How to Make a Medical Complaint - Pt. 2: A Step-by-Step Guide
Welcome to Part 2 of our four-part blog series on How to Make a Medical Complaint In Alberta, Canada.
Before continuing, please review our blog post on how to determine if making a medical complaint is necessary, and how to decide upon the urgency.
If you have decided that making a medical complaint is warranted and necessary, here are the steps for doing so effectively.
Take a witness, whenever possible
During all meetings with nursing staff and managers about an incident, make every effort to bring a witness. Your witness should be allowed to make notes. A professional patient advocate, or legal assistant, is the best person for this role but any calm, logical person is appropriate. It’s a human truth that most people behave better, and more honestly, when a third party is in the room.
Making a complaint
Against a facility or hospital
There is a very specific order in which to make a complaint regarding treatment within a hospital or long-term care/residential facility in Alberta. Choosing to not follow these steps will delay action. Here are some guidelines:
First and foremost, whenever possible, initiate these steps as logically as possible. Try to take the emotion out of your complaint. We acknowledge this can be very difficult when something dangerous or life-threatening has happened to you or a loved one, however, to be taken seriously it is important to slow down, take a breath and let your emotions settle before continuing with the complaint process.
Make detailed notes for yourself about the incident, using the classic W5 reporting technique:
Who: Who was the patient, and who was the healthcare provider?
What: What happened? Try to give as many details as possible. What did you or your loved one do? Was it reported immediately? What was the outcome when it was reported?
Where: Name of the hospital, unit, room, location in room (ex. bathroom)
When: As close to an exact time as possible.
Why: What might have led to this event? ie. state of mind of the patient, state of mind of the healthcare provider, how busy was the unit, was it understaffed, etc
3. Write down anything and everything that was said and done that will jog your mind later. These are your notes, and should not be shared with hospital staff. Do not let anyone take your notes, and do not allow them to be photocopied.
4. Find and talk to the right person:
With as calm a mind as possible, ask to speak to the Charge Nurse – there’s one on every shift, and on day shifts they are most often called the Patient Care Coordinator (PCC) or, in a care facility, the RN on duty. Ask to meet in a quiet room. Do not speak openly in a public area, such as the nursing station. If your complaint is not taken seriously and/or is not resolved, move on.
If you’ve decided to escalate the concern, and it’s during a day shift 7am-3pm Monday-Friday, ask to speak to the Nursing Manager, or if in a care facility, the Director of Care. You will likely get resistance at this point. Nursing Managers and Directors of Care are often very busy, relying on their Charge Nurses to resolve issues. However, you have every right to ask for the Nursing Manager or Director of Care, saying that you will wait (whenever possible), but will expect to see them before end-of-day.
If you are escalating the concern on a weekend, or between the hours of 3pm-7am, and only if the situation can’t wait until morning, ask to speak with the Nursing Supervisor or Nursing Site Manager. Use your notes and be specific. Why does this require action and resolution right away?
5. Next, ask that an Incident Report be written, and that you are allowed to read and sign it. Only do so if it is accurate.
6. If the problem is not resolved in a timely manner through the Nursing Manager or Director of Care, bring your questions, concerns or recommendations to the resident and family council, if there is one.
7. Be sure also to provide feedback to the facility’s Patient Relations Department to hopefully, at the very least, make them aware and result in quality control changes.
Send to the AHS Patient Relations Department for complaints against a hospital or facility overseen by Alberta Health Services that management will need to address.
Send to Covenant Health Patient Relations Department for complaints against a hospital or facility overseen by Covenant Health that management must address.
If the problem involves residential care and is still unresolved, you may contact the Continuing Care Licensing Office about the Continuing Care Act regulations.
Note: These are NOT emergency lines. The offices generally take 48 hours or more to respond, Monday through Friday.
For steps on how to make an effective complaint in writing (recommended, via email), please see: Writing an Effective Medical Letter of Complaint in Alberta
Against Registered Nurses, Nurse Practitioners, Midwives, Licensed Practical Nurses & Registered Care Aides
First, follow the steps above for making a complaint against a hospital or facility. Additionally:
If the problematic caregiver is an RN or Nurse Practitioner, and you have their name, you can also make a complaint to the College of Registered Nurses of Alberta.
If an LPN is involved in the incident, a complaint to the College of Licensed Practical Nurses of Alberta would be indicated.
If a registered care aide is involved in the incident, the employer is legally obligated to report the abuse to the Alberta Health Care Aide Directory.
If the negligent practitioner is a Midwife, or if you want to verify their credentials, see College of Midwives of Alberta (CMA). Please be aware that only midwives registered with the CMA are entitled to use the title “midwife”, manage labour or deliver a baby. Learn more
More details in Resources below.
Against a Physician
Doctors generally are not employed by the hospital, and their actions within a hospital are not mandated or controlled by the hospital.
Exceptions are:
Emergency room physicians
Hospitalists
Critical care/intensive care specialists
However, all serious incidents and deaths that occur within the hospital are to be reviewed by a special review panel. Doctors are also required to communicate effectively and fully with all other care providers to ensure the best possible outcomes.
Any complaints about a physician should be directed to the Patient Relations Department of AHS or Covenant Health and the College of Physicians and Surgeons of Alberta (CPSA).
More details in Resources below.
In the case of questionable death
If you think your loved one has died under unusual or suspicious circumstances, immediately reach out to the Alberta Office of the Chief Medical Examiner (OCME) so they can make sure the body is held for examination and possible autopsy.
Most deaths are reported to the OCME by police, AB Ambulance Service and hospitals or long-term care homes.
Anyone can report a death to the OCME that they believe meets the reporting requirements under the Fatal Inquiries Act to be investigated by an independent body.
More details in Resources below.
3. Escalating to a Formal Medical Complaint
Patient Concerns Resolution Process (PCRP)
The Patient Concerns Resolution Process (PCRP) through Alberta Health Services is available to all members of the public to express concerns about the health services they receive. This process addresses complaints for all acute care hospitals, clinics, and all publicly funded assisted living and residential (long term care) facilities. The PCRP also oversees patient care in assisted and residential care facilities that are privately owned, but that “contract” beds to the health authority.
A Patient Concerns Consultant (PCC) will work with Program and/or Senior leadership of the facility in question to resolve your concern. You can also lodge a complaint with the Continuing Care Licensing Office when it involves residential care facilities.
Note: Wherever possible, make your complaint in writing via email - see blog post How to Write a Medical Letter of Complaint in Alberta - so that a chain of response will be established. If you must make a verbal complaint via voicemail, leave as much information as possible about the incident and location, and clearly state your name and phone number. If you have not received a response within 42 to 72 hours, follow up. If you do receive a return call, write down the name of the person you speak with, their direct number or extension, email address, date and time you spoke, along with all other details.
If you are not ready for the returned call, ask for a specific time for them to call back. Regain your composure and take control of the call. If you lose your composure – and especially if you feel you are losing your temper – ask that the call be continued at a later time, or state that you will continue the complaint process via email.
More details in Resources below.
Some Issues to Note
As experienced Patient Advocates, we have some considerable concerns about the Patient Relations Department of AHS and Covenant Health. However, in the overall process, making a complaint to them is essential.
Concerns to note to help you set your expectations realistically:
The offices are understaffed with high turnover.
The turnaround time for a complaint is well beyond 48 hours, and a final report can take weeks, months or longer.
They work for the hospital or health authority, and there is no immediate external accountability. Even when a complaint is taken to the next step of the Patient Concerns Officer (PCO), there is no requirement that recommendations be put into place.
There is often little investigation into complaints, and the response is often a rubber-stamped, “We’re very sorry for your experience.”
In just about all complaint processes we have been a part of, the PCCs have taken the side of the doctors, nurses, and management in question.
In the rare cases where suggestions were made for change, the Patient Relations Department has little in the way of authority to follow through to make sure these changes were made.
All of this said, a complaint to the Patient Relations Department must be made, in order to take next steps with other complaint procedures. Any lack of appropriate response should be noted in the next level of formal complaint.
4. When you’re still not getting anywhere
If the hospital, nursing staff, and Patient Relations Department are not responding appropriately, or at all, and you require an immediate resolution, you can contact the AB Ombudsman to request an external review, or your MLA, but you will need to show what you’ve done to resolve this situation via other avenues.
If and when you do receive a written response from the Patient Concerns Consultant from the AHS Patient Relations Department, and if you are not satisfied, you can request to have your concern reviewed by a Patient Concerns Officer (PCO). The PCO is the Executive Director of the Patient Relations Department, and oversees the PCRP.
If you still believe the ensuing decision of the PCO to be unfair, you may request a review by the AB Ombudsman. Each investigative step must be complete before the next can be initiated, therefore, this is not a course of action for issues that require urgent resolution.
In conclusion
When making a formal medical complaint:
Be logical, but stay angry and motivated.
Be assertive and follow up, follow up, and follow up some more.
You can make a difference.
Links & Resources
For greater detail on each of the above steps, and all contact info for the offices mentioned, see:
Making a Medical Complaint in AB: Links, Contacts & Resources
Credits to Connie Jorsvik of PatientPathways.ca
Edited and adapted by Corinne Hewko for the Alberta healthcare system
