Unless a complaint is resolved promptly at the hospital level, a patient whose pain is not treated will have
suffered unnecessarily. Advocates or family should not give up, however. Here are steps to take if the hospital and its personnel prove intransigent.
- If the patient's care is provided or paid for by an HMO, contact the state HMO
regulator?usually the state insurance commission. Click here for a list of state HMO
regulatory authorities and contact information. HMOs really do
not like to have to deal with regulators.
- File a complaint with JCAHO
if the hospital or nursing home is not helping you get relief. Although the JCAHO pain management standards
are not yet required, they will be included in JCAHO's 2001 surveys. In addition, JCAHO
standards now in effect require hospitals and nursing homes to respond to and resolve patient
- If the patient is Medicare-eligible, file a complaint with the fiscal intermediary (the insurance
company that actually audits and pays bills submitted by your doctor and hospital on behalf
of Medicare) and with the Health Care Financing Administration (HFCA), Medicare's federal
administrator. Day-to-day decisions about quality of care covered by Medicare are made by regional fiscal intermediaries?insurance carriers that contract with HCFA to provide first-line Medicare
management. They do not want to pay medical providers for inadequate care. A list of HCFA regional
offices is provided by the Center for Patient Advocacy
in its resources center.
- File a complaint against the doctor on an emergency basis with the state medical licensure
board. You can obtain the contact information for your state's medical board (see the
Federation of State Medical Boards). If the situation is
immediate, make your complaint first by telephone, requesting advice on specific emergency
procedures. Complaints do not have to be elaborate. You will need only a clear, short summary
of the facts. Identify the name of the doctor, name of the facility, patient condition, the nature of
the problem and steps taken to resolve the complaint. It is very important for medical
licensure boards to hear about undertreatment of pain. Boards
have been quick to censure doctors for using "too many" opioids, with bad effects for pain
patients. They need to understand the flip side. Only one state medical board has formally censured
a doctor for undertreatment of pain.
- Consult an attorney regarding medical malpractice
and "intentional infliction of emotional distress" tort claims. These claims are either filed with the
local court or, in some states, resolved by mandatory arbitration. When
risk-managers recognize that untreated pain or negligent end-of-life care can cause liability, change
will occur. However, every complaint is different and every state has its own body of law.
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This content is provided by the Project on Palliative Care Law of the Bazelon Center for Mental Health Law. For more information visit the Project's web site at www.painlaw.org.