Posts Tagged confidentiality

Having a Mental Illness Makes You a Security Risk

This is just disturbing:

When Lois Kamenitz arrived at Pearson International Airport in November, hoping to board a flight to California, she was stunned to learn that U.S. border officials were barring her entry. The reason: Years ago, she attempted suicide.

The 64 year-old Toronto woman was fingerprinted and photographed. She questioned the U.S. Customs and Border Protection officer about how he accessed her medical records. He said he didn’t. Instead, he knew police had attended her Toronto home in 2006 because she had done “violence to self.”

[snip]

How and why her personal information was passed to a foreign government is extremely troubling, say advocates for civil rights and the rights of psychiatric patients, who believe Kamenitz’s privacy rights were invaded.

It’s not an isolated incident, says Ryan Fritsch, legal counsel for the Psychiatric Patient Advocate Office. He has heard of about eight similar cases in the past year, all involving non-criminal contact between police and people with mental health issues — records of contact that end up at the Department of Homeland Security.

Considering 20% of Canadians will have a mental illness during their lifetime, the direct and indirect costs to the economy, and the stigmatization that presents a serious barrier to care and treatment, further demonization of the mentally ill by labelling them as a “security risk” hardly seems helpful to anyone. Supposing you suffered from depression, and your employer sent you across the border on a regular basis. Would you take the risk of disclosing your depression if it would end up in the hands of government agents who may or may not arbitrarily deem you a risk?

The confidentiality/privacy issue is a whole other matter. Suffice to say, you get the feeling any meaningful protection of personal information is probably a sham, and if you care about such things, you should disclose such information bearing that fact in mind.

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At Veterans Affairs, Confidentiality is Meaningless

This story has been bouncing around the last day or so, but the more I think about it, the more disturbing I find it:

Confidential medical and financial information belonging to an outspoken critic of Veterans Affairs, including part of a psychiatrist’s report, found its way into the briefing notes of a cabinet minister.

Highly personal information about Sean Bruyea was contained in a 13-page briefing note prepared by bureaucrats in 2006 for then minister Greg Thompson, a copy of which was obtained by The Canadian Press.

The note, with two annexes of detailed information, laid out in detail Bruyea’s medical and psychological condition.

[snip]

The privacy documents show 614 people within Veterans Affairs accessed Bruyea’s computer file between 2001 and 2010, records that are kept in a password-protected computer database. Of those, 156 exchanged varying amounts of personal information, according to a trail of internal emails.

The material appears to have been shared with an additional 243 individuals, including both Liberal and Conservative political staffers, through briefing notes and emails during the 2006 transition between governments. [Toronto Star]

In health care, there is a term of art  — “circle of care” — which describes the health care professionals directly involved with a patient’s treatment, and by implication, those who have direct access to confidential information related to her or his care. For example, if you are hospitalized, your circle of care would include your primary nurse, your physician, and maybe some others — the physiotherapist, perhaps, or the social worker. Generally speaking, you can’t access the health records of any person outside the circle of care without explicit written consent of the patient. Papers need to be signed and so on.

I understand Veterans Affairs might need to request access to confidential medical records to assess benefits and treatment. What I’m having difficulty with is imagining circumstances where a cabinet minister, hundreds of bureaucrats, three senior civil servants, and staffers and various other flaks should have access to confidential medical information without permission. How is the Minister of Veterans Affairs part of the circle of care? Or, for that matter, a staffer in the PMO?

It’s disgraceful enough that the health care information of any Canadian, let alone a veteran, was used for political purposes. But the real scandal is the safeguarding within Veterans Affairs to protect confidential medical records of veterans. Apparently, there isn’t any.

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About Anonymity, Confidentiality, and Fear

I wrote a post a few days ago about the family member of a patient threatening to report a colleague at another hospital to the College of Nurses of Ontario. In response, I received an email from a nurse in British Columbia who deleted her entire blog when it became apparent she had readers from government domains, including the College of Registered Nurses of British Columbia. She writes (I quote with permission):

Even though I have nothing incriminating on my blog, because I was aware of the “small world” thing that is Canada…..I didn’t trust  what I was seeing.   Perhaps I am paranoid.  Perhaps all it was, was someone interested in what I blogged about (some of the references were papers drawn up by the government itself)…..but since I value my income….and know what the CRNBC is capable of – witch hunting…..and if they ever decided to haul me in or whatever……I decided I would leave nothing to chance and deleted everything.   Just wanted to let you know – be very wary of who is doing what out there……  I don’t trust anyone out there in the government – or any governing body……and in my 30 years plus of nursing……I have seen a lot of what they can do…..

It is sad and disheartening to see yet another nurse-blogger take a dive because of feared retribution from someone in authority. Even sadder when our professional regulatory bodies — with some justice, I’m afraid — are viewed by the frontline as The Enemy. Is it good public policy when nurses self-censor themselves because they fear losing their licences?

I also appreciate the concern expressed in the email. I am the Queen of Paranoia myself. Rest assured, I have been very diligent in applying the principles outlined in my disclaimer. I am resolutely anonymous. I can count on one hand and have fingers to spare the number of people who know my true identity. And, I figured out a little while ago — like, I think, most health care bloggers eventually do — that the stories I share with you about my experiences in the Emergency Department aren’t actually about working in a hospital: they concern human beings, the good, the bad, and the funny — especially the funny. (I’m looking at you, Dr. Weanus.)

The point being, the importance isn’t in the details but in the narrative, the exposition of the human condition. So a lot gets changed, which protects patients (and myself) — but the essence always remains. I want cover my butt, you see, and continue to regale you with tales from the Other Side of the Bed Pan.

So I’m going to carry onwards and upwards, more fool me. Where angel fear to tread, and so on.

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What the Doc is Really Doing with his Blackberry

Ooops. For the record, no patient confidentiality was harmed in the creation of this blog.

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