Health 411: Several options for lodging patient complaints

First you should seek help for your pain, suggests Dr. Michael Carome, deputy director of the Health Research Group at Public Citizen in Washington, D.C., a nonprofit consumer advocacy organization.

The letter writer "may need to seek another provider who will hopefully evaluate the current symptoms, the care he previously received and recommend a treatment plan to help his pain," Carome says.

To get the surgeon to accept responsibility for his actions, there are a number of steps you can take.

A physician who no longer wishes to treat a patient is required to notify him or her in writing. The doctor also needs to refer the patient to another physician and provide him or her with information about how to access the medical records that were compiled during treatment. Failure to do so amounts to patient abandonment, an infraction that would justify an investigation by the state medical board.

It's important that a complaint is filed "if a patient believes the quality of care that they received was poor or not the standard of care they should have received," says Jennifer Simoes, a spokeswoman for the Medical Board of California in Sacramento.

Complaints can also be lodged with state medical societies. You can find a list of them on the American Medical Assn.'s website, http://www.ama-assn.org (click on the "Patients" tab to find the Medical Society Directories).

If the surgery was done at a hospital, you can file a complaint there as well. Many hospitals have patient ombudsmen whose job is to address patient complaints.

In the likely event that the hospital is accredited by the Joint Commission — a non-governmental agency that accredits and certifies medical facilities throughout the country — you can file a complaint there.

According to Michael Kulczycki, executive director of the Joint Commission's Ambulatory Care Accreditation Program, his organization's Office of Quality Monitoring fields consumer complaints that are used to determine if a hospital is out of compliance with its accreditation standards. In a situation like this, he says, "we would focus on the continuity of care and appropriate follow-up to the patient."

If appropriate, the Joint Commission would bring the situation to the attention of the hospital, which in turn would be asked to examine the physician's behavior to determine if further action is needed. You can file your complaint online at http://www.jointcommission.org. Go to Report a Complaint About a Health Care Organization in the Action Center box on the home page.

If you have Medicare, you can contact your regional Medicare Quality Improvement Organization (QIO). These organizations review medical care and help consumers with complaints about the quality of care they received. You can find the QIO near you by visiting http://www.ahqa.org and clicking on QIO Locator.

Some state insurance commissioners might step in if your care was covered by a private insurer, Kulczycki adds.

Finally, if you feel the doctor engaged in negligence or malpractice, talk to a lawyer. "Ultimately another way physicians are held accountable is through litigation," Carome says.

I'd like to know all the health insurance options for persons with preexisting conditions who are not eligible for Medi-Cal or Medicare.

Although you say you're not eligible for Medi-Cal (California's Medicaid program) or Medicare, it's worth checking to make sure you've uncovered all the public and/or low-cost private programs available. Many people are eligible for some kind of publicly funded health program but don't know it.

Case in point: A survey of 19,000 uninsured patients seeking care in four San Diego hospital emergency rooms found that nearly 80% were unknowingly eligible for some form of government insurance.

The survey, which is ongoing, is conducted by the Foundation for Health Coverage Education, a San Jose-based organization that helps people find insurance. Ankeny Minoux, the foundation's president, says the results represent good news because most people who sought care in those emergency rooms can sign up for a federal, state or county program.

You can take the foundation's Health Coverage Eligibility Quiz to learn about the public and private insurance offerings that might be available to you. The quiz is on the foundation's home page, http://www.coverageforall.org.