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Censure and fine for inappropriate access to clinical records.

A registered nurse (RN), "Mrs L", who inappropriately accessed the electronic clinical records of nine different people on 19 different occasions between January and September 2011, has been censured and fined $6000.

At a hearing in May 2014, the Health Practitioners Disciplinary Tribunal found L guilty of professional misconduct, the charge brought by a Professional Conduct Committee (PCC). She accepted her conduct amounted to professional misconduct warranting a disciplinary sanction. "If is a serious breach of the privilege nurses are given to access patient medical records, to do so other than for the proper care of patients. It is also clearly a matter of community expectation that such conduct amounts to professional misconduct," the tribunal stated.

The tribunal heard from a number of witnesses about the distress they felt because of the inappropriate access to their clinical records. Mrs Y and Mr Y, whose records had been accessed, both worked at the same district health board (DHB) as L. Mrs Y began work in the same department in 2005 and reported directly to L, who was the charge nurse. In 2007, Mr Y also started work at the DHB and was L's line manager for operational issues. There was a difficult working relationship between L and Mr and Mrs Y, which had become particularly difficult during 2011.

Between January and September 2011, L began accessing the laboratory and radiology results of Mrs and Mr Y, their two daughters and five other patients with the same surname. She accessed these records on 19 different occasions, nine of which were on September 1, 2014. L submitted that on that day she had a "meltdown" of stress related to the on-going employment issues with Mr and Mrs Y.

In early November 2011, L attended a training session on the DHB's electronic patient records system and learned it was possible to track who had accessed patient records. Later that month, she told her line manager she had accessed the laboratory test results of Mrs Y and her family.

Apology offered

In her evidence, L offered an apology to Mr and Mrs Y and their family, and accepted she had no right to access their patient records and that it was breach of their privacy. She found it difficult to explain her actions and said they were "totally aberrational" and believed they were the result of significant workplace stress, accumulated over five years.

A report prepared by "Dr S" for the tribunal on behalf of L, stated the risk of any further behavioural acting out was extremely low. Her degree of insight and the shame and remorse she expressed was highly congruent.

In considering penalty, the tribunal said aggravating features included access on 19 separate occasions; that L was a highly experienced charge nurse who knew what she was doing was a violation of patients' rights to privacy; and she had abused the high level of trust placed in her as an RN not to access patient records for an unauthorised purpose.

Psychological distress

Mitigating features included that L reported her misconduct to her employer and was subsequently honest and forthright with the DHB and the PCC; she was under a high level of psychological distress at the time of the offending, which was out of character for this otherwise highly regarded charge nurse; she had expressed a high level of regret and remorse; she had already suffered serious consequences; and there was no evidence she disclosed patient information or had any malicious intent to misuse it.

In its penalty decision in August 2014, the tribunal censured L and fined her $6000. She was also ordered to pay costs of $11,422. She was required to provide any employer with a summary of the tribunal's decision.

The tribunal prohibited the publication of L's name and any particulars that might identify her; health details relating to L and the patients whose records she accessed; the names of tribunal witnesses; and the names of patients whose records were accessed.

The tribunal ordered that a copy of its decision and a summary be posted on the tribunal's website (www.hpdt.org.nz) and a notice stating the effect of its decision be published in Kai Tiaki Nursing New Zealand and the Nursing Council's newsletter News Update. The decision number is 640/Nurl3/266P.
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Title Annotation:disciplinary notices
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Dec 1, 2014
Words:715
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