The Code, the Commissioner and Complaints Dr Katie Elkin Associate Commissioner Legal & Strategic Relations Rural GP Network Conference March 2014 Overview • HDC: Vision and Mission • The Act and Code • Complaints Resolution • Case Studies HDC: Vision and Mission HDC Vision Engagement Transparency Consumer Centred System Culture Seamless Service HDC Mission Independently upholding consumer rights by: • promotion and protection; • resolving complaints; • service monitoring and advocacy; and • education. The Act and Code The Health and Disability Commissioner Act 1994 • Establishes the Office of the Health and Disability Commissioner, and the Commissioner’s roles and functions • Provides for a national Health and Disability Services Consumer Advocacy Service • Provides for the appointment of an independent Director of Proceedings Purpose of HDC “To promote and protect the rights of … consumers and, to that end, to facilitate the fair, simple, speedy, and efficient resolution of complaints” HDC Act 1994 Medico-legal context Patient Harmed Compensation Malpractice litigation Complaint Resolution Provider Accountability Quality Improvement Jurisdiction • Health or Disability Service • Health or Disability Service provider • Health or Disability Service consumer Code of Rights • Consumers have rights and providers have duties (clause 1) • Every provider must take action to inform consumers of their rights and enable consumers to exercise their rights (clause 1) • Sets out 10 rights (clause 2) • Provider compliance (clause 3) The Code of Rights Consumers have rights and providers have duties • respect, dignity, fairness • appropriate standards • communication, informed choice, consent • support, complaints • research and teaching Complaints Resolution Number of complaints received by HDC per year 1,900 1,800 1,700 1,600 1,500 1,400 1,300 1,200 1,100 1,000 2006/2007 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 2012/2013 2013/2014 (projected) Complaints in context • 15 million GP consultations • 370,000 acute hospital discharges • 3,500 complaints to advocacy • 1,600 complaints to HDC Complaints received about group providers in 2012-13 General Practice 17% Rest Home 8% Dental 4% Pharmacy 3% Prison 2% DHB 45% Other 21% Number of complaints received about general practices per year 450 400 350 300 250 200 150 100 50 0 2006/2007 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 2012/2013 2013/2014 (projected) Number of complaints received about General Practitioners per year 400 350 300 250 200 150 100 50 0 2006/2007 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 2012/2013 2013/2014 (projected) Top issues complained about in general practice complaints • Treatment • Communication • Medical Records/Reports The Complaint Process Seek further information (if necessary) Unless Complaint Received • Complaints Assessment Triage outside jurisdiction • Provider response • Obtain Clinical Advice (where required) Complaint resolution method • • • • • Referral Advocacy Mediation Investigation No further Action Complaint resolution options Broad options for complaints resolution: • • • • • • Referral to another agency (e.g. Medical Council) Referral to provider Referral to advocacy Mediation conference Formal investigation Take no action / no further action Focus is on local and early complaints resolution HDC complaints closed 2012/13 Referred to Provider 12% OJ 7% Referred to Registration Authority 7% Referred to Advocacy 7% Withdrawn/Resolved by Parties or Commissioner 4% Formal Investigation 4% Referred to Other 2% No Further Action 57% Complaints to HDC 2011/12 and 2012/13 2011 - 2012 2012 - 2013 1380 1551 Complaints Closed 44 29 8 Investigations Breach opinions Referrals to Director of Proceedings 60 42 16 Complaints management • Recognising signs of dissatisfaction • Identifying any misunderstandings • Diffusing through open and honest communication • Personally interacting with complainant • Apologising • Seeing complaints as a learning opportunity Learning from complaints Case Study 1 Case Study 12HDC00555 • Mrs D lived in a serviced apartment in a retirement village • The village did not provide rest-home or hospital level care, but did offer some limited nursing care • Local GP, Dr H, held a weekly clinic at the village • The GP and the two village nurses worked largely independently from one another • Mrs D enrolled with Dr H’s practice Case Study 12HDC00555 – closed December 2013 • At a routine check up, Dr H ordered a variety of tests • One result indicated Mrs D may have diabetes • Dr H arranged further tests, but did not arrange a fasting glucose test (recommended) • The second round of tests were also abnormal • Dr H did not organise any further tests, did not inform Mrs D of the results Case Study 12HDC00555 • 7 visits to Dr H over next 18 months • Dr H did not inform Mrs D of results, or take any follow-up action • 18 months later, Dr H ordered blood tests which again showed abnormal glucose level • Pathology report recommended further testing to diagnose diabetes. • Not actioned and no diagnosis made Case Study 12HDC00555 • Needs assessment organised • Prior to assessment, Dr H ordered further blood tests • Results returned 2 days before assessment, and confirmed a diagnosis of diabetes • Needs assessor noted results and organised hospital admission for full medical review • Woman diagnosed with diabetes in hospital Case Study 12HDC00555 Findings – Dr H Breach of Right 4(1) • Failure to manage elevated glucose levels • Failure to ensure abnormal results followed up • “Extremely poor care” Breach of Right 4(2) • Inadequate record-keeping Breach of Right 6(1)(f) • Failure to inform Mrs D of her test results Referred to Director of Proceedings Case Study 2 Case Study 12HDC00281 – closed December 2013 • Mrs A experienced a sudden onset severe headache, with vomiting and diarrhoea • No previous history of migraines, but a smoker • Taken to accident and medical clinic • Seen by GP, Dr D Case Study 12HDC00281 • Dr D did not obtain full history, including smoking • Did not refer Mrs A to, or discuss her case with, the on-call medical registrar • Dr D diagnosed a migraine brought on by alcohol, and prescribed anti-nausea and pain medication • Dr D’s shift finished immediately after seeing Mrs A. Handed over to a second GP, Dr E for observation and monitoring following medication administration Case Study 12HDC00281 • Dr E reviewed Mrs A twice. 40 minutes after medication administered, Dr E noted that her pain had decreased • Dr E prescribed further anti-nausea and pain medication and Mrs A went home • Mrs A collapsed early the following morning • Mrs A was taken to hospital by paramedics. A CT scan showed a large untreatable subarachnoid haemorrhage • Mrs A died later that morning • That morning Dr D made a retrospective addition to Mrs A’s clinical records Case Study 12HDC00281 Findings – Dr D Breach of Right 4(1) • Failure to obtain a full history • Failure to investigate the possible diagnosis of SAH Adverse Comment Adding to records without annotating as retrospective Findings – Dr E Adverse Comment Not found in breach, but criticised for suboptimal recordkeeping, and a lack of critical thinking Findings – Clinic Policies adequate – no breach Engagement Transparency Consumer Centred System Culture Seamless Service www.hdc.org.nz
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