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When you want to make a complaint but don’t know where to start, go to a patient advocate
On January 17, the Supreme Court of India directed a Hyderabad-based super- specialty hospital to pay Rs 2.05 lakh as compensation to the widow of a patient who had died of a heart attack, while being treated at the hospital for a shoulder injury. The National Consumer Disputes Redressal Commission (NCDRC) said the inability of the hospital to explain what caused the patient’s death left many questions unanswered.
Why Speak Up at the Hospital?
- To improve the situation after a mistake
- To take action for preventing the problem from becoming worse
- To take action that can prevent the problem from happening to others
Fret not. Go to a patient-advocate. Since this is not a formally recognized role in India yet, look for a person who is seasoned and mature to act as your advocate before you seek a meeting to sort out issues with the hospital administration.
What is a “medical accident”?
‘Clinical negligence’ is the legal term used to describe a medical accident where a patient has been harmed, not because of a complication that could not have been avoided, but because a doctor did not deliver the proper standard of care. It doesn’t always mean that the doctor handling the procedure was incompetent – it just means that he made a mistake that he shouldn’t have.
When to Call a Patient Advocate
If you need support in getting answers or in obtaining documentation.
When you want to make a complaint but don’t know where to start.
When you are considering legal action but would like some answers first.
When you feel lost and vulnerable in the complex healthcare system, while battling a serious illness.
When you wish you had more support, but don’t know how to get it.
When you need an independent person to represent you.
When you simply need someone to listen.
Clinical negligence may include:
- Making a mistake during surgery
- Carrying out a procedure without the patient’s consent
- Administering the wrong drug to the patient
- Making a wrong diagnosis
Clinical negligence can also include not doing things that should be done, such as:
- Not giving timely treatment
- Not warning the patient or the family about the risks of a particular treatment
When you have a complaint...
Inform the doctor that you would like answers to questions about your care. Be firm but also be polite. Next, have a strategy in hand. Think through all your questions and write them all down. Run these past your patient-advocate. Inform the hospital in advance that a friend will accompany you to this meeting in order to help you understand the medical issues.
A Case-in-Point
A 64 year old diabetic man was planning to sue his health insurance company. The insurance company had rejected his claim for reimbursement, saying that his illness was pre-existing (it was present before he took out the policy.) The advocate pulled out his medical history and organised all his records. He pored over the patient’s papers, consulted various medical experts and was able to finally prove to the insurance ombudsman that the claim was justified. The patient was able to get his claim reimbursed without having to go through the hassle of filing a case. Later on, the advocate contacted other insurance companies about supplemental medical plans for this patient, arranged conference calls with those companies to see what plan best met the patient’s needs, and got his insurance provider changed so that he would have hassle-free settlement of claims in the future.Know how much time you have been allotted for the meeting and ask your questions in order – the most important ones first. If your doctor won’t speak to you (which is common) seek an appointment with the hospital’s complaints redressal department (if they have one), or the human resource department. If they ask you to file a written complaint, be careful how you draft this. You may later, depending upon the outcome of your meeting, intend to file a suit against the hospital, in which case, you need to be extra careful about what you commit to paper, because this can be used as evidence.
Don’t be provoked into saying anything that you may regret later. Don’t convey a sense of having been wronged. Read and re-read your questions a few times to make sure that your charges are well-substantiated and that they don’t come across as wild, baseless accusations.
If you are not successful in resolving the issue, you have three choices in the matter:
- You can file a complaint against the doctor with the State Medical Council
- You can file a complaint with the State Consumer Court
- You can file a criminal lawsuit against the erring doctor and hospital in a court.
Remember that....
Doctors aren’t perfect, and they too make mistakes. As buyers of a medical service, patients have every right to raise their voice against medical negligence. You can’t be expected to accept deficient care or poor treatment. Making a formal complaint won’t just benefit you as a consumer, but it may also benefit the community at large, and perhaps act as a deterrent in preventing the doctor or hospital from making similar mistakes in the future again. Most cases of medical malpractice involve negligence or acts of omission by doctors who fail to meet the standards of treatment that their patients both need and deserve.
How to Speak Up at the Hospital
- State your concerns, needs, and expectations clearly.
- Rest assured that complaining will not compromise your care. Hospitals want to resolve your problem as quickly as possible.
- You should be clear about your own expectations. What do you want? What do you expect the hospital to do? This allows the hospital to know how they can help.
- If you do not receive a timely response, or want to address a problem after you’ve left the hospital, contact the hospital’s customer service
- You can use the staff of the patient and family relations department as patient advocates to discuss your case and how best to proceed.
- It is usually best to resolve problems through face-to-face conversations. These can result in better and faster understanding.
A patient-advocate, trained in legal matters should be able to help you:
- Establish that a medical duty was owed to you
- That the duty owed to you was breached in some way.
- That this breach caused some sort of injury or death, and finally,
- That the hospital now owes you compensation for the damages causes. These damages can be physical or emotional, Listening is a key skill of an advocate. Even patients know that advocates are not experts in medicine or surgery. But when someone listens to them with empathy, letting them vent, they can heave a sigh of relief. They are reassured that there is someone on their side, who will help them sort out their problem.
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