The State Grievance Examiner has the discretion whether to conduct a field investigation or rely on
documentation submitted in the grievance process. Where sufficient documentation exists, personal interviews of staff are not necessary.
(Level IV decision in Case No. 00-SGE-08 on 2/21/01.)
A client’s mother filed a written complaint on his behalf about the treatment he was receiving from his
doctor. She was referred to the doctor, instead of the Client Rights Specialist. Since this was a formal complaint, the doctor
had a conflict of interest and it was inappropriate to refer the matter to him. (Level IV decision in Case No. 00-SGE-08 on 2/21/01.)
Where violations of client rights are found, the matter may be referred to the Bureau of Quality Assurance
Certification Unit to determine if any violations of certification requirements occurred. (Level IV decision in Case No.
00-SGE-08 on 2/21/01.)
Financial assistance for housing is not an issue covered by client rights and such decisions cannot be
challenged in the grievance process in DHS 94. (Level III decision in Case No. 01-SGE-02 on 6/6/01.)
A grievance was filed on well past the 45-day timeframe in DHS 94.41(5)(a). However the county reviewed it at
Level I and II. It is within the client rights specialist’s discretion to accept complaints that are filed after the timeframes. A
long delay in filing a grievance after an event significantly compromises the quality of the investigation that may be
conducted. Individuals often do not recall all the details of what happened or what was said after such a lengthy period of time. In this case,
since it was accepted at Level I and II, it was also accepted at Level III. The Level III review was limited to a desk review of this case
based on the available documents. The ability to conduct a thorough investigation was limited by the delay in the filing of the grievance. (Level
III decision in Case No. 00-SGE-16 on 6/19/01, upheld at Level IV.)
A complainant questioned whether a county Client Rights Specialist (CRS), by virtue of employment by
the county, could conduct an impartial investigation into his grievance. CRSs are required to be impartial to the issues of a
specific grievance. Merely working for the county does not create a conflict of interest for a CRS. The many levels of appeal,
including two levels of state review, ensure that the grievance process as a whole is free from bias. (Level IV decision in Case No.
00-SGE-16 on 8/14/01.)
A woman complained about her doctor, alleging that the medications he prescribed for her may have
caused an adverse heart reaction leading to an emergency visit to the hospital. This allegation was reviewed by the Bureau of Regulation
and Licensing (BRL), which reviews medical allegations of malpractice or injury to others. BRL did not find that the heart reaction and
emergency room visit was necessarily caused by the medication. The grievance process defers to BRL’s medical expertise on such issues and
thus there was no finding of any rights violation. (Level III decision in Case No. 00-SGE-03 on 9/12/01.)
A patient complained that his grievance about his therapist was not promptly investigated. It was
noted that he had threatened to kill his wife, her boyfriend and his therapist and the police delayed the investigation by requiring
a waiting period for further action, allowing each party time to seek an injunction against the other. The police also required signed releases
from both spouses. The delay in processing his complaint was reasonable under the circumstances. (Level III decision in Case No. 01-SGE-06
on 10/18/01.)
Where a Level II grievance decision did not state that the grievance was unfounded and did not advise the
complainant of his right to appeal, the complainant’s right to the grievance procedure was violated. It was thus appropriate to allow
him additional time to appeal to Level III. (Level III decision in Case No. 01-SGE-06 on 10/18/01.)
Where the complainant was not provided a copy of the Level I decision and given the opportunity to provide
additional input prior to issuance of the Level II decision, his rights were violated. The issue of the hospital’s grievance system being in
compliance with the DHS 94 requirements was referred to the Bureau of Quality Assurance. (Level III decision in Case No. 01-SGE-06 on
10/18/01.)
A service recipient asked a temporary receptionist for a grievance form. The temp asked other staff where
the forms were. The case manager heard about the request and asked the individual to come to her office to discuss her concerns. The grievance
she wanted to file, however, was about her case manager. There was no evidence that anyone tried to talk her out of filing a complaint,
nor any indication of reprisal, retaliation or discrimination because of her grievance. There was no violation of her right to file a complaint.
The temp asking other staff where the grievance forms were did not violate her right to confidentiality. (Level III decision in Case No. 01-SGE-05
on 11/29/01.)
A patient’s mother complained that her daughter’s doctor violated her daughter’s confidentiality. The
Level I Client Rights Specialist did not address this issue in his written response. The failure to address this issue was a violation
of the right to have the grievance fully investigated. (Level III decision in Case No. 01-SGE-02 on 12/10/01.)
The law states that, "A patient or a person acting on behalf of a patient" may file a complaint. It
was a violation of the complainant’s rights when a Level I Client Rights Specialist refused to investigate her allegation that her
ex-husband’s right to confidentiality had been violated. (Level III decision in Case No. 01-SGE-02 on 12/10/01.)
A facility was under the impression that a mother’s complaint on behalf of her daughter could be handled
informally and internally. The complaint itself stated that she wished to file "a formal grievance". The informal resolution
process can only be used if all parties agree to it. The facility violated the mother’s right to bring a complaint by not handling it
as a formal grievance. (Level III decision in Case No. 01-SGE-02 on 12/10/01.)
A facility issued what amounted to a Level II decision without first providing the complainant a
copy of the Level I decision. The purpose of requiring the facility to provide a copy of the Level I decision is to allow the complainant
the opportunity to review the decision and provide any additional input to the person making the Level II decision. This was a violation
of the complainant’s rights. The facility was requested to revise its grievance process to comply with DHS 94. (Level III decision in Case No.
01-SGE-02 on 12/10/01.)
Level IV reviews are limited to consideration of factual information that was not available for the Level III
review. (Level IV decision in Case No. 99-SGE-05 on 3/29/02.)
Where a Level III decision found that the patient’s right to make and receive a reasonable amount of
phone calls was violated, the complainant’s appeal to Level IV on that issue was dismissed. (Level IV decision in Case No.
99-SGE-05 on 3/29/02.)
A complainant was out of state for an extended period of time and did not receive his Level III grievance
decision until his return. This was sufficient justification for the Administrator to allow a late appeal of that decision.
(Level IV decision in Case No. 01-SGE-07 on 3/29/02.)
A complainant raised issues regarding the "couples therapy" he and his wife received. At Level II
of the grievance process, it was concluded that the complainant was not a client, in the context of therapy that was provided, and thus did not
have access to the grievance process. At Level III, it was concluded that the complainant was a patient by definition since he was referred
to as such numerous times in the treatment records, had his own diagnosis, and had a joint "treatment plan" with his wife. Thus, he
had access to the grievance process like any other "patient". (Level III decision in Case No. 00-SGE-11 on 4/30/02, dismissed at
Level IV for lack of standing to appeal because the ruling was in his favor at Level III.)
A parent filed a complaint about a doctor giving the wrong pills to her minor children. But she refused to
sign a consent form allowing the Level I Client Rights Specialist (CRS) access to the children’s treatment records. This limited the CRS
to trying to resolve the matter informally. Although it was the parent’s right to refuse access to the treatment records, it prevented
the CRS from conduct a complete, formal grievance investigation. Given the lack of a formal grievance, the appeal to Level III was
denied. (Level III decision in Case No. 02-SGE-01 on 5/2/02.)
A complainant wanted to expand his original complaint at Level III of the process to include several other
issues regarding his treatment. The State Grievance Examiner rightfully refused to allow the expansion of the original complaint and correctly
referred the complainant to Level I to raise those additional issues. New issues must go through the entire grievance process,
starting at the first level. (Level IV decision in Case No. 00-SGE-11 on 8/26/02, upholding the Level III decision.)
Where the Level III decision found in favor of the complainant on the two issues he raised, the complainant
was without standing to appeal the decision to Level IV. (Level IV decision in Case No. 00-SGE-11 on 8/26/02.)
