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Commissioner Sought State Probe

June 24, 2008

By Robert Boyer, Times-News, Burlington, N.C.

Jun. 24–A county official has revealed key details in an ongoing controversy at the Alamance County Health Department.

Commissioner Bill Lashley said Monday he was the public official who asked Sheriff Terry Johnson to call in the SBI to investigate the department’s record-keeping and use of patient-provided aliases in work-excuse notes.

Last Wednesday, Dr. Kathleen Shapley-Quinn, the health department’s medical director, and Karen Saxer, a nurse practitioner, were suspended with pay pending the outcome of the State Bureau of Investigation inquiry.

Word of Saxer’s suspension came from a memo from Interim Health Director Tim Green.

In memos to Shapley-Quinn and Saxer, Green wrote that each is “on investigatory suspension with pay until further notice.

“The investigation is related to possible performance or conduct deficiencies,” Green concluded.

Lashley, who also serves on the health board, said Monday that Shapley-Quinn should be charged if Bureau investigators find that laws were broken.

“She’s no better than anybody else. If she breaks the law, she should be prosecuted.” Lashley and health board Chairman Keith Whited say the department’s handling of aliases related to medical records and work notes violates federal HIPAA laws concerning patient privacy and other state and federal laws covering identity theft.

At the June 17 meeting of the county Board of Health, members, at Whited’s urging, approved policy changes giving the board stronger oversight concerning patient records and required the release of all names and identifying information in a patient’s file to “non-medical third parties,” among other things.

The flap over the aliases surfaced on May 20, when Nursing Director Marilyn Burns reported to a health board subcommittee that health department medical staffers, at the request of some patients, had been issuing the work notes using alias names. The names were kept separate from the patients’ medical files.

Patients asked for work notes with aliases two or three times a month, department officials say. Most of them were Hispanic, Burns has said.

At the health board meeting on June 17, Shapley-Quinn confirmed that the practices had continued until about a month ago, when she instructed the medical staff to discontinue writing notes with aliases until she had received guidance on whether to continue the practice.

Shapley-Quinn said the issue first came up in the summer of 2007, when the medical staff asked for guidance on the “complex” issue to balance department policy with the agency’s primary goal of maintaining public health.

By law, health departments are required to treat all county residents who seek care, regardless of whether the are legal U.S. residents.

JILL MOORE, AN associate professor at the UNC School of Government, specializes in public health law and said she is an expert on HIPAA, the federal guidelines covering patient privacy.

“There is nothing in HIPAA that requires where you put your records,” she said. “HIPAA regulates what you do with your records once you have them.” Writing aliases in work notes also squares with HIPAA, provided the patient authorized the use of the name and the medical worker gives the note to the patient, not the employer, Moore said.

Records, like aliases, can be kept apart from a patient’s file, provided there are “reasonable safeguards” against unauthorized disclosure.

On the issue of whether health department staffers who write such “aliases” help their patients break the law in some cases, Moore said she is still consulting with criminal law experts to get a better handle on what she refers to a “new frontier in the law.” There are no reported cases in North Carolina of health care workers being charged with a crime by including an alias in a work note, Moore said.

The issue of criminality revolves around whether health care providers know a person is using a false name to commit a crime and whether they know they are helping the person break the law.

“Do you have a duty to ask?” she said. “How would a health provider know?” People have a number of reasons for using alternate names, Moore said. Some women go by their maiden and married names.

Some, like prominent or famous people, use false names when seeking care.

The first case is an example of a legitimate use, she said. The second is an illegitimate, but also legal use she added.

Dr. Leah Devlin, the state’s health director, said there is no statewide policy when it comes to such issues.

Local health boards set policies for their health departments.

Citing the SBI investigation, Devlin declined to talk about the controversy in Alamance County. But in general, Devlin said public heath agencies “need to do whatever we can to serve every individual we can, because that’s in the communities’ health interest.

“It really important for us to eliminate barriers to care when we can,” she added.

Whited and Lashley are running for office in the November election — Whited for a district court judgeship, Lashley for another term as commissioner. In his bid against incumbent judge Tom Lambeth, Whited has taken a strong stand against illegal immigration.

Whited has said that as health board chairman, his stance on the issue is about protecting the department and its employees and has nothing to do with politics.

ALSO ON MONDAY, Lashley provided this additional background on how the SBI became involved: Whited told him about the issue on May 21, the day after Burns’ report to the Personal Health Committee.

Lashley said he then consulted with County Manager David Smith, who asked if he had spoken with the sheriff about the issue.

After the June 16 county commissioners’ meeting, Lashley consulted with Johnson and Smith. The sheriff, Lashley said, told him he would contact the SBI.

On Monday, Lashley produced a memo from Green detailing Shapley-Quinn’s and Saxer’s suspension.

In the memo, Green wrote that last Wednesday, Johnson, Assistant County Attorney Clyde Albright and County Human Resources Director Joyce Graves-Hinton held a conference call with him to discuss the situation.

On Wednesday, Graves-Hinton asked Green to instruct Shapley-Quinn “to turn in her keys” Thursday morning, “and that County (Management Information Systems) would be locking her computer.”"I told her she was not being dismissed but that she would be suspended with pay,” Green wrote. “We are in the process of arranging for temporary coverage of her duties as medical director,” Green continued. “I do not know how long she could be on leave — possibly several weeks pending results of the investigation.” To comment on this or any Times-News story online go to TheTimesNews.com, find the story, go to the bottom and follow the directions

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