Terminated from Residency - advice needed

[DaBears318]

Long time lurker but haven't posted much. Here is my story:

I was about to finish PGY2 Family Medicine Residency when I was terminated for a HIPAA/compliance violation. What occurred was, that I had contacted a patient via phone on a rotation (thinking the patient was mine) prior to an appointment with Occupational Medicine. We had a short discussion about medical history over the phone (what I had gleaned from EPIC). I quickly realized I had no business reason to speak to the patient, so I apologized. Conversation was over. Nonetheless the patient reported me to the hospital. HR was involved and after an investigation, terminated me for a violation of HIPAA, compliance issues and unauthorized disclosure of patient protected health information. I had not been in trouble before during residency. I am extremely upset and disheartened, and I knew I was taking a risk when calling a patient over the phone but it was an honest mistake.

I would like to continue with medicine of course, my dream is to be a primary care physician doing inpatient and outpatient medicine and ideally would like to work in the private practice setting. I have had no academic problems during residency and have passed all of my boards (1, 2 and 3 COMLEX) and have done well on in service examinations. The decision to terminate me was out of my PDs hands and we have a good relationship. He is willing to write LOR for me, as are several core faculty members and attendings. I was about to finish my PGY2 year. I am frantically searching for someone to take me as a 2nd year, but so far no luck. I am seriously considering several options: 1) apply through the match as a PGY1 2) continue searching for open PGY2 or possibly PGY3 spots or 3) leaving clinical medicine altogether and searching for an alternative career. Obviously option 3 is not as appealing to me and I am willing to redo residency elsewhere if needed. I have my permanent license in a neighboring state as they will give you one after PGY1 year, so I may be able to moonlight in that state in the meantime. I just do not know where to go from here or what my chances would be to even be accepted to another program. I want to give up but my wife and family are urging me not to. Any advice would be much appreciated. I obviously will need to remedy my mistake and I have already searched out compliance/HIPAA courses and training and possibly counseling. Thank you all for taking your time to read and reply to me.

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[IM2GI]

Geez that seems rather harsh. What led you to believe that it was your patient? All you did was call them and discuss their own personal medical history? How did the process play out through HR?

 

[AdmiralChz]

Yikes, this definitely seems harsh. So harsh that I wonder if this is the full story - no offense, but unless you severely violated HIPAA and shared the information with others (or did this with a highly VIP patient) then this seems a bit extreme. Is there any body you can appeal this decision to? Unfortunately, your options are very, very limited here with getting back into this program (and you seem accepting of that, which is positive).

If everything is in order as you say it is (scores, rotation evaluations and LORs), I think you should be able to find an open PGY-2 (even midway through the year, perhaps even a modified PGY-3 opening) at some program. I bet your PD and other faculty can ask around on your behalf at programs nearby. The good news here is most specialties average about a 5% attrition rate so openings are bound to occur, or they (meaning larger programs) may even be able to squeeze you in as an extra body (which is always helpful with call, rotation schedules etc). The bad news is that you might have to be rather flexible with geographics and this might require a significant move.

Definitely not the end of your clinical career, but be ready to discuss what happened at length with other programs. They'll want to ensure this won't happen again at their institution.

 

[IM2GI]

Yikes, this definitely seems harsh. So harsh that I wonder if this is the full story - no offense, but unless you severely violated HIPAA and shared the information with others (or did this with a highly VIP patient) then this seems a bit extreme. Is there any body you can appeal this decision to? Unfortunately, your options are very, very limited here with getting back into this program (and you seem accepting of that, which is positive).

If everything is in order as you say it is (scores, rotation evaluations and LORs), I think you should be able to find an open PGY-2 (even midway through the year, perhaps even a modified PGY-3 opening) at some program. I bet your PD and other faculty can ask around on your behalf at programs nearby. The good news here is most specialties average about a 5% attrition rate so openings are bound to occur, or they (meaning larger programs) may even be able to squeeze you in as an extra body (which is always helpful with call, rotation schedules etc). The bad news is that you might have to be rather flexible with geographics and this might require a significant move.

Definitely not the end of your clinical career, but be ready to discuss what happened at length with other programs. They'll want to ensure this won't happen again at their institution.

Yea the story does not add up. Im sure trivial stuff like this happens daily. Surely more to the story.

OP were you fired or your contract not renewed?

 

[ThoracicGuy]

Yea the story does not add up. Im sure trivial stuff like this happens daily. Surely more to the story.

OP were you fired or your contract not renewed?

I've seen hospital employees fired quickly for looking at VIP medical records during training, so I can see some hospitals out there taking a zero tolerance approach to any possible HIPAA violation. It sounds like the OP was fired on the spot as they are looking for an open PGY-2 year, though it is the norm for there to be more to the story that wasn't told in the beginning...

 

[Light at end of tunnel]

Maybe the good @SageRad might be able to weigh in, perhaps channeling some spousal input as well on an employment matter?

 

[IM2GI]

I've seen hospital employees fired quickly for looking at VIP medical records during training, so I can see some hospitals out there taking a zero tolerance approach to any possible HIPAA violation. It sounds like the OP was fired on the spot as they are looking for an open PGY-2 year, though it is the norm for there to be more to the story that wasn't told in the beginning...

It's one thing to intentionally look at a VIP chart.

If we are to believe OP, it sounds like he was pre-reading for clinic and just contacted the wrong patient? That is fairly harmless.

 

[ThoracicGuy]

It's one thing to intentionally look at a VIP chart.

If we are to believe OP, it sounds like he was pre-reading for clinic and just contacted the wrong patient? That is fairly harmless.

I agree. As described, I think it's an overreaction. I've seen hospitals overreact when it comes to HIPAA, though.

 

[SageRad]

Maybe the good @SageRad might be able to weigh in, perhaps channeling some spousal input as well on an employment matter?

My own appraisal was that, based solely on what was presented in the OP, the punishment was way too harsh for the crime. It seemed like an innocent mistake, the kind that gets made daily, with no harm and no foul. Who here has not picked up or opened the wrong chart?

That said, while my wife (employment attorney) agreed with me and the rest of us, she did say that if it is the policy of the organization for zero tolerance for HIPAA violations, HR may not have had any leeway or discretion in the matter. Perhaps they have had a high profile or costly HIPAA violation in the recent past, and now they have policies in place that are too aggressive on the punitive side.

Still, I cannot help but think that there is more to the story.

 

[Gastrapathy]

Couple questions?

Was the patient someone with a higher expectation of confidentiality (i.e. Public figure, hospital employee, etc)?

Why were you calling? Why did you think he/she was your patient? You aren't an occ med physician, are you on an occ med rotation?

Unintentional acquisition of information is not a breach if it occurs during your normal work. Breach Notification Rule
(So accidentally clicking on the wrong chart should not get you fired). I hope there is more to the story here.

 

[operaman]

" I knew I was taking a risk when calling a patient over the phone but it was an honest mistake"

Huh? I call patients all the time and I've never once even considered that I was taking a risk. This is what makes me think there's more to the story. I've even called VIPs, employees, etc., and never once felt I was taking any sort of a risk. That's just part of the job.

 

[Shikima]

HIPPO - Created by lawyers, for lawyers for an excuse on over interpretation of what it was intended.

 

[rokshana]

" I knew I was taking a risk when calling a patient over the phone but it was an honest mistake"

Huh? I call patients all the time and I've never once even considered that I was taking a risk. This is what makes me think there's more to the story. I've even called VIPs, employees, etc., and never once felt I was taking any sort of a risk. That's just part of the job.

i agree, especially in the outpatient setting, there are many times that calling the patient is needed to give results, to change medication,etc...heck i remember getting fussed at because i DIDN'T call a patient and give information to his wife!

 

[Perrotfish]

i agree, especially in the outpatient setting, there are many times that calling the patient is needed to give results, to change medication,etc...heck i remember getting fussed at because i DIDN'T call a patient and give information to his wife!

So for the OP this is obviously either only part of the story or an insane overreaction on the hospital's part, but there is a take home lesson here: confirm who the person on the other end of the phone is with a name AND a date of birth before you start giving medical information to them. The clerks and nurses do it, you can too.

 

[evilbooyaa]

I'm very confused as to how you call a patient that is not your responsibility. I am not a fan of calling patients so I would find every excuse to NOT have to call a patient and delegate that work elsewhere if I can.

I agree if this is the whole story it's an over-reaction to a 'zero tolerance' policy which is likely rarely, if ever, enforced.

So for the OP this is obviously either only part of the story or an insane overreaction on the hospital's part, but there is a take home lesson here: confirm who the person on the other end of the phone is with a name AND a date of birth before you start giving medical information to them. The clerks and nurses do it, you can too.

Sounds like the OP was talking to the patient directly, so this shouldn't be an issue. The issue is that OP had no reason to contact the patient.

 

[grapefruit17]

Seems ridiculously harsh for a mistake that was pretty minor...Im curious why the patient went out of his way to report you. It seems like most patients may be slightly annoyed but I'm not sure how many would take time out of their day to report it, unless something was said to upset them.

And you had a good record before this so, it seems crazy.

I also wonder how many residents get fired from your residency, if this is a common theme..I mean, I've read stories on here about people showing up drunk to rotations and getting fired, and I've heard rumors of others showing up intoxicated and only getting probation. Your punishment seems so severe compared to other stories.

 

[IM2GI]

OP posts thread, is still active reading SDN, and goes silent.

If you want advice, reply to some of our questions above.

 

[IM2GI]

I'm very confused as to how you call a patient that is not your responsibility. .

Do you not have an outpatient clinic? Those of us who see patients in a continuity clinic call them all the time...

 

[evilbooyaa]

Do you not have an outpatient clinic? Those of us who see patients in a continuity clinic call them all the time...

Re-reading what I posted, it wasn't clear what I meant. I meant that calling a patient who is not under my care. I'm confused as to how you call a patient who has not even been under your care.

 

[LucidSplash]

Perhaps I'm misreading the OP, and we definitely need clarification, but my reading is that the OP called a patient and disclosed information about a different patient, accidentally. He believed the patient he was calling was his patient but it was a different person and thus there was inappropriate disclosure of PHI. And the patient reported him.

OP can you clarify if this is the scenario or not?

If I'm right, I think the severity of the situation is due to the patient reporting the OP. The admin likely is under pressure to keep this from becoming a public debacle.

 

[evilbooyaa]

Perhaps I'm misreading the OP, and we definitely need clarification, but my reading is that the OP called a patient and disclosed information about a different patient, accidentally. He believed the patient he was calling was his patient but it was a different person and thus there was inappropriate disclosure of PHI. And the patient reported him.

OP can you clarify if this is the scenario or not?

If I'm right, I think the severity of the situation is due to the patient reporting the OP. The admin likely is under pressure to keep this from becoming a public debacle.

It sounded like OP called a patient who he had looked up in EPIC to discuss their medical history. Why he did this is unknown to me. However, he determined halfway through the conversation, that his review of EPIC (which was for this patient, and his subsequent discussion with the patient) was completely unnecessary, as this was not a patient that he had any connection to. He then told the patient this, apologized, and hung up the phone. 1 Resident, 1 patient, but the resident had no reason to look at that patient's file.

That is where my confusion is- who spends the time to look up a patient on EPIC when it's not their responsibility? Fine, that can happen if you're mistaken on who you're supposed to see the next day. However, who CALLS the patient to essentially perform the history aspect of an H&P prior to seeing the patient? I pre-read on patients all day every day but I'm not calling them prior to their appointment in clinic to discuss their history.

 

[IM2GI]

It sounded like OP called a patient who he had looked up in EPIC to discuss their medical history. Why he did this is unknown to me. However, he determined halfway through the conversation, that his review of EPIC (which was for this patient, and his subsequent discussion with the patient) was completely unnecessary, as this was not a patient that he had any connection to. He then told the patient this, apologized, and hung up the phone. 1 Resident, 1 patient, but the resident had no reason to look at that patient's file.

That is where my confusion is- who spends the time to look up a patient on EPIC when it's not their responsibility? Fine, that can happen if you're mistaken on who you're supposed to see the next day. However, who CALLS the patient to essentially perform the history aspect of an H&P prior to seeing the patient? I pre-read on patients all day every day but I'm not calling them prior to their appointment in clinic to discuss their history.

I know some residents/fellows who call patients ahead of time that they try to talk out of coming in to be seen, because they are lazy.

 

[gutonc]

I know some residents/fellows who call patients ahead of time that they try to talk out of coming in to be seen, because they are lazy.

Once you're an attending, you have people for that.

 

[Gastrapathy]

I know some residents/fellows who call patients ahead of time that they try to talk out of coming in to be seen, because they are lazy.

Before the days of work hour rules, our clinics were always the post call afternoon (i.e. Hours 32-36). My favorite resident when I was an intern would call our clinics starting at 5 pm the day prior and take care of them over the phone (his patients, my patients, etc). He got one of the wards to let us use a room and, if they needed an exam, he'd talk them in to coming in that night. We would have like 1 patient each left by the next pm. Somehow, he still ran a team with ~25 patients and always knew everything on rounds.

 

[evilbooyaa]

Before the days of work hour rules, our clinics were always the post call afternoon (i.e. Hours 32-36). My favorite resident when I was an intern would call our clinics starting at 5 pm the day prior and take care of them over the phone (his patients, my patients, etc). He got one of the wards to let us use a room and, if they needed an exam, he'd talk them in to coming in that night. We would have like 1 patient each left by the next pm. Somehow, he still ran a team with ~25 patients and always knew everything on rounds.

But which attending was supervising those "clinics" at 5pm at night?

 

[Gastrapathy]

But which attending was supervising those "clinics" at 5pm at night?

Attending? Supervise?

Another story then:
When I was a ward resident, our attendings did 2 week blocks. On day 10, our attending strolled in to chat with me and after he left, the interns asked who he was.

 

[Trismegistus4]

I agree we need more information. Why was the OP calling the patient? Did he think he was calling one patient, but somehow accidentally call someone else? If so, how did that happen? Did he have a patient named John Smith whom he thought he was calling, but somehow looked him up wrong and accidentally called the wrong John Smith? Why was he reported for disclosing protected health information? He makes it sound like he was getting information from the patient he called. Did he tell this patient something about the medical history of the patient he thought he was talking to? OP, please clarify.

 

[bannie22]

I agree we need more information. Why was the OP calling the patient? Did he think he was calling one patient, but somehow accidentally call someone else? If so, how did that happen? Did he have a patient named John Smith whom he thought he was calling, but somehow looked him up wrong and accidentally called the wrong John Smith? Why was he reported for disclosing protected health information? He makes it sound like he was getting information from the patient he called. Did he tell this patient something about the medical history of the patient he thought he was talking to? OP, please clarify.

Not sure how more information would help with answering OP's questions.


OP you have thought about your options clearly and I wish you the best.