What was the highlight of the Macy’s® Thanksgiving Day parade when we were kids? The Snoopy® float (shown below) was probably right up there, along with the Sesame Street® and Disney® floats. Spectators of the Protected Health Information (“PHI”) Breach Parade (and of the “silent brigade” of Business Associate breaches, discussed in this blog series on August 1, 2011) will be awed by the sight of the recent, somewhat bizarre, Business Associate (“BA”) breach involving Stanford Hospital’s emergency room data, as reported in the New York Times by Kevin Sack on September 8, 2011. The PHI of 20,000 emergency room patients seen in the Palo Alto, CA hospital reportedly somehow made its way from the hospital’s BA, Multi-Specialty Collection Services, to a public website used by students. The publicly-posted information included names and diagnoses for patients who visited the emergency room during a 6 month period in 2009.

This PHI breach stands out for a couple of unusual aspects. First, the data was allegedly made publicly accessible in September of 2010 as a spreadsheet attached to a document on the Web site “Student of Fortune,” a site describing itself as “Your source for easy online homework help!” As reported in the Sack article: “Gary Migdol, a spokesman for Stanford Hospital and Clinics, said that the spreadsheet first appeared on the site on Sept. 9, 2010, as an attachment to a question about how to convert the data into a bar graph."  The PHI breach was purportedly discovered on August 22, 2011 by a Stanford Hospital patient and reported to the hospital. The fact that nearly a year had lapsed from the time of the breach to its reported discovery suggests that the PHI was

  1. not recognized as “real” by viewers,
  2. not thought by viewers to be worth noting or reporting, and/or
  3. not actually viewed by anyone during the year it was accessible to students seeking bar graph tutorial. 

Nonetheless, the volume of patients affected, the sensitivity of the PHI data (more on that in a minute), the apparent lack of sufficient care by the BA, and the surprising nonchalance of whoever posted the PHI to be sifted and sorted by “Students of Fortune” accessing a publicly available Web site combine to make an attention-grabbing PHI breach event (the Snoopy float). 

Also reported on a New York Times blog site by Nick Bilton on September 8, 2011, Senator Richard Blumenthal (D-CT) introduced a bill, the Personal Data Protection and Breach Accountability Act of 2011, that, if passed, would impose strict storage and protection requirements for companies that store online data for more than 10,000 people. (Senator Blumenthal was previously highlighted in several postings in this blog series for his groundbreaking activities as Attorney General of Connecticut in investigations and enforcement actions against entities involved in PHI security breaches.)

While “Student of Fortune” was certainly not “storing” the emergency room PHI, the bill would likely affect BAs such as Multi-Specialty Collection Services. To the extent the Blumenthal bill imposes new or additional privacy and security provisions, Covered Entities and BAs handling large amounts of PHI would be subject to these provisions in addition to existing HIPAA/HITECH and state law requirements.

Back to the Snoopy float – the Stanford Hospital PHI breach (and the manner in which it was reported in the Sack article) stands out for a number of ironies. A large amounts of sensitive PHI was accessible to the public, but obscurely so (only to Students of Fortune using a particular learning tool and astute enough to recognize, or care about, the sensitivity of the information). If the Stanford Hospital patient had not noticed and reported the PHI breach, would the breach have ever been noticed? Would any patient have been harmed? (If a tree falls in the forest when no one is present, does it make a sound?) 

Even more ironic is the fact that one affected patient may actually have been harmed as a result of the breach reporting, rather than from the breach itself. The Sack article quotes (by name) a patient’s mother who “intercepted” the breach notice mailed from Stanford Hospital to her 21-year-old son (leaving the reader to wonder why Mom is opening her adult son’s mail and whether she was authorized to access his PHI). Mom is quoted as stating (i) that her son received psychiatric treatment at Stanford in 2009 and (ii) “My son, I can tell you [Kevin Sack], is fragile and confused enough that this would have sent him over the edge."  One can only hope that the disclosure of his "fragile" state in a national newspaper will not have a similar effect.  Perhaps, in this post-Facebook and Twitter age, we could all use reminders about what kind of information is private and sensitive, when we should report breaches of it, and with whom we should share it.  The Snoopy float is a good reminder.    

A final irony is that Michael Mucha, the Stanford Hospital Chief Information Security Officer at the time of the Stanford PHI breach, has written extensively and has been widely-quoted regarding information security. He has been quoted as saying, “The biggest thing we [Stanford Hospital] focus on with all of this is control of the data.” Unfortunately the Snoopy float PHI breach belies the level of control of the data that can be exercised by Stanford and other Covered Entities, even with safeguards in place.

This story will undoubtedly have further developments. It will be especially interesting to see what statement, if any, Stanford provides to the U.S. Department of Health and Human Services (“HHS”) about its PHI breach for posting on the HHS list of reported large breaches of unsecured PHI affecting 500 or more individuals.

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