Making complaints

Contributed by Susan Brooks and current to 1 September 2005

Health consumers have a right to be treated with respect and reasonable care. Reasonable care includes (but is not limited by):

• a proper diagnosis with appropriate testing;
• referral for specialist advice;
• routine screening;
• advice about correct use of drugs and warnings about misuse;
• competent and appropriate treatment for the condition; and
• confidentiality.

In some circumstances, a failure to provide reasonable care may give rise to an actionable claim for negligence (see further below under ‘MEDICAL NEGLIGENCE’).

There are, however, less formal and less costly means of complaining about the standard of medical treatment received.

If you are unhappy with the treatment you have received from a health service provider, the first point of contact is the provider or practitioner. If the prospect of interacting with them again is worrying, then the clinic, practice or hospital in which that practitioner works should be the next step.

There are officers or departments in the major hospitals in Western Australia who deal with consumer concerns and complaints. They liaise between health consumers, staff and visiting practitioners. For instance, Sir Charles Gardner Hospital has a Public Liaison Officer and Royal Perth Hospital has a Manager of Customer Service. Smaller hospitals should have a person delegated to hear complaints.

The Office of Health Review provides another avenue for complaint, as do the practitioner registration boards which regulate most health service providers (their details are in the Contact Points section below).

THE MEDICAL BOARD

If your complaint is with a medical practitioner and you are concerned about the behaviour continuing then you may wish to make a complaint to the Medical Board of Western Australia. The Board only acts on complaints that concern breaches by a doctor of the Medical Act 1894 (WA). A doctor could be breaching the Medical Act if he or she is ‘grossly careless or incompetent in providing treatment or if he or she behaves improperly’.

The Board will not normally deal with complaints concerning:

• disputes about fees and charges;
• most disputes over contents of insurance reports made by a doctor;
• disputes that arise from a clash of personalities between the doctor and the patient.

Complaints to the Board must be made on the appropriate form. This can be downloaded from the Medical Board website (see Contact Points at the end of this chapter). The doctor concerned will be sent a copy of the complaint and will be asked to provide a written response. If a sub-committee of the Board considers there are insufficient grounds on which to proceed to a formal inquiry the matter will go no further and you will be advised accordingly. If the Board considers the actions of the doctor may have breached the Medical Act the doctor will go before the Professional Standards Committee of the Board. This committee deals with minor misdemeanors that attract a reprimand or a fine up to $5,000. If the Board considers that the complaint is of a serious nature and requires a full inquiry then it will be referred to the State Administrative Tribunal.

An inquiry can also be instigated where it appears to the Medical Board that a doctor may be dependent on drugs or alcohol or may be suffering from a physical or mental illness, which affects his or her ability to practice as a doctor.

Penalties for breaching the Medical Act include:

• a fine, not exceeding $10,000;
• a reprimand;
• suspension from being able to work as a doctor for a certain period of time, not exceeding 12 months;
• removal of the doctor’s name from the Medical Register; and/or
• restrictions on the ability of the doctor to continue practising.

Appeal from decisions of the Medical Board can be made to the State Administrative Tribunal: see further CHALLENGING GOVERNMENT DECISIONS.

OFFICE OF HEALTH REVIEW

(See also DISABILITY AND THE LAW)

If your complaint does not concern a breach of the Medical Act or the Medical Board cannot solve your problem then you can contact the Office of Health Review. The Office is an independent statutory body established to deal with health and disability complaints. It has authority to do this under the Health Services (Conciliation and Review) Act 1995 (WA).

You can complain to this office about anyone who claims to provide a health service, public or private including (but not limited to):

• Hospitals
• Medical specialists
• General practitioners
• Dentists
• Chiropractors
• Ambulance services
• Prison health services
• Alternative health care services
• Social workers in a health setting
• Physiotherapists
• Psychologists
• Nurses
• Podiatrists
• Mental health services

The Office can deal with complaints that allege any of the following:

• A public provider has acted improperly by not providing a health service;
• A public or private provider has acted unreasonably in the manner of providing a health service;
• A public or private provider has acted unreasonably by denying or restricting the consumer’s access to records kept by the provider;
• A public or private provider has acted unreasonably in disclosing or using the consumer’s health records or confidential information about the user;
• A service provider has acted unreasonably by not properly investigating an initial complaint, or has not taken proper action on the complaint;
• A public or private provider has acted unreasonably by charging in relation to a fee; and
• Any of the above situations occurring in the context of a prison health service.

The Office of Health Review cannot accept complaints regarding:

• Sub-standard food and preparation;
• The refusal of a private practitioner to see a person;
• Matters that have already been decided by a court or tribunal.

Complaints must be submitted on a complaint form that can be obtained from the Office (see Contact Points) or downloaded from its website at www.healthreview.wa.gov.au.

The complaint form needs to be lodged within one year of the health service having taken place, although it may still be accepted if there is a good reason for the delay. Complaints cannot be accepted for any services provided prior to September, 1995.

A copy of the complaint will usually be sent to the provider, who will have the opportunity to provide a response. This enables the Office to remain neutral and impartial. The Office is not a consumer advocacy service.

The Office of Health Review aims to negotiate or conciliate with parties to a complaint to try and bring matters to a resolution. The resolution can include things such as an apology, an explanation, accessing the service (if the complaint involves denial of service), payment of compensation or reimbursement of costs.

If the complaint is not resolved by the Office of Health Review, then complaints can be made directly to the various practitioner boards or health care facilities. If still not resolved then the complainant should consult a lawyer.

The Office of Health Review has not been affected by the establishment of the State Administrative Tribunal.