A Healthcare Centre’s Grievance Procedure

Byevan lee

When an adverse event involving a patient occurs, a healthcare centres will not sit idly by hoping that the patient will just leave it alone. Like any functioning service provider, healthcare centres will have to deal with complaints. Most centres will ordinarily have an internal complaints management system which is generally referred to as a “Grievance Mechanism”. There has been much talk and doubts about the utility of grievance mechanisms in genuinely resolving medical accidents or a shield for the organisation.

It must be stated at the outset that formal complaints to healthcare centres rarely result in compensation pay-outs which is to a certain extent due to the law and the need to prove negligence. People will find universally, that not many will readily admit to wrongdoing in any setting especially so in medical negligence claims where the pay-outs can potentially be astronomical.

This article sets out the procedures for lodging complaints in Malaysian healthcare centres.

Private Hospitals, Clinics and Dental Clinics

There is a statutory framework grievance procedures in private hospitals which is set out in Regulation 40 of the Private Healthcare Facilities and Services (Private Hospitals And Other Private Healthcare Facilities) Regulations 2006. For small private clinics and dental clinics, there is Regulation 27 of the Private Healthcare Facilities and Services (Private Clinics or Private Dental Clinics) Regulations 2006. In both settings, a grievance procedure is essentially as follows: –

  1. a complaint is submitted to the relevant officer namely the patients relation officer of the hospital or any member of staff of a clinic;
  2. the receiving officer will then document and refer the complaint to the designated person-in-charge of the healthcare centre within 3 working days for hospitals or the next working day for clinics;
  3. an investigation will be undertaken and a written reply containing the results of the investigation will be furnished to the complainant within 10 working days for hospitals or 14 for clinics; and
  4. if the complainant is dissatisfied with the reply, he may the escalate the matter to the Director-General of Health, Malaysia who will launch an investigation and notify the complainant of the results of the investigation.

Sometimes, the patient and/or his family members may be invited to attend a grievance or a bereavement meeting (for cases involving death) where the patient will be allowed to ventilate his grievances and the healthcare centre will usually respond with explanations. The patient may be allowed to take written notes and ask questions. Sometimes, minutes of the meeting will be given to the patient.

A healthcare centre’s grievance procedure would ordinarily be outlined on their website or their Patient’s Charter of Rights. It is worth asking for that information if it is not readily available.

For cases involving the death of a patient, a complaint by his next-of-kin may instead be tabled in a Mortality & Morbidity Assessment under Section 72 of the Private Healthcare Facilities And Services Act 1998. Unfortunately for the patient’s family, the results of such investigations are largely protected from disclosure by the Act.

Government Healthcare Centres

There is no statutory framework for governmeant healthcare centres but there is a guideline issued by the Ministry of Health entitled, “Guideline on the Management of Medico Legal Complaints in the Ministry of Health“. As it is a guideline, is not neccessarily always followed. Some of the larger hospitals will internally investigate complaints. For small clinics, the presiding State Health Department (Jabatan Kesihatan Negeri) or District Health Office (Pejabat Kesihatan Daerah) may undertake the investigation. For dental clinics, there is the State Dental Health Department (Jabatan Kesihatan Pergigian Negeri) and the District Dental Health Office (Pejabat Kesihatan Pergigian Daerah)

Per Parts 1 & 2 of the Guideline, the grievance mechanism in Government healthcare centres should typically be as follows; –

  1. a complaint is either lodged directly to the healthcare centre or through the Sistem Pengurusan Aduan Awam (SisPAA) on the Ministry of Health’s website;
  2. an Internal Inquiry will be conducted within 30 days from the date of the complaint;
  3. the complainant will be summoned to be interviewed by the Internal Inquiry committee;
  4. the Internal Inquiry committee will inform the complainant of its findings and conclusion;
  5. if the complainant is disatissfied with the results of the investigation, an Independent Inquiry which will not involve the complainant will be undertaken;
  6. the Independent Inquiry committee will notify the complainant of its findings and conclusion;
  7. if there is a finding of negligence and the complainant has issued a demand for compensation, an ex-gratia meeting may be set up where the complainant will have to attend the meeting either accept or reject the offer for compensation.

Ex-gratia payments are unheard of and there is currently no way to verify whether cases (if any) were settled at sensible amounts. The drawback of pursuing a complaint against Government healthcare facilities is that there is no stipulated time frame as to when any of the committees are required to conclude their investigations and notify the complainant of their findings. A patient may be left in the lurch waiting for an update only to either reach an unfavourable outcome or a low settlement offer.

Traditional & Complementary Medicine Centres

There is also no statutory framework for T&CM centres. There is however a Ministry of Health issued guideline entitled, “Guidelines for Traditional and Complementary Medicine Healthcare Facilities and Services in Malaysia“. Generally, T&CM centres are expected to draw up their own patient grievance plan and to educate their patients on their rights to raise their grievances and the grievance procedure.

Guideline 5.2.11 sets out the process of a grievance procedure in a T&CM centre.

  1. a complaint is lodged to any member of staff;
  2. the receiving officer must document and forward the complaint to the person-in-charge of the centre within the next working day;
  3. an investigation must be conducted and a reply furnished within the time frame stipulated the T&CM’s centre’s own patient grievance plan; and
  4. the reply must contain the results of the investigation, plan of action by the T&CM centre, and the contact details for further communication if the patient is dissatisfied with the reply.

Unlike in the private healthcare centre setting, there is no provision for escalating the matter to the Director-General of Health, Malaysia (it does not mean that it cannot be done). The time frame by which a reply must be furnished is dependent on the T&CM’s patient grievance plan if there even is one in the first place. Like in Government healthcare centres, patients will be left in the lurch waiting for a reply.

University Healthcare Centres

Univeristy-owned healthcare centres are somewhat of an anomaly. They are not exactly private nor government healthcare facilities. They are owned and managed by universities which are uniquely given legal life by the University and University Colleges Act 1971. By virtue of section 24B of the Act, every employee of a university which includes the healthcare practiotioners practising in university-owned healthcare centres are deemed public officers.

Some university healthcare centres if not all fall back to the Ministry of Health’s guidelines. There is currently no guideline governing complaints to university healthcare centres. It is however safe to say that these centres do have their grievance mechanisms and would not depart too far from the private and Government settings.

A patient may safely lodge a complaint directly to the healthcare centre. There have been patients who have been invited to attend grievance and bereavment meetings.

Closing

The saying goes, “if you know, I know”. An “internal investigation” which does not yield negligence will not harm the patient’s chances of succeeding in a claim in Court. An investigation which yields damning results can advance a case in Court or see to an early settlement. A self-serving investigation will be to the detriment of the healthcare centre.

If there are valid grounds to do so, the patient should go ahead and lodge a complaint to the healthcare centre. Just don’t wait too long before finally consulting a medical negligence lawyer.

Evan Lee Sian Wen
Advocate & Solicitor
29 September 2024

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