Tuesday, October 12, 2010

Privacy Complaints
What to do about them

This article has been chosen for reposting on KevinMD. blog


Few patients enter our health care system prepared for the unexpected and embarrassing circumstances that can routinely happen.  Most can accept it when we’re treated with modesty and respect.  But not many are prepared for those times when you might be unnecessarily exposed or treated rudely.  The possibilities for embarrassment are endless and it is usually unexpected.   When avoidable incidents do happen, most patients are not prepared to speak up.  Many regret their inability to speak at the time of the incident.

In fact it is important to speak up at the time of occurrence if at all possible, or if not, as soon as possible thereafter.  It can often be difficult or impossible to identify the offenders days or weeks after the occurrence.  Situations are most likely to be rectified if they are brought to the immediate attention of the offenders and their superiors.   A common example would be being exposed in an examining room when someone leaves the door open or comes in without warning.  Few patients appreciate that but most don’t say anything.  But if you wait several days to complain, it is likely that the office will not remember who was involved.  Despite your embarrassment, the office personnel may recall nothing unusual; it was just in a day’s work for them and consideration of patient’s privacy doesn’t cross their radar.  In a hospital a common occurrence would be for the patient to be exposed during a bath or procedure with the curtain or door being left open.  The potential is even greater for embarrassment if you’re in a semiprivate room and your roommate has visitors.   Even without exposure, having your history taken in a semiprivate room with or without visitors present may cause you to reveal embarrassing and confidential information.  Once again, if you don’t speak up immediately, it will be difficult to identify the perpetrators later.

It helps to have a clear idea what you want from your protest.  A simple apology is the easiest to obtain and may be all that’s needed.   If you want a clear indication that policies will be changed to prevent re-occurrences of the problem, you will need to go beyond a simple apology and communicate the problem with the physicians or managers in charge.  They may indicate that policy directives will be updated and sent out on their own, but if not you may have to request that they take specific action to correct the problem.

The best course of action to take depends on where the incident occurred.  Usually make the complaint immediately to the person who caused it.  In an office, this could be the physician, nurse or assistant.  If you’re not immediately satisfied with the response, also bring your complaint to the physician in charge.  If the infraction was incidental, a simple apology should be enough.  If the infraction was part of a pattern of behavior, you should notify the physician in charge.  If you don’t complain at once, the next best course is to call or write a letter as soon as possible afterwords.   If the complaint is serious and you remain unsatisfied by the response, the usual next course of action is to lodge a complaint against the physician with the state medical board.  All 50 states have them.  Here is a link to them.  If they don’t handle the complaint themselves, they will tell you where to take it.  All states have a board which investigates complaints against physicians.  In all cases, when a written or electronic complaint is filed, you should keep copies and note that you will send copies to their superiors , or to the state and federal institutions which may have jurisdiction.

In a hospital, again make your displeasure immediately known to the person responsible.   If not satisfied, take your complaint to the head nurse or physician in charge.   Try to get the names of the people involved so that you can pursue the complaint more profitably.  If the complaint is against a specific nurse, you can also complain to the state nursing board.  Again all 50 states have them and will investigate complaints.   State boards are listed here. Most hospitals will deal with complaints against specific personnel internally.  If this doesn’t work, continue up the hospital hierarchy.  Most hospitals have a patient advocate whose job it is to handle complaints.  Start with her, but remember that she still works for the hospital no matter her title.  If still no satisfaction, I would send a letter to the CEO of the hospital.  When formulating complaints against a hospital, it is well to remember that nearly all publish a patient bill of rights which might give you considerable help in outlining your complaint.  If still unsatisfied, you should consider sending a complaint to the state board that regulates and licenses hospitals (I haven’t found one website that lists them for all states.)  Another possibility is sending a complaint to JCAHO, the Joint Commission on Accreditation of Healthcare Organizations, usually now shortened to the Joint Commission.   They are more likely to respond to systemic complaints against a hospital rather than one incident unless there were life threatening implications to the occurrence.

Of other venues to be considered, probably nursing homes are the most common source of complaints.  All states have regulations for nursing homes.  Many also have further laws concerning elder abuse.  Once again, see if the problem can be solved internally in the facility, but if the nursing staff and management won’t help, complaints to the state are appropriate.

Probably the last place to complain is with HIPAA.  They do take patient complaints but they are not oriented towards individual complaints unless it clearly has to do with information transfer.  If say a hospital posted photos of your operation on an instructional site without your permission, it could fall under their purview.  There is no right of private action under federal law though there may be under individual state laws.  Finally you can contact a lawyer at any time but beware that most privacy violations won’t bring large monetary damages.  So do so only if you are really motivated to obtain redress as the attorney bills will be significant.

If you have violations to share or questions to ask, please comment below.

16 comments:

Anonymous said...

Excellant article. This is the first step-by-step action plan that I can recall ever seeing. Especially one that takes into account desired degrees of results.

swf

Joel Sherman said...

Thanks swf. Feel free to make other suggestions.

Anonymous said...

Joel:

Here's an interesting thread on allnurses called "My Day as a Patient." A nurse reflects on extremely poor care she had. As you read the thread, you gain some insight as to the knowledges nurses have about how to complain and to whom. Worth reading.
http://allnurses.com/general-nursing-discussion/my-day-patient-513097.html
Doug/MER

Joel Sherman said...

Interesting thread Doug. My thought was that maybe the oncology floor she was sent to did not routinely take care of post operative patients and had no clue what was needed.
I note who I called a head nurse is now referred to as the nurse manger (NM) commonly. But bring your complaints to anyone in charge.

Anonymous said...

If I had a dime for every time I've heard someone say they regret not saying something at the time after being unnecessarily humiliated or abused, I'd be rich enough to buy my own hospital and hire male nurses myself.

Anonymous said...

While I see your point Dr. Sherman, how much training should a CNA need before they report a blood-soaked bed?
I agree with the post following:
"I think every hospitalized patient needs an advocate (famliy member, friend, etc) to be with them most of the time during the stay.As you found out, being a nurse does not necessarily mean you can advocate for yourself. If you are sick enough to be in the hospital, you probably will find it hard to insist on the things you need."

This speaks volumes as to the posters who kept asking this OP why she did not stand up for herself. Many nurses said she may have been too weak or ill. If someone who is familiar with the atmosphere of a facility and still can not speak up, is it any wonder a non-seasoned patient can not?
Only Advocates can be the final check and balance, in my humble opinion.

swf

Joel Sherman said...

swf, the CNA needs to know enough to realize that post op patients need incisions and dressings checked. If you've never done post op care, you may not think of it.
But I agree that every patient would benefit from a patient advocate. My wife was recently seriously ill (she's fine now), but I stayed by her side continuously for about the first 36 post op hours.

Anonymous said...

Glad to hear she is fine....and may I say what a wonderful gift that was for her.
Perhaps a specific article about using advocates and what they should expect from the medical community (and preparing for the experience irself) could eventually be done here?
swf

Joel Sherman said...

An article about advocates is a good idea, swf. I don't know enough about it to write definitively though I'll try to educate myself.
If anyone would like to write about it, please let us know.

Anonymous said...

There is a thread by Trisha Torrey about patient advocacy, you can get on the email list and get updates, while modesty is not the focus, she did touch on modesty when she made a comment that was taken as suck it up guys. she did clarify and her thread is dedicated to advocacy

MC Kean said...

Done all of the above in complaint. Even more. Went to my state and federal representatives. Now, I am writing a book. The truth is there is allopathic medicine was founded and is grounded in violations of patients informed consent. If they informed us honestly, we would pass on most of their medical "care".

Joel Sherman said...

McKean, we'd be interested in knowing more details about your complaints and how they were handled. You're not the first on these blogs to be stimulated to write a book about your problems. See the cancer thread on the companion blog.

Anonymous said...

carry a medical card, listing no implied consent, the right to self determination and the right to your own autonomy. Then list the medical directives you may have listing your heath care agent who knows your wishes in the event your being incapacitated. Tell medical staff what your wishes are, or as in my case I pulled out my I.V. and everything else I was hooked up to and walked out.

Joel Sherman MD said...

I am reposting this comment from Bernstein as it is in response to this article.

Dr. Sherman - that is a great article you wrote. Let me add a few things regarding a hospital visit (as you covered a physician office visit well.) I would most definitely say complaints at the time of incident are very valuable. Unfortunately often patients are intimidated, fearful, confused and/or don't feel empowered to complain. But if they can - it can make a difference for the rest of the stay. All patients are given some type of Patient Rights document at registration or early in their inpatient stay (but not necessarily in an ED visit though). That Patient Rights document should list (in addition to all their rights) multiple phone numbers including one for the State licensing agency, the Joint Commission, a grievance line, and possibly a patient safety line. It may also list a Compliance Hot Line. All of these can be used immediately as needed. Also, many hospitals have House Managers. They manage real time the nurse staffing and patient flow. They are there 24x7 and would be a good person to demand to talk too about gender specific care. If they aren't sure of the patient's rights they usually check with someone who is. Many patients call down to Administration and leave a complaint. Many patients call the operator and ask for the Risk Manager (this is a good strategy). Some even ask for the Compliance Officer (also a good strategy). As for calling the Patient Advocates - they generally call and work with the unit Nurse Manager. If the Nurse Manager doesn't appreciate your issue or doesn't feel it has merit you may have to try the others I listed. Lastly if you do not get prompt resolution you should indicate "I want to file a grievance". The Patient Rights will tell you who to call to file a grievance. And even if you do this and do not get reasonable resolution you will have increased chances that gov't surveyors will find deficiencies when they investigate your complaints.

For those who are interested here is a link to the hospital Conditions of Participation with the interpretive guidelines (for a general acute care hospital): http://www.cms.gov/downloads/som107ap_a_hospitals.pdf

The text below each standard indicates the meaning and the interpretation of this Federal regulation. Look at all the Patient Rights starting at (42CFR) 482.13. It is easy for a hospital to get tripped up on these, especially if a patient is demanding a seemingly new paradigm for care and front line staff dismiss it and/or belittle the requests. - Compliance PhD

Anonymous said...

I found a website that lists psychiatrists that have molested,raped and/or tormented patients under hypnosis or medications,( Psychiatric Crime Database), is there a sight that lists such doctors and nurses for patient abuse...and worse. Concerned patient.

Joel Sherman MD said...

Anon, there is a national database of physician violations, but it is not accessible by individuals as far as I know.
However every state also maintains a list which should be accessible, so check with your state.