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Health Care Complaints Commission
The Complaints Process
The Commission receives and deals with complaints involving individual health practitioners, such as doctors, optometrists and acupuncturists, and health service organisations, such as hospitals.
Complaints about individual health practitioners involve different procedures from those made about health organisations. This is indicated in the two process flowcharts as shown below.
To view more information for each step please move your mouse over the flowcharts below.
If the Director of Proceedings considers that a matter does not meet the threshold for prosecution, the matter can be terminated, referred back to the Investigations Division to gather further evidence, or referred to the Commissioner to determine the outcome in line with statutory requirements.
The Director of Proceedings determines whether a complaint should be prosecuted before a disciplinary body. The Director of Proceedings is not subject to the direction and control of the Commissioner regarding decisions on complaints. The Director of Proceedings must consider certain criteria when determining whether to prosecute a matter:
the protection of the health and safety of the public.
the seriousness of the alleged conduct.
the likelihood of proving the alleged conduct.
any submissions made by the health practitioner concerned.
Make comments to the health practitioner. Comments made to a health practitioner are a statement that inadequate care or treatment was provided.
Complaints about individual practitioners are subject to formal investigation by the Commission where, if substantiated, the complaint would provide grounds for disciplinary action or would involve gross negligence on the part of a practitioner.
The focus of investigations is on the protection of public health and safety, rather than trying to obtain redress for individual complainants. The Commission does not act for the complainant when investigating a complaint, and must remain impartial. The purpose of an investigation is to obtain information so that the Commission can objectively determine the most appropriate action (if any) to take.
Where a matter is assessed as being appropriate for conciliation, it is referred to the Health Conciliation Registry. The Registry maintains a panel of independent expert conciliators who can facilitate a meeting of the parties to the complaint and guide them in seeking a resolution of the issues that underlie the complaint. Conciliation is a voluntary and confidential process.
Refer the complaint to the appropriate Registration Board to take action under the relevant health registration legislation. In some cases, the Registration Board may have the power to refer the practitioner for performance or impairment assessment. The Registration Board may also decide to counsel the practitioner about the conduct that is the subject of the complaint.
Often a complaint may be resolved with the assistance of a Resolution Officer. Resolution Officers are officers of the Commission and they remain neutral in the assisted resolution process. It is their role to help all parties attempt to resolve the complaint. Participation in assisted resolution is voluntary.
In some instances it is appropriate that a complaint be referred to the relevant Registration Board or another body to be dealt with by them. Actions that Registration Boards may take include counselling, as well as impairment or performance assessment for doctors and nurses.
Once a complaint about a health practitioner is received, the Commission will assess the complaint. Depending on the nature of the complaint, some of the key steps involved in assessing a complaint are: contacting the complainant to clarify the complaint; notifying the practitioner and seeking a response to the complaint; obtaining health records to assist assessment in cases where the complaint raises concerns about clinical issues; and seeking clinical advice. The Commission has nursing and medical advice available to assess the appropriateness of the health care or treatment provided to the subject of the complaint. All relevant information, including any expert advice, is compiled into an assessment brief which, together with the file, is assessed by the Commission in consultation with the relevant Registration Board if the complaint is about a registered health practitioner.
If the Commission is not satisfied that sufficient steps have been taken within a reasonable time as a consequence of its report to the Minister, it may make a special report on the matter to Parliament.
If the Commission is not satisfied that sufficient steps have been taken within a reasonable time as a consequence of its report to the Director-General, it may, after consultation with the Director-General, report to the Minister.
If the Commission makes recommendations to a health organisation, a report detailing the recommendation is provided to the Director-General, NSW Department of Health .
The Commission follows up the implementation of recommendations with the Department of Health or private health organisation on a quarterly basis.
Complaints about health practitioners can be received either by the Commission or by the Registration Board if the practitioner is registered under health registration legislation.
The Commission receives and deals with complaints involving individual health practitioners, such as doctors, optometrists and acupuncturists, and health organisations, such as hospitals.
Once a complaint about a health organisation is received, the Commission will assess the complaint. Depending on the nature of the complaint, some of the key steps involved in assessing a complaint are: contacting the complainant to clarify the complaint; notifying the provider and seeking a response to the complaint; obtaining health records to assist assessment in cases where the complaint raises concerns about clinical issues; and seeking clinical advice. The Commission has nursing and medical advice available to assess the appropriateness of the health care or treatment provided to the subject of the complaint. The relevant information, including any expert advice, is compiled into an assessment brief which, together with the file, is assessed by the Commission. The possible outcomes of assessment are detailed below.
In some instances it is appropriate that a complaint be referred to another body to be dealt with by them. This can include referral to the Director-General of the Department of Health if there has been a breach of certain legislation.
The Commission can refer the complaint to the health organisation for them to resolve directly with the complainant. This can only be done where the health organisation that has been complained about is a public health organisation such as a hospital or clinic operated by an Area Health Service. The provider must agree before a referral for direct resolution is made.
Often a complaint may be resolved with the assistance of a Resolution Officer. Resolution Officers are officers of the Commission and they remain neutral in the assisted resolution process. It is their role to help all parties attempt to resolve the complaint. Participation in assisted resolution is voluntary.
Where a matter is assessed as being appropriate for conciliation, it is referred to the Health Conciliation Registry. The Registry maintains a panel of independent expert conciliators who can facilitate a meeting of the parties to the complaint and guide them in seeking a resolution of the issues that underlie the complaint. Conciliation is a voluntary and confidential process.
The Commission can discontinue dealing with a complaint for many reasons, including the age of the matter complained of, or that it might be better dealt with by some alternative means of redress.
Complaints about health organisations are subject to formal investigation by the Commission where they raise a significant issue of public health or safety, or significant questions about the appropriate care or treatment of an individual. The focus of investigations is on the protection of public health and safety, rather than trying to obtain redress for individual complainants. The purpose of an investigation is to obtain information so that the Commission can objectively determine the most appropriate action (if any) to take.
At the end of an investigation into a health organisation/health practitioner the Commission may:
Terminate the complaint and take no further action
At the end of an investigation into a health organisation/health practitioner the Commission may:
Refer the subject matter of a complaint to the Director of Public Prosecutions for the consideration of criminal charges.
At the end of an investigation into a health organisation the Commission may:
Make comments to the health organisation. Comments made to a health organisation are a statement that inadequate care or treatment was provided.
At the end of an investigation into a health organisation the Commission may:
Make recommendations to the health organisation. Recommendations are made where an investigation discloses poor health service delivery and identifies improvements that could be made to practices.
If the Commission makes recommendations to a health organisation, a report detailing the recommendations is provided to the Director-General, NSW Department of Health.
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