How to make a complaint about a healthcare provider if you or a loved one have encountered substandard care at a dentist or doctor’s office or a medical facility, such as a hospital or nursing home?

Not every health care complaint rises to the level of a malpractice claim, but for patients whose issues do not meet the criteria, there still are avenues to pursue regarding poor treatment or bad behavior in the medical field. Patients can bring their concerns to the attention of their health care providers, but doing so effectively requires some knowledge and preparation.

First, let’s talk about the kinds of health care issues which may warrant a formal complaint, but which are unlikely to support bringing an actual malpractice claim with worthwhile (and recoverable) injuries and damages.

Then we’ll dive into how to write an effective complaint and follow up for results.

Types of Health Care Complaints

These issues often do not meet the stringent criteria necessary for a successful malpractice lawsuit, but still deserve attention and rectification. You may wish to make your provider aware of concerns in these areas:

  • Poor bedside manner or behavior perceived to be rude or insulting
  • Inconvenient office policies or practices
  • Long wait times or cancellations
  • HIPAA violations or breaches of patient privacy
  • Discrimination
  • Errors in the medical record
  • Billing issues, suspicion of fraud in billing or “up-billing”
  • Quality of care issues
  • Poor communication, such as not returning phone calls

All of the above situations can be maddening and can even contribute to an actual medical malpractice claim, but individually, they would rarely become the basis for a malpractice lawsuit.

Most of the time, the injury or damage resulting from these types of actions are so limited as to not be worthwhile to launch an expensive malpractice case and the expert witnesses those cases require. It might cost more to prove what happened and why it was wrong than you would recover, but don’t despair – you’re not out of options.

Complaints About a Health Care Provider

There are very effective non-legal ways to address such concerns. Of course, you can directly address your concerns with your doctor or the practice’s office manager. Or, vote with your wallet and take your business elsewhere. You could even write a negative (but HONEST) review online to publicize your concerns. But what if you think authorities need to be aware of your concerns?

How to Write an Effective Complaint

If you think your complaint warrants further investigation by licensing authorities, you can file a formal complaint against a health care provider with the state licensing authority, usually a medical board.  State medical boards are responsible for issuing licenses, and regulating the behavior of their licensees.

Below we offer some suggestions on how to structure a medical board complaint to maximize its impact.

Write it Down

When making a complaint about a negligent health care provider or a substandard medical practice, the first thing is to document the facts of your concern in writing. Written complaints provide a clear record and carry more weight than a verbal recounting of your issue with a staff member. Having contemporaneous documentation that you clearly communicated your concerns to the target provider may also help later, if your complaint goes further.

Emphasize Facts

Present your case objectively, focusing on factual details rather than your emotions. Do not exaggerate for attention. Stay calm and be sure you are communicating only verifiable truths. This approach lends credibility to your complaint and strengthens your position, as well as ensuring that you will be taken seriously.

Specificity Matters

The names of facilities, the first and last names of providers and the dates and times of events are of the utmost importance. Do some research using online resources to find the legal names of the doctor and their office name and location(s) where your care was provided. It does no one any good to make a vague complaint about an unspecific target.

Include Essential Details

Ensure your complaint contains key details such as provider and facility names, addresses, contact information, and the specifics of the complaint including dates, times and what you think was done wrong. Be prepared to answer questions or provide additional information or documentation if you are asked. This facilitates a thorough investigation.

Be Clear and Concise

Edit your complaint to be as concise as possible while ensuring all essential information is included. A well-structured, to-the-point document is more likely to garner attention and prompt action than a rambling, emotionally charged screed. A good piece of advice is to always “sleep on it”– take a 24-hour break and then re-read and revise if necessary to make sure you’ve communicated clearly. In addition, if you have a specific request for how to address your complaint, make that clear as well.

Follow-Up Protocol

Keep a log of all communications regarding your complaint. Make copies of any letters and the attached documents and notes regarding conversations, including times and dates. Ask for a deadline by which you should expect a response to your complaint. Stay proactive in following up on your complaint’s progress. Request updates regularly to ensure your concerns are being addressed promptly and adequately.

Take a Comprehensive Approach

Consider submitting complaints to all available regulating authorities if the issue is truly serious. This approach increases the likelihood of a thorough investigation and resolution. Depending on your case, the below links might be good sources for finding where to file your medical board complaint.

Medicare/Medicaid Complaints: https://qioprogram.org/locate-your-bfcc-qio
Consumer Assistance for Medicare/Medicaid Services: https://www.cms.gov/cciio/Resources/consumer-assistance-grants
Find Your State Medical Board: https://www.fsmb.org/contact-a-state-medical-board/
US Department of Veterans Affairs: https://www.va.gov/health-care/

With the above guidelines in mind, you can effectively address your complaint with the appropriate parties. Your diligence and attention to detail can make a significant difference in ensuring accountability in the healthcare field.

Consult an Experienced Medical Malpractice Attorney

If you have more serious concerns with significant injuries or damages, and you think you have a valid malpractice claim, you can call Wallace Wason, PLLC at (703) 638-7717 for a free case evaluation or fill our contact form for a reply from our intake staff.

Image Credit: