Providence Health Care (PHC)
February 2005
I went to Mount St. Joseph's Hospital and I was asked questions that I believed to be illegal. When I protested I was told that if I did not answer all the questions that I would not be allowed in the hospital for tests (which I later found out was illegal). They also refused to explain why they wanted the information (also illegal) except to say, regarding the religion question, that they are a faith-based hospital (what happened to separation of church and state). Mount St. Joseph's Hospital is run by Providence Health Care, a catholic organization, which runs St. Paul's and other hospitals.
February 24, 2005
I filed a complaint with the OIPC.
"When I went to Mount Saint Joseph Hospital on February 18, 2005, I was required to provide information that I believe contravenes the Privacy Act.
I was required to tell them my religion, my occupation, who employed me, and how long I had lived at my current address. I was not given an option of providing the information. When the woman asking the questions asked what my religion was, I asked her why she wanted to know. She said that it is just a question, and repeated the question. I asked again and told her that I didn't want to provide this information. She said this is a catholic hospital (I thought it was a public hospital) and that they wanted it on record in case I should need...(I can't remember the exact words, but essentially it was final rites or whatever). I was trying to get into the hospital for a 10 minute procedure.
When she asked me the other questions, I again asked why the questions were being asked. Again, she said it is just a question, and would repeat the question. I told her that I didn't want to answer these questions and I was told that before I could be admitted (ie. have the procedure done), the form had to be filled out. In other words, I had no choice if I cared about my health. I felt that I was being black-mailed.
I want to know:
1. Why are these questions asked? How does the hospital having this information relate to a 10 minute outpatient procedure (or any procedure/stay)?
2. Why was I refused an answer when I asked why this information was required?
3. Who do they share this information with? (I want names)
4. I want this information deleted from every database or other recorded place.
5. They already had information on me in their database although I don't recall ever being in their hospital. Where did this information come from?
6. The length of time at my current residence is not noted on the form. So obviously it wasn't even necessary to fill out the form. So again why was it asked?
7. When did they start asking these questions because I don't recall ever being asked these questions in the past?
8. I want their procedures and form changed because I do believe that it violates the privacy act. At the very least people should be informed why these questions are being asked, and which questions are optional.
9. Also, there were two pages related to being admitted and I was only given a copy of page 1. Why wasn't I given a copy of page 2?
I believe that demanding to know a person's religion is a violation of the criminal code. Do you pursue this or do I need to see a lawyer?
Comment:
You may wish to continue reading the details. There is a lot to be learned from them or you may wish to go to the final report prepared by OIPC, dated January 3, 2006.
March 1, 2005
Response from Morag Wilmut, OIPC
"We have received your complaint under the Freedom of Information and Protection of Privacy Act (the Act) about the information Mount Saint Joseph Hospital collected when you went to Mount Saint Joseph Hospital on February 18, 2005.
It is the policy of the Office of the Information and Privacy Commissioner to refer a complainant back to the public body, where the complainant has not first given the public body an opportunity to respond to and attempt to resolve the issue. There is no indication in your letter that you have contacted Mount Saint Joseph Hospital in writing regarding your concerns. We are therefore not assigning your complaint to an officer for investigation at this time. You may instead contact the Mount Saint Joseph Hospital in writing regarding your complaint. I am enclosing a complaint form you may wish to use when contacting Mount Saint Joseph Hospital.
Once you have received a response from Mount Saint Joseph Hospital about your concerns, if you believe that they have not dealt with it adequately, you may wish to write to our Office again. If you decide to do this, please provide us with written details of both your complaint to the Mount Saint Joseph Hospital and Mount Saint Joseph Hospital's response. At that point, we will consider whether further investigation by this Office is warranted."
March 1, 2005
I sent the exact letter to Mount Saint Joseph Hospital, Privacy Officer, only leaving out "Do you pursue this or do I need to see a lawyer?"
April 6, 2005
I received a response from Zulie Sachedina, Vice President, Human Resources and General Counsel, Providence Health Care.
"I am writing in response to your complaint regarding Mount Saint Joseph Hospital under the Freedom of Information and Protection of Privacy Act (FOIPPA) and your letter dated March 11, 2005.
I will look into your concerns in detail; however, in light of this complaint being made under FOIPPA and wanting to ensure we follow the proper protocols, I am writing to ask if you will provide permission to release your name to the departments who may have been involved in your care at Providence Health Care. If you agree, it will enable us to look at the circumstances in your individual case.
Please reply back to me, in writing, whether or not I can release your name to others within Providence Health Care, with the sole purpose of reviewing the concerns detailed in your letter. If more convenient you may fax me at 604-806-8894."
April 7, 2005
My letter to Ms. Sachedina
"No, you may not release my name to the various departments. Who I am, at this point, is irrelevant; I do not believe that I was being singled out for different treatment by your admitting office. You have a standard form on which you ask certain questions, as identified in my last letter. You refuse to admit people unless they answer these questions. Why?
If you still feel you need to ask departments about me, as an individual, then I want to know which departments you need information from, what this information would be and why you need it?"
Comments:
I did not believe that I was being discriminated against and therefore this problem went beyond my individual case. It affects everyone who enters the hospital and I wanted it resolved on that basis. And why would she need to contact all the various departments involved in my care to address an admittance form issue?
April 19, 2005
I filed a complaint with OIPC, attention Morag Wilmut
"As requested in your letter of March 1, 2005 I sent a letter to Mount Saint Joseph Hospital (copy attached). I received a response from Providence Health Care (copy attached).
As you will note they waited until the 30 days were almost expired to write asking for more information. I consider this to be nothing more than a delaying tactic since the information is irrelevant. The form was not designed for me (unless I am being personally discriminated against). The form/questions are, I believe, generic and asked of everyone. There was a question regarding where they got my information they already had in the system, but again, this should be generic, ie where do they usually get this type of information.
I would also like to know why Providence Health Care wants to know my Canadian status, ie whether I am a Canadian citizen, landed immigrant, etc. I would like to think having a doctor's referral, and a health number to be sufficient.
Please ensure that these questions are answered. Otherwise, I will pursue this through different avenues (organizations who are already aware of my questions/process)."
April 21, 2005
I received a response from Ms. Sachedina.
"Your letter dated April 7th was received in my office April 19th, as it had not been addressed to my attention.
Providence Health Care does have a standard form for Admitting, and standard guidelines for gathering this information. Some information is mandatory under the Ministry of Health regulations and some information, such as Religion, is asked to enable Providence Health Care to care for individuals more sensitively. This question should not require a response should a person not wish to provide one.
Without your permission to release your name to the Admitting Department, the only follow up that this office can take is to advise the Admitting Department that Providence has received a complaint and provide the basic information in your letter (anything that would not identify the writer), and advise the department to follow up with all of their staff on their guidelines to ensure that questions are asked with sensitivity and awareness of how to explain the reasons for the questions asked. I will proceed to do this."
Comments:
Paragraph One: The letter had been addressed to the privacy officer so apparently their staff did not know the name of the privacy officer.
First of all, they had wanted to release my name to all departments, not just the admitting department. And, basically what they wanted to do was blame this situation on the admitting person, but my sense was that she was doing what she was told to do. The forms did not identify the questions as optional. And, even now, the privacy officer was refusing to state why these questions were asked. She didn't need my name to answer those and other questions. I found it interesting that they were asking their staff to ask these questions sensitively; I guess they want them to be asked sensitively so people don't get upset at being asked illegal questions.
I filed a complaint again with the OIPC.
April 25, 2005
Letter to Ms. Wilmut, OIPC
"Attached is a response that I received from Providence Health Care. Allowing Canada Post 2 days to deliver a letter locally, it is unfortunate that it took Providence Health Care 10 days to give the letter to the appropriate person (how many privacy officers do they have?) and that, during those 10 days, no one contacted me regarding a delay in response.
However, as you will note, with the exception of the religion question (where they agree that this question should not have been demanded), my questions have still not been answered. I can only wonder why they are refusing to explain why they ask the other questions and where they got my information from. Where do they usually get information on people. I would think that there could only be one or two sources where they would get personal information for their medical records.
This refusal to answer questions, even when asked directly several times, does not give me any confidence that they will encourage their departments to identify which questions are mandatory and which are optional. Again, I believe that this should be identified on the forms so there is no confusion."
May 11, 2005
Letter from OIPC, Morag Wilmut
"We have received your complaint that Mount Saint Joseph Hospital allegedly collected personal information in an inappropriate manner in violation of the Freedom of Information and Protection of Privacy Act (the Act). Your case has been opened as of April 22, 2005 and has been assigned to Patrick Egan, who will be the Portfolio Officer performing the preliminary investigation. By copy of this letter, I notify Mount Saint Joseph Hospital of the investigation and provide Mount Saint Joseph Hospital with a copy of your letter to this office.
Please address future correspondence to Patrick Egan who will be handling your complaint."
Comment:
In opening a file as of April 22, 2005, they cc'd Cindy Wong, FOI Coodinator, Mount Saint Joseph Hospital. I never heard her name again. Apparently, no one knows who the privacy officer is. However, in further correspondence they added FOI Coodinator to Ms. Sachedina title. Did they even have a privacy officer or did they appoint Ms. Sachedina as privacy officer after I wrote?
May 27, 2005
Letter to Patrick Egan, OIPC
"It has been 4 months since I wrote to the Privacy Commissioner regarding Providence Health Care (Mount Saint Joseph Hospital) and almost two months since I received your last letter from Morag Wilmut and still I am no further ahead than I was 4 months ago.
Why is this taking so long? Legally, an enterprise is suppose to have a valid reason, related to the transaction, for asking questions before they ask the questions. Why are you allowing them to spend months to come up with a reason to justify the questions? They should have been able to answer these questions immediately. Did you not set a time limit? Or do they have an indefinite time limit?
My doctor wants me to go to the hospital but, of course, I am hesitant to do so until this is resolved. Needless to say, if anything happens to me my lawyer will be involved.
I also phoned you on May 20th and left a message. I understood from your message that you would be out of the office under May 30th. However, I have never received a response. Please explain why.
If you can't set time limits, I will. If I don't have the answers to my questions by July 11, I will pursue this matter through other avenues, and this will include action against your inaction."
Comments:
I believe I put the wrong date on this letter. This letter must have gone out in June.
July 11, 2005
Letter from Patrick Egan, OIPC
"I am writing in response to your letter dated May 27, 2005. I apologize for the time it is taking to attempt to resolve your concerns and for not providing you with an update sooner.
Morag Wilmut's letter to you on May 11, 2005 indicated that your case was opened as of April 22, 2005, and it was assigned to me on May 11, 2005. In normal circumstances the Office of the Information and Privacy Commissioner attempts to investigate and resolve complaints within 120 working days. At this time I am working towards a deadline of October 14, 2005. I will, however, certainly try to complete my investigation sooner if possible.
My investigation, so far, has included:
- Reading the correspondence between yourself and Mount St. Joseph Hospital and Providence Health Care;
- Conversations with Ms. Zulie Sachedina, of Providence Health Care, about the admitting process; about the personal information collected during this process; about possible improvements to Providence's admission form; and about the nine questions you submitted to Mount Saint Joseph's Hospital in a letter dated March 11, 2005;
- Receiving copies of Mount St. Joseph's Record of Admission form and the registration system guidelines;
- Consultation with colleagues in this office about the general concerns you brought to our attention;
- Consultation with an Information and Privacy manager in the Vancouver Island Health Authority about what kinds of questions their hospitals ask.
My preliminary investigation leads me to believe that the outstanding issues are:
1. Determining which items of personal information being requested, for admission to Mount Saint Joseph Hospital, are mandatory and which ones are voluntary. The second part of this issue is an explanation for why this information is needed and then being able to communicate this clearly to patients.
During my conversations with Ms. Sachedina she made it clear to me Providence health care providers will not deny anyone medical treatment because of incomplete admission information. I encourage you to get medical care if and when you require it. I hope I have provided answers to some of your questions. I will continue working to attempt to resolve your remaining concerns."
Comments:
The degree of my anger to the last paragraph is obvious in my response.
July 16, 2005 (I had cooled down somewhat by now)
Letter to Mr. Egan, OIPC
"I was completely flabbergasted when I received your letter of July 11, 2005. In it you state that 'during my conversations with Ms. Sachedina she made it clear to me Providence health care providers will not deny anyone medical treatment because of incomplete information.' I am appalled at Ms. Sachedina and your arrogance at what I can only assume is an attempt to scam me, your ignorance and/or complete denial of the obvious. How can your resolve my concerns if you don't even know why the complaint was filed? Let me reiterate from my first letter. The whole basis for filing the complaint was because I was denied admittance to a hospital unless I answered all the questions, including the one regarding my religion.
I have already been told by my doctor's office that I will have to arrive at the hospital at least two hours in advance in order to fill out all the paperwork. I know, from experience, that if I refuse to fill out this paperwork that I will be denied admittance and that will be a waste of valuable hospital and my doctor's time, not to mention my time. If I could have received medical treatment without answering all the questions we wouldn't be going through this process. But you feel qualified to tell me that, what has happened, will not happen. Unbelievable.
I will not be going to the hospital until I am assured that my privacy, my rights will be respected and protected. I will not submit again to what I consider to be nothing less than blackmail.
I phoned you in May and left you a message on your answering machine, to which you did not respond when you returned on May 30. I asked you to add another question which is 'why does the hospital want to know my citizenship status.' This is a question on another form by a hospital administered by Providence Health Care. It asks if I am a citizen, landed immigrant, etc. Again, why is this question being asked? What has it to do with my health care? I want to know why this question, plus the questions asked, is being asked, how the information will be used and disclosed?
This actually leads to another question. Who designs the forms/questions for the hospitals? Does Providence Health Care or each individual hospital? Do I have to go through this process with each health care unit (or whatever they are called) or with each hospital?
Most forms that you fill out now have an asterisk beside those questions which are mandatory. Also many places now attach to a questionnaire a page (or more) explaining the reasons for the questions. This would seem an appropriate solution for the hospitals. When I was at the doctor's office and they asked me to fill out some forms for the hospital, they didn't know why some of the questions on the form were being asked. My understanding of the privacy law is that it is illegal to demand an answer to a question unless you can explain the purpose for the question and why the information is required to complete the transaction being undertaken.
I consider the hospitals to be essentially a government agency since they operate on taxpayer money. As such, these agencies should be the first to uphold the laws of this province and nation and the rights of its citizens, not abuse, not consider themselves above, these laws and rights. In addition, the government should be ensuring that organizations, funded by my and other citizens money, are operating in accordance with the law."
July 21, 2005
Response from Ms. Sachedina, Providence Health Care:
"As per your request, please find further and more comprehensive information related to your complaint. As you have continued to refuse to have your name released to those departments involved in your admission, there are some areas we cannot address fully.
I will attempt to respond to each of your questions in your original letter dated March 11, 2005.
1. Why are these questions asked? How does the hospital having this information relate to a simple outpatient procedure (or any procedure/stay)?
Providence Health Care (PHC) is a faith-based hospital whose mission encompasses the care of the whole person, including spiritual care. The registration clerks are instructed to ask clients would you like a religion noted on your health record? It is optional for the client to provide religion. If the client has any questions such as will not providing religion or not being catholic affect my care?, the clerk is to reassure the patient that spiritual care is a service provided by PHC should the patient desire it. If the patient were to request spiritual care during their stay, having their religion noted on the file permits PHC to provide spiritual care by the appropriate denomination as stipulated by the patient.
2. Why was I refused an answer when I asked why this information was required?
It was clearly inappropriate of the staff member to refuse this information when questioned. Given the restriction of releasing your name, we are unable to identify which staff member may have been involved in order to follow-up with them.
3. Who do they share this information with (names)?
Registration information is the basis of the health record and begins the care process. Demographic information is used to ensure client identity, i.e. that the right person is given the right treatment. It is kept for auditing purposes for eligibility by BC Hospital Programs. Finance may also use the information for billing if it is required. If the patient requests spiritual care, Pastoral Care will look at the religion and provide the appropriate caregiver. The encounter level information, insurance, next-of-kin, address, etc. is kept in the system approximately 20 months and visit information is maintained about two years.
4. I want this information deleted from every database or other recorded place.
The only place that the religion is recorded is in the Eclipsys ADT Database which forms the basis of the clinical repository/health record. Religion does not go to another database. If the client does not want religion noted on his/her electronic or paper chart it can be deleted (if in fact it was collected). By law, Health Records must be retained forever in some form. (Attached are relevant sections of the BC Hospital Act).
5. They already had information on me in their data base although I don't recall ever being in their hospital. Where did this information come from?
PHC has one data base for all of it's member hospitals: Youville Residential Home, Langara Residential Hospital, Brock Fahrni Pavilion, Holy Family Hospital, St. Vincent's Hospital, Mount St. Joseph's Hospital, and St. Paul's Hospital. We also register all the satellite hemodialysis clinics: Cambie Street, Sechelt, Powell River, North Shore, Squamish, and Richmond. PHC has a variety of out-reach services: Geriatric Outreach Clinic, occupational therapy, etc. External electrodiagnostic tests have person-related information attached. Almost every patient that receives service at PHC is registered. Given the limitations on releasing your name, we cannot do a search to determine whether you were ever seen at one of our sites in the past.
6. The length of time at my current residence is not noted on the form. So obviously it wasn't even necessary to fill out the form. So, again why was it asked?
This information is required under the Ministry of Health and Ministry Responsible for Seniors (Hospital Programs Division Policy Manual) Chapter 2 Eligibility and Benefits, Section 2.2 Eligibility, subsection 2.2.1 Determining Eligibility. The wording of the policy follows below for your information.
Policy
In determining whether a person is a beneficiary a hospital must determine if a person is a resident, where a resident is either:
...is physically present in British Columbia at least six months in a calendar year
If the client told the registration clerk that s/he resided at their current address greater than six months nothing has to be noted in the chart.
7. When did they start asking these questions because I don't recall ever being asked these questions in the past?
The requirements to register and to confirm that an individual is a beneficiary have been in place since before 1979.
8. Why aren't people informed why these questions are being asked, and which questions are optional?
Centralized training for all registration staff is provided by the Client Registration and Information Services (CRIS) staff. The registration clerks are instructed on what information is to be collected and the reasons. CRIS also sends out regular reminders to staff and keeps an accessible manual with all the procedures. It is an expectation that the clerk would answer all questions regarding the information collected. Additionally, there is Help Desk support for all registration clerks Monday to Friday to obtain an answer to any question they may have. As well, Patient Placement, during the off hours, plays a support role for clerks regarding the collection of information. Since the incident in question took place with a day procedure, the clerk had multiple individuals they could have contacted to assist them with the questions if they could not answer them.
9. There were two pages related to being admitted and I was only given a copy of page 1. Why wasn't I given a copy of Page 2?
There is only one form printed off with an extra copy. One copy is for the Health Record. The other copy is shredded unless required by either Emergency, who keep records for three months so they can pull up the chart on return patients very quickly, or for out-of-province, non-residents, and self paying patients where copies are sent to Finance.
I hope that the above answers adequately respond to your questions. In case you are not aware, patients do have the right to access their full health records via Health Records."
Comments:
Again, Ms. Sachedina states that I have refused to have my name released to those departments involved in my admission. Actually, she asked to release my name to all departments involved in my health care, which is quite different from releasing my name to admissions. But then again, she uses the plural form of department, which begs the question, just how many departments are involved in an admission. Also, I did not outright refuse but I did make permission conditional. Apparently, only unconditional permission was acceptable.
Note that in responses 1, 2 and 8 Ms. Sachedina blames the staff for not providing answers while she continues to do the same. While she addresses why religion is asked, she does not explain why the questions of employer and occupation were asked.
July 26, 2005
Response from Patrick Egan:
"I will attempt to answer the questions you pose. I asked Ms. Sachedina for assistance in answering these questions.
1. Why does the hospital want to know my citizenship status?
I believe a person's citizenship status has less to do with direct health care and more to do with the administrative functions necessary to make sure the hospital is getting reimbursed for the services it provides to its patients.
My understanding is that in order for a hospital to be reimbursed, by the provincial government, for the cost of a patient's visit it must first verify that the patient is eligible for health insurance. One of the criteria for eligibility is being a resident. The hospital must verify that the patient is a resident of Canada, makes their home in BC and has been physically residing in BC for the past six months. Ms. Sachedina's July 21 letter may also help to explain this.
2. Who designs the forms/questions for the hospitals? Does Providence Health Care or each individual hospital?
According to Ms. Sachedina the forms are designed by individual hospitals with input from the Health Authority and the Ministry of Health Services. In addition, a hospital Forms Committee reviews all the forms used in the hospital including the admitting form. Ms. Sachedina expects that as time goes on the forms will be more uniform across the province.
The second part of my investigation into your complaint is to continue to explore this question and other broader questions about what information is legally required to be collected and how best to collect it so the patients understand why it is being collected and what it will be used for.
Thank you for your suggestions. I believe some hospitals may already be using pamphlets to explain the information collecting procedures.
3. Do I have to go through this process with each health care unit or with each hospital?
I believe there is some kind of admitting process each time but I am not sure if it is the same each time. Ms. Sachedina says the process may be quicker if you attend the same hospital more than one time because some of the information is now stored in their data systems. However, some information must still be collected again. Ms. Sachedina explained that the admitting process is meant to accomplish a number of objectives. These include verifying that they have the right person so the correct records and treatment plan can be retrieved, updating any new information (address, next of kin, etc) and confirming insurance coverage."
July 30, 2005
My response to Patrick Egan:
"1. Citizenship Status & reimbursement for services
I notice on one form that the question is actually broken down into several parts. Are you: a BC Resident, Canadian Citizen, Landed Immigrant, Visa, Refugee. Again, why are they asking these questions? Are all of these people issued health care cards?
What is the purpose of a health care card? Can anyone obtain a health care card?
It is my understanding that the purpose of a health care card number is to show that someone is covered and doctors/hospitals, etc. will be reimbursed for medical services. When I have gone to my doctor, to other places for tests, etc. I have not been asked a question regarding my citizenship or residence, although I am sure that these people are equally interested in being paid. Obviously they consider my health card number sufficient.
2. Length of Time at Current Residence
The question I was asked as how long had I lived at my current residence, not have I resided in Canada for the last 6 plus months. I may have lived at my current residence for 2 months, having moved from another Canadian residence. So the question asked is at odds with the supposed purpose related to the transaction at hand.
Again, like the citizenship question above, I believe that this question is illegal.
3. I notice that both you and Ms. Sachedina neglected to answer the questions:
a. Why was I asked my occupation?
b. Why was I asked for the name of my employer?
You state that 'the second part of my investigation into your complaint is to continue this question and other broader questions about what information is legally required to be collected and how best to collect it so the patients understand why it is being collected and what it will be used for'. How long do you anticipate this taking. As stated before, my doctor wants me to go to the hospital but I refuse until this is resolved. So I need to have resolved the question of what questions can legally be asked and to have all information illegally obtained removed from the hospital records. Only then will I feel comfortable going to the hospital."
Comments:
At this time I did not realize that the hospital had omitted information when explaining who had access to patient information (see letter of July 21, 2005).
August 15, 2005
Response from Patrick Egan:
"During my investigation I will be looking for the answers to some of the questions you ask in your letter. For example, your questions about citizenship, residency, occupation and employer are important and they are included in my investigation.
With respect to your questions about the BC CareCard I refer you to the Health Insurance BC web site at http://www.hibc.gov.bc.ca/ where you may find the answers you are looking for. If you wish to call them their phone numbers are 604-683-7151 or (toll-free) 1-800-663-7100. I am not sufficiently informed, at this time, to accurately answer your questions about the CareCard.
I respect your need to know what information health care providers can legally collect from you as soon as possible. At this time I am not able to give you a specific date when my investigation will be complete. However, I continue to give this investigation my full attention."
September 27, 2005
Letter to George Abbott, Provincial Minister of Health
"On February 18, 2005 I went to St. Joseph's Hospital for a 10 minute procedure. I was asked questions such as my religion, my occupation, my employer and how long I had lived at my current address. I was refused entry to the hospital unless I provided the information. And I was refused an explanation as to why they wanted the information. I know that some, if not all, of these questions contravene the Privacy Act. I believe that the question about my religion also contravenes the Charter of Rights.
I filed a complaint with the privacy Commissioner in February but I was told that because it was a public body I had to lay a complaint with the hospital first; actually, I thought I did that when I told the admitting person that I didn't want to answer the questions. So I wrote a formal complaint to the hospital, who then took the maximum amount of time to not answer the questions. Then I wrote again to the Privacy Commissioner.
So now it is seven months later, I am no further ahead and my doctor wanted me to go to the hospital several months ago (of course, I must arrive 2 hours early to fill out all the papers). But I refused unless I am assured that my rights, my privacy were protected. I will not submit again to what I felt was blackmail. Of course, I had not anticipated that resolving this situation would take so long. The Privacy Commissioner's office had said that they would try to resolve things quickly.
I also realize that even when the Privacy Commissioner provides their determination that I may have to take this matter further. After seven months Providence Health Care is still refusing to even explain why they want the information and the Privacy Commissioner does not seem to have the ability or desire to insist that Providence answer the questions.
I would like to know:
1. Why the Ministry of Health did not ensure that hospitals/doctors, etc. were in compliance with the Privacy Act before providing funding? You have had more than 2 years to do this. I feel that I am being put in the uncomfortable position of doing your job.
When a person goes to the hospital, they are at their most vulnerable. It is not the time to find out that the government has failed to protect their rights.
2. I would like to know why a complaint must first be formally sent to a public body; why the special status. This is a health issue and delays can be physically and emotionally costly.
To add insult to injury, your American MSP collector is demanding that I pay for services that are currently unavailable to me. "
October 19, 2005
Letter to Patrick Egan:
"Your deadline for resolving this case was October 14, 2005. This has not happened and I have not heard from you for several months. I find this absolutely appalling. It has been 8 months since I first filed a complaint. Determining what questions an organization has the legal right to demand is not rocket science. And this is affecting my health.
This weekend I will proceed to pursue this through other avenues."
November 8, 2005
Since Providence Health Care is a catholic organization I wrote a letter to the Pope explaining the situation. He didn't care to respond. Perhaps this explains Providence Health Care's attitude.
October 26, 2005
Response from Patrick Egan:
"Thank you for your letter dated October 19, 2005. I apologize again for the length of time this investigation is taking. I am, in fact, in the process of writing my investigation report in response to your complaint.
Unfortunately, it has not been a simple process to determine what information must be collected and what information is voluntarily collected during a hospital admitting process. A survey of BC hospitals reveals every admitting form is different and there does not appear to be one person or government department who is able to say what has to be on the admitting form and what does not have to be on it. I have submitted a list of questions to a newly formed committee that is looking at privacy issues in the health care field and I am now awaiting their response before I finish my report. I hope to have my report completed as quickly as possible."
November 23, 2005
Letter from Patrick Egan:
"Thank you for your letter dated November 5, 2005. I am writing to inform you that I have completed my investigation into your complaint. Our Director of Policy and Compliance is now reviewing my investigation report. When the review is complete and any revisions are made I will mail it to you. I anticipate I will be able to mail it to you late next week.
I apologize for the length of time this investigation is taking. I appreciate your patience."
November 29, 2005
A letter from Effie Henry, Executive Director, Health Authority Branch, in response to a letter I sent George Abbott, Minister of Health on September 27, 2005:
"Thank you for your letter of September 27, 2005, to the Minister of Health about providing pre-admission information at Mount Saint Joseph Hospital. I am responding on behalf of the Minister.
I appreciate your concerns about being asked to provide specific information (such as your religion, occupation and employer) prior to your admission to Mount Saint Joseph hospital.
In your letter you ask whether the Ministry of Health ensures hospitals and doctors comply with the Freedom of Information and Protection of Privacy Act (FOIPPA). Secondly, you ask why the Office of the Information and Privacy Commissioner (OIPC) asked that you first send a complaint to the public body before filing a complaint with the OIPC.
Health authorities and hospitals are separate public bodies under FOIPPA and, as such, are independent from the Ministry in respect to complying with privacy requirements of the Act. The OIPC, as the overseeing body, is responsible for ensuring compliance with the FOIPP Act.
The Ministry is not in a position to comment on the OIPC process for dealing with complaints. I note that you have already been in contact with the OIPC, and I suggest that you continue to work directly with them to address your concerns.
As Providence Health Care is responsible for Mount Saint Joseph Hospital, I have forwarded a copy of your letter for their information."
Comment:
My understanding is that OIPC does not have the authority to force the hospitals or health authorities to comply with FOIPPA. They can only recommend. The Ministry of Health is not responsible (What are they responsible for?). We are paying these hospitals out of our tax dollars and yet no one can require that the hospitals/health authorities operate in accordance with FOIPPA.
December 1, 2005
Letter to George Abbott (this letter and the Nov. 29 letter from the Ministry of Health crossed the mail)
"I wrote to you on September 27, 2005 regarding Providence Health Care. I have not received a response and, based on information from your staff, I'm not likely to receive a reply. If you wish to show your contempt for the democratic rights of citizens, there are no direct actions that I can take. However, we shall see if you can show such disdain for my legal rights.
I don't believe that you have the legal right to charge me under MSP for services that I could not utilize because you were in violation of the Privacy Act. I want all monies paid returned and no additional amounts charged, covering the period February 24, 2005, when I first laid a complaint under the Privacy Act, to such time as the complaint is fully resolved and I can, once again, access medical services.
You have 30 days to comply. Otherwise, I will probably see you in court."
December 15, 2005
Letter from Patrick Egan:
"I regret to inform you that unavoidable delays have prevented me from sendng you my final report. I had hoped to have it mailed to you by now. The report is finished and is taking some time going through our review process. I assure you that as soon as it has been through its final review I will send it to you."
December 16, 2005
I e-mailed Gordon Campbell essentially the same letter that I sent to George Abbott on September 27, 2005.
December 21, 2005
E-mail from Gordon Campbell's office:
"Thank you for your e-mail regarding your February 18, 2005 visit to St. Joseph's Hospital. I'm sorry to hear it was such as frustrating experience for you.
My staff has made enquiries on your behalf and I understand Effie Henry, Executive Director of the Health Authority Branch responded to you on November 29 of this year.
I am sharing your latest e-mail with the Minister of Health Services, the Honourable George Abbott. I can assure you that he, or a member of his staff, will respond to your questions directly."
Comment:
Again, no one is responsible.
December 21, 2005
My response to Gordon Campbell's e-mail:
"I contacted George Abbott, Minister of Health & Effie Henry did reply on his behalf. They stated that the 'Health Authorities & hospitals are separate public bodies under FOIPPA and, as such, are independent from the Ministry in respect to complying with private requirements of the Act. The OIPC, as the overseeing body, is responsible for ensuring compliance with FOIPP Act.' So, I don't know why you would refer this back to them.
Now, my understanding of the Privacy Commissioner's office is that they respond to complaints, they do not go to each government body and review their privacy practices to ensure compliance before a complaint is laid. However, I may be wrong.
But I am not playing the 'this is not my responsibility, it's someone else's, and someone else says it's not my responsibility, it's someone else's and so on' game. Ultimately, Gordon Campbell is responsible and it is his name or the government of BC (Gordon Campbell) that will go on any legal action.
You may also wish to know how difficult it is to contact the Minister of Health. Apparently, they don't have an answering machine or voice mail. They just have one person to answer the phone and if that person is away from the phone, or whatever, the phone just rings. On the first occasion that I tried to contact the office by phone, the phone just rang, so the operator contacted the Deputy Minister of Health to see if there was a problem, the Deputy was able to contact the Minister's office and then the Deputy contacted the operator and said she could get through now. The second time I tried to contact the office, the operator, just said that the line was busy (which I assume probably mean't 'not answering') and to try again later."
January 3, 2006
Final Report by Patrick Egan:
"This letter is in response to your complaint, submitted to our office by letter dated April 19, 2005, that Mount Saint Joseph Hospital ('MSJH) contravened the Freedom of Information and Protection of Privacy act ('FIPPA'). I have been assigned to investigate this matter. In accordance with s. 40 of FIPPA, the Commissioner has delegated the authority to me under s. 42(2) of the Act to investigate the complaint. In conducting this investigation, I am exercising the delegated power to investigate, make findings and dispose of the complaint.
[A summary of events that lead to this report was inserted here].
Issue 1: Does MSJH have the authority, under section 26 of FIPPA, to collect personal information about a patient's citizenship, residency, religion, occupation and employer?
Legislation:
FIPPA governs the collection, use and disclosure of personal information by a hospital. The sections of FIPPA relevant to the collection of personal information are included below:
Purpose for which personal information may be collected
26 No personal information may be collected by or for a public body unless
(a) the collection of that information is expressly authorized by or under an Act,
(b) that information is collected for the purposes of law enforcement, or
(c) that information relates directly to and is necessary for an operating program or activity of the public body.
Other legislation that is relevant to the collection of personal information during the admitting process includes the Hospital Act, the Hospital Insurance Act and the Medicare Protection Act.
The Hospital Act states that certain personal information must be collected by the hospital when a patient is registered. The relevant section is copied here:
Register of patients
18 (1) The licensee of a hospital must keep at the hospital a register of patients in a form prescribed by the chief inspector, in which the licensee must enter the following:
(a) the full name, age and usual address of every patient, the date of the patient's admission to the hospital and the name and address of the patient's next of kin;
(b) the name of the practitioner attending each patient;
(c) the date on which each patient is discharged from the hospital, or, in the event of the death of a patient in the hospital, the date of the patient's death;
(d) other particulars prescribed by the chief inspector.
The Hospital Insurance Act states that only beneficiaries are eligible for the general hospital services provided for in this legislation.
The Medicare Protection Act defines who may be a beneficiary. A beneficiary is a resident who is properly enrolled in the Medical Services Plan (MSP) under this legislation. The Medicare Protection Act also defines the criteria for being a resident. The definition is provided below:
resident means a person who(a) is a citizen of Canada or is lawfully admitted to Canada for permanent residence,
(b) makes his or her home in British Columbia, and
(c) is physically present in British Columbia at least 6 months in a calendar year, and includes a person who is deemed under the regulations to be a resident but does not include a tourist or visitor to British Columbia;
DiscussionAccording to FIPPA, there are only three circumstances under which personal information can be collected by public bodies. Section 26 of FIPPA states there must be legislation permitting collection, the collection of personal information is necessary for an operating program or activity, or the information is collected for law enforcement purposes.
Collecting personal information during the hospital's admitting process cannot be considered collection for law enforcement purposes. Therefore, under FIPPA, hospitals can only collect personal information when authorized by other legislation or when the information is necessary to run a hospital program or activity. The Hospital Act authorizes the MSJH to collect the full names, ages, addresses of patients as well as the names and addresses of their next of kin. Health care is the central program of a hospital and personal health information is gathered because it is necessary to provide health care. A related operating program is the payment for health care. In order to get paid for the services they provide, it is necessary for hospital's to collect personal information from patients to determine who is going to pay for these services.
Residency and Citizenship Status
The Ministry of Health and British Columbia Medical Services Plan (MSP) pays hospitals for the medical services they provide to provincially insured patients. A significant portion of a hospital's health care funding is paid through block funding provided by the Ministry of Health. This pays for hospital services provided primarily to inpatients that are insured under MSP. As its name implies, this funding is provided in a block and the hospital does not need to account for every single patient or procedure. Other funding originates from the daycare or outpatient services that are usually paid for by MSP on a billing and reimbursement basis, which must account for every patient service and procedure. When an inpatient or outpatient carries private insurance or is insured by another organization, the Workers Compensation Board (WCB) for example, the hospital will recover the health care costs from that insurer.
Hospitals are responsible for making sure they have identified the proper person and for ensuring that person qualifies to be a beneficiary of MSP or some other insurance plan. Currently, the interface between hospital systems and the MSP systems does not allow the hospitals to confirm a patient's MSP coverage electronically. To determine if a patient meets BC's residency requirements, the hospital has to determine that the patient meets all three criteria for the definition of a resident as presented in the above definition. The hospital must determine that the patient is a citizen or is lawfully admitted to Canada for permanent residence, that if they just moved to BC, that they have resided in BC for at least three months and that, as a BC resident, they have been present in BC for at least six months in a calendar year. This would include asking questions about an individual's citizenship, current address, length of residence at current address and previous addresses if the individual has lived less than six months at their current address.
On the evidence before me, I find that MSJH was authorized by section 26 of FIPPA to collect personal information about your citizenship and residency status.
ReligionMany hospitals run pastoral care programs. Providence Health Care states that it is a faith based-institution with a connection to the Catholic Church and that their health care facilities provide pastoral care on a voluntary basis. Providence's web site indicates that MSJH does run a pastoral care program and explains the services the program provides. MSJH states that a patient's religion is only collected with the voluntary consent of the patient. According to a copy of a Providence memo, dated April 28, 2005, Providence advises staff to ask the question in this way: Would you like your religion noted on your chart?
You have complained that this was not the question you were asked, that it was not presented to you as a voluntary choice and that you were not provided with an explanation of why it was needed.
Part of my investigation into this matter involved talking to other hospitals and health authorities about their handling of the collection of religious information. Vancouver Island Health Authority, for example, is in the process of revising their registration and admitting process to ensure it conforms to FIPPA. They recognize that spiritual or pastoral care is an important element of good health for some people. Rather than rule out the collection of religious information, they are changing how they ask the question. They now ask patients during registration if they would like their name added to a list that will be given to visitors from their faith-group and/or the hospital chaplain. If the patient says no the questioning stops there. If the patient says yes then the patient's religion is recorded. This process not only allows the patient to be informed about, and consent to, the collection of their personal information, it also informs the patient about how their personal information will be used and disclosed to others.
The Office of the Information and Privacy Commissioner has, in the past, commented on the collection and use of religious information by hospitals or care facilities. Excerpts from two case file summaries are provided below. The full file summaries can be viewed online by navigating to the Office of the Information and Privacy Commissioner's website (www.oipc.bc.ca) and navigating to the 1996/1997 and 1999/2000 Annual Reports.
In 1996, a chaplain at a hospital complained to the Commissioner that her hospital did not ask for a patient's religion upon admission to the hospital.
With respect to the collection of information about a patient's religion, the Office advised the chaplain that the issue for a hospital is whether the information is directly related to, and necessary for, the hospital providing health care or determining a patient's eligibility for benefits to cover the cost of the hospital stay. The Office clarified that, in the case of religious information, the purpose of the collection is for pastoral visits. In short, the hospital does not have a need-to-know this information, except to assist a member of the pastoral care team to visit a patient. Therefore, religious information may appropriately be collected only where a patient has clearly expressed a wish to see a member of the pastoral care team.
The Office also advised the chaplain that her right to access a hospital's list of patients was covered under the same principle. When patients provide their names and addresses to the hospital for the purpose of the provision of health care or administration of health care benefits, they would not reasonably expect that this information would be disclosed by the hospital to a member of the pastoral team when they have not indicated their desire for this to happen. The Office emphasized that it is the Commissioner's view that when a patient indicates a desire for a pastoral visit, it is appropriate for the hospital to release the name, religion, and perhaps address (in order to determine the suitable person to visit) and location of the patient in the hospital to the appropriate member of the pastoral team. In addition, some hospitals have taken the proactive step of having cards available at bedside for patients to request a visit.
In 2000, pastoral care providers and the managers of patients' records at some long term care facilities found themselves in a dispute over the release of patient information. Pastoral care providers were asking for routine access to patient files to set up visits with patients of their respective denominations.
The first issue that needed to be addressed was the automatic collection of patient's religious affiliation. According to the patient records manager, the only reason that this information is required is if the patient is interested in receiving pastoral care services. One of the key principles of privacy protection is to only collect that information which is necessary to the task. In this instance, asking the patient if they would like to receive pastoral care is the first step. Then if they answer, yes they can disclose what religious denomination they wish to receive a visit from. The pastoral care department would only receive the lists of those who positively identified a wish to access pastoral care. Those who did not wish to have this service would have their privacy protected.
In the long-term care setting, it was determined that the inclusion of a 'pastoral care consent form' in the admission package would be the most effective way to collect the necessary information. This form would contain all of the necessary details for the pastoral care provider on the condition of patient consent. The consent would be voluntary, and the information provided by the patient would be related only to their spiritual needs as opposed to their clinical needs. Pastoral care providers expressed concern that some patients may answer no and then change their minds at a later date, so the consent form was drafted to clearly state that a patient may consent to pastoral care at any time, and can do so by contacting the pastoral care office or by making an anonymous request.
Another issue that arose was the provision of the entire list of those patients seeking pastoral care to each provider. This again was determined to be more information than each individual group needed to have and an invasion of the privacy of those seeking the service. It was suggested each denomination should only receive the list of patients that were seeking pastoral care from that denomination. This was accomplished by establishing an honour based system of colour coded files that could be accessed by clergy and volunteers. Although it would have been more ideal to have the lists under lock and key or available only through a staff member these options were impractical in a situation where the information may be needed at any hour of the day by a wide range of individuals.
Pastoral care is clearly a legitimate program provided by hospitals. Under Section 26 of FIPPA, hospitals are authorized to collect information that is related to and is necessary to operate a pastoral care program. In order to operate this program hospitals must first determine if the patient wants to participate. Only when that question has been answered in the affirmative should the patient be asked if they want their religion noted on their chart. MSJH's question is a prompt for further discussion about pastoral care but it is not the correct question to start with. As the Commissioner's Office has suggested above, asking the patient if they want pastoral care may be more appropriate question than the one MSJH currently uses. A question such as this would also satisfy the hospital's obligation to inform the patient how the information will be used and who it will be disclosed to.
Based on the information above, I find that MSJH did not comply with section 26 of FIPPA when the admitting clerk requested the name of your religion.
Occupation
Providence Health Care, in response to this complaint, issued a memo, dated April 28, 2005, to registration staff about questions that may be sensitive for patients. These questions included requests for an individual's occupation and employer. The memo indicates that this information is required to substantiate the individual's eligibility for hospital benefits. My research into the reasons why an individual's occupation was required led me to find it is not necessary for a hospital to collect information about an individual's occupation.
VIHA indicated that if an individual presented a valid WCB claim number to them they would have no reason to collect additional information about the workplace. In cases where a workplace injury is presented and the WCB is not yet involved, the hospital would collect information about the accident, the employee's Social Insurance Number and the employer's name, address and postal code. If the individual wanted to make a WCB claim, the hospital would provide them with a WCB form to fill out. VIHA no longer collects information about occupations.
Based on the information above, I find that MSJH was not authorized by section 26 of FIPPA to collect personal information about your occupation.
EmployerMy investigation into the reasons why information about an individual's employer was required led me to find it is not necessary for a hospital to collect this information unless the patient is being admitted for a work related injury or illness. In that case WCB may be the insurer and additional information about the patient's employer might have to be collected. If the reason for admitting has nothing to do with the workplace, there is no reason to collect employer information.
VIHA indicated that if an individual presented a valid WCB claim number to them they would have no reason to collect additional information about the workplace. In cases where a workplace injury is presented and the WCB is not yet involved, the hospital would collect information about the accident, the employee's Social Insurance Number and the employer's name, address and postal code. If the individual wanted to make a WCB claim, the hospital would provide them with a WCB form to fill out. VIHA no longer collects information about occupations.
Based on the information above, I find that MSJH was not authorized by section 26 of FIPPA to collect personal information about your occupation.
EmployerMy investigation into the reasons why information about an individual's employer was required led me to find it is not necessary for a hospital to collect this information unless the patient is being admitted for a work related injury or illness. In that case WCB may be the insurer and additional information about the patient's employer might have to be collected. If the reason for admitting has nothing to do with the workplace, there is no reason to collect employer information.
VIHA indicated that if a patient presented a valid WCB claim number to them they would have no reason to collect additional information about the employer or workplace. In cases where a workplace injury is presented and the WCB is not yet involved, the hospital would collect information about the accident, the employee's Social Insurance Number and the employer's name, address and postal code. If the patient wishes to make a WCB claim the hospital provides them with a WCB form to fill out.
Based on the information above, I find that MSJH was not authorized by section 26 of FIPPA to collect personal information about your employer.
ISSUE 2: Does the MSJH have an obligation, under section 27(2)(a)(b) and (c) of FIPPA, to explain to a patient why personal information is being collected?
Legislation
FIPPA recognizes the individual's right to know and understand why personal information is being collected and how it will be used. Public bodies have an obligation to provide this information to enable individuals to make informed decisions when asked to provide personal information. Section 27(2) of FIPPA states:
How personal information is to be collected
27 (2) A public body must ensure that an individual from whom it collects personal information or causes personal information to be collected is told
(a) the purpose for collecting it
(b) the legal authority for collecting it, and
(c) the title, business address and business telephone number of an officer or employee of the public body who can answer the individual's questions about the collection.
DiscussionOne of the questions you asked our office was why the admitting clerk at MSJH was not able to answer your questions about why certain personal information was being requested. Section 27(2) of FIPPA, quoted above, states that when a public body collects personal information from an individual they must tell the individual why the information is being collected and what it will be used for and with whom it will be shared. They must also inform the individual under what authority they are collecting the information. Finally, they must also provide the contact information for an officer of the public body who can answer the individual's questions about privacy and access. You stated that the admitting clerk at MSJH did not provide this information to you when you requested it.
Both the Vancouver Coastal Health Authority and the Vancouver Island Health Authority post their privacy statements at admitting points so they are easily accessible to incoming patients. These privacy statements include why information is being collected, how it will be used, who it may be shared with and under what authority it is being collected. Both statements indicate that information is primarily being collected to provide the best health care and for determining eligibility for health insurance benefits. They also provide contact information if further information is required. MSJH did not have posters or brochures available in the hospital to provide this information.
I note that MSJH has not been able to respond to this particular aspect of your complaint because you declined to allow MSJH to disclose your name to allow them them to determine which admitting clerk was involved in your registration. I am not able to fully investigate this part of your complaint without disclosing your name.
Based on the above, I am unable to determine whether MSJH complied with section 27(2). I have, however, provided MSJH with recommendations with respect to providing notice to patients.
Summary of FindingsI find that MSJH was authorized by section 26 of FIPPA to collect personal information about your residency and citizenship status.
I find that MSJH did not comply with section 26 of FIPPA when the admitting clerk requested the name of your religion.
I find that MSJH was not authorized by section 26 of FIPPA to collect personal information about your occupation.
I find that MSJH was not authorized by section 26 of FIPPA to collect personal information about your occupation.
I make no finding with respect to MSJH's compliance with section 27(2).
RecommendationsI recommend that MSJH review their practice of collecting information about a patient's religion and ensure their policies are compliant with FIPPA. I recommend MSJH modify their existing process by first asking patients if they want pastoral care and then providing individuals with enough information to allow them to understand how their personal religious information would be used and disclosed. A consent form would provide additional information and clarity about the program.
I recommend that MSJH stop their practice of collecting information about their patients' occupation.
I recommend that MSJH review their practice of collecting information about their patients' employer. Their policy and procedures need to clarify the narrow set of circumstances in which employer information can be collected.
I recommend that MSJH makes certain that staff who are collecting personal information are aware of MSJH's obligations under section 27(2) of FIPPA.
I recommend that MSJH create posters and brochures that provide information about:
- the purpose for collecting personal information;
- the authority to collect personal information; and
- the contact information of a MSJH employee who can answer questions about the collection and use of information.
The posters can be displayed at points visible to patients being registered or admitted. The brochures should be handed directly to patients.
ConclusionI have talked to Ms. Sachedina about these findings and recommendations. Ms. Sachedina has stated that MSJH is using your complaint to create a learning opportunity and has agreed to make the following improvements:
1. Notification statements and brochures will be ready for use in January 2006.
2. MSJH will provide a comprehensive refresher course on privacy issues for admitting staff in January 2006.
3. MSJH will no longer ask questions related to employment and occupation; and
4. MSJH will follow my recommendations when asking questions about religion.
Based on MSJH's response it is my opinion that all outstanding matters have been resolved. Our purpose in enforcing FIPPA is not to impose penalties but to ensure public bodies understand their obligations under FIPPA and to ensure, when necessary, that public bodies change their practices so that they conform to FIPPA. Your complaint file is now closed.
Please call me at (250) 356-2529 before January 18, 2006 if you have any questions or comments on this report. I will inform MSJH of this result with a version of this letter with your identifying information removed.
Comments:
Under religion you will note that the memo advising staff how to ask the question, was dated after my complaint to the hospital and OIPC.
Under discussion, Issue 2, 3rd paragraph, you may note from previous correspondence that I made the disclosure of my name conditional. Conditions which MSJH did not want to meet. But then OIPC just took Ms. Sachedina's word and never discussed the matter with me.
Under Religion - When patients provide their names and addresses to the hospital for the purpose of the provision of health care or administration of health care benefits, they would not reasonably expect that this information would be disclosed by the hospital to a member of the pastoral team when they have not indicated their desire for this to happen. Yet this is still happening. Pastors still have access to the database with everyone's information. Vancouver Island Health Authority's method of providing a list to a pastor of those patients requesting his/her services protects patients privacy. Why isn't Providence Health Care required to implement the same procedure? Why does Providence Health Care allow pastors access to databases with all patients complete information?
Under discussion, Issue 2, 1st paragraph, it states a public body...must tell an individual why the information is being collected, what it will be used for and with whom it will be shared. This is interpreted so generally, by both the hospitals and OIPC, as to apply to almost anything and anyone and therefore is virtually useless. If it were interpreted more specifically, hospitals would be required to state, in more detail, who has access, why and how much.
Under discussion, Issue 2, 4th paragraph, I appreciate the fact that OIPC will not disclose my name. But the fact that I am obligated to contact the public body and give them an 'opportunity to respond to and attempt to resolve the issue', makes this point pretty much a facade. I think, in the majority of cases, the public body can figure out who laid the complaint by reviewing who has recently contacted them about that particular issue.
Again, the idea of enforcing FIPPA is deceptive because, my understanding, is that OIPC has no powers to enforce.
Also, OIPC does not penalize the public body, which, of course, is why they have no reason to proactively conform to the Act (the hospital has had 13 years to comply, and Ms. Sachedina is a lawyer). After all, nothing will happen to them if they are found guilty . In the meantime, people, like me, are penalized by the whole process. For 13 years they have been collecting information illegally.
January 8, 2005
My response to Patrick Egan, OICP
"While I disagree with a few of the statements that were made in the report, I am please that it is finally completed and that changes will be made. And, I do recognize the research that you have done.
But, I am appalled that Ms. Sachedina would blow this off as a learning experience. I would probably have agreed if this had been resolved a year ago. But, in my opinion, Providence Health Care made every effort to avoid compliance. Now, I can't begin to express my disgust, my contempt for the individuals, the faith, the god, that would put the collection of information (that, in my opinion, any reasonable person would know to be illegal) ahead of the health and welfare of a human being.
Now, by cc of this letter to Ms. Sachedina, I want all information removed from my files, in Providence Health Care hospitals, that does not conform with the law. I expect to be notified when this has been done.
Also, if I say "No" to pastoral care, are my personal records kept in a place inaccessible to anyone but medical staff?
Also, this file may not be completely closed as I have given the province (ie. Gordon Campbell) until this week to refund my MSP payments for the period when I was unable to access hospital care because the hospitals were in violation of the law, or I will be looking at legal action. So, you may be required to provide information.
I also hope that you plan to ensure that all hospitals, doctors, etc. are in compliance with the Privacy Act. My understanding of the Privacy Act is that an organization is suppose to be in compliance with the Act as of January 1, 2004. Plus, I was disappointed that I was not given any information on the committee looking into health care privacy.
Thank you again for the work you have done on this complaint."
Comment:
I confused the implementation of PIPA (January 1, 2004) with FOIPPA which is October 4, 1993.
January 19, 2006
Response from Ms. Sachedina.
"I am in receipt of a copy of your letter to Mr. Patrick Egan, Office of the Information and Privacy Commissioner.
I note that your letter requests the removal of information that does not conform with the law. Accordingly I have instructed, and can confirm, that the following information has been removed from the electronic system and from the registration information on your paper patient record.
1. Reference to your religion.
2. Reference to your occupation.
3. Reference to your employer.
Since changes to patient records require explanation, a copy of Mr. Egan's report, your letter dated January 8, 2006 and this response will be placed on your patient record to serve as the explanation for the changes to your patient record. I trust that this will meet with your approval.
I am aware that you are not satisfied with our response to your complaint. I had very much hoped to address your concerns with the specific clerk involved in your admission. However, in light of your refusal to consent to the disclosure of your name, this course of action was not possible. I do want to take this opportunity to acknowledge that your complaint has prompted a general review our processes and we have implemented the changes recommended by Mr. Egan."
January 23, 2006
Letter to Ms. Sachedina.
"You really amaze me. You write me a letter, again blaming the clerk and me for the lack of a speedy resolution to my case, completely ignoring the fact that your hospital, your organization were in violation of the law and you refused to do anything about it until the report came out. And, what, you think I'm going to buy into in? You know the only person you are really demeaning is yourself and your organziation when you refuse to accept responsibility for your own actions!!!
You told me what information you had deleted. But, as my letter stated, I want all information that is not in compliance with the law, deleted. If I find out that you have any information collected at any time, by whatever means, that is not in compliance with the law, I will sue your ass off. I am not playing games with you.
I also want to know who has access to my records. Since I have said no to pastoral care, are my personal records kept in a place inaccessible to anyone but the necessary medical staff. You have 30 days to provide a complete response or you will again be in violation of the law. I have a legal, not to mention a moral (look the word up in your dictionary), right to know who has access to my personal information (and this includes my medical and all other information relating to me just in case you decide to play semantics)."
March 15, 2006
I filed a complaint with the OIPC for Providence Health Care's refusal to respond to my question.
"I sent a letter to Providence Health Care on January 23, 2006 asking Since I have said 'no' to pastoral care, are my personal records kept in a place inaccessible to anyone but the necessary medical staff. Providence Health Care has, again, shown its contempt for the rights of individuals by refusing to respond.
This is an issue that arose from [an OIPC File Number]. The Privacy Commissioner's report stated: 'Another issue that arose was the provision of the entire list of those patients seeking pastoral care to each provider. This again was determined to be more information than each individual group needed to have and an invasion of privacy of those seeking the service. It was suggested each denomination should only receive the lists of patients that were seeking pastoral care from that denomination. This was accomplished by establishing an honour system of colour coded files that could be accessed by clergy and volunteers. Although it would have been more ideal to have the lists under lock and key or available only through a staff member these options were impractical in a situation where the information may be needed at any hour of the day by a wide range of individuals.'
Needless to say this greatly concerns me. I want to know exactly who has access to any and all of my records, and do they have access to all my information or part of it, and if so, who has access to which part. For example, where are my records kept (under lock and key, or in an easily accesssible file container); is it kept in electronic or paper form, is it ever left unattended by medical staff and who has access. This would include information about the coded files again, where are they kept, what information is accessible, and who are the wide range of individuals who may need this information.
My medical information is confidential, or suppose to be, and yet it seems that everyone and their brother has access to it.
I also want to know why Providence Health Care, which is essentially a government agency, is allowed to continually show such contempt for the laws of this province."
March 20, 2006
Letter from Rebecca Harvey, Ministry of Health
"In order for the Ministry to investigate the alleged MSP charges you refer to, we require more information on these charges. Could you kindly provide invoices and proof of payment and any other relevant details on the charges so Ms. Rajinder Manak, Supervisor, Customer Service MSP, 4464 Markham St., Victoria, BC, V8Z 7X8, can investigate them and address your concerns.
Thank you in advance for providing the additional information on the alleged MSP charges."
March 24, 2006
Letter to Rebecca Harvey
"Alleged MSP charges? If this weren't so sad, it would be humourous. You are telling me that your American company doesn't know if it invoiced me for MSP premiums for the period stated in my letter? You are telling me that your American company doesn't know if it received and cashed a cheque from me for part of that period? Your telling me that your American company doesn't know that they are sending me threatening letters because I have not continued to pay for services that are not available to me because your hospitals are in violation of the privacy laws. You give my private, confidential medical information to an American company, and now, to add insult to injury, you want me to do your goodamn American company's work for them. Get real.
I will be happy to provide invoice and proof of payment, in court. Then you can explain why you are taking money out of my pocket and giving it to this goddamn American company, who, apparently, have no record of what they have done and are doing. You can also explain why you are allowing hospitals to violate people's rights."
Comments:
I really do feel that this was just a scam, supported by the fact that I never heard from them again. They do, or should have, this information since that is they're job; how else do they do they're billing. But I think they were just looking for an excuse. Unlike most people, I actually do have this information. But on principle I will not submit to, what I consider, is a con.
April 3, 2006
Letter from Barbara Haupthoff, OIPC
"We have received your correspondence dated March 15, 2006 alleging that Providence Health Care has not responded to your letter requesting information about how your personal information in the custody of Providence Health Care is secured against unauthorized access.
It is the policy of the Office of the Information and Privacy Commissioner to refer a complaintant back to the organization, where the complaintant has not first given the organization an opportunity to respond to and attempt to resolve the issue. You have indicated in your letter that you have written to Providence Health care regarding your concerns on January 23, 2006.
In order for this office to open a file on your behalf, we require certain documents in support of your concerns. We need a copy of your January 23, 2006 letter to Providence Health Care. Our records suggest that Ms. Zulie Sachedina is the Freedom of Information Coordinator for Providence Health Care and her address is: 1081 Burrard Street, Vancouver, BC V6Z 1Y6. Ms. Sachedina is the appropriate person to respond to your concerns on behalf of Providence Health Care. You may wish to forward your January 23, 2006 letter to Ms. Sachedina for response.
Until we receive this additional information we are unable to proceed with this matter. If we have not received this information from you by April 18, 2006 we will assume that you no longer require the assistance of this Office and will consider the matter closed."
Comment:
This information was forwarded to Ms. Haupthoff, OIPC as requested.
May 2, 2006
Response from Providence Health Care:
"In response to your questions as to who has accessed your records. Providence Health Care has reviewed its processes and conducted an audit on your file.
According to our audit, your electronic record was accessed one time by Kit Schindell, Director of Patient Records, in response to your initial complaint. A copy of the audit is attached for your information.
As previously communicated to you, your paper Health Record File is available to you at no charge and you can request a copy of your record from Health Records, you will be able to review the current status of your file. For information on accessing your file, further information is found on our website: www.providencehealthcare.org info for patients & residents/patient records."
Comments:
The audit on my file was puzzling:
1. This was not the question asked. My question was "I also want to know who has access to my records. Since I have said no to pastoral care, are my personal records kept in a place inaccessible to anyone but the necessary medical staff." The question answered was wrong and incomplete. Ms. Sachedina is a lawyer, so I have a very difficult time believing that this was an error.
2. Only one person had accessed my records and on 12/9/2005. Providence Health Care was certainly eager to access my records to determine who was the admissions clerk who had initially entered my information but her name is not identified;
3. As late as January 19, 2006 Ms. Sachedina was upset because I would not give unconditional permission to access my admission records and yet the Director of Patient Records accessed my records on 12/9/2005 without my permission and for purposes unknown. Ms. Sachedina says that it was in response to my initial complaint. But my initial complaint was almost a year prior and, during December 2005, the only thing happening on my complaint was the OIPC finishing the report.
4. The audit identifies the occupation of use (occupation of the person using my information) as patient representative. I consider a patient representative as a person I select to make decisions on my behalf because I am incapacitated which, of course, does not fit this situation.
5. In addition, I did have the initial outpatient procedure at the hospital but apparently that didn't require anyone to access my records.
6. It was between January 6 and 19 that the illegally collected information was removed from my file but supposedly they did this without accessing my records because no name is identified for that period.
May 18, 2006
This letter is inserted before my May 10, 2006 letter because, according to the OIPC, it appeared that my letter was not put in the system before this letter was sent)
Response from Barbara Haupthoff:
"This letter is in response to your complaint under the Freedom of Information and Protection of Privacy Act (the Act) that Providence Health Care had not responded to your inquiries concerning possible unauthorized access to your personal information. I had spoken to Zulie Sachedina at Providence Health Care about your complaint. I have now received a copy of Ms. Sachedina's response to you.
Since you have now received a response to your inquiries to Providence Health Care, it would appear that there is no further issue for review by our office. Our file is now closed.
If you are not satisfied with the response, however, please provide written details of any further issues you would like this office to address."
Comments:
I guess there are one of three explanations: both organizations read the question incorrectly and didn't notice that the answer was still incomplete, neither one of the organizations can read, or they just want to sweep the real questions under the rug.
May 10, 2006
My response to Barbara Haupthoff:
"I received a letter from Providence Health Care, dated May 2, 2006 and it indicates that you also received a copy.
Obviously it doesn't come anywhere near answering my question. Again, Providence Health Care has violated the Privacy Act, as I am entitled to know who has access to my information.
Since this issue will likely end up in court, I am going to restate my question. I want to know who has access to anyone's records at any time. For example, if someone had been in the hospital, for whatever reason, who would have access to their records, all doctors in the province/country/world or only certain doctors and, if so, which ones; all nurses, technicians, pastors, volunteers, etc.? Do they have access to all the medical information or part of it (if so, who has access to what part)? If your access is limited, how is this enforced?
Where are the records kept (under lock and key, or in an easily accessible file container); is it kept in electronic or paper form, is it ever left unattended by medical staff, what safety features protect my information (ex. firewalls if on a computer). This would include information about the coded files -- again where are they kept, what information is accessible, and who are the wide range of individuals who may need this information? If a person opts out of pastoral care, does this affect who has access to their records?
I am sending this directly to you as Providence Health Care has shown that they don't respect people's rights, and will only respond to a question if directed to do so by you and then they only give a facade of complying by actually avoiding the question.
However, I will be able to show in court that I have given you and Providence Health Care every opportunity to resolve this matter.
In a letter from Providence Health Care, dated January 19, 2006 they state: "Since changes to patient records require explanation, a copy of Mr. Egan's report, your letter dated January 9, 2006 and this response will be placed on your patient record to serve as the explanation for the changes to your patient record. I trust this will meet with your approval". It does not, I do not want any of that information on my file. You are removing information that was illegally obtained so no additional information should be required. Also, there is the potential for this information to be used to discriminate against me especially since I don't know who has access to my records.
Everyday that you delay protecting my privacy, which is my legal right, is another day that I am denied medical care which is another legal right. This puts you and Providence Health Care in a very precarious position. As stated before, I was suppose to be in the hospital a year ago."
June 7, 2006
Letter from Ms. Haupthoff, OIPC
"We have received your complaint that Providence Health Care allegedly has not provided you with sufficient information concerning the security of your personal information under the Freedom of Information and Protection of Privacy Act (the Act). Your case has been opened as of May 12, 2006 and has been assigned to Patrick Egan, who will be the Portfolio Officer responsible for mediation of this matter. By copy of this letter, I notify Providence Health Care of the investigation and provide Providence Health Care with a copy of your letter to this office."
July 19, 2006
Email to Ms. Haupthoff, OIPC
"I sent you a letter re Providence Health Care May 10, 2006. Would you tell me when I can expect to receive a reply?"
Comment:
My error. I forgot that the case had been assigned to Patrick Egan.
July 28, 2006
I have not received a reply to this email. If I do not receive a reply by August 3, 2006 I will pursue this through other avenues."
Comment:
I had attached the email of July 19.
July 28, 2006
Reply from Ms. Haupthoff, OIPC
"A new file was opened with regard to your May 10, 2006 letter to our office. Your file number is (xx) and your Portfolio Officer is Patrick Egan. Your message has been forwarded to Mr. Egan, who is currently away from the office. Mr. Egan will return to the office on August 8 should you wish to contact him."
August 8, 2006
Email to Patrick Egan, OIPC
"I have been very patient. So, if I do not have a reply by August 11, 2006, I will take action."
August 8, 2006
Letter from Patrick Egan:
"Your Tuesday, August 08, 2006 11:09 AM email was forwarded to me this afternoon. As you know, this file was assigned to me on June 7, 2006. I am investigating your complaint that Providence health care did not provide you an adequate answer to your question concerning the security of your personal information, specifically your questions about who has access to your records and whether your records are inaccessible to everyone but the necessary medical staff.
I am in the preliminary process of speaking with Ms. Sachedina about your complaint and am providing her with more detailed questions as you have provided to us in your May 10, 2006 letter.
I hope to complete my investigation as soon as possible. However, complaints are investigated in the order they are received and I am still investigating a number of complaints that preceded yours. As a result, I am not yet able to say when I will be finished."
September 5, 2006
E-mail to Patrick Egan:
I was told that last fall an organization had been formed to look into privacy matters in the medical field. Yet, almost a year later they are still treating people's privacy rights with contempt. Of course, I don't know anything about this organization or whose interests they are trying to protect since you refused to provide any other information.
I understand your constraints in this matter but I am not prepared to wait another year or more to have this resolved. I need medical care and I have a legal right to medical care, and this does not mean a right subject to blackmail, so I will be pursuing this through other avenues, as well."
September 5, 2006
I wrote to Tony Clement, Federal Minister of Health. I outlined what had happened to date. I also stated:
"I am contacting you because I believe the federal government has a responsibility under the Health Act and Privacy Act to ensure that people have access to health care. I believe the Health Act states that all people will have equal access to necessary medical care. It does not say, access if you submit to blackmail, or access if you give up your rights, etc. I believe the provincial government is in violation of the Health Act and it is your role to ensure its enforcement. I also believe that you have a responsibility to ensure that my money, that you send to the provincial government, is spent appropriately (and that means to provide me with medical care).
Also, I understand that the provincial governments were allowed to pass their own privacy laws, as long as those laws were, in essence, the same as the federal privacy laws. While your federal privacy commissioner's office has said that the Office of the Privacy Commissioner of Canada does not supercede the Office of the Information and Privacy Commissioner for BC, I believe you do have a right, if the provincial act is not operating in conformance with the federal act. I believe the provincial government has violated the Privacy Act by:
1. Not having their organizations in compliance with the privacy laws as of January 1, 2004.
2. By taking an extraordinarily long time to resolve privacy matters, thereby jeopardizing a citizen's health. It took the provincial privacy commissoner's office approximately nine months to make a decision on the initial complaint and to have the information removed from my file. It has been over 8 months since I asked who has access to my medical information and I am still waiting for an answer.
I hope that you will step in and have this situation resolved soon. I need medical care (in addition to the tests I needed over one and a half years ago), my doctor has told me that I am long overdue to see her and yet I sit here, waiting, because the hospitals, apparently, have no idea who has access to my medical records (or don't want to answer). Either way it is a really appalling situation. My question is not a trick question. It is a basic question that the hospitals should have no problem answering and the fact that they do should raise serious concerns with you, as it does me.
As I said, I believe you have a responsibility in this. If anything happens to me due to lack of care because the hospitals were in violation of the law, I will take legal action and hold everyone involved responsible. I am also investigating other avenues to resolve this problem, such as the press.
I can think of absolutely no justifiable excuse for what is happening, and I don't think any court would either".
Comments:
I erred in using the date January 1, 2004. That applies to PIPA, which is for private organizations. The FOIPPA, which applies to public bodies, came into effect October 4, 1993 (OIPC, Role and Mandate, pg. 2) .
November 28, 2006
Response from Tony Clement, Minister of Health (apologized for delay in responding):
"I would like to clarify that the Canada Health Act is the federal legislation that sets out the basic criteria and conditions that provincial and territorial health insurance plans must meet to qualify for federal transfer payments under the Canada Health Transfer. The Act's criteria relate to such matters as the comprehensiveness of insured services covered, universality of population covered, reasonable access to insured services without impediment by way of user charges or otherwise, portability of benefits and public administration of the health insurance plans on a non-profit basis. Residents of a province or territory are entitled to have access to insured health care services in the setting where the services are provided and as the services are available in that setting. The Act does not address matters related to personal health records or privacy issues.
The situation you described involves the collection of personal information by a provincial health care organization. The Privacy Act applies only to personal information collected, used and disclosed by federal departments and agencies. The federal Personal Information Protection and Electronic Documents Act protects personal information held by private sector organizations, with the exception of those jurisdictions in which provincial legislation has been deemed substantially similar. Consequently, it is the provincial Information and Privacy Commissioner, rather than the federal Privacy Commissioner or Minister of Health, who is responsible for reviewing your case.
The provincial and territorial governments have primary responsibility for matters related to the administration and delivery of health care services, including setting their own priorities, administering their health care budgets and managing their own resources. Therefore, I recommend that you share your concerns with the Minister of Health...."
December 12,
My response to Tony Clement:
"I did contact the Minister of Health of B.C. but he, like you, claim no responsibility. Apparently, nobody is responsible. How convenient.
It is your responsibility to enforce the Canada Health Act. As you state, 'The Act's criteria relate to such matters as reasonable access to insured services without impediment by way of user charges or otherwise.' You also state, 'Residents of a province or territory are entitled to have access to insured health care services...'. I don't have access to health care services without an impediment, ie the violation of my rights.
You also state that 'the federal Personal Information Protection and Electronic Documents Act protects personal information held by private sector organizations, with the exception of those jurisdictions in which provincial legislation has been deemed substantially similar'. So, are you saying that the federal Privacy Commissioner does nothing to protect people's privacy, that he does not respond to complaints, that the federal act (like the provincial) is just a convenient piece of paper (a fantasy that sounds good at first -- your privacy rights are protected -- we have passed an act) but, in reality, means absolutely nothing and people can just ignore it? At the provincial level, I have learned that one can just ignore the FIPPA and any other privacy act. Nothing will be done about it, there's no enforcement (hell, the Privacy Commissioner's Office doesn't even bother to respond to any complaint they don't like). So, you are saying that provincial privacy laws mirror the federal, ie they are both a farce.
You have a responsibility to step in if a provincial government or its agencies are not fulfilling their obligation and are impeding access to health care either directly or by lack of action. I understand that about 30% of my tax dollars paid to the federal government goes to provide me with health care. Well, you have collected my money, now give me health care.
I hear that an election is likely very soon. I can assure you that if this situation is not fully resolved by then, I will make it an issue."
December 1, 2006
Report from Patrick Egan:
"This letter is in response to your complaint under the Freedom of Information and Protection of Privacy Act ('Act} that Providence Health Care (Providence) has not provided you with sufficient information about the access to and security of your personal information. Specifically you want to know who would have access to your patient records if you were admitted to a Providence hospital and how your personal information in both electronic and paper form are secured against unauthorized access. I have been assigned to investigate this matter. In accordance with s. 49 of the Act, the Commissioner has delegated the authority to me under s. 42(2) of the Act to investigate the complaint. In concluding this investigation, I am exercising the delegated power to investigate, make findings and dispose of your complaint.
Background
On January 23, 2006, you wrote to Providence and requested to be told who had access to your records. You also wanted to know if your personal information was kept in a place that was inaccessible to anyone but the necessary medical staff.
On March 15, 2006, you wrote to our office with a complaint that Providence did not respond to your January 23, 2006 letter. File .... was opened and Providence was contacted regarding their lack of response.
On May 2, 2006, Providence responded to your question about who has had access to your personal information. Providence conducted an audit of the electronic records containing your personal information and provided you with a copy of the audit. Our file was closed.
On May 10, 2006, you wrote to our office stating that Providence's response did not answer your question. You restated your question as: Who has access to anyone's records at any time.
On May 12, 2006, File .... was opened to investigate your complaint that Providence did not provide you with sufficient information concerning the access to and security of your personal information.
Issues
The following issues have been investigated:
1. Has Providence made reasonable security arrangements to protect against unauthorized access or disclosure under s. 30 of the Act?
2. Has Providence ensured that personal information in its custody is disclosed only as permitted under s. 33.1 or s.33.2 of the Act?
Investigation
Issue 1 Has Providence made reasonable security arrangements to protect against unauthorized access or disclosure under s.30 of the Act?
Section 30 of the Act states:
Protection of personal information
30. A public body must protect personal information in its custody or under its control by making reasonable security arrangements against such risks as unauthorized access, collection, use, disclosure or disposal.
Your complaint letter only spoke of your concern about inappropriate access by or disclosure of your personal health information to other care providers or employees and what security measures were in place to prevent this. As a result, I have investigated Providence's security arrangements in general and with respect to unauthorized access or disclosure by care providers or employees.
I spoke with Mr. Yoel Robens-Paradise, Director of Health Records Services for Providence, about the security arrangements in place for patient health records. Mr. Robens-Paradise noted that all health records created since April 1, 2006 are kept in electonic form. Since April 1, 2006, Providence has embarked on a project that will see it scan all patient paper records and convert them to electronic records. This is part of a wider federal and provincial initiative to shift from paper records to electronic health records.
Paper Records
Prior to April 1, 2006, when a patient was admitted to a Providence hospital and moved to a unit any existing patient records were requested from the Health Records Department (HRD). The HRD was responsible for finding the records and sending them to the appropriate unit. While not in use, patient records are stored in a locked file room in the basement of the hospital. Access to the storeroom is only available to HRD staff that are retrieving or returning records. The HRD does not store patient records other than those that are in transition between a unit and the storeroom. The HRD is staffed 24/7 and is not accessible to the public or non hospital personnel. During night shift the HRD is locked and admittance is gained only by having HRD staff unlock the door.
During a patient's stay at the hospital their health records are kept on the unit. Patient records are typically kept in binders and stored on shelves behind the unit's nursing station and inaccessible to passing members of the public. Nursing stations are staffed 24/7 by unit clerks or nurses. While on the unit, health records are not kept under lock and key. During a patient's stay the health records are accessed by health care providers and the patient's health care is documented in the records by hand. When a patient is discharged, their health records are returned to the HRD. Since April 1, 2006 HRD has been scanning returned paper records and adding them to the patient's electronic health record. It is my understanding that once paper records have been scanned the scanning is validated as complete and the paper records are securely destroyed and disposed of.
Prior to April 1, 2006, a patient's paper health record was tracked by using a bar code on the file folder. The bar code was swiped when it left storage and then was swiped again when it was returned to storage. While on the unit the paper health records required every health care provider to log each entry so the person who made the entry could be identified. When care providers only viewed the record they were not required to log this fact.
When an individual visits an out-patient clinic they usually get same day treatment or treatment over a number of days without staying overnight. Out-patient clinics keep records for every visit by a patient. In the past, each clinic would create and store its own paper patient records much the same way as a dentist's or doctor's office would. Health records are stored in the clinic on shelves, sometimes locked file rooms but always behind locked doors when the clinic is closed. Providence is in the process of changing this practice so that all out-patient records are returned to HRD when a patient does not need to return for further treatment.
Electronic RecordsAccording to Mr. Robens-Paradise, electronic health records are stored on secure servers and not on individual computer hard drives and therefore, not at risk by theft. The secure servers are situated in the hospital.
Electronic records can only be accessed through hospital computer terminals. At this time, electronic health records created at Mount Saint Joseph Hospital cannot be accessed by another Providence employee at another hospital. They cannot be accessed by any doctor outside the hospital.
To access electronic patient health records on the secure servers, hospital employees or health care providers require an assigned user ID and a password. Each person with access rights is assigned a profile which defines the limits of their access. There are approximately 30 different profiles. For example, nurses who are working on the fifth floor will have a profile that only permits them to access electronic health records for patients who are on the fifth floor. Providence describes this type of access as geographic access. Doctors may have a profile that permits them to access the health records for all patients in the hospital. Pastoral care providers and hospital social workers are also provided with geographic access when a patient requests their services. If pastoral care is being provided to someone in the renal unit the pastoral care provider will have access to the records for patients in the renal unit. The narrowest profile available is by individual unit. When an electronic records is accessed, it is electronically stamped with the time, date and name of the individual who accessed the record. When a patient is discharged, their electronic health records are no longer accessible.
Providence has an agreement with the Vancouver Coastal Health Authority in which they share an Information Technology team who maintain Providence's computer networks and ensure the networks are kept secure.
Issue 2 - Has Providence ensured that personal information in its custody is disclosed only as permitted under s.33.1 or s.33.2 of the Act?
Your complaint did not allege a specific case of unauthorized disclosure but rather questioned what assurances Providence could provide you about their ability to prevent possible disclosure of your personal information to unauthorized employee's or service providers. The Act restricts a public body's ability to disclose personal information in its custody. In this case, the Act permits the disclosure of personal information to an employee or service provider of a public body if it is necessary for those individuals to carry out their duties. The relevant provisions are copied below.
Disclosure of personal information
33 A public body must ensure that personal information in its custody or under its control is disclosed only as permitted under section 33.1 or 33.2.
Disclosure inside or outside Canada
33. (1) A public body may disclose personal information referred to in section 33 inside or outside Canada as follows:
...
(e) to an individual who is a minister, an officer of the public body or an employee of the public body other than a service provider, if
(i) the information is necessary for the performance of the duties of the minister, officer or employee, and
(ii) in relation to disclosure outside Canada, the outside disclosure is necessary because the individual is temporarily travelling outside Canada;
(e.1) to an individual who is a service provider of the public body, or an employee or associate of such a service provider, if
(1) the information is necessary for the performance of the duties of the individual in relation to the public body, and
...
Disclosure inside Canada only
33. A public body may disclose personal information referred to in section 33 inside Canada as follows:
...
(c) to an officer or employee of the public body or to a minister, if the information is necessary for the performance of the duties of the officer, employee or minister;
...
When I asked Providence how they met their obligations to restrict disclosure of patient personal information to that required by employees or service providers to carry out their duties, they provided me with a copy of their 'Confidentiality/Access to Information Policy and Procedures'. This document outlines Providence's policies on maintaining privacy and providing access to information. This policy is required reading for all new Providence employees or others doing business for or with Providence (including contractors, volunteers, reseachers and physicians) and is included in Providence's orientation package. All new employees or others doing business with Providence are also required to indicate their understanding of the policy by signing the 'Pledge of Confidentiality/Statement of Understanding Form' within the first month of being hired. Providence has recently hired a Privacy, Access and Information Manager who will take part in the new employee orientation process by explaining Providence's privacy policy. Privacy and access matters were previously the responsibility of the Vice President of Human Resources.
The policy states that all information including computer generated data concerning patients, residents, employees, and corporate operations is strictly confidential. A breach of confidentiality is defined as an intentional or inadvertent unauthorized access to, or disclosure of, confidential information including clinical or personal information regarding patients, family members, visitors, friends or colleagues. The policy also states that Providence employees have the responsibility to report a breach of confidentiality. Further, if Providence confirms that a breach of confidentiality has occurred, the employee(s) involved may be subject to disciplinary action up to and including dismissal.
With respect to maintaining confidentiality, Providence provides the following procedures to new employees or others doing business with Providence:
- Obtain or access only enough information that is necessary for performing your job duties. Do not share information with others unless they need to know the information to carry out their duties. Viewing information other than that required to perform job duties is a violation of confidentiality even if the information is not disclosed to another person.
- Do not discuss personal information in any area where individuals who are not authorized to receive the information are present, unless required to do so by law or with the permission of an authorized individual.
- If an intentional or inadvertent breach of confidentiality occurs notify the appropriate person.
Analysis
It is my opinion that Providence has made reasonable security arrangements to protect the personal information in its custody from unauthorized access or disclosure. Their paper records are either behind locked doors or are under the supervision of hospital staff at all times. Electronic records containing patient personal information are stored on secure servers and are only accessible through the in-hospital computer network which is maintained by information technology professionals. Approved hospital employees, physicians or service providers who need to view electronic health records are provided with a profile which includes a user ID and an individual password. Only individuals with an approved user ID and password are able to access electronic health records. Access to electronic records is restricted by a user's need to know profile. At this time electonic health records cannot be accessed by users outside of the hospital.
Based on my review of the 'Confidentiality/Access to Information Policy and Procedures' it is my opinion that Providence has reasonable procedures in place to ensure that personal information is disclosed to its employees only as permitted by ss. 33, 33.1 and 33.2 of the Act. Providence has implemented and maintains a need to know policy with respect to access to or disclosure of patient information. Only employees or service providers who need access to your personal information to carry out their employment duties are permitted to look at your records. This means, for example, that pastoral care providers are not permitted to access or view a patient's personal information if that patient has declined their services. Pastoral care providers have been informed of this policy and have signed a pledge indicating that they understand this policy. The policy includes sanctions against those who contravene the policy.
Findings
Based on my investigation I find that Providence is complying with s. 30 (Protection of personal Information) and ss. 33, 33.1 and 33.2 (Disclosure of personal information).
Considering your original questions, I believe my investigation has addressed and resolved your concerns.
Comments:
Under Electronic Records it says that health records created in Mount Saint Joseph cannot be accessed by another Providence employee at another hospital. They cannot be accessed by any doctor outside the hospital and Electronic records containing patient personal information are stored on secure servers and are only accessible through the in-hospital computer network. Yet, on July 21, 2005, Ms. Sachedina states that PHC has one database for all of it's member hospitals. That was the explanation as to why they already had information on me even though I had never been to Mount Saint Joseph's Hospital before. So obviously they were able to access personal information from another hospital.
Again, pastoral care providers should not have access to the computers.
January 11, 2007
My response with Concerns/Questions to Patrick Egan's letter of December 1, 2006, is identified in his January 22 reply as questions, with the exception of the paragraph below,
"Please note that when I refer to personal information that includes all information that the hospital has on the person."
January 22, 2007
Patrick Egan's response:
"I have copied your questions below and will attempt to respond to each one immediately after the question. I consulted with Inta Sloman, Providence's Privacy, Access and Information Manager, to assist in answering some of your questions.
Question 1:
pg. 2 - You state that "Your complaint letter only spoke of your concern about inappropriate access by or disclosure of your personal health information to other care providers or employees..." This is incorrect. I asked "I want to know exactly who has access to any and all of my records....". There were no limitations. So, I want to know if anyone else has access to a person's records. Perhaps this boils down to what is included in other care providers. Does that include everyone who is not an employee who has access to personal information (such as computer technicians, etc.)?
Response:
When I, and Providence, use the term access we refer to lawful access. Lawful access refers to the situation when an individual is authorized to access (look at) patient health records in circumstances that are consistent with the 'Freedom of Information and Protection of Privacy Act (FIPPA). Providence has, in my opinion, implemented reasonable physical security and policies and procedures to prevent unlawful, unauthorized or inappropriate access to patient records. Who has lawful access? Only those individuals who require access to a patient's records to carry out their duties, whether that duty is medical care, file administration or converting paper records to digital format by scanning them, are authorized to access a patient's records. Providence's policy on access may be defined as a need to know policy, meaning if you do not need to know the information you have no right to be looking at it (or accessing it). According to Providence, this policy is strictly enforced and continually reinforced with everyone who works or volunteers at their hospitals.
Given my findings that Providence has implemented reasonable policies to prevent unauthorized access, this is not an issue I will investigate further.
Providence allows only employees to have access to patient records. An employee refers to people employed by the hospital, medical personnel with working privileges at the hospital and service providers (or contractors) who are providing services (for example, contracted food services). Health care providers would include all those people involved in a patients' care including nurses, social workers, doctors, specialists and physiotherapists. All these people are bound by Providence's policy and procedures and sign a pledge of confidentiality to indicate their understanding of the policy. Anyone working at the hospital under contract is contractually obliged to follow the same confidentiality policies as employees. The contract language provides for sanctions if the policy is breached.
Question 2:
pg. 2 - Paper Records - This does not seem to make sense. While not in use, patient records are stored in a locked file room in the basement of the hospital... The HRD does not store patient records other than those that are in transition between a unit and a storeroom. So who is storing the records?
Response:
If St. Josephs has a medical file on a person who is not in the hospital for medical care their file is in the basement storage. When a person needs medical care and is registered as a patient, the Health Records Department (HRD) is notified by the unit clerk. HRD then retrieves the file from the basement. The HRD may retain the file for a short while to update it and then they move it on to the unit where the patient is staying. When I said the HRD does not store records, I meant they do not provide long term storage of files in their offices. The files are only in the HRD offices long enough to prepare them for either the ward unit or the basement storage room as they move from storage to the unit and back again. That process is changing as records become electronic.
Question 3:
pg. 2 - last paragraph - During a patient's stay the health records are accessed by health care providers - Who do you define as health care providers.
Response:
Health Care Providers are people who provide direct health care to a patient. Nurses and Doctors, any specialists or therapist who might also be involved. Anyone who provides care would likely need to know what care has already been provided. They would also need to document the care they have provided. If a patient has requested spiritual or pastoral care then they would be included as one of that patient's care providers. Providence has a need to know policy. Therefore, a care provider who is not providing care to a patient has no right to look at the patient's records.
Question 4:
pg. 3 - It is 'my understanding' that once paper records have been scanned the scanning... Was this not confirmed by Providence Health Care?
Response:
As part of my original conversation with Providence we talked about the conversion of paper files to electronic files in the context of a file's movement from secure storage to unit clerk when a patient is admitted. At the time, Providence confirmed the process in a general way and that was sufficient for my investigation. For your information, Providence has stated that, during the start-up phase of this program, scanned records are being held back from destruction until consultations with the Ministry of Health are complete. Providence expects to soon implement their policy that requires scanned records to be shredded 60 days later.
Question 5:
pg. 3 - Health records are stored in the clinic on shelves.... Who attends to these files and are they ever left unattended?
Response:
According to Providence, during office hours clinic staff monitor these files. Outside office hours the clinic is closed and locked.
Question 6:
pg. 3 - paragragh 5 - At this time...cannot be accessed by another Providence employee.... They cannot be accessed by any doctor.... Are they plans to change this?
Response:
Yes. There are national and provincial initiatives to create electronic health records that can be accessed remotely by authorized individuals. I do not know what the security protocols will be. Eventually, for example, a BC resident requiring medical attention in Ontario will be able to access their medical records via computer.
Question 7:
pg. 3 - Pastoral care providers and hospital social workers are also provided with geographic access when a patient requests their services. If pastoral care is being provided to someone in the renal unit the pastoral care provider will have access to the records for patients in the renal unit. The narrowest profile available is by individual unit.
I object to pastoral care providers and hospital social workers having access to the records of patients who do not request them. I suggest the hospital provide an individual profile. I know this can be done with computers because Revenue Canada does it; I also know that you can even restrict people to certain information, for example a pastor could enter an ID number and the only information that would appear is the names of those patients who requested their services; lots of different programs do this. I don't see why these people should get preferential treatment. Or, if someone wants pastoral care, they or their families could call the appropriate church and request it.
Response:
Providence is a Catholic organization which has the legal right to provide spiritual or pastoral care in their hospitals. Every patient, however, also has the right to refuse spiritual care if they desire.
Again, I refer back to my discussion about the term access. In this context the term access refers to lawful access, that is, being authorized to look at the files. If a pastoral care provider reads a file they did not have a need to see, that is, they accessed the file inappropriately, they would be subject to sanctions outlined in either the policy or their contracts.
As you know, the electronic patient record system includes the ability to audit access so if there was a concern an electronic trail of who had access could be viewed. Ms. Sloman has informed me that the audit system is being updated to a pro-active system that will notify the proper authorities in real time if an electronic record is accessed by an unauthorized individual. If you enquire, Providence may be able to explain to you why individual profiles are not provided. This is not an issue I will investigate further.
Question 8:
pg. 4 - 1st paragraph- Again, my question was not limited to employees or service providers. In fact, service providers is a very vague term. Who are the service providers and why would they need access to an individual's information. Is a service provider the same as a care provider?
Response:
Sorry if I am mixing my use of the terms care provider and service provider. A more descriptive term for care provider is health care provider. Generally, I may use the term employee when referring to employees and service providers. Employees are those who are employed by the hospital in the typical sense of the word. Nurses, nurses aides and clerks for example, who are hired and paid by the hospital and have an employment relationship with the hospital as their employer. When I refer to service providers I refer to people who may work for a company which has a contract with the hospital and who are directly employed by the contractor rather than the hospital. In some cases a service provider could also be a single person with a contractual relationship with the hospital. Common examples of service providers might be janitorial services, food services, communication services, security services and perhaps some kinds of specialized medical services. As I noted above, contracted service providers are subject to contractual language which requires that they maintain a high level of confidentiality when working with hospital records, including patient records. A care provider would be someone who provides some kind of health care. They could be an employee, a service provider or a volunteer.
Question 9:
pg. 4 - Again, it states "The Act permits the disclosure of personal information to an employee or service provider of a public body if it is necessary for those individuals to carry out their duties. It is not necessary for pastors, etc. to have access to the information of people who have not requested their services.
Response:
If a patient does not want pastoral care, their personal information will not be disclosed to a pastor or spiritual care provider. Pastors are not permitted to access the personal information of patients who do not want pastoral care.
Question 10:
pg. 4 - last paragraph - Do contractors, volunteers, researchers, etc. also have access to personal medical files? If so, why? (This may be the same question as the paragraph above). What is the process for screening volunteers, etc. who may have access to personal medical files? Obviously, people, such as volunteers, have nothing to lose by breaking a confidentiality pledge.
For that matter, what is the process for screening pastoral care providers.
Response:
The need to know policy means only those who need to know can look at a patient's personal information. I am not sure what you mean by screening. If you mean what procedures do volunteers or pastoral care providers go through to ensure they are aware of the confidentiality policies and procedures, they go through the same procedures as employees and service providers and sign a confidentiality pledge. As I noted above, people under contract are subject to contractual obligations to maintain confidentiality and report privacy breaches.
Question 11:
pg. 4 - last paragraph - re hiring a Privacy, Access and Information Manager Is this more than a name change?
Response:
This Manager is a new person hired by Providence to take on the responsibility previously covered by the Vice President of Human Resources. This is a management position.
Question 12:
1. pg. 4 - last paragraph - you state that "The Privacy, Access and Information Manager will take part in the new employee orientation". Does this also apply to contractors, volunteers, etc. (this may be included in the question above)? It would appear from my experience that current employees also need training in privacy rights and legislation. I also know that many people sign forms indicating their understanding without having even read the appropriate material much less understanding it and how it affects their particular obligations. So, telling me that people are required to read Providence Health Care's very general and vague Confidentiality/Access to Information Policy does not give me comfort that my rights will be protected.
Response:
Yes, see above answers about service providers contracts. According to Ms. Sloman, there is an ongoing process of education with both the new workers and the existing workers with respect to privacy obligations and rights.
Question 13:
pg. 5 - first paragragh - employees have a responsibility to report a breach of confidentiality - what about contractors, volunteers, etc.
Response:
Contractors and volunteers are contractually obliged to report breaches.
Question 14:
pg. 5- first paragraph - "...that a breach of confidentiality has occurred, the employee(s) involved may be subject to disciplinary action up to and including dismissal". Again, what action is taken against contractors, volunteers, etc.
Response:
According to Providence, there are provisions in each contract regarding privacy and the sanctions possible if the contractor breaches confidentiality.
Question 15:
Is the breach of confidentiality reported to the patient so they have the option to lay charges against the person involved or even the hospital since the hospital is responsible for the actions of the people they authorize or is the breach of confidentiality hidden?
Response:
Breaches of this type are reported to our office. The public body's analysis of the breach will determine if the individual whose information was disclosed need to be notified. We have more information on privacy breaches on our website at http://www.oipc.bc.ca/. Follow the Government and Public Bodies link under the Public Sector graphic.
Question 16:
pg. 5 - "Obtain or access only enough information that is necessary for performing your job duties". I fail to see how Providence Health Care is ensuring this if, for example, they allow pastoral care providers/volunteers, etc. access to every patients complete information. Obviously, they don't need that much information. In fact, pastoral care providers would need, at most, the names of those who chose their services.
Response:
Providence does not allow care providers and others access to every patients' complete information. See above answers for more information.
Question 17:
pg. 5 - again the statement "Providence has implemented and maintains a need to know policy with respect to access to or disclosure of patient information seems to conflict with the statement that people have access to all patients complete information on a unit". Same with the statement "pastoral care providers are not permitted to access or view a patients personal information if that patient has declined their services". How do they know which patients have requested their services and how do they access that information without seeing other people's information.
Response:
The pastoral care provider would be told who has requested his or her service. Patient records are kept separate from each other. If a pastoral care provider had permission to access a patient's record they would not need to flip through another patient's records to find what he or she was looking for.
Question 18:
According to Providence Health Care (stated on a sign posted at the hospital) a person's personal information can be used to support research as outlined under S35 of FOIPPA. Please explain why and how a person's information is used.
Response:
If information is disclosed to research a number of conditions set down in s. 35 of FIPPA have to be met. This includes rendering the information anonymous as soon as possible. Please contact Mount Saint Joseph's Hospital if you require more information about research projects they support.
Question 19:
Also stated on a sign at St. Joe's is:
Please note that the following questions will be asked by the admitting staff:
(1) Do you want callers or visitors to know of your presence here in the hospital and of general conditions?
NOTE: A NO response applies to all callers and visitors including all your family members, friends and florists.
Question: Does this mean that if I chose not to have pastoral services that their NO response will be activated and no information will be given to anyone?
Response:
According to Ms. Sloman, the answer is no.
Question 20:
Has Providence Health Care confirmed that the information in your letter is accurate.
Response:
Yes. I often provide public bodies with a draft copy containing the facts I have gathered so they have a chance to review and comment on the accuracy of my facts. I spoke with Ms. Sloman about my answers in this letter to confirm their accuracy and completeness.
Question 21:
I've also heard that you recently got powers to take information from people/organizations that were not being cooperative. Is that what happened here?
Response:
I'm not aware that our office has received any new powers. Under various provisions of the Freedom of Information and Protection of Privacy Act the Commissioner has certain powers. One of them is the power to require any record to be produced by a public body to the Commissioner (see s.44). Providence was always cooperative, no legislative powers were enforced to carry out my investigation.
If you have any further questions about Providence's privacy policies or how they collect, use and disclose patient information please call Inta Sloman, Providence's Leader Privacy, Access and Information, on her direct line at (604)806-8336. Our file is now closed."
Comment:
You may have noticed that several of the answers were non-answers. That is to say, words were put on paper but they did not answer the question.
February 18, 2007
Letter to Ina Sloman.
"Again I ask, who exactly has access to personal/medical information? Who exactly are the service providers, ie specifically are they vendors, if so, what do they sell, are they janitors, etc. and why and how much access do they have to personal/medical information? When I refer to access I refer to being able to obtain information because there is no physical obstacle.
'Providence's policy on access may be defined as a 'need to know' policy, meaning if you do not need to know the information you have no right to be looking at it (or accessing it)', [letter from Privacy Commissioner's office dated 1/22/2007 herein referred to as letter 2]. 'According to Providence, this policy is strictly enforced', [letter2]. How do you enforce this if the lowest profile available is by individual unit (ie floor) [letter from Privacy Commissioner's office dated 12/1/06 herein referred to as letter 1]?
The same question with regard to care provider, second paragraph. 'A care provider who is not providing care to a patient has no right to look at the patient's records' [letter 2]. How do you know whose records they have accessed and how much information they have seen?
I would like to know why individual profiles are not provided.
'..the audit system is being updated to a pro-active system that will notify the proper authorities in real time if an electronic record is accessed by an unauthorized individual' [letter 2]. When will this happen? How does this operate, ie. how would you know if an unauthorized individual accessed an electronic record; what does an electronic record consist of, ie how much information - all the person's information, or part, etc.?
'If a patient does not want pastoral care, their personal information will not be disclosed to a pastor or spiritual care provider. Pastors are not permitted to access the personal information of patients who do not want pastoral care', [letter 2]. Again, how do you stop them; when they access the computer on a floor, how do they know who they are looking for, or access who they are looking for without seeing other people's information? 'The pastoral care provider would be told who has requested his or her service', [letter 2]. In which case, why do they even need to access people's information?
Why do volunteers need to access personal information? Why do contracted food services need access to personal information, is the access limited to specific personnel, and how do you know how much information they have accessed?
What is the process for screening volunteers, pastors, service providers, etc. to ensure that they do not have a criminal, or other inappropriate, background?
I understand that you will take part in the new employee orientation regarding privacy. Does this also apply to contractors, volunteers, pastors, etc.?
'...that a breach of confidentiality has occurred, the employee(s) involved may be subject to disciplinary action up to and including dismissal' [letter 1]. What sanctions could you apply against a pastor or volunteer that would discourage them from breaching confidentiality?
I would like to know which research projects you support and who is involved, ie which organizations and companies?"
March 7, 2007
Response from Ms. Sloman:
"I would like to acknowledge receipt of your letter, which is dated February 18, 2007. I would also like to acknowledge that I have reviewed the findings of the OIPC as contained in their letter to you of December 1, 2006. It is my understanding that a full investigation was completed and the file is now closed.
The investigation concluded that St. Paul's has made reasonable security arrangements to protect personal information and has reasonable procedures in place to ensure that personal information is disclosed in an appropriate manner.
The questions that you are raising in your letter relate to questions around the specifics of the current and future auditing systems, screening of volunteers, etc., our orientation program, specifics about how we would deal with a pastor or volunteer re breach of confidentiality, and which research projects we support and who is involved.
With respect to the following questions, these are outside my job duties and I would direct/advise you as follows:
Auditing/IT compliance questions: Information Technology Department
IMIS
Vancouver Coastal Health
(IT is a shared function led by VCH)
Screening for volunteers, pastors, etc. Providence Health Care Human Resources
Research Projects: Not possible to provide this information
With respect to how we would deal with a breach of confidentiality situation; this is totally dependent on the circumstances of the breach. We would follow sound labour relations practice and the sanction would be commensurate with the seriousness of the breach.
Finally, with regard to the new orientation program, this is being developed and the specifics have not been determined yet.
You have asked some further questions around access and these were answered through the investigation process conducted by the OIPC."
Comments:
Two pages that didn't provide a single answer. I certainly feel that the change in personnel was a name change only.
May 5, 2007
Letter to Ms. Sloman:
"In a letter from Ms. Sachedina, dated May 2, 2007 (actually dated 2006 in error), then responsible for privacy issues, she stated that only one person had accessed my records. This was not the question asked but I do have questions with the response.
1. Why did Ms. Schindell, Director of Patient Relations, access my records on December 9, 2005? Ms. Sachedina said that it was in response to my initial complaint, but that complaint was laid March 1, 2005. Why would she be accessing my records nine months later?
2. Ms. Sachedina complained, as late as January 2006, that I would not give her (unconditional) permission to access my records to determine the name of the admitting clerk. Yet, the name of the admitting clerk was not identified on the record. And Ms. Schindell went ahead and accessed my records without my knowledge, much less my permission. Please explain.
3. Why was Ms. Schindell identified as patient representative under occupation of user? She obviously wasn't representing me.
4. I also had an outpatient procedure on February 18, 2005. Was no one required to access my records at that time?
5. Between January 6 and 19, 2006 illegally collected information was removed from my records. Did no one have to access my records to remove the information?"
May 8, 2007
Letter to Human Resources, Providence Health Care
"According to Providence Health Care, volunteers and pastors are allowed access to patient information in the database. Do you screen volunteers and pastors, ie. do you check to see if they have a criminal background, do you check that the pastors claim to work for a church is true, before they are allowed to access patients confidential information, etc."
May 8, 2007
Letter to Information Technology. IMIS, Vancouver Coastal Health.
"I understand that IT is a shared function with Providence Health Care. Ms. Sloman, Leader, Access, Information and Privacy, Providence Health Care told me to contact you regarding the following questions.
Ms. Sloman had stated:' ..the audit system is being updated to a pro-active system that will notify the proper authorities in real time if an electronic record is accessed by an unauthorized individual' [letter 2].
My questions:
1. When will this happen?
2. How does this operate, ie. how would you know if an unauthorized individual accessed an electonic record?
3. What will be the lowest level of access, ie. a unit, an individual, sections of an individual's records?
3. What does an electronic record consist of, ie how much information all the person's information, or part, etc.?"
MAY 8 (or 9), 2007
Phone call from Inta Sloman, Providence Health Care
"Good morning, it's Inta Sloman, from Providence Health Care. I am the Leader of Access, Information and Privacy. I'm calling about your latest letter and I'm just wondering if it might be better if I met with you in person and got a feel for really what your issues are and I'm just thinking it may be better to talk in person and get a sense for what exactly you are looking for and perhaps how I could help you. So, if you could call me back, my phone number is 604-806-8336, and just let me know what you think of this proposal. Otherwise I most certainly can reply to your letter in writing but my thought is it might be an idea to meet in person. So give me a call either way. Thanks, bye"
MAY 12, 2007
Letter to Into Sloman
"I have no doubt that you would like to meet in person. We would no doubt be on your turf, behind closed doors, no openness, no transparency, you could say anything and, later, deny everything.
You are stating that after more than two years of correspondence you don't have an understanding of “my issues”. If the questions “who specifically has access to personal/medical information”, “why did Ms. Schindell access my records”, are “too complex” for you, then perhaps you need a different job, one that is less “challenging”.
Also, I did not give you my phone number nor did I give you permission to call me. I know I have said this before, but now it's in writing, you and everyone in your organization will contact me only in writing."
May 18, 2007
Letter from Inta Sloman, Leader, Access, Information and Privacy.
“As per your wishes, we will only communicate in writing. However, I truly regret your rejection on my offer to meet to see whether or not we might be able to resolve your questions, issues, and concerns.
Accordingly, the following is Providence's response to the questions raised in your letter of May 8th.
With respect to your questions (one through five) the following is our response:
QUESTIONS ONE AND TWO: I have spoken to Ms. Schindell and from her recollection, she would probably have had a brief scan of your records in response to medical staff letting her know that you were expressing concerns. At an early stage in a possible complaint to come, she would have checked to see if you were an inpatient or outpatient or discharged, etc. This type of scan by Ms. Schindell occurs regularly throughout her work-day.
As a Director of Patient Relations, it is Ms. Schindell's job role to ensure that client complaints and concerns are addressed. Accordingly, she would have looked at your records as a proactive measure to a formal complaint by you.
In summary, her access to your records was done on the basis that St. Paul's takes all complaints seriously, and she was exercising due diligence with respect to her job duties. Under the law (FOIPPA), this is allowed as complaint investigation and management is a quality assurance function, which is permitted under the legislation.
QUESTION THREE: The title Patient Representative is no longer used within this organization. The Director of Patient Relations represents Providence Health Care and deals with the complaints, concerns, commendations and inquiries concerning patient care that are presented by physicians, leaders, staff, patients and families.
QUESTIONS FOUR AND FIVE: In response to these questions, I will be making enquirires and will get back to you as soon as is possible with answers.
On behalf of Providence Health Care, I would like to wish you the best.”
Comments:
I have no doubt Ms. Sloman regrets my rejection of her offer to meet. Since she refuses to answer the questions, I have no doubt that the purpose of the meeting would be to sweep this “problem” under the carpet and get rid of me. But, of course, she doesn't want that in writing, she doesn't want the general public to know. Also, lies can't be proven to have been said because they wouldn't be writing.
Again, Providence Health Care doesn't answer the question. Ms. Sloman has “conveniently” ignored several things that I had specifically pointed out. For example, she states that Ms. Schindell “...had a brief scan of “my” records...you were expressing concerns”, “at an early stage of a possible complaint to come, she would have checked”, but, as I pointed out, my records were accessed nine months after I expressed concern, after I laid a complaint. At this time, the only thing happening was that the OIPC report on this complaint was in the final stages of review.
Also, her letter states that Ms. Schindell would have accessed my records “in response to medical staff letting her know that you were expressing concerns.” I didn't talk to medical staff, other than the admitting clerk (nine months earlier) and Ms. Sachedina, who is a lawyer not medical staff.
And, why would Ms. Schindell be accessing the information when the responses were coming from Ms.Sachedina and Ms. Sloman.
Ms. Sloman states “as Director of Patient Relations, it is Ms. Schindell's job role to ensure that client complaints and concerns are addressed.” Providence Health Care refused to respond to my complaint until they were contacted by the OIPC. Again, Ms. Schindell never addressed any of my concerns; I hadn't heard of her until I read my record. And many questions are still unanswered.
Ms. Sloman also states “that St. Paul's takes all complaints seriously”. Apparently, so seriously that she doesn't even have the right hospital; my complaint was laid against Mount St. Joseph.
Also stated in her letter “complaint investigation and management is a quality assurance function”. Then I guess we are assured of low quality in our hospitals that Providence Health Care manages.
I have better things to do than meet with Providence Health Care (note that I did not say Ms. Sloman because she did not specify who or how many people would be involved) and listen to their verbal bullshit.
May 30, 2007
Letter from Ms. Sloman.
“Further to my most recent letter, I indicated that I would be providing you with further information with respect to questions four and five of your letter dated May 8, 2007.
You are requesting information (not records) so, accordingly I am providing you with two contact names who you may get in touch with to obtain the information you require.
With regard to question four – Ms. Debbie Kwan, Professional Practice Leader, Health Records Services (604-806-9288) will help.
With regard to question five – Ms. Vicki Johnson, Leader, Client Registration and Information Services, (604-806-8198) can be of assistance.”
Comments
Again, Ms. Sloman falls back on the difference between requesting information and a record. And Ms. Sloman is not concerned that people, who apparently should have left an audit trail, haven't.
As stated Dec 1, 2006, by OIPC, “Prior to April 1, 2006 ....While on the unit the paper health records required every health care provider to log each entry so the person who made the entry could be identified”. Yet, the admissions clerk, who entered information into my health record, is not identifiable.
Letter of Dec. 1, 2006 states, “When an individual visits an out-patient clinic they usually get same day treatment or treatment over a number of days without staying overnight. Out-patient clinics keep records for every visit by a patient.” And yet, apparently, no one made any record of my visit on Feb. 18, 2005.
Letter dated Jan. 22, 2007, OIPC - "As you know, the electronic patient record system includes the ability to audit access so if there was a concern an electronic trail of who had access could be viewed". Yet, the person who accessed my file to remove the illegal information is not identifiable.
June 13, 2007
Letter to Debbie Kwan, Professional Practice Leader, Health Records Services, Providence Health Care
“I was referred to you by Ms. Sloman. I received a copy of the audit of my electronic health records as at February 28, 2006. The only name showing on the audit was Ms. Schindell when she accessed my records in December of 2005. I was registered at Mount St. Joseph on February 18, 2005. Why isn't the name of the registration clerk, who would have entered my information, shown. Also, I had an outpatient procedure on February 18, 2005, at Mount St. Joseph. Was no one required to access my records at that time?
Please note that I only accept responses in writing.”
Letter to Vicki Johnson, Client Registration and Information Services, Providence Health Care
"I was referred to you by Ms. Sloman. I received a copy of the audit of my electronic health records as at February 28, 2006. The only name showing on the audit was Ms. Schindell when she accessed my records in December of 2005. But, I was registered at Mount St. Joseph on February 18, 2005. Why isn't the name of the registration clerk, who would have entered my information, shown. Also, between January 6 and 19, 2006 illegally collected information was removed from my records. Did no one have to access my records to remove the information?
Please note that I only accept responses in writing.”
Comments
You may note that I have not yet received a response from Information Technology. IMIS, Vancouver Coastal Health or Human Resources, Providence Health Care (both dated May 8, 2007), the last referrals
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