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How one offshore worker sent tremor through medical system

Outsourced UCSF notes highlight privacy risk: "Lubna Baloch sat in her office in the sprawling Pakistani commercial center of Karachi and gazed at the e-mail she'd composed. She tried to imagine the reaction half a world away when the people at UC San Francisco Medical Center saw what she'd written.

The famous U.S. hospital would have to take her seriously, Baloch knew, when it realized she was prepared to post its confidential patient records on the Internet. That is, unless UCSF helped her get the money she was owed from the mysterious Tom Spires, her link in a long chain of medical transcription subcontractors.

'Your patient records are out in the open to be exposed,' Baloch wrote in her e-mail, 'so you better track that person and make him pay my dues or otherwise I will expose all the voice files and patient records of UCSF Parnassus and Mt. Zion campuses on the Internet.'

Then the kicker: 'Just to make you believe that I am not bluffing I am attaching latest voice file and text of your hospital.' Baloch had included private discharge summaries for two UCSF patients.

She clicked the send button on her computer screen.

The message arrived at UCSF on Oct. 7, 2003. It would get a swift reaction from hospital officials, but not in the way Baloch was expecting. Her brief e-mail would send shock waves throughout the U.S. medical establishment and prompt legislation to change California privacy laws. People's livelihoods, including her own, would be ruined."

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