perhaps do not minimize possibility of coercion or undue influence."
OHRP faulted the university for proceeding with the four studies without submitting them in advance for approval by the ETSU Investigative Review Board.
The university also was cited for failing to get informed consent from the parents of two student participants who were under the age of 18.
Among the steps promised by ETSU were ensuring that team coaches were not present when students are asked to give their consent to participation in the research and doing random interviews of research subjects in the future to query whether there was any undue pressure.

Friday, October 17, 2014

Four CHOP Patients Hit in Spring Norovirus Outbreak

By Walter F. Roche Jr.

 Four patients in addition to 19 nursing staffers were sickened in an outbreak of norovirus earlier this year at the Childrens Hospital of Philadelphia.
A hospital spokesman disclosed the number of patients affected in response to questions Friday.
As previously reported, state inspection records disclosed the number of staffers who were sickened but provided no information on patients.
The outbreak prompted a visit to the facility in May by state regulators and the subsequent issue of a citation for failing to follow state and federal regulations.
CHOP officials say that all the deficiencies have been corrected and new procedures and retraining programs put in place to ensure there are no future incidents.
Disclosure of the state citation comes as CHOP has been designated by the U.S. Centers For Disease Control and Prevention as one of the pediatric hospitals across the country that will be called upon to handle ebola cases involving children, if and when any occur.
According to the six-page state inspection report, the outbreak occurred when CHOP staffers failed to properly sanitize a room previously occupied by a norovirus patient. Inspectors also faulted the facility for failing to require that any sickened workers not report to work until 48 hours after they displayed no symptoms of the virus.
The outbreak occurred in late March and early April of this year.
Norovirus, which has become increasingly common on ship cruises, is marked by severe vomiting and diarrhea.
According to CHOP officials all the patients and staffers recovered from the outbreak.

Thursday, October 16, 2014

Childrens Hospital of Philadelphia Cited in Norovirus Outbreak

By Walter F. Roche Jr.

Nineteen nursing staffers at Childrens Hospital of Philadelphia were stricken with norovirus earlier this year after workers failed to properly sanitize a contaminated patient's room.
The outbreak, which has not previously been made public, triggered an inspection by the state Health Department and  a six-page citation by the agency for violations of state regulations.
According to the health agency report, workers at CHOP "failed to implement appropriate cleaning protocols in accordance with facility policy to ensure care was provided in a safe setting for one nursing unit affected by the Norovirus."
The outbreak, which occurred in late March and early April of this year, struck staffers in 4E/4S, a post surgical unit.
A CHOP spokeswoman said all the staffers recovered. She said some patients also were sickened but did not provide further details.
The state report, which was issued in May, concluded that hospital workers failed to properly sanitize the room with a hospital approved bleach.
In addition state inspectors found that the hospital failed to require that affected workers remain out of work for 48 hours after any symptoms disappeared.
It was not until March 27 that the staffers were directed not to return to work until 48 hours had passed without norovirus symptoms, the report states.
The state found that between March 11 and April 10, 19 CHOP nursing staffers were identified with norovirus symptoms.
Norovirus is highly contagious and results in acute gastroenteritis. Symptoms include diarrhea and vomiting. It can be fatal especially for the young, elderly and those with a compromised immune system.
Disclosure of the outbreak comes amid growing concern about an international outbreak of deadly ebola virus and more contained outbreaks of enterovirus D68. CHOP, in fact, has treated four confirmed enterovirus victims. That number may grow pending test results from the U.S. Centers for Disease Control and Prevention.
Two Texas health care workers, who were involved in the treatment of a now deceased ebola victim, have been diagnosed with ebola.
A CHOP spokeswoman, Rachel Salis-Silverman, said that the Spring outbreak helped the facility in dealing with the current issues.
"This norovirus outbreak among staff taught CHOP that a process needed to be put into place for earlier identification of an outbreak, and additional training on sanitizing patient areas was required. These new processes help support CHOP’s broader preparations underway, which are designed to address the most recent outbreaks," she wrote in an email response to questions.    
CHOP, state records show,  filed a plan of correction following the May inspection in which they stated that staffers had been retrained on proper cleaning methods. That plan was implemented by early July.
More recently CHOP was again cited by state inspectors for giving a patient 10 times the proper dose of morphine.
The seven-page report dated Aug. 8 concluded that staffers failed to follow a series of safety checks before administering by intravenous solution 1.5 milligrams of morphine instead of the 0.15 dose prescribed by a physician.
While the unnamed patient subsequently had decreased respirations, "Naxalone was given with immediate improvement in his respirations."
According to the state records, both inspections were triggered by unidentified complaints.
CHOP also filed a corrective action plan following the overdose incident which included retraining of staff in proper safety checks before administering "high-alert medications."

Wednesday, September 10, 2014

Data Breach on 3,780 Temple Patient Records

By Walter F. Roche Jr.
Personal health records for 3,780 patients which could be used for identity theft were stolen in late July from an office of the Temple University Physicians in Philadelphia.
Rebecca Harmon, spokeswoman for Temple University Hospital said Wednesday in an email response to questions that letters have been sent to all the affected patients informing them of the theft and offering a year's worth of free identity monitoring service.
According to Harmon an unencrypted desk top computer containing the patient records was stolen from a Temple University Physicians department of surgery office in July. The theft was discovered July 21.
"The computer contained files with patient information that could be used for identity theft," Harmon said in the email.
The files included the "full name, age, procedure type and billing codes for 3,780 patients... and in some instances the name of the referring physician and or medical records number," she continued.
Harmon stressed, however, that the files did not include social security numbers or any financial data.
She said the theft was reported to local police and the U.S. Department of Health and Human Services, which requires the reporting of such incidents affecting 500 or more people.
"We deeply regret this incident and the inconveniences this may have caused our patients," Harmon concluded.
She said that in addition to an internal investigation other steps have been taken to prevent a recurrence including staff training and heightened security procedures.
The Temple incident is the second in recent weeks involving health records of Philadelphia area patients. The parent company of Chestnut Hill Hospital and several other Pennsylvania hospitals, Community Health Systems, reported that thousands of patient records may have been improperly accessed earlier this year by hackers from China.