Receiving a formal complaint can be daunting. Regardless of whether the complaint has validity, as the health care provider, you are responsible for responding and face serious consequences for non-compliance. Not sure where to start? Read on.
Who is responsible for overseeing complaints?
The Virginia Department of Health Professions (DHP) is charged with receiving all complaints made against regulated healthcare professionals. DHP’s mission is to ensure safe and competent patient care by licensing health professionals, enforcing standards of practice, and providing information to health care practitioners and the public.
Anyone, YES ANYONE, can get online and file a complaint against a health care provider regulated by DHP. This means patients, co-workers, employees, family members of patients, etc. can file a complaint. DHP investigates each complaint, regardless of how hollow or misguided it may seem. I have assisted in responding to a complaint that the waiting room chairs were uncomfortable.
In addition to direct patient complaints, DHP investigates all settlements and adverse verdicts against health care providers. Responses to these investigative letters are almost always handled by the litigation counsel who represented the provider in the settlement or trial.
How will I know if a patient has filed a complaint?
Generally, if you are the subject of a complaint, you will receive a letter from an investigator requesting certain information, records, your response to the complaint including an analysis of your care, whether you have changed your practice because of complaint or the underlying outcome and a variety of other questions tailored to the complaint. Sometimes, you may get a call from an investigator before you get a letter.
Many investigations are closed with no action after the provider submits a written response satisfactory to the regulating board. However, some investigations result in recommendations, reprimand, or may go on to the Informal Conference and even Formal Conference phases of the administrative process. There are many different paths an investigation can take and there are a variety of resolutions from no action to reprimand, to a consent order with terms (including in some cases suspension of your license among others).
What should I do when I receive a letter or a call from my regulatory board asking me to respond to a complaint?
Do not ignore DHP. Take the investigation seriously. This is your livelihood, your license, your reputation. You must cooperate with and be respectful of the regulatory board throughout the process.
Do not fire off a glib, nonchalant response NO MATTER how silly you might find the complaint. In my experience, some of the biggest headaches for providers have come from doing just this. Rather than respecting the complaint, DHP and the process, a provider shoots off a dismissive response and creates a world of headaches for himself that an attorney must then clean up with added, expense, headache, time and, possibly, administrative proceedings. Oh, the stories I could tell.
Do contact your professional liability carrier to find out whether you have coverage for regulatory matters such as board complaints and to alert them to the issue. If you have coverage for these matters, request counsel to assist with the response.
Should I hire an attorney to help me respond?
Yes, you should always consult with experienced counsel before responding, even if you do not have coverage. There are many experienced counsel who can assist you at reasonable rates. It is worth the expense.
Why? Once a response to a complaint investigation is filed, the assigned investigator reviews the response, ensures all the questions were answered and issues addressed, and then she creates a report for the Board – the decision makers. Experienced counsel has been through this exercise many times and knows how to provide a complete response to DHP, in the appropriate tone and format that will, in many cases, avoid additional questions, meetings, and proceedings. Counsel can help you articulate and present your response in a way that will help minimize additional inquiry. In short, experienced counsel will save you time and worry, and will help keep your mind on doing what you do best – providing patient care.
What if I am not a licensed health care provider? Does this still apply to me?
Are you a professional licensed by and regulated by a licensing board? This advice applies to you too! Don’t go it alone. If you need help with an investigation or have any questions about the process contact Tanner Pilcher at firstname.lastname@example.org or schedule an initial consultation. Tanner has over 15 years of experience working with healthcare providers and regularly counsels providers through the varying stages of DHP investigations.