Seems like Iowa hospitals are facing an epidemic of nosiness — and HIPAA violations.

The Des Moines Register documented a slew of workers who’ve been fired in the past month for unauthorized access of medical records and related offenses. They include:

• A patient orders coordinator at Mahaska County Hospital was fired for allegedly accessing the records of her boyfriend’s ex-wife, as well as a hospital volunteer.
• Another patient orders coordinator at Mahaska viewed various emergency and obstetrics patients’ records, including those of the birth mother of her adopted child, her ex-husband, her current husband and several other family members.
• A worker (title not given) at Keokuk Area Hospital was accused of sharing a patient’s medical information via public Facebook messages with another hospital worker. The patient was not identified by name, but enough details were included that s/he could be identified.
• A worker (title not given) at Mercy Hospital Medical Center was fired after looking at a particular patient’s medical records out of personal curiosity. Several workers had been previously warned against accessing the patient’s records. The patient was a child born at the hospital in February.
• A phlebotomy clerk at University of Iowa Hospitals was fired after telling several other co-workers medical details of a patient who plays on one of the University’s sports teams. Information she shared included his name, the team he played for, his underlying medical condition and how often he had blood drawn.

Depressing, isn’t it?

On the bright side, both Mahaska employees were fired after other staffers reported the incidents, and co-worker reports seem to play a part in some of the other reported instances. So training on the importance of adhering to HIPAA and keeping patient records confidential is working — sort of.

Sermo, the physicians-only website, recently asked members to share their stories of the strangest thing they’ve removed from a patient — and then published the “winners” on its public blog to see if anyone could top them. Among the doozies:

• A seashell from a surfer’s lung, which had been lodged there for about a year.
• Two toy dogs from a child’s stomach (he said he swallowed one by accident, and the second one so the first one wouldn’t be lonely).
• One pathologist seems to have had a number of colorful patients. He or she removed — a large zucchini (rectum), the spiral from a spiral-bound notebook (man’s urethra) and a cigarette lighter (stomach).
• A bound and gagged Barbie doll from a patient’s stomach.
• His mother’s real pearl necklace from a 50-year-old man’s bladder.
• Five pens, two permanent markers, three straws, two toothbrushes, and four Oreo cookie wrappers — at one time, from the same patient’s stomach.
• A windshield wiper blade (we’ll let you guess where it was), and
• A Mighty Morphin Power Ranger (again, we’ll let you guess).

Some docs took a more light-hearted approach to the question. Several said the most unusual object they had removed was “a hospital administrator’s own head” from a particular orifice. And one psychiatrist said the only thing he had ever removed were neuroses.

Have a better story than the Mighty Morphin Power Ranger? Share it in the comments.

A new study from the American Medical Association looked into which doctors — by gender, age, specialty, etc. — are most likely to get sued or have other liability claims against them.

The report (downloadable) makes interesting — if sometimes maddening — gawking material. For example, a review of the records found that 65% of claims are dropped or dismissed, and another 30% are settled or decided via an alternate dispute method. Only 5% of claims actually go to court — of those, 90% are decided for the physician.

Even a win can be costly, however: Average costs to defend against a claim were just under $40,700. For claims that were dropped or withdrawn, it cost an average of just over $22k to defend; cases that go to trial average more than $100k to defend.

More frustrating: The rate of claims seems to have little correlation to actual malpractice. The AMA researchers found that among closed claims, 3% of patients hadn’t suffered any injury and in another 37%, there had been no error.

Worse: Many injured patients and wrongly accused doctors don’t get true justice. The researchers found that 27% of claims are paid despite the doctor not making an error. At the same time, 27% of patients who suffered from an error receive no compensation.

By the numbers

A doctor’s specialty, type of practice and even gender play a role in how likely he or she is to face liability claims.

Not surprisingly, the study found that the specialties with the highest rate of claims were general surgery and obstetrics/gynecology, with nearly 70% of physicians in those specialties facing suits during their careers.

Least likely to face claims: pediatricians and psychiatrists. Less than 30 percent of doctors in these specialties were sued during their careers.

The study also found that the type of practice can increase a doctor’s risk of being sued. Among physicians in solo practices or single specialty group practices, 45% faced lawsuits in their careers. The rate was only 40% for physicians working in hospitals, and 37% for doctors in multi-specialty group practices. Owners of practices are also more likely to be sued than employees.

Male doctors are twice as likely to be sued. In part, because they are concentrated in specialties with high rates of claims and are more likely to own their practices. The researchers noted that other studies indicate differences in interpersonal skills may contribute to some of the gender gap in lawsuits, but the data is difficult, at best, to quantify.

The breach was discovered by a photographer for The Boston Globe, who noticed a 20-foot by 20-foot pile of paper when he was dropping off his own trash. He checked out the cache of paper, curious why it wasn’t being recycled. Closer examination showed the paper was a mass of patient records from at least four Massachusetts medical centers and their associated pathology groups. The hospitals affected are Carney, Holyoke, Milford and Milton.

The investigation is ongoing, but so far it appears that the a billing vendor used by several of the pathology groups dumped the records. The billing company was sold at the beginning of this year — most of the records were from 2009.

A small sample of the records collected by The Globe contained sensitive data including patient names, addresses, insurance information, Social Security numbers, pathology reports and post-miscarriage lab work.

A few things are still unclear, including how many patients — at how many hospitals — may have been affected. The hospitals are trying to determine whose records may have been compromised so they can begin notification procedures.

Data breaches of this sort aren’t uncommon, but it appears in this case that the hospitals had no reason to believe the records weren’t being disposed of properly.

Unfortunately, even hospitals with strict adherence to privacy controls can fall victim to a data breach if one of it’s countless physicians, other associated health care providers, billing companies, insurance partners or other contractors who have access to patient data aren’t as careful.

Over a five-year period, Harlem Hospital Center in New York had some 7,000 echocardiograms that were only read by technicians — the ordering physicians never saw them, for reasons that aren’t clear.

Pretty scary sounding. But follow-up examination of the records found that of the 7,000 ECHOs, only 14 of them had been misdiagnosed. Twelve of those 14 patients were contacted — and none of them had suffered any adverse effects.

That silver lining is disguising a nasty gray cloud. Delving further into that data indicates something doesn’t add up.

To be so accurate in diagnosing via the tests (99.8% accurate, to be exact), the hospital would have to have the world’s best team of technicians — and one wonders why the physician oversight would be needed.

It would also seem safe to assume the doctors ordered those tests for a reason — yet they clearly didn’t use the results when deciding on a course of treatment for their patients. Why not? And why didn’t anyone notice that vital test results were missing?

For that matter, with so many patients seemingly unaffected by their ECHOs never being read, it’s fair to ask how many of those patients actually needed the test performed in the first place.

Without more information, it’s hard to come up with acceptable answers: Perhaps most of the patients were retested later. Possibly more patients were negatively affected than has been disclosed. It’s also possible that this group of ECHOs was not representative of the majority of tests. (Physicians and techs may have given lowest priority to results which showed no indication of disease — and these are the tests that fell through the cracks in the system.)

Regardless, this case has served to shine a light on some of the less visible signs that something has gone wrong with the health care system. Do you blame it on overworked/distracted employees, defensive medicine run amok or something else? Let’s hear your thoughts in the comments.

Note to emergency room personnel: Refrain from taking grisly photos of dying patients and posting them online.

In April, a 60-year-old man was violently attacked by another resident at his nursing home. The victim was stabbed more than a dozen times with such ferocity that he was nearly decapitated. He was brought to the emergency department of St. Mary Medical Center in Long Beach, California.

As he lay dying, multiple nurses and other hospital staff took photos of the man and his injuries and posted them on Facebook.

The photos were up for two days before another hospital employee saw them and reported the incident.

The hospital fired four of the employees involved and disciplined three others.

While this is obviously an extreme case, it’s hardly the first time a medical center has had to deal with the fallout from employees posting patient information on social networking sites. Health care workers have difficult jobs, and it’s unrealistic to expect them not to occasionally vent about the stresses they deal with every day. Nor is it realistic to think staffers can be blocked from using social networking sites.

What administrators can expect is for employees to never post information that could identify a specific patient, and to make sure that even complaints are brought up professionally. (There’s a world of difference between someone posting about how tired they are after a 12-hour shift vs. something like: “Ugh. Stupid patient coded and made me miss True Blood tonight!”)

Where the appropriate lines are drawn can get even more confusing when employees use Facebook and similar sites as part of their jobs. Someone who spends a portion of every day Tweeting information about hospital news, educational programs and the like, may start to get too comfortable sharing information online and blur the boundary between personal and professional use.

Bottom line: If your organization doesn’t already have a policy on what’s considered appropriate use of social networking sites, it’s time to establish one. Employees should be reminded that anything they post online is public — no matter how many privacy settings they use — and that those posts related to their work must always remain professional.

A recent article by American Medical News anticipates an increase in new hires in 2010. Some of the indicators include an increase in job ads, continued demand and moderate growth of facilities despite the impact of the recession on the larger economic environment.

Divorces can be ugly. Going through your soon-to-be ex-wife’s medical records is uglier.

That’s the allegation against Dr. Mark Schleiss, a pediatric infectious disease researcher at the University of Minnesota.

According to his estranged family, Schleiss accessed their medical records. Among other things, Schleiss (who no longer lived with the family) showed up uninvited to his daughter’s medical appointment even though he hadn’t been told about it. He also monitored the frequency of his wife’s visits to a therapist.

The state medical board investigated, but did not punish the doctor. His family claims his position and connections at the University are shielding him from more severe sanctions.

Collett Schleiss, now his ex-wife, said she was informed by the University that her husband had accessed the family’s records improperly, and that his access to medical records would be “monitored” for the next six months.

Schleiss declined to talk to local reporters about the case unless his wife waived her right to medical privacy.

Recent research found that doctors, in particular, are concerned that patients’ access to their notes could lead to needless confusion and concern and possibly worsen doctor-patient communication. The article appears in the Annals of Internal Medicine.

Among the concerns doctors expressed:

• Common jargon/shorthand, such as using “patient complained SOB” for “patient presented with shortness of breath” may cause patients to be confused or even insulted.
• Doctors may feel the need to withhold speculative diagnoses, such as the chance a patient may have cancer, for fear of upsetting the patient before test results are in.
• Additional questions from patients who are confused or worried by something in their records may eat up already precious time from a doctor’s day.

No doubt, there may be some growing pains as clinicians and patients both learn to navigate with this new tool. But more information is likely to lead to better informed patients in the long run.

What are your thoughts? Will improved access to patient records help or hinder the doctor-patient relationship? Share your thoughts in the comments.

A New Jersey woman claims a hospital denied her treatment because it couldn’t — or wouldn’t — accommodate her religious beliefs as part of her treatment.

Rona Mohammed went to the emergency department at Somerset Medical Center, complaining of chest pain. When told that she would need an EKG, Mohammed requested a female practitioner for the test. Mohammed, a practicing Muslim, is required to keep her body covered in front of men she is not related to.

According to a lawsuit she later filed, Mohammed was left waiting for hours without being seen, until her husband finally drove her to another hospital. She’s suing for religious discrimination and violation of the Patient Bill of Rights.

A lawyer for Somerset Medical Center denies Mohammed was discriminated against. The hospital claims Mohammed was informed of her treatment options and left the hospital against medical advice.