VA Medical and Mental Health Records to include Psychotherapy Notes


Registered Member
Attention all Veterans:

My local VA, Mountain Home VA, Johnson City, TN allows all VA employees that work there to have full access to all veterans' medical and mental health records to include psychotherapy notes (these are the counseling sessions you have with your mental health providers)

I filed a HIPPA and Privacy complaint with the VA Privacy Officer at my VA about my caregiver's Caregiver Coordinator accessing, reading and sharing my psychotherapy notes with the monthly Caregiver Program Board. A veteran's psychotherapy notes requires written permission from the veteran which she didn't have nor did she have a medical need to know.

My caregiver discussed this with my psychologist and nurse psychiatrist and neither one were aware of their required involvement with the Caregiver Program, shocked that the Caregiver Coordinator was able to access their psychotherapy notes and there wasn't a medical need to know.

The Caregiver Coordinator and Caregiver Supervisor informed my caregiver they have the authority to do so but couldn't provide any proof. None of the VA Caregiver Program literature or regulations states anything about them accessing records to review for eligibility, compliance, review them, review them every 90 days, to ensure veteran is seeking care, etc..

If our Primary Care Team was involved according to the Caregiver Program regulations then what is the medical need for them to access our records and it doesn't give them full access as it violates the 'minimum necessary' rule.

Ok, so that is how I found out about the veteran's records at Mountain Home VA. I have a separate thread on the VA Caregiver Program.

So, based on this I filed a Privacy Complaint with the Privacy Officer which informed us that all veteran's records are assessable to all VA employees there and she has no way to limit access, to protect our records by means of encrypt/password/passcode/pin, to disable a VA employees access to my records and no means of tracking who accessed, what was accessed and when it was accessed unless I ask her to mark my records as sensitive. But marking it sensitive didn't prevent any employee from accessing my record, it only allowed her to track who, when and what was accessed but it would only start from the time she marked my record.

She got back from the VISN Caregiver Coordinator and the Chief Psychology that the Caregiver Program would need access to a veteran's record but didn't state what 'medical need to know' or medical justification in needing access. Also, as I was told by the Caregiver Program that they accessed to ensure eligibility, programmatic compliance and that I was seeking care. Even if the regulations allowed them to then why do they have to read my psychotherapy notes? The system shows if you have an appointment, what department and if you made it, canceled it or rescheduled it thus seeing a veteran is seeking care. But going back to the regulations, it's my Primary Care Team that create and maintain my treatment care plan for the program not the Caregiver Coordinators.

Basically, the Privacy Officer sided with the VISN and Chief Psychology (no names were provided) and agreed with them without doing her own research to determine if they were in violation. I provide her handouts of the regulations governing that program and she sided with them. I thought Privacy Officers are required to investigate all evidence, regulations and medical need to know or to provide treatment (the Caregiver Program doesn't provide any treatment to a veteran) and billing. Not to take the words of people who feel or might not know the regulations governing that program.

So, we go to the Patient Advocate and filed a complaint against the Caregiver Coordinator and later the Caregiver Supervisor when we found out that she is the one telling her employees to do this. We haven't found out the results of our complaint. We did get our appeal decision letter this weekend which sided with the Caregiver Programs' decision even though the program is not responsible for what my Primary Care Team is which I sited the regulations and points against what the Caregiver Program did but they sided with the program. Now I have to do the next level appeal which I believe it goes to the VISN level.

I haven't heard anything about how are records are not being protected and not monitoring violations or unauthorized access or obtaining a written authorization for psychotherapy notes.

You can file a complaint through the Health and Human Services for HIPPA violations online or by mail, They are responsible for receiving complaints of HIPPA violations, investigates and then decides action/no action.

Please get this out to all veterans to check their records management for HIPPA and VA Privacy Policy at their local VA. Veterans can request a SPAR report through the VA Privacy Officer's office by providing a written request and the timeframe you want the report. A veteran can request this report anytime they want or need it.
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