Dear Capital and Coast District Health Board,

I write to you in my role as the Advocate of the late Samuel Jacob Fischer who was a patient of Te Whare o Matairangi psychiatric inpatient facility between January 31st 2015 to the time of his discharge to the Wellington Hosptial's Intensive Care Unit where he died on the 20th April 2015.

I request the following information under the provisions of the Official Information Act 1982:

1) The audit trail of all attempted login and successful login activity to Mr Fischer's Electronic Health Record (EHR) between Tuesday 21st January 2015 to Wednesday 31st Aug 2019.

Including but notwithstanding any information on the CCDHB 'Concerto' IT system and shared care 3DHB system referred to by staff as the 'E-Tree'.

2) Include in the release of point 1 above, the record of:
a) all persons who accessed the EHR
b) details and confirmation of the privileges of persons identified in point 2a) above
c) the user identifier
b) date and time of access
c) location of access
d) duration of all activity including view-only activity
e) details of any known illegal activity by those without access privileges
f) actions taken in relation to any known illegal activity

This information will be easily available and on hand as the HISO 10029:2015 Health Information Security Framework standard for the New Zealand health and disability sector requires:

The designated EHR System administrator
i) to keep an audit trail of all login attempts to any EHR system including successful login activity. The log should include at least user identifier, date, time, location, and duration of all user activity within an application (including view-only activity).

The designated Manager
ii) to maintain and monitor a secure physical log book or electronic audit trail of all access.

I understand that a decision on a request for information under the Offical Informations Act 1982 should be made within 20 working days of receiving that request.

Yours faithfully,

Mr Jak Wild
Advocate of the deceased
Samuel Jacob Fischer

Dear Robyn Fitzgerald [CCDHB],

Please forward an acknowledgement to Mr Nigel Fairley (General Manager, 3DHB Mental Health, Addictions and Intellectual Disability Services), for his 29.08.18 letter which I received the day of which was the deadline for his legislated obligation to respond to this Official Information Act (OIA) request, that being the 20th day after CCDHB received my request.

Please refer to my previous concerns noted in my latest communications regarding the OIA request for release of Mr Fischer's Electronic Health Record. I request the same consideration with this OIA, (i.e. greater transparency in communications from CCDHB by asking communications go via this fyi.org.nz website, and asking for responses to each OIA being specific and separate to prevent confusion, misrepresentation or diversion)

In reference to the aforementioned response from Mr Fairley to OIA's currently requested. For reference purposes below, at the end of this communication, I have appended and inserted the paragraph from Mr Fairley's letter, which is specific to the OIA request for Te Whare o Matairangi staffing records.

By way of an acknowledgement of CCDHB's contention of "concerns as to the privacy of staff outweighing other considerations which render it desirable, in the public interest, to make that information available". Can CCDHB re-consider the second part of this OIA request by designating an unidentifiable number for each staff member so by removing concerns as to privacy?

By way of an explanation as to the information that is requested being of public interest. The release of staffing records will facilitate investigation of documented evidence which shows either understaffing and/or mismanagement of safe staffing rosters during the admission period in which Mr Fischer died.

Evidence of understaffing and/or mismanagement of safe staffing rosters includes nurses working back to back shifts, including one instance two days before Mr Fischer died in which Mr Fischer's primary nurse worked three eight hour shifts in a thirty six hour period. This resulted in Mr Fischer's nurse having only an eight hour break (including travel time time to and from work) between the second shift which was a night shift ending at 2300hrs, and the third shift which was an early morning shift starting at 0700hrs. The timing of this concern was at a crucial point in Mr Fischer's treatment, and on the face of it breached the nurses duty of care provided to Mr Fischer.

The first part of this OIA request for the standard 28 day staffing roster that was in operation for Te Whare o Matairangi's Te Taha Tauira and Whakatau Wairua wards during Mr Fischer's 2015 admission does not include any privacy concerns therefore is requested to facilitate investigation and inquiry into Mr Fischer's death and is in the public interest as to the need for investigation of understaffing and/or mismanagement of safe staffing levels.

Please respond within the legislated obligations pursuant to the Official Information Act 1982.

Yours sincerely,

Mr Wild
Advocate of the Deceased
Samuel Jacob Fischer

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Appended letter received by email on 29.08.19 from CCDHB. Text specific to OIA request for:
OIA request 2019-147

By email dated 7 August 2019, you submitted an OIA request for a copy of "the standard 28 day staffing roster that was in operation for Te Whare o Matairangi's Te Taha Tauira and Whakatau Wairua wards during Mr Fischer's 2015 admission". You also requested "the staffing records indicating names of staff, shift times and any shifts designated as overtime for those staff who worked on the Te Taha Tauira and Whakatau Wairua Wards between 31st January 2015 until 17th April 2015".
On 31 July 2015, you requested copies of staffing rosters throughout the period of Mr Fischer's admission to Te Whare o Matairangi and ICU under the OIA. We responded on 27 August 2015 refusing your request. In doing so, we noted that the names of the staff who cared for Mr Fischer were documented on the file.
?[.) Te-Upoko-me-te-Karu-o-Te-lka
Mental Health, Addictions and

Intellectual Disability Service

We have again considered your request, and again refuse this request on the grounds that it is necessary to protect the privacy of those staff who were not involved in Mr Fischer's care. We have considered whether, in the circumstances of this particular case, the withholding of this information is outweighed by other considerations which render it desirable, in the public interest, to make that information available. We do not believe that any such considerations exist in this case, bearing in mind that this information has no relevance to the care of Mr Fischer.

For the same reasons, we also refuse the second part of your request.

Yours sincerely,

Mr Wild

Dear Robyn Fitzgerald [CCDHB],

Please disregard the last communications in relation to this OIA. It was intended for OIA 2019-147 (CCDHB designated reference number) which has since been replied to.

Yours sincerely,

Mr Wild

Dear Robyn Fitzgerald [CCDHB],

Please forward an acknowledgement to Mr Nigel Fairley (General Manager, 3DHB Mental Health, Addictions and Intellectual Disability Services), for his 29.08.18 letter which I received the day of which was the deadline for his legislated obligation to respond to this Official Information Act (OIA) request, that being the 20th day after CCDHB received my request.

Please refer to concerns noted in my latest communications regarding the OIA request for release of Mr Fischer's Electronic Health Record. I request that the same consideration be given with processing this OIA request, (i.e. greater transparency in communications from CCDHB by asking communications go via this fyi.org.nz website, and asking for responses to each OIA being specific and separate to prevent confusion, misrepresentation or diversion)

In reference to the aforementioned response from Mr Fairley to OIA's currently requested. For reference purposes below, at the end of this communication, I have appended and inserted the paragraph from Mr Fairley's letter, which is specific to this OIA request; 'Audit trail detailing access to the late Samuel Jacob Fisher's Electronic Health Record'

By way of an acknowledgement of CCDHB's contention that "the request is too large, and the system is unable to undertake the audit". Please re-consider this request by limiting the period in which the information is sought, down from the period between Tuesday 21st January 2015 to Wednesday 31st Aug 2019, to a much smaller period from 1800hrs on 17th April 2015 to Wednesday 31st Aug 2019. This would result in a request for the release of a very much reduced and reasonable amount of information.

By way of acknowledgement of CCDHB's contention that "we also note that, even if the request was limited in scope, it is likely that we would consider withholding the information on the grounds of the privacy interests of staff". Please re-consder this request based on the reduced timeframe which would result either in the identification of persons solely authorised to access Mr Fischer's electronic record via CCDHB's 'Decision Support Unit Systems Analysis' for reasons of matters related to his death, or persons not duly authorised to access Mr Fischer's electronic health record.

The information is sought to aid investigation and inquiry into Mr Fischer's death as well as in the pubic interests as there is evidence that procedures around the correct management of Mr Fischer's health information subsequent to his death were not adhered to. This includes evidence indicating document tampering, incorrect closure of the hard copy clinical file, and removal of documentation from Mr Fischer's health record.

Please respond within the legislated obligations pursuant to the Official Information Act 1982.

Yours sincerely,

Mr Wild
Advocate of the Deceased
Samuel Jacob Fischer
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Appended letter received by email on 29.08.19 from CCDHB. Text specific to OIA request for:
'Audit trail detailing access to the late Samuel Jacob Fisher's Electronic Health Record'
OIA request 2019-166 (CCDHB designated reference number).

Dear Mr Wild,

....By email dated 21 August 2019, you requested;

1} The audit trail of all attempted login and successful login activity to Mr Fischer's Electronic Health Record (EHR) between Tuesday 21st January 2015 to Wednesday 31st Aug 2019.

Including but not withstanding any information on the CCDHB 'Concerto' IT system and shared care 3DHB system referred to by staff as the 'E-Tree'.

2) Include in the release of point 1 above, the record of:
a) all persons who accessed the EHR
b) details and confirmation of the privileges of persons identified in point 2a} above
c) the user identifier
b) date and time of access
c) location of access
d) duration of all activity including view-only activity
e) details of any known illegal activity by those without access privileges
f) actions taken in relation to any known illegal activity

We have tried to respond to your request by running an audit for the period requested. However, the request is too large, and the system is unable to undertake the audit. In any event, even if this was possible, we understand it could potentially number hundreds if not thousands of pages. We therefore refuse this request on the grounds that the information requested cannot be made available without substantial collation and research. In doing so, we have considered whether fixing the charge or extending the time limit would enable the request to be granted, but do not believe that it would. We also note that, even if the request was limited in scope, it is likely that we would consider withholding the information on the grounds of the privacy interests of staff....

Regards
Nigel Fairley
MHAIDS

Dear Robyn Fitzgerald [CCDHB],

Further to this request for release of an 'Audit trail detailing access to the late Samuel Jacob Fisher's Electronic Health Record' for the purpose of transparency I reference here the latest response from CCDHB to this OIA request.

Please forward an acknowledgement of correspondence received 3.09.19 from Ms Iris Reuvecamp (Legal Counsel 3DHB Mental Health, Addictions and Intellectual Disability Services), who has now superseded Mr Nigel Fairley (General Manager, 3DHB Mental Health, Addictions and Intellectual Disability Services) in managing this OIA request.

In follow up to this release of the audit trail which the CCDHB had refused as detailed in previous correspondence, I refined my initial request to address CCDHB's grounds for refusal. This was by limiting the number of staff to those persons solely authorised to access Mr Fischer's electronic record via CCDHB's 'Decision Support Unit Systems Analysis' for reasons of matters related to his death, or persons not duly authorised to access Mr Fischer's electronic health record, and limiting the time frame of records requested, so by addressing each of CCDHB's objections.

Ms Reuvecamps 3.09.19 response to my refined request was:
"We will consider this request and will respond within 20 working days".

I will await the release of the requested information subject to the provisions of the Officia Information Act 1982.
Yours sincerely,

Mr Wild