Health-Care Headaches: 
How to Complain
J. Greene

Q: My mother came home today from a 16-day hospital stay. There were many problems with the facility, varying from total neglect to abuse. Where does one make a formal complaint above the hospital administration level?

A: It’s unfortunate your mother had such a bad experience in the hospital. There are several agencies that oversee hospital care, and you can certainly file complaints with them. But in reality you can probably make the biggest impact on the institution by making your concerns known to top management. After all, hospitals are big business these days, and they want to keep their customers — also known as patients — happy.

      You don't say whether you or your mother made complaints while she was still hospitalized. There are some things you can do at that point, such as taking your concerns to the nursing supervisor, if your worries were about nurses or aides. Most hospitals also have a person on staff known as the patient advocate, who will intervene to resolve problems on behalf of patients. Most disputes arise because of poor communication, so having a third party come in to listen to both sides can resolve things pretty quickly.
      If you don't get satisfaction from those staff members, then feel free to go directly to the hospital administrator, recommends health-care consumer advocate Vincent Riccardi, M.D. He says the hospital administrator is probably not aware of specific lapses in care, and in fact may be shielded from them because of the institution's bureaucracy. And yet, the person on top is the most interested in ensuring that the business is run well. "The hospital business is so competitive now," Dr. Riccardi notes. "The last thing these guys want is grief from an unhappy patient" jeopardizing their insurance contracts.
      The best way to communicate your concerns is in a face-to-face meeting with the administrator, Dr. Riccardi says. "That is the best way to really have an impact, and they'll listen," he suggests. If you can't get in to see the administrator, write a letter directly to that person.
      If you're unsatisfied with your audience with the hospital's top bureaucrat, find out who owns the hospital and contact that company or organization. That could be a large national for-profit chain, a religious organization or a local government agency.
      Continuing up the medical food chain, another way to get your criticism heard and acted upon is to follow the money: Take your complaints to whoever is paying the bills. If your mother is over 65 or disabled and on Medicare, then try calling the local Medicare counseling service. You can get a referral to your local office by calling (800) 638-6833.
      If your mother's insurance is through an insurance health plan, let its administrators know about your troubles. Also, if the coverage is ultimately purchased by an employer, take your comments to the human resources department of the company. At the very least, the employer should know whether it's getting good care for the dollars it's plunking down in health benefits.
      There are also government agencies out there that oversee hospitals, and you can certainly file a complaint with them. Generally the hospital gets its license from the state health department, which would take any complaints.
      If you have a serious complaint against an individual licensed professional, such as a nurse, doctor or anesthesiologist, you can take that to the state licensing board for that profession. Call the particular board to find out how to file a written complaint.
      Another group overseeing hospitals is an organization called the Joint Commission for the Accreditation of Healthcare Organizations. The joint commission sends out a team every three years to inspect the way hospitals are run and then rates them on their procedures. Losing Joint Commission approval can cause a lot of trouble for a hospital, because many insurers — including Medicare — require that hospitals be accredited before they'll pay the bills. Still, the JCAHO isn't that open to consumer complaints unless something really bad happens — like a death or serious injury — in which case you could certainly inform the Joint Commission. The phone number is (708) 916-5800.
      Always remember that when you’re in the hospital it’s your choice — if the situation is really bad you always have the option of going elsewhere, assuming your health is stable enough to do so. Talk to your attending physician if you can't get the problem resolved while you're hospitalized.
      Also, keep in mind that most U.S. hospitals voluntarily abide by a Patient Bill of Rights, which says that patients have the right to:

bulletReceive considerate and respectful care
bulletBe well-informed about their illness, possible treatments and likely outcomes, and to discuss this information with their doctor
bulletKnow the names and roles of people treating them.
bulletConsent to or refuse a treatment
bulletHave an advance directive, such as a living will or health-care proxy
bulletExpect that treatment records are confidential
bulletReview medical records and have the information explained.

Our Rights Return
Our Rights Return