A county employee who asked not to be identified told the Houston Chronicle that two high-ranking administrators told him the fired employees had looked at the medical records of Dr. Stephanie Wuest, a first-year Baylor College of Medicine resident assigned to Ben Taub General Hospital.

Wuest became a patient at Ben Taub on Oct. 29, after she was shot in a grocery store parking lot. She is expected to make a full recovery, her mother said [Nov. 25].

Most of the fired employees worked at Ben Taub. They include managers, nurses, clerks and other employees.

"It could be that the district wants to draw a hard line against any violations of the law in order to discourage the federal Office of Civil Rights from imposing large civil or criminal financial penalties," said Stacey Tovino, a professor of health law at Drake University who writes frequently on HIPAA.

She noted that many institutions fire employees for that reason.

Still, Tovino said the level of sanction could be considered harsh given HIPAA's standards requiring institutions to report violations to the federal government. She said the law defines such breaches as those posing "a significant risk of financial, reputational or other harm to the individual."

Tovino questioned whether employees accessing a colleague's record out of concern about her prognosis would meet that threshold.