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A client also filed a complaint with the Department of Health Services Bureau of Quality Assurance (BQA),
which certifies providers and clinics. The issues raised in that context were reviewed as part of a separate process. The grievance
procedure reviews complaints in the context of DHS 94 rights, and does not deal with licensing or certification issues.
Thus, there is no standing to raise licensing and certification issues in the grievance process, too. (Level IV decision
in Case No. 00-SGE-11 on 8/26/02, upholding the Level III decision.)
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The Client Rights Specialist at Level I must attempt to resolve matters to the satisfaction of the patient
whenever possible. But the CRS must also be prepared for the more tedious, potentially adversarial,
process of gathering facts from parties that may have quite different perspectives. (Level IV decision in Case No. 01-SGE-08
on 8/27/02, modifying the Level III finding.)
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Where a patient filed a detailed complaint about her medications, the Client Rights Specialist at Level I referred the matter
for a medical review. The Level I decision acknowledged there had been difficulties with medication adjustments but said there were "no major
findings of inadequate medical practice. He found no violation of the patient’s right to be free from unnecessary or excessive medications.
The CRS provided few details or facts to support his conclusion. This was a violation of the patient’s right to an
adequate investigation in the grievance procedure. (Level IV decision in Case No. 01-SGE-08 on 8/27/02, upholding the Level III finding.)
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An ex-patient complained that an inpatient treatment facility overcharged him for some smoking materials. County funds
paid for those materials, rather than the patient. The issue was thus between the county and the facility and the issue was
not appropriate for the grievance process. (Level III decision in Case No. 02-SGE-05 on 3/19/03.)
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The 45-day time limit for filing a complaint was not followed when a complaint was filed 7 months
after the alleged mis-diagnosis. Case was dismissed as untimely filed. (Level III decision in Case
No. 03-SGE-01 on 7/16/03.)
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A grievance must be filed within 45 days of the occurrence of the event or circumstances or of the time when the event or
circumstances "should reasonably have been discovered" or whichever comes last. Here, a minor’s prior physician apparently misdiagnosed
him. The minor was later correctly diagnosed and appropriately treated during a stay at a state mental health facility. His parents filed
a grievance about his original misdiagnosis seven months after his discharge from the state facility. The grievance was not timely
filed. The program director’s refusal to accept this late complaint was an exercise of his discretion. He could
have accepted the complaint, but chose not to. He did not abuse his discretion. In fact, there would have been little
point in accepting it since the doctor in question was no longer working for the program. (Level III decision in
Case No. 03-SGE-01 on 7/16/03.)
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The DHS 94 grievance process has no jurisdiction over an independent physician delivering services through an office that
is not part of a program. Patient rights still apply, but violations must be dealt with through the licensing process. (Level
III decision in Case No. 03-SGE-01 on 7/16/03.)
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Even though the DHS 94 grievance process has no jurisdiction over an independent physician delivering services through an office that is not
part of a program, the physician was still obligated to inform his patients of their rights under Sec. 51.61, Wis. Stats.
And, when the physician became part of an organized service corporation, he was also obliged to inform his patients
that the DHS 94 grievance process applied as of that time. (Level III decision in Case No. 03-SGE-01 on 7/16/03.)
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A hospital noted on appeal of findings of rights violations that the State Grievance Examiner (SGE) had not contacted the patient’s
doctor directly during the Level III review. The hospital asserted that this evinced a lack of professional courtesy and constituted
a violation of due process. The SGE should probably have contacted the doctor to provide him with a sense of fairness. But the SGE
has broad discretion in how to conduct Level III reviews. Where the SGE felt he could rely on the written records available to him,
failure to contact the doctor was not an abuse of that discretion or a violation of due process. (Level
IV decision in Case No. 02-SGE-04 on 9/19/03.)
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A Level III decision described a doctor’s progress notes as being "inadequate", but found no rights violation.
This issue was not addressed on appeal because, no matter how the notes were characterized, the outcome (no rights violation)
was not affected. (Level IV decision in Case No. 02-SGE-04 on 9/19/03.)
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A court decision to order medications cannot be challenged in the grievance process. (Level III decision in Case No. 03-SGE-10
on 10/23/03.)
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A complaint alleged that a county did not properly allow access to the Grievance Procedure appeal process as described in
DHS 94. Per DHS 94.51, regarding complaints that are related to the existence or operation of grievance resolution
systems, the State Grievance Examiner has original jurisdiction over this issue. (Level III Decision
in Case No. 03-SGE-05 on 1/23/04.)
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The Division of Hearings and Appeals, as described in the Medical Assistance Waivers Manual, is only available
for the purpose of addressing issue of denials of eligibility, terminations of eligibility, and reductions in waiver services.
They are not the proper referral agency for someone appealing a client rights grievance about other
issues in the DHS 94 grievance procedure. (Level III Decision in Case No. 03-SGE-05 on 1/23/04.)
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A complainant wanted to appeal the county’s Level II grievance decision made under DHS 94. He was incorrectly referred to the Division
of Hearings and Appeals instead of the State Grievance Examiner. Since this appeal information was incorrect, his
rights were technically violated. (Level III Decision in Case No. 03-SGE-05 on 1/23/04.)
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A complainant wanted to appeal the county’s Level II grievance decision made under DHS 94. He was incorrectly referred to the Division
of Hearings and Appeals instead of the State Grievance Examiner. The county agreed that a mistake had occurred in
this process. They revised the county manual and added the correct standard appeal language to the end of the grievance decisions
that the county issues. Thus, the violation of rights was remedied and the issue was considered resolved.
(Level III Decision in Case No. 03-SGE-05 on 1/23/04.)
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There is insufficient evidence to conclude that a facility’s Chief Legal Counsel discouraged someone from filing a complaint.
The facts indicate he merely informed the individual that he did not believe he had a malpractice claim that would
be upheld in court. The fact that the individual was able to bring this complaint and appeal it up through the grievance process
to Level IV indicates that his right to complain was not violated. (Level IV decision in Case No. 02-SGE-07 on 3/10/04.)
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A man complained on his wife’s behalf that her original complaint was not responded to. There was evidence in the record to
indicate the facility may not have received the original complaint. But they did receive the copy provided by the husband
later. They responded to the issues involved as if there was one combined complaint from the two of them. No rights
violation was found. (Level IV decision in Case No. 02-SGE-07 on 3/10/04.)
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A complainant alleged that the facility’s Client Rights Specialist (CRS) did not identify himself as such to him in a timely manner.
There was evidence in the record that the CRS’s name and title were provided to all patients at the facility. If the individual
was not re-informed of his title as CRS when discussing his issues with him, this was a technical violation of his rights.
(Level IV decision in Case No. 02-SGE-07 on 3/10/04, modifying the Level III decision.)
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A psychiatric hospital erred by not also informing the patient’s wife when his cost of care exceeded his insurance coverage,
as she requested. The hospital needed to revise its admissions policies and procedures to cover release of billing information to those who
may be responsible for it. The couple request that the remainder of their outstanding bill for psychiatric care be waived.
While it is concluded that his rights were violated, the remedial action requested exceeds the scope of the grievance process.
If the couple wants to pursue that resolution independently, they would need to contact the facility to request a settlement or a private
attorney for civil litigation. (Level III Decision in Case No. 03-SGE-07 on 4/22/04.)
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The sister/guardian of a woman filed a grievance about the care the woman had received while she was living in her own apartment. She
asked for $500 per year replacement of the ward’s homestead money, which she previously received because she was in an apartment
instead of an Adult Family Home, where she now resides, and $300 for moving expenses because the county did not move her.
The grievance procedure does not have authority to award monetary damages. (Level III Decision in Case No. 03-SGE-04 on 6/15/04.)
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The law states that "any person who is aware of a possible violation of client rights" [emphasis added] may file a
complaint on behalf of a client. Where a facility refused to accept an ex-patient’s complaint on
behalf of current patients, his right to file a complaint was violated. (Level III decision in Case No. 04-SGE-01 on 7/2/04)
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Where an ex-patient filed a complaint on behalf of current patients, all of whom had guardians, the
facility was obligated to check with the guardians to see if they wished to pursue the
complaint. (Level III decision in Case No. 04-SGE-01 on 7/2/04)
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Where a facility initially refused to accept a complaint from an ex-patient, but then, after receiving advice
from the Client Rights Office, did accept the complaint, the rights violation was remedied. (Level III decision
in Case No. 04-SGE-01 on 7/2/04)
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The Level III decision thoroughly addressed all of the complainant’s issues. In her appeal to Stage 4, the complainant
provided no new evidence sufficient to justify reversing the Level III decision. The Level III decision was therefore affirmed.
(Level IV decision in Case No. 04-SGE-07 on 8/15/05)
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A Level III decision found that a service provider had addressed all ten of the concerns a client raised and that the matter was considered
resolved. The client was given notice of his right to appeal the Level III within 14 days. He appealed
45 days after the Level III was issued. The client was asked to show good cause why he had not appealed within the
time frame. He did not respond. His lack of response lead to the conclusion that he was no longer interested
in pursuing the matter. The complaint was therefore dismissed. (Level IV decision in Case No. 05-SGE-09
on 4/3/06)
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The information contained in response to a client’s grievance included personal and subjective observations that were
not appropriate. Here, the provider was informed of the appropriate information to include in the program level review
of a grievance and this concern was considered resolved. (Level III Decision in Case No. 05-SGE-003 on 6/8/06)
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There is nothing inherently wrong with a facility Client Rights Specialist (CRS) conferring with the facility’s attorneys
on issues pertaining to patient rights. The patient rights laws and rules are complex. Seeking the advice of counsel is often
a good way to ensure that the facility is in full compliance with those rights. (Level IV decision in Case No. 06-SGE-04 on 8/18/06)
