PATIENT CONFIDENTIALITY: LOST AND FOUND


BACKGROUND An MDDUS adviser receives a distressed call from a Dr B who is a community paediatric specialist registrar. She has been summoned to a disciplinary hearing of her employing foundation hospital trust to answer to an allegation of breached patient confidentiality. A data stick belonging to Dr B had been


found by a cleaner in a local health centre and had been returned to the director of postgraduate training. On the unencrypted data stick were a number of named patient assessments with details of a highly confidential nature. On being confronted, Dr B admitted that


she had first suspected the USB stick might be missing a week before it was found. But she had been convinced the stick was somewhere in her flat and would “eventually turn up”. Only after four or five days had Dr B begun to grow increasingly worried and decided to look for it in a few “logical” places, including the health centre, before reporting it missing. A letter from the trust confirms that Dr B


had been made aware of the trust’s security policy and had attended an induction session where it was made explicit that personal


data keys were prohibited items for use in storing patient data. In the same session it was made clear that any loss of confidential data must be reported immediately to the trust and an educational supervisor.


ANALYSIS/OUTCOME The MDDUS adviser accompanies Dr B to the disciplinary hearing where a number of issues are raised. Evidence is provided that Dr B failed to maintain the security of the information on the stick by having it encrypted with password protection and failed to ensure that the disk itself was kept in a safe place. But even more fundamental she breached trust policy in the first place by using a personal USB stick to store highly confidential information. In addition Dr B did not report the stick missing until after it was found by the cleaner. Dr B is found to be in serious breach of trust policies and procedures in relation to


patient confidentiality and data security. She is issued with a final


written warning and is subject to additional supervision in regard to issues of probity and patient confidentiality. The matter is also referred to the GMC and


two case examiners conduct an investigation resulting in a formal Rule 11 warning from the regulator.


KEY POINTS


● Ensure you know and follow the data security policy and procedures of your employing trust or health authority.


● Use only authorised encrypted USB drives or other devices to store


confidential patient information.


● Authorised USB data devices should in general only be used on an exceptional


basis where it is essential to store or temporarily transfer data.


CLINICAL NEGLIGENCE: HARD TO SWALLOW


BACKGROUND: A 32-year-old patient, Miss D, undergoes root canal treatment from her dentist, Mr F. During the procedure Mr F drops a small metal instrument which slips down the patient’s throat. He finishes the root treatment and then immediately refers Miss D to hospital with a note explaining what has happened. At the hospital, the patient undergoes


exploratory procedures under general anaesthetic and X-rays and the instrument is finally found in her abdomen. She spends the night under observation in hospital and is discharged the next day under instructions to stay at home until the instrument passes from her system. She is off sick from work for a week and eventually passes the instrument several days after she swallowed it. Mr F receives a letter of complaint from Miss D who accuses him of negligence for


WINTER 2012


failing to prevent her from swallowing the instrument. She intends to make a claim for compensation for loss of earnings and other out-of-pocket expenses related to her hospital stay.


ANALYSIS/OUTCOME: Mr F contacts MDDUS for help after receiving the letter of complaint. When asked by an adviser, the dentist admits that he did not use rubber


dam. On that basis, the adviser concludes that the situation is indefensible and seeks to reach an agreement with the patient over compensation. Following discussions, a modest settlement is agreed to cover loss of earnings and expenses but no admission of liability is accepted on behalf of Mr F.


KEY POINTS


● Always use rubber dam when carrying out root treatment to avoid swallowing of dental instruments.


● If a dental instrument is swallowed, or if you suspect an instrument has been


swallowed, immediately refer the patient for hospital treatment with a letter explaining the situation.


● Make a clear note of the incident in the patient’s records, outlining the treatment


given and whether a referral was made. 21


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