How to file a grievance against a doctor in the USA

A reader writes:

I work as the person who handles complaints for a mid-size hospital with clinics and outlying facilities in the midwest, and I want to make sure that the people on your site (since I myself am large and have experienced the discrimination against fat women) have what they need to truly get effect.

* If it happens in a clinic or doctor’s office, find out who the doctor is employed by. Perhaps the doctor is self-employed, but perhaps not. If he has admitting privileges at a large local hospital, he may well be employed by that hospital.
* If it happens at a hospital, (and this is important to do word for word) ask for the house officer/supervisor to make a formal grievance. The important word is “grievance.”
o Once this is filed, this initiates a chain of events that is overseen by CMS (Center for Medicare/Medicaid Services). This chain of events should happen EXACTLY, or the hospital can be fined or lose its ability to take Medicare EVEN IF THE PATIENT IS NOT ON MEDICARE!
+ A letter should be sent within 7 days acknowleging the grievance.
+ A follow-up letter should be sent every 7 days thereafter until there is a resolution.
+ A resolution letter closes it out with their investigation and findings.
* What should you do if any of this does not happen as it should?
o Send a letter to CMS.
o Send a letter to the local state health department. (Their regulations will differ by state, but they have more people to go and show up at the hospital and talk to someone.)
o Send a letter to the TJC. (Formerly, JCAHO…The Joint Commission)
* Whether or not this has satisfied you, send a letter to your insurance company. They also tend to investigate, because delayed medical treatment raises their costs.

Leave a comment

5 Comments

  1. I wanted to file a grievance against a doctor whom I felt had touched me inappropriately and called our health department to ask how to go about it. I was told that, essentially, it would be my word against his. I didn’t pursue it.😦

    Reply
  2. Wow thank you for this, this is definitely information that is needed and helpful as i know I have often wondered how to handle things after going through stuff that I have with doctors.

    Reply
  3. Thank you. Good to know — and I think it’s important to always document stuff and write a formal letter of complaint even if you get told “it’s your word against his/hers,” because for all any of us know other people have complained, too, and eventually there can be a cumulative effect.

    Reply
  4. Perrin

     /  June 15, 2009

    Really great advice. So often people simply do not know what to do. Often they don’t even know what their rights are.

    A few additional points:

    – Keep copies of all your correspondence.

    – Be polite, be professional but be persistent.

    – Every state has a medical practice board that licenses and oversees physicians. (There are similar boards for nurses, physical therapists, psychologists, etc.) You can pursue complaints about the clinical quality of your care by filing a grievance with your state’s medical practice board. You can do this simultaneously with filing a grievance against the hospital/clinic.

    – Know the patient bill of rights in your state. You should be able to find it online. In my state, for instance, you are entitled to have a response in writing if you request it; the hospital also has a deadline for when they must respond to your complaint.

    The more you know about the process, the better off you’ll be and the less likely they’ll be able to pull a fast one on you. Many people really don’t understand their rights, and unfortunately doctors and hospitals can and do take advantage of this and violate your rights with impunity.

    A word of warning though. Many state health departments are overworked and understaffed. They may not have the resources to investigate a case that isn’t horrendously egregious, plus their authority is often limited by state statute. Medical practice boards also have limitations in terms of the types of cases they investigate and the bar is sometimes set rather high for filing a complaint, e.g. in some states you have to have your letter notarized.

    I’ve been through the process, actually for something that involved a medical injury and had nothing to do with fat/weight. It was eye-opening, and I don’t mean in a good way.

    Reply
  5. littlem

     /  June 18, 2009

    Thank you so much for taking the time to put all this together. A lot of people don’t know what to do.

    Reply

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