When can I complain to a hospital?

You can complain to a hospital if you think your doctor gave bad care or acted inappropriately. lt does not matter if you received your care at that hospital or somewhere else so long as your doctor works at the hospital. Hosp¡tals will look ìnto complaints about any doctor who works with them. When a doctor works at a hospital, he or she is "on staff" there.

How do I complain to a hospital?

1. lf you did not see your doctor at a hospital, you must first find out at which hospital your doctor works. You may have to ask the doctor's office. You can ask, "What is the name of the hospital where my doctor is on staff?"

2. Call the hospital and tell them you have a complaint about a doctor on the medical staff. Ask for the address where you should send your complaint letter.

3. Write a letter explaining your complaint. Be as clear as possible. Include dates, and notes from conversations. Describe the type of treatment you received from your doctor. Also, include the names of any other doctors who treated you or to whom you talked about your problem. Explain exactly why you think the care you received was poor quality. Keep a copy of everything you mail.

4. After you have mailed your complaint, do not be afraid to follow up. Call to make sure that the hospital received your complaint and ask about what the next steps will be.

What happens when I complain to the hospital?

The hospital will review your complaint. Usually, a group of doctors from the hospital will read and discuss your complaint. They will also look at your medical records and may talk to your doctor. The action they take depends on how serious they think your complaint is. They may punish the doctor. They may make him or her stop working at that hospital. Or they may refer your case to the Medical Board. The hospital cannot B¡ve you money and they cannot take away your doctor's license. Even though this option is less formal that the other three described in this packet, hospitals are often the most likely to read and look into your complaint.

Unfortunately, not all complaint get a positive reaction from hospitals, even when they're very serious and well documented. Doctors, like lawyers, are hesitant to punish another member of their profession.

Note: This packet only talks about what to do if you are unhappy with a decision your doctor made. If you are unhappy with a decision your health insurance plan made, you can contact the State of California help line at (888) 466-2219.

When may I file a grievance?

1. Your doctor denies or unnecessarily delays treatment that you think you need.

2. Your doctor provides poor medical care.

3. Your doctor treats you rudely or violates your confidentiality.

4. Your doctor is billing you for services that should be covered by your health insurance plan.

5. Any other situation where you think your doctor is violating the rules of your health insurance plan.

How do I file a grievance?

1. Call the Member Services Department of your health plan.

2. Ask for the forms you need to file a grievance.

3. Complete the forms, keep a copy for your records, and mail the originals to your health plan.

Within 30 days, your health plan is required to tell you what actions they are taking in response to your grievance. During this 30-day period, the health plan will investigate your complaint, and may talk to your doctor and contact you for more information about your complaint.

If your health plan takes more than 30 days to resolve your grievance, or if you are not happy with your health plan's final decision in the grievance process, you can appeal that decision. An appeal can be filed with the California Department of Managed Health Care (DMHC) within 6 months of the final decision. The DMHC can be contacted at (888) 466-2219 for more information or reached online at www.dmhc.ca.gov. The complaint forms for the DMHC are at the end of this packet.

Other resources?

The California Patient's Guide gives a detailed explanation of your health care rights and the grievance process. It includes sample letters and forms. To get a free copy, you can call the DMHC at (888) 466-2219. The guide is also available online at www.calpatientguide.org.

What is a licensing board or medical association?

The licensing board is the organization that gives your health care provider the license to practice medicine (or in other words, to see and treat patients).

A medical association is an organization that represents specific groups of health care providers (such as doctors or dentists). Some associations are for specialists (for example, pediatricians). There are local, statewide, and national medical associations.

If you are unhappy with the care you received, a medical association or the appropriate licensing board will investigate your complaint. Depending on their findings, they may take action to punish your doctor or dentist. The type of punishment you doctor or dentist receives depends on what happened. However, the associations and licensing boards never award money to patients.

If your complaint is very serious, you may want to contact a licensing board. Only a licensing board can administer the most serious punishment: it can take away a health care provider's license.

If your complaint is less serious, you may decide to contact one of the medical associations. If a medical association thinks your complaint deserves a more serious punishment than they can give, they will refer the complaint to the California State Attorney General's Office or the appropriate licensing board.

What are the different licensing boards and how do I contact them?

The licensing board for doctors, physician assistants, and affiliated healing arts professionals is the Medical Board of California. Their contact info is:

Medical Board of California Central Complaint Unit

1426 Howe Ave., Suite 54, Sacramento, CA 95825-3236

Phone: (800) 633-2322 or (916) 263-2424

The Medical Board of California accepts complaints about:

• Doctors

• Dispensing opticians, spectacle lens dispensers, and contact lens dispensers

• Licensed midwives

• Research psychoanalysts

The Board also investigates complaints about licensees in the following professions; however, the disciplinary action is taken by the licensing entity listed after each profession.

• Physician Assistants: contact the Physician Assistant Committee of the Medical Board of California.

• Doctors of Podiatric Medicine: contact the Board of Podiatric Medicine.

• Osteopaths: contact the Osteopathic Medical Board of California.

• Psychologists and Psychological Assistants: contact the Board of Psychology.

Below is the contact information for the most common licensing boards.

The licensing board for physician assistants:

California Physician Assistant Committee

2005 Evergreen Street, Suite 1100, Sacramento, CA 95815

Phone: (916) 561-8780 Fax: (916) 263-2671

The licensing board for podiatrists:

California Board of Podiatric Medicine

2005 Evergreen Street, Suite 1300, Sacramento, CA 95815

Phone: (916) 263-2647 Fax: (916) 263-2651

The licensing board for osteopaths:

Osteopathic Medical Board of California

1300 National Drive, Suite #150, Sacramento, CA 95834

Phone: (916) 928-8390 Fax: (916) 928-8392

The licensing board for registered nurses:

California Board of Registered Nursing

P.O. Box 944210, Sacramento, CA 94244-2100

Phone: (916) 322-3350 Fax: (916) 547-7693

The licensing board for acupuncturists:

California Acupuncture Board

1747 N. Market Blvd., Suite 180, Sacramento, CA 95834

Phone: (916) 515-5200 Fax (916) 928-2204

The licensing board for psychologists and psychological assistants:

California Board of Psychology

2005 Evergreen Street, Suite 1400, Sacramento, CA 95815

Phone: (916) 263-2699

The licensing board for dentists, registered dental hygienists, and registered dental assistants:

Dental Board of California

2005 Evergreen Street, Suite 1550, Sacramento, CA 95815

Phone: (916) 263-2300 Fax: (916) 263-2140

If you have a complaint about a physical health care provider, you can contact the Medical Board of California or other licensing board, the California Medical Association, or your local medical association.

What types of complaints does the Medical Board of California accept?

The Medical Board of California will investigate any complaint made against a health care provider it licenses, unless the issue relates to Medi-Cal or Medicare.

The Medical Board investigates complaints about:

• The quality of care and treatment provided by your doctor.

• Substance abuse by a doctor (for example, drug or alcohol use).

• Sexual misconduct.

• Dishonesty about medical issues.

• The unlicensed practice of medicine.

• Other improper behavior.

How do I file a complaint with the Medical Board of California?

You can call the Board's Central Complaint Unit with any questions. Questions can be about whether to file a complaint, or how to file a complaint.

Your complaint must be against a specific health care provider. To file a complaint with the Medical Board:

1. Fill out the forms at the end of this packet. Make a copy for your records. Mail the originals to the Medical Board.

2. After investigating your complaint, the staff of the Medical Board will take the appropriate actions.

3. You will receive a letter of correspondence with a control number for your complaint. To check on the status of your complaint, call the Medical Board with your control number.

How do I complain to a medical association about a problem with a doctor?

The California Medical Association (CMA) is an organization that represents and advocates for more than 30,000 California doctors. It has local chapters all over California. If your doctor is a member of the CMA, you can contact your local CMA chapter for help. The main office does not handle complaints, but you can ask them for the address and phone number of a local chapter. The Legal Center of the CMA also keeps this information. The CMA can be reached at (916) 444-5532 or online at www.cmanet.org.

After you contact the local chapter, a "mediation committee" will be assigned to your case. This committee will look at any situation where your doctor gave bad medical care or behaved unethically. The local chapter will them try to resolve your complaint. Any doctor who is a member of the CMA is required to go through this process if you request it. The CMA cannot make your doctor give you money or take away your doctor's license. However, the local chapter will investigate the situation for you and review it with the help of other doctors. If the CMA thinks the problem is extremely serious, it can refer the problem to the Medical Board or the State Attorney General.

Contacting the local medical association

You must contact the medical association of the county in which your doctor practices. Some doctors practice in more than one county but have one main office. You should try to make the complaint to the County where to doctor has his or her main office, if possible.

For Alameda and Contra Costa Counties, contact:

Alameda - Contra Costa Medical Association

6230 Claremont Avenue, Oakland, CA 94618

Phone: (510) 654-5383 Fax: (510) 654-8959

For San Francisco County, contact:

San Francisco Medical Society

1003A O'Reilly Avenue, San Francisco, CA 94129

Phone: (415) 561-0850 Fax: (415) 561-0833

You may contact the California Board of Psychology if you have a complaint about a psychologist or psychologist's assistant. You do not have to contact the Medical Board first. A complaint form is included at the end of this packet. Note: Psychiatrists, unlike Psychologists, are medical doctors (MDs) and are licensed by the Medical Board of California.

What types of complaints does the California Board of Psychology accept?

The California Board of Psychology punishes illegal, irresponsible, or unprofessional behavior. The types of behavior that fit this description are:

• Providing services without the proper training or license.

• Violating the patient's confidentiality agreement (telling people about a patient's case without the patient's consent).

• Sexual contact with a patient.

• Drug or alcohol abuse.

• False advertising, fraud, or other crimes.

• Paying or accepting payment for referrals.

• Focusing therapy on the mental health professional's own problems instead of the patient's.

• Having interactions with the patient besides providing mental health care.

• Any other unprofessional, unethical, or irresponsible acts.

Are there complaints that the Board of Psychology will not accept?

Yes, The Board has no authority over:

• Fee or billing disputes.

• General business practices (for example, the way the mail letters or bills).

• Personality conflicts (for example, if you think that your psychologist is competent but you just don't like him or her).

• Persons who are licensed by other boards (for example, clinical social workers; marriage, family, and child counselors; educational psychologists; psychiatrists; or psychiatric technicians).

What happens if I file a complaint with the California Board of Psychology?

The Board will tell you it has received your complaint within 10 days of its receipt.

If your complaint involves a minor violation, it may be handled in one of several ways. The Board may:

1. Work to reach an agreement between you and the psychologist or psychologist's assistant;

2. Send a warning letter to the psychologist or psychologist's assistant; or

3. Set up an educational conference for the psychologist or psychologist's assistant.

If your complaint involves a major violation, such as sexual abuse, serious lack of responsibility, or incompetence, the California Board of Psychology will send your case to the Medical Board. You will be told if this happens. At this point:

1. A trained person from the Medical Board will investigate your complaint.

2. The investigator assigned to your case will interview you. During the interview, you will be able to discuss the details of your complaint and ask questions about the investigation process.

3. The investigator will also interview the psychologist. Details of your complaint and the investigation are confidential, but your psychologist or psychologist's assistant will be told about your complaint and given an opportunity to respond.

If you have a complaint about a dentist, registered dental hygienist, or registered dental assistant, you can contact the Board of Dental Examiners, the California Dental Association, or your local dental association.

What types of complaints does the Board of Dental Examiners accept?

The Board of Dental Examiners punishes dentists, dental hygienists, and dental assistants who act unprofessionally, perform work they are not qualified to do, or make significant or repeated mistakes. For example:

• Charging a fee for services the dentist did not perform.

• Crimes related to dentistry, including drug or alcohol abuse, breaking laws about prescribing medications, or giving out dangerous drugs or narcotics.

• Giving or helping someone else give unlicensed dental care, or practicing under a false name.

• False advertisement, including advertising professional superiority.

• Improperly changing patients' records.

• Unsafe or unsanitary office conditions.

• Abandoning patients.

• Other improper conduct.

If you want the Board of Dental Examiners (Dental Board) to investigate your complaint, you must complain in writing.

When should I contact the California Dental Association {CDA)?

The California Dental Association (CDA) investigates complaints about the quality of dental care. It also looks at unethical behavior. The CDA uses a system, free of charge, called "peer review." A "peer review committee" is a group of volunteer dentists. If you file a complaint, the peer review committee will investigate what happened. Then, the committee will decide how it thinks your complaint should be resolved. If you disagree, or you think the peer review process did not consider all the facts, you can ask for an appeal. However, your dentist can also appeal. Appeals are made to the Counsel of Peer Review.

THE APPEAL REQUEST MUST BE MADE WITHIN 30 DAYS OF THE LETTER TELLING YOU WHAT THE PEER REVIEW COMMITTEE DECIDED.

The decision of the Council's appeals panel is final.

How does the peer review system work?

All disputes and complaints that are evaluated within the peer review system must follow the following guidelines and procedures:

• The local chapter of the CDA carries out the peer review.

• You must sign a Patient Agreement Form. This says that you will accept the decision of the Dental Association professionals who are members of the California Dental Association have already agreed to this.

• You must also sign an Authorization for Use and Disclosure of Health Information Form. This allows the committee to legally get your dental records for the investigation.

• A panel of at least three dentists will examine you, unless the treatment you received cannot be evaluated (for example, if you already corrected any problems with the treatment).

• The dentist can choose to talk to the peer review committee.

• The committee will contact all other involved parties for information. For example, they may call your insurance provider or other dentists who treated you.

• The peer review committee will evaluate all available evidence, such as your dental records, x-rays, or statements from other treating dentists. You will receive a "letter of resolution" telling you what the committee decided, and why. Your dentist will also get a copy of this letter.

• You will receive information about appealing when you receive the final decision.

Are there any types of complaints the peer review system will not investigate?

The peer review system does not investigate complaints if:

1. Your complaint involves something that happened more than 3 years ago;

2. You already filed a lawsuit against the dentist;

3. You are asking your dentist to pay you for time lost from work, pain and suffering, mileage, or other medical expenses;

4. Your complaint is about your dentist's fees (but you can complain if you are being charged for a treatment your dentist never completed); or

5. Your complaint is unrelated to the treatment (for example, if the complaint is solely about your dentist's attitude).

How do I file a complaint with a local dental association?

The local dental associations are part of the statewide peer review system described above. Contact the association in the county where your dentist practices to start the complaint process.

Alameda County Dental Society

1345 Grand Ave, Suite 102, Piedmont, CA 94610

Phone: (510) 547-7130 Fax: {510) 547-7191

Contra Costa Dental Society

3406 Hall Lane, Lafayette, CA 94549

Phone: {925) 284-8662 Fax: {925) 284-8661

San Francisco Dental Society

2143 Lombard Street, San Francisco, CA 94123

Phone: (415) 928-7337 Fax: (415) 928-5297

What is malpractice?

"Malpractice" means medical mistakes or poor- quality medical treatment. This includes treatment that makes your health problem worse instead of better and treatment that causes new health problems. It also includes failure to treat a problem. If you think your doctor, psychologist, or dentist committed malpractice, you may choose to sue them in a court of law.

Examples of malpractice:

• The doctor or dentist is slow to diagnose a disease or condition, or doesn't diagnose it at all.

• A mistake happens during a procedure or operation.

• The doctor or dentist does an operation without the informed consent of the patient. This means the doctor or dentist did not make sure the patient understood all the risks of the treatment and what the alternatives were before the operation.

• After making the right diagnosis, the doctor or dentist treats the health problem incorrectly.

• The doctor or dentist prescribes the wrong medication and this leads to more health problems.

How do I file a malpractice lawsuit?

If you think that you have a medical malpractice claim, you should contact a lawyer immediately.

YOU ONLY HAVE A LIMITED TIME TO FILE YOUR CASE.

Every county has a lawyer referral service that you can call to help find you a private attorney that may be able to help you.

For Alameda County, contact:

Alameda County Bar Association's Lawyer Referral Hotline Phone:

(510) 302-2222 ext. 4

For Contra Costa County, contact:

Contra Costa County Bar Association's lawyer Referral and Information Service Phone:

(925) 825-5700

For San Francisco County, contact:

The Bar Association of San Francisco's lawyer Referral and Information Service Phone: (415) 989-1616

What will happen once I start a malpractice lawsuit?

After your first consultation with a lawyer, he or she does not have to take your case. Make sure you understand if the lawyer is agreeing to represent you. It is the lawyer's responsibility to determine quickly whether your case is strong enough to go forward. (If the lawyer thinks that the case is not strong, he or she should tell you his or her reasons why). In addition, you must first reach an agreement with the lawyer about how the lawyer will be paid. The lawyer may want you to pay him or her by the hour, or, the lawyer may agree to advance all the costs. In this case, he or she will only be reimbursed and paid if you win and get money awarded to you. This is called a "contingent" fee. This contingent fee is set by law and the amount of the fee is set by law. If your lawyer is representing you "on contingency," you do not pay your lawyer unless you win your case. Make sure that you understand what your fee agreement and your retainer with the lawyer says before you sign it. You should get any agreement with an attorney in writing.

At the first meeting, the lawyer will want to see a detailed medical history. You should make a list of all the doctors or dentists who treated you. The lawyer will also want the names of all hospitals you have visited. It may help for you to prepare a written time line of all medical treatment you received. Include as many details as possible, such as dates, doctors, symptoms, conversations with medical providers, and treatment received. Afterwards, the lawyer will want to see your medical records. The lawyer will probably not be able to tell you if you have a good case before reviewing your medical records.

If you do go forward with a malpractice lawsuit, it may take years before it is resolved. Make sure your attorney has current contact info for you if you move or change phone numbers.

If you can't find an attorney to represent you, it doesn't necessarily mean you have a weak case-there might just be too little money at stake to make it worthwhile for a private attorney looking to make a profit. You can represent yourself in Small Claims Court, in which you can ask for up to $10,000.