Australia: Not what the doctor ordered: Responding to a Health Ombudsman complaint in Queensland

Last Updated: 8 February 2018
Article by Rachel Drew and Rose Sanderson

Most Read Contributor in Australia, March 2019

In Queensland, the Office of the Health Ombudsman (the OHO) receives and manages complaints about health service providers.

For health practitioners in New South Wales, the relevant body is the NSW Health Care Complaints Commission.

In other states and territories, the Australian Health Practitioner Regulation Agency handles complaints. This article focuses on complaints made within Queensland, but please contact us if you would like advice on the complaints processes in other jurisdictions.

The scope of regulators to manage complaints

Anybody can make a complaint about a health service. The OHO has the power to deal with complaints about registered health practitioners under the Health Practitioner Regulation National Law Act 2009 (Cth).

OHO powers include complaints made about unregistered health practitioners, such as nutritionists, naturopaths, dieticians and speech pathologists. The OHO deals with complaints about both public and private entities which provide health services.

The complaints process

Patients may make a complaint for a number of reasons, for example, the patient may be dissatisfied with a health service and want an apology for any distress caused, or may wish to improve the service for the public. When the OHO receives a complaint, it will typically decide whether to accept or reject the complaint within seven days unless the complaint is considered to be complex. If the complaint is accepted, the OHO will commence the assessment process which can take up to 30 days.

In some circumstances, the OHO may ask the health practitioner to provide submissions as to why action should not be taken in response to the complaint. The OHO will usually allow a health practitioner to provide a response within 14 days from the date of the request.

If the OHO decides to take a complaint forward, it may:

  • assist to facilitate a local resolution
  • facilitate a conciliation to resolve the complaint
  • refer the complaint externally
  • investigate the complaint; or
  • take immediate action against the health service provider, such as suspending a practitioner's registration or prohibiting the practitioner from providing a health service.

Even if a complaint is not taken further, the OHO will keep a copy of the complaint on file to assist in identifying any systematic behaviour.

How to handle a complaint

Local complaint

If you are approached at a local level, we recommend that you take time to listen to the patient's complaint and take steps to reflect on any possible solutions. Taking a complaint seriously in its infancy can prevent a formal complaint from being lodged with the OHO. The OHO recommends to consumers that a local approach is taken initially, and if the local discussion does not result in a satisfactory outcome, a formal complaint is made.

It will be beneficial for you, or your employer, to have a complaints process which sets out the steps involved in receiving, investigating and resolving complaints. For example, your complaints process may include the following steps:

  1. Listen to the consumer about their complaint, and if the conversation is verbal, take adequate notes about the details of the complaint.
  2. Take the time to explain to the consumer how the complaint will be managed. This can ensure that the consumer is confident with the process and may prevent escalation of the complaint.
  3. If you feel that it would be inappropriate for you to personally manage the complaint, put the consumer into contact with somebody who can manage the complaint.
  4. Give the consumer an idea of the timeframe in which the complaint will be assessed and actioned.
  5. Handle the complaint in a reasonable way, and even though the complaint may upset you, ensure you do not harass or intimidate the complainant.

Formal complaint

If a complaint to the OHO is made, you will receive written notification of the complaint.

Once you have read through the complaint, you may like to consider the following guide to handling the complaint.

  1. Any contact from a health complaints Regulator should be given urgent priority.
  2. Retrieve and ensure you have complete records in relation to the patient's treatment history, and assist to demonstrate how the consumer's health matter was handled.
  3. Make a note of any key dates, such as the date on which a response is required from you.
  4. Call your medical indemnity insurer and provide any relevant documents (such as the complaint letter and your notes).
  5. If the complaint requires a response:
    1. place the facts in chronological order, and make sure that any factual inconsistencies in the complaint are corrected;
    2. make reference to your notes from the event, and attach a copy; and
    3. if relevant, do not be afraid to express any sympathy and always respond in a reasonable way.

As a general rule, you should never contact the patient directly, as this will often be considered as inappropriate.

Key takeaways

  • If you are approached locally about a complaint, make sure you follow a reasonable process and take the complaint seriously – this can prevent a complaint from being escalated.
  • Do not be afraid to contact your insurance provider to request assistance. Your insurance provider can provide support and guidance in responding to the complaint.

This publication does not deal with every important topic or change in law and is not intended to be relied upon as a substitute for legal or other advice that may be relevant to the reader's specific circumstances. If you have found this publication of interest and would like to know more or wish to obtain legal advice relevant to your circumstances please contact one of the named individuals listed.

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