Frequently Asked Questions - Health Consumers

If you would like to speak to someone at the Commission for more information before you lodge a written complaint you can contact the Inquiry Line during business hours, Monday to Friday from 9am – 5pm on 1800 043 159.

If you have immediate concerns about the health and safety of a person, you can contact emergency services on 000 or go to your local hospital.

If you need health advice you can phone the Health Direct hotline on 1800 022 222 or visit the website on www.healthdirect.gov.au to check your symptoms, find a health service or find health information.

The fact sheet “Not happy with your doctor?” uses simple English and illustrations to show the different options people have to raise concerns.

I’ve lodged my complaint with the Commission – what happens next?

Click here to find out how the Commission manages complaints.

How do I find out if my practitioner’s registration has been cancelled or has any conditions on it?

You can check whether there are any restrictions on their practice by searching the national register that is maintained by the Australian Health Practitioner Regulation Agency (AHPRA).

AHPRA also maintains a national register of practitioners whose registration was cancelled under the Health Practitioner Regulation National Law.

Can I make a complaint about an unregistered health practitioner like a massage therapist, counsellor or naturopath?

Yes. The Heath Care Complaints Commission manages complaints about unregistered health practitioners. In NSW there is a Code of Conduct that outlines the requirements for safe and ethical practice that unregistered health practitioners must adhere to.

You can find out more about the Code of Conduct for unregistered health practitioners here. If you believe that an unregistered health practitioner has breached the Code of Conduct you can lodge a complaint with the Commission.

I’m seeking compensation or a refund – can the Commission help?

The Commission is not able to order providers to pay compensation, to issue a refund or to reduce fees.

If you are seeking compensation, you may wish to obtain legal advice.

If you are seeking a refund you may wish to contact the Office of Fair Trading or to obtain legal advice

Can I be sued for making a complaint?

If a complaint is made in good faith then you cannot be subject to legal action or liability.

It is an offence to knowingly make false allegations or provide false information to the Commission.

Can I make an anonymous complaint?

Yes, however it may be difficult for the Commission to gather the information it would need to properly and fairly assess your complaint if you choose to remain anonymous.

The Commission usually seeks a response from the health service provider and is required to notify them of the nature of the complaint and who made it. If the Commission is not able to clarify any information you provided or ask for further information that it needs to assess the complaint it may have to discontinue the complaint.

You can contact the Inquiry Line service for further information on 1800 043 159.

What can I do if I’m not happy with the way the Commission has managed my complaint?

If you are dissatisfied with the assessment decision the Commission has made about your complaint, and feel that we have overlooked something, or if new information has come to light you can contact us in writing within 28 days of the date of your decision letter to request a review.

There are other bodies you may complain to about specific concerns you have in relation to the Commission:

This has been a difficult experience – where can I seek further support?

The Commission acknowledges that dealing with health care concerns can be a stressful and difficult experience for patients, families and carers. If you need support for your health and wellbeing during the process you can call Lifeline on 131114 or Beyond Blue on 1300 22 4636.

You can access details of other support and advocacy groups here.

I have a question about accessing or amending my health information (medical records).

ACCESSING YOUR HEALTH INFORMATION

You are entitled to request access to your health information and medical records. Although the information is about you, the original records belong to the health service provider (such as the doctor, or hospital or clinic) that created them. If you wish to access your health information you can ask to speak to the Privacy Contact officer (in a hospital setting) or the practice manager at your clinic or health centre. They should be able to explain the process for accessing your health information. The Information and Privacy Commission of NSW has an excellent fact sheet about accessing your health information on their website.

The Health Care Complaints Commission is unable to retrieve your health information for you and cannot direct a health service to provide it to you, however the Information and Privacy Commission may be able to assist if you have a complaint about accessing your health information. You can find our more on the Information and Privacy Commission’s website www.ipc.nsw.gov.au or phone them on 1800 472 679.

AMENDING YOUR HEALTH INFORMATION

If you believe there is a mistake in your health records you can request your provider to correct it. It is best to make your request in writing. If the provider agrees there has been an error they will make an amendment to the record to note the correct information. However, it is possible that the provider may not agree that their record is inaccurate. If there is a disagreement about the accuracy of information or an opinion in your medical record you can ask the provider to place a letter from you about why you do not agree, or information such as a report from another health professional next to the information in your file.

The Health Care Complaints Commission is unable to direct that medical records be changed. If you are not happy with the way a health care provider has managed your request for a correction to your record you can make a complaint to the Information and Privacy Commission. You can find our more on the Information and Privacy Commission’s website www.ipc.nsw.gov.au or phone them on 1800 472 679.

I have a complaint about a medico-legal report or Family Court report. Can the Commission assist?

When visiting a practitioner for an independent medico-legal assessment the role of the practitioner is not to treat the patient, but to conduct an assessment and to report to the body that requested the information. The content of such reports is weighed up in those processes and the Commission may determine not to take further action on a complaint of this nature, having regard to Section 27(1)c of the Health Care Complaints Act.

In these cases the correct body to make a complaint or appeal to is the body that has requested the report.

The following links may be helpful:

Complaints about Family Reports and Family Consultants

Complaints about reports for Workers Compensation and Motor Accident Injury claims

The Commission is unable to assist with complaints about the content of medico-legal reports, however it can consider complaints about the professional conduct of the practitioner carrying out the assessment. If your complaint is about the professional conduct of a health practitioner you can lodge your complaint online.

I want to make a complaint about mental health care.

People who have been involuntarily admitted to hospital under the Mental Health Act, and disagree with the decision can make an appeal to the Mental Health Review Tribunal. The Health Care Complaints Commission is unable to assist with complaints about decisions made by the Mental Health Review Tribunal. The Mental Health Advocacy Service or the Official Visitors may be able to provide further information and assistance.

MAKING A COMPLAINT TO THE COMMISSION

People who have been involuntarily admitted have the same rights to complain about their health care and treatment as any other patient. They can speak to their doctor, or the medical superintendent, the manager of the service, or an Official Visitor. They also have the same right as any other person to complain to the Health Care Complaints Commission about issues of care and treatment such as:

  • lack of information about their condition, treatment or treatment plan
  • medication issues
  • problems in communication with their treating team, doctor or case manager
  • lack of physical health care or access to physical health care
  • issues concerning restraint or seclusion
  • issues of care – attitude, lack of care, delay in care
  • problems with discharge planning or refusal to admit

You can lodge your complaint online or speak to an Inquiry Officer on 1800 043 159 for further information.

I’m concerned about fees in my health care.

The government does not regulate fees charged for health care services by private health providers (for example, doctors, dentists, denture makers, optometrists, physiotherapists and podiatrists, etc). Private practitioners, private hospitals, day surgeries and nursing homes can decide what they will charge for their services in the same way as any other business.

If you are asked to pay for something you were not expecting, or your bill is substantially higher than what had been discussed, the first thing you should do is discuss the situation with your health care provider. Sometimes there might have been a misunderstanding or error in the bill.

If, after speaking with your health service provider, you still feel that the charge is unfair or unreasonable, you need to communicate this to them, preferably in writing. It is better to deal with the matter rather than withholding payment, as the health service provider may decide to put unpaid bills in the hands of a debt collection agency. It may be possible to negotiate an agreement on how to pay the account, for example, by instalments.

The Health Care Complaints Commission is unable to assist with complaints about fees in health care and can’t assist people to get refunds, compensation or to have their bills changed. The following organisations may be able to assist if you have questions about your medical bills or you are seeking a refund.

Private Health Insurance Ombudsman

If you are a member of a health fund, contact the Private Health Insurance Ombudsman (PHIO) on 1800 640 695. PHIO provides more detailed information on the topic of medical bills.

Office of Fair Trading

If you are seeking a refund for goods (for example dentures, glasses, orthotics), which are faulty or for a service you feel you did not get what you paid for, contact the Office of Fair Trading on 13 32 20.

Medicare

If you are concerned about overservicing or the correct use of item numbers, contact Medicare Australia on 13 20 11.

My doctor won’t see me – does a practitioner have to see a patient?

The only time a practitioner is obliged to see a patient is when a person’s life is in danger and they require urgent emergency treatment. If you have an emergency, let the doctor or the receptionist immediately know that this is an emergency and that you need urgent help.

In non-emergency situations, a doctor or other health practitioner may decline to see a patient. This might be because:

  • They don’t have any free appointments available and taking on a new patient would compromise the care they can provide to existing patients.
  • They don’t feel they have the right expertise to help.
  • There has been a breakdown in the relationship between the practitioner and the patient.
  • There is a risk that professional boundaries could be crossed.

When a practitioner declines to see a patient they will often refer the patient to another provider.

A practitioner cannot refuse to see a patient on the basis of discrimination (race, religion, gender etc.) If you believe a practitioner has refused to see you on such a basis you can lodge a complaint with the Anti-Discrimination Board of NSW. The Board can be contacted on 1800 670 812.

I have a question about consent for treatment.

Medical and dental treatment requires valid consent from the patient. Informed consent means a patient will be given clear information about what is involved in any proposed treatment and their treatment options. Health care providers need to obtain valid consent from a patient before examining or treating them. If a patient lacks capacity, consent should be sought from the person with the proper authority, except in situations where the treatment is urgent and necessary to save a person’s life or prevent serious damage to their health.

For consent to be valid the provider needs to ensure that the patient has:

  • the capacity to provide consent.
  • a good understanding of any side-effects, risks, benefits and alternatives regarding the proposed treatment.
  • been informed about the fees involved.
  • given consent voluntarily, without being pressured.

Health care providers are responsible for providing information, encouraging patients to ask questions and clarifying that the information has been clearly understood.

Patients are responsible for weighing up the available information and making an informed decision.

A person must be able to understand and communicate what they are agreeing to for their consent to be valid. Some people, whether permanently or temporarily, may lack capacity to give consent. Where this is the case a substitute decision maker, with the legal authority to act in the role, may give consent on their behalf.

Children under 14 years of age are considered to lack capacity to consent to their own treatment. Consent for treatment must be obtained from a child’s parent or legal guardian until the child turns 14.

From the age of 14, a minor may be mature enough to give their own consent. Health practitioners should assess whether the young person is capable of consenting and if not, should seek the consent of their parent or guardian. A young person’s valid consent cannot be overruled by their parents.

From 16 years of age, the consent of a young person is generally viewed as sufficient.

The Health Care Complaints Commission can assist with complaints based on concerns that valid consent was not obtained prior to treatment or care being provided to a patient. You can contact our Inquiry Service on 1800 043 159 for more information or make a complaint online.

I’m a health care provider and a complaint has been made about me.

It is important to understand that many health practitioners may, at some stage of their career, have a concern raised about them. In many cases, less serious complaints can be successfully resolved with a response from the health service provider that acknowledges the complainant’s concerns and provides a clear explanation for the issues that have been raised.

The Commission acknowledges that being the subject of a complaint can be a challenging and stressful experience for a health practitioner. If the Commission has contacted you to request a response to a complaint you may find the following information helpful

Other questions?

You can talk to one of our Inquiry Officers if you have questions or need more information before you make a complaint. You can call on 1800 043 159 or complete an online inquiry form for assistance.

Still need more information

If you would like to speak to someone at the Commission for more information before you lodge a written complaint you can contact the Inquiry Line during business hours, Monday to Friday from 9am – 5pm on 1800 043 159 or submit an online inquiry.

Online inquiry

Ready to lodge your complaint

All complaints must be made in writing and we aim to assess complaints within 60 days. Your complaint will be allocated to an assessment officer and we will write to you to explain the outcome of your complaint.

Click here to make a complaint

Track my complaint

You can track the progress of your complaint online.

Click here to track your complaint