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Filing a Complaint Against a Health Care Institution
La loi vos droits
Health Care Users and ProfessionalsFiling a Complaint Against a Health Care Institution
Rose, Erica’s grandmother, just left the hospital after spending three weeks there because of a broken hip. Erica thinks that the hospital staff treated her grandmother without any respect or compassion. For example, a staff member brusquely took Rose from one department to another, without giving her the time to put on her hospital robe decently. Also, after returning to her long-term care center, Rose wasn’t served the menu prescribed by her doctor, which caused her health to deteriorate. Erica wonders if her grandmother has the right to complain, and if yes, to whom? Is there anyone who can help her grandmother?The health and social services system has developed a process to handle complaints made by its users whose rights have not been respected. In this Infosheet, Éducaloi informs you about the reasons for making a complaint, how to do it, the time limits, and the available resources.
What are the rights of patients?
The law sets out the rights of users of "health or social services establishments". The user can file a complaint if one of these rights was not respected. Here are the main rights:Right to be informed
- Be informed of your state of health.
- Be informed of possible treatments, their risks and side effects.
- Be informed of care and services available in your area.
- When a treatment does not go through as planned, be informed of the consequences, of measures taken to resolve the situation, and of measures that prevent the situation from happening again.
Right to receive care
- Receive the care required by your state of health, particularly when your life or your physical integrity is threatened.
- Receive care that is continuous, personalized, and adequate from a scientific, human, and social perspective.
- Choose your health professional, depending on available resources and the freedom of the professional to accept or refuse a patient.
- Receive care in English, if you want.
Right to decide
- Consent (agree) to care, personally or through your legal representative. To find out more, see our Infosheet called “Consent to Care.” (http://www.educaloi.qc.ca/en/loi/health_care_users_and_professionals/61/)
- Leave as soon as you are released from an establishment or stay if there is no place for you in another establishment.
- Participate in decisions concerning your state of health and be accompanied when these decisions are being made.
You can file a complaint against an establishment, an employee, or a professional who doesn’t respect these rights. The context (for example, the resources and staff available to the establishment), the organization of work, and the applicable laws and regulations all help determine if a right was not respected. The establishment cannot restrict a user’s rights, for example, by forcing him to sign a discharge.
What is a “health or social services establishment?”
The complaint process described in this Infosheet applies to CLSCs, hospitals (including psychiatric hospitals), youth centers, residential and long-term care centers (CHSLDs), and rehabilitation centers.In general, any public or private establishment is a health establishment if it offers diagnostic services, general medical care, health services at the primary level of care, and lodging services.
Do these rules about the complaint process apply to all health and social service establishments?
This complaint process does not apply to certain private establishments that offer care for your health, for example: certain vaccination clinics, assisted reproduction clinics, dermatology clinics, and physiotherapy clinics. A Centre d’aide et d’accompagnement aux plaintes (CAAP), which is an organization whose mission is to help and support users, can tell you if the complaint process applies to a particular establishment (see the question “Who can help me file my complaint?”).If you want to complain about the services you received in an establishment to which the complaint process does not apply, you must contact a person who is in charge of this establishment: person in charge of customer service, ombudsman, director. Sometimes, you can also have other recourses. See the question “Is this the only complaint process that exists?”
Who can file a complaint?
Any user who thinks that one of his rights has not been respected can file a complaint.If the user is dead, his heirs can file a complaint on his behalf. If the person whose rights were not respected is a child or is unable to file a complaint himself, a representative can file a complaint on his behalf. This representative can be the person’s parents, his tutor, his curator, his mandatary in case of incapacity, a close relative, or someone else who shows a particular interest for the person.
To find out more about these representatives, read our Infosheets: Curatorship for Adults (http://www.educaloi.qc.ca/en/loi/senior_citizens/47/), Tutorship for Adults (http://www.educaloi.qc.ca/en/loi/senior_citizens/49/) and Mandates in Anticipation of Incapacity (http://www.educaloi.qc.ca/en/loi/senior_citizens/52/).
How does a user file a complaint against a health or social services establishment?
The user can complain verbally, or he can write down his complaint. He can get help from a Centre d’aide et d’accompagnement aux plaintes (CAAP), which is an organization whose mission is to help and support users (see the question “Who can help me file my complaint?”). The complaint is addressed to the local complaints commissioner of the establishment (“the commissioner”). When she receives the complaint, the commissioner first informs the user that his complaint has been received (she has three days to do this). She then carries out a first evaluation of the complaint. If she finds that the complaint is without foundation – for example, if the user’s complaint is not related to the one of the rights described above or if the user is complaining just because he dislikes an employee of the establishment – she rejects the complaint and informs the user about her decision.But if the complaint seems serious, the commissioner investigates what happened. She questions the user and the other people involved, and she checks the facts. She must send her decision, including the results of her investigation and a detailed report, to the user (or his representative) within 45 days. The decision is sometimes accompanied by recommendations made to the establishment’s board of directors, its management and/or the person in charge of the relevant services at the establishment.
The local complaints commissioner must also inform the user that he has two years to contact the Health and Social Services Ombudsman (http://www.protecteurducitoyen.qc.ca/en/domaines/reseau_sante.asp), if he is dissatisfied with the commissioner’s decision. (See the question “What is the role played by the Health and Social Services Ombudsman?”)
Is the process different if the complaint is filed against a doctor, a dentist, or a pharmacist who works at a health or social services establishment?
A little. If the complaint concerns a doctor, a dentist, or a pharmacist, the commissioner sends the complaint to the medical examiner of the establishment. The medical examiner carries out the investigation. He has 45 days to examine the complaint and provide a decision to the user and the professional. The medical examiner also informs the user about how the user can ask the review committee to review (check) the medical examiner’s decision.If the user wants the decision to be reviewed, he must start the review procedures within 60 days after receiving the decision. The review committee then has 60 days to review the decision and to communicate its conclusions to the user, the professional, the medical examiner, and the local complaints commissioner of the establishment.
The medical examiner cannot handle complaints in which a doctor, a dentist, or a pharmacist seriously violated their respective codes of ethics; for example, a doctor who sexually touches a patient. In such cases, the medical examiner sends the complaint to the relevant professional order.
Can the content of my complaint be used against me?
No. When a user files a complaint in good faith (i.e. without an intention to harm), the person against whom the complaint is filed cannot use the information provided by the user against the person in a law suit. Moreover, the user cannot be sued for the consequences of his complaint, and no one has the right to take reprisals against him. The answer is the same whether the complaint was rejected or accepted.For example, Aimée filed a complaint against an employee who mistreated her: the employee was harsh to her despite a recent surgery and insulted her. After an investigation, the commissioner realised that the employee had been involved in such incidents in the past, so the commissioner recommended to the board of directors to fire the employee. The employee does not have the right to sue Aimée for losing her job and the establishment does not have the right to take reprisals against Aimée, for example, by refusing to provide her with care in the future.
What is the role played by the Health and Social Services Ombudsman?
When a user is not satisfied with the decision made by the local complaints commissioner or when a user does not get an answer from the commissioner, he can file a complaint with the Health and Social Services Ombudsman. The Health and Social Services Ombudsman first examines the complaint to see if he will handle it or reject it. He can reject the complaint if he finds that:- It is frivolous (not very serious); or
- It is made to harm the person against whom it is made; or
- It is made after more than two years; or
- It is made too late for the Ombudsman’s involvement to be useful.
The Ombudsman gives the establishment and the user the chance to explain their positions. He can ask them for any documents that he thinks will be useful to making his decision.
The Ombudsman promptly communicates his conclusions and recommendations to the user and the establishment. The establishment then has 30 days to inform the Ombudsman and the user of the solutions it has adopted.
How do I file a complaint against a community organization, a senior citizens home, a private nursing home or ambulance services?
The complaint process is relatively the same as that for health establishments. You or your representative can file a complaint with the relevant health agency, which is the organization that coordinates the health services available in a particular territory. The complaint is then sent to the regional complaints commissioner named by the board of directors of the agency.After receiving the complaint, the regional complaints commissioner examines it. Within 45 days after receiving the complaint, she sends her conclusions and her recommendations to the agency or the relevant establishment and to the user or his representative. She informs the user that the user can ask the Health and Social Services Ombudsman to review her decision.
In the Laval and Montreal areas, you should file your complaint regarding ambulance services with the Service Quality and Complaints Commissioner for Corporation urgences-santé.
Who can help me file my complaint?
There are a few places you can turn:1. The Centres d’assistance et d’accompagnement aux plaintes (http://www.rpocaa.org) (CAAPs) help users and their representatives during the complaint process. The CAAPs have offices in all regions of Quebec and most of them belong to the Regroupement provincial des organismes communautaires d’assistance et d’accompagnement - an organization that groups together many CAAPs.
The CAAPs are not the legal representatives of the users, but they:
- Inform the user about the complaint process;
- Write the complaint (if necessary);
- Help clarify what the complaint is about;
- Help and support the user through all the steps during which the complaint is being processed; and
- Facilitate dialogue between the different parties involved while making sure that the user is satisfied.
To get help, the user can contact the CAAP of the area where he lives. If he was not treated near his home, the user can choose to contact the CAAP of the area where he lives or the CAAP of the area where he was treated.
2. The user’s committee of a health establishment can also help users with the complaint process, or accompany them in this process. Each health care establishment in Quebec must create a user’s committee. To find the committee’s contact information, users can contact the Service Quality and Complaints Commissioner (http://www.msss.gouv.qc.ca/en/reseau/plaintes.php).
Is there a time limit for filing a complaint?
The earlier the better. As time goes by, the parties involved in the complaint may forget what exactly happened, which makes processing the complaint more difficult.Also, as explained above, if a user is dissatisfied with a commissioner’s decision, the Health and Social Services Ombudsman cannot review that decision, if more than 2 years have passed between the decision and the complaint made to the Ombudsman.