Avoiding Abandoned Patient Records
After being with this office for more than 21 years, I had hoped that we had finished hearing about abandoned patient records. While there should never be a circumstance where patient records containing the personal health information of individuals are abandoned, such instances unfortunately continue to occur. There was a big push years ago to come up with strategies to address this problem, including the Ministry of Health (Ministry) establishing the Health Records Protection Working Group that released 11 recommendations. [1] Unfortunately, and shockingly, the problem persists.
Trustees have clear responsibilities to protect and appropriately collect, use and disclose personal health information under their custody or control, subsection 22(1) of The Health Information Protection Act (HIPA). That section of the Act clearly states that those duties continue to apply to a former trustee until they transfer custody and control of the personal health information to another trustee or to an information management service provider that is a designated archive. Various events including retirement, relocation, leaving the profession, termination of employment, bankruptcy, incapacity and death can result in situations where the obligations of the former trustee are legally mandated to continue until proper transfer of custody and control – but this is not always the case.
When the OIPC receives complaints regarding abandoned patient records, our primary concern is to ensure the records are secure while we investigate to determine where responsibility lies. In the event the responsible party is out of our reach, and depending on the circumstances, we may turn to the Ministry or other health stakeholders (e.g., appropriate health regulatory body or the Saskatchewan Health Authority) for assistance.
In a recent case involving abandoned personal care home records left behind at a spot that had been vacated, we worked with the Partnership, Privacy and Legislative Services branch of the Ministry. The personal care home in question, the former trustee, had ceased operating. Boxes of abandoned patient records were discovered after the home was closed. In this particular case, to ensure the protection, management and eventual disposal of the records of the patients of the former trustee, the Ministry requested a Minister’s Order under subsection 22(2) of HIPA to appoint a third party to act in the place of the former trustee. The Minister’s Order was required to legally transfer the personal health information in the records found on the premises to the third party or to an information management service provider that is a designed archive. The wording of section 22(2) of HIPA is as follows:
22(2) Where a former trustee fails to carry out the duties continued pursuant to subsection (1), the minister may appoint a person or body to act in place of the former trustee until custody and control of the personal health information is transferred to another trustee or to an information management service provider that is a designated archive.
Why do trustees abandon the health care records of the people who have placed their trust in them? There is no single answer to this problem. The best we can do is to focus on solutions. Our primary goal should be to ensure that there are effective processes in place to prevent records from becoming abandoned. Such processes should include trustees and their staff being educated to have a clear understanding of their responsibilities and legal obligations as a trustee. Trustees need to understand that those responsibilities do not end when they cease to be a trustee.
Having a succession plan in place in the event of unforeseen changes in circumstances also goes a long way in preventing abandoned patient records. That succession plan should clearly identify what will happen to personal health information of patients which will ensure ongoing security of those records and a process for patients to gain access to their records up until those records are up for destruction.
As noted as far back as 2017, our office has been providing the following guidance to those closing a practice, which is still relevant:
- If you have not done so already, create an inventory of all records (paper and digital) in your custody or control;
- If you do not have one, create a record retention/disposition schedule for all records;
- Custody or control of patient records must be clearly established before taking action;
- Before transferring patient records, enter into a written agreement with the successor trustee or IMSP (that is a designated archive, see HIPA Regs s. 4);
- Ensure that any multi-function devices that may contain personal health information are sufficiently wiped/erased or hard drives are destroyed;
- Provide advance, adequate notice (letters to patients, notice on doors, voicemail message and details in the newspaper and/or online) to patients and others to prevent personal health information from becoming misdirected;
- Securely transfer patient records; and
- Leave no records behind including securely destroying any records that are up for disposition.
If a member of a regulated profession, the trustee can also seek advice from its health professional body which also happens to be prescribed as designated archives in the HIPA Regs. Or, at any time, you may reach out to our office for further advice.
[1] Health Records Protection Report April 2014, Report of Saskatchewan’s Records Protection Working Group to the Deputy Minister of Health