Filing Complaints Against Health Care Professionals
When to File a Complaint/What to Expect
The state of Tennessee is graced with some of the finest health care professionals, educational institutions, postgraduate programs and treatment facilities in the United States. The majority of health practitioners in Tennessee are competent and caring individuals and most persons are satisfied with the level of care they receive.
However, when a problem is experienced with a practitioner, you have the right to report him/her. If you believe that a practitioner’s performance or behavior is not acceptable, you may file a complaint through Health Related Boards, Office of Investigations.
Issues Not Within Board Authority
- Fees and/or billing disputes (amounts charged for services, overcharges, etc)
Contact Consumer Affairs at 1-800-342-8385
The Department of Health has the authority for various licensing boards whose responsibilities are to protect the public interest. This is accomplished through enforcement of the particular Practice Act of each board, which examines, licenses, and oversees the practice of the licensees. The licensing boards oversee individual practitioners and in some instances regulate educational programs.
The responsible board evaluates the credentials and qualifications of each practitioner. After practitioners become licensed, the Board will review any complaint received that may put the professional behavior and/or performance of the practitioner in question. Such complaints may suggest a violation of the Practice Act. Complaints are received from various sources, i.e. the general public, insurance companies, hospitals and other health care facilities, health professionals and the news media. If you feel that a practitioner has failed to live up to his/her professional responsibilities, the Health Related Boards want to hear from you.
While a board cannot assist with civil or criminal matters and does not represent individuals, the Tennessee Practice Acts allow the licensing boards to act on behalf of the people of Tennessee at large. When a board determines that disciplinary action against a practitioner is necessary, the action focuses on prevention of further problems with the practitioner and the protection of future patients. In essence, a board has the power to control a practitioner’s ability to practice in the future in the state of Tennessee, but cannot impute criminal penalties. Any person seeking to recover fees or monetary remedies for injuries should consult a private attorney regarding those matters. The State of Tennessee has no jurisdiction over these types of situations.
Filing a Complaint
While the Department of Health hopes that you will never have to file a complaint against a health care practitioner, doing so is a simple matter. You may contact the Complaint Divisions of the Department of Health at 1-800-852-2187 to request a complaint form. (PH-3466)
The form must be completed in its entirety. All materials received in connection with the complaint will become property of the Department of Health and cannot be returned. Please return the complaint to:
Office of Investigations
665 Mainstream Drive, 2nd Floor, Suite 201
Nashville, TN 37243
Top 10 Most Frequently Asked Questions for persons who may file a complaint:
- 1. How do I file a complaint?
- The Allegations Report form (click here) can be downloaded and must be completed in its entirety. The form and any attachments should be submitted to the Office of Investigations at the address located on the form. PLEASE NOTE: All materials received become the property of the State of Tennessee and cannot be returned.
- 2. Can I remain anonymous?
- Yes. You may file a complaint without revealing your identity. However, make sure to provide enough information in the Allegations Report to allow for an adequate review of the issues, including an investigation, if an investigation is required. PLEASE NOTE: The Office of Investigations will not be able to provide status reports for Allegations Reports that are filed anonymously.
- 3. How long does the process take?
- Phase 1 of the review process takes a minimum of two (2) to four (4) weeks, depending on the review schedule for that particular profession. Depending on the nature and complexity of the allegation(s), if an investigation is required, the investigation process can take a minimum of three (3) months.
- 4. Can I appeal the decision, if I do not like and/or agree with it?
- No. The decision is final. PLEASE NOTE: All Allegations Reports are taken very seriously and are reviewed by a competent professional licensed in the relevant field and an attorney working on behalf of the relevant licensure board. To ensure a thorough review, please provide all information and details along with your Allegations Report. Unless the facts contained in Allegations Report have changed, the file will not be reconsidered.
- 5. Will I be contacted by an investigator?
- Yes, if an investigation of your Allegations Report is required. The contact is normally made by telephone. You will also receive a written notification about the final outcome of your complaint.
- 6. Will my name be revealed to the practitioner?
- Your name, as having filed the complaint, will be not be revealed to the practitioner. Pursuant to T.C.A. §63-1-117, the identity of the complainant is confidential and will not be disclosed. Therefore, staff will neither confirm nor deny the identity of the complainant. However, if your medical record is requested from the practitioner as a part of the investigation, the practitioner may draw an inference as to the identity of the complainant.
- 7. Can I get a copy of the investigative findings?
- No. After the Allegations Report is filed with the State, the matter becomes part of a legal process which is made confidential under state law. Therefore, the investigative findings are confidential and cannot be disclosed.
- 8. Can the State help me get a refund or money for damages?
- No. The health professional licensure boards have the authority to control a practitioner’s ability to practice in the future. Any person seeking to receive refunds or monetary remedies for injuries related to the allegations contained in the Allegations Report should consult a private attorney as soon as possible.
- 9. Will you take my complaint over the phone?
- Allegations can be received by telephone. However, we encourage the use of the Allegations Report form (click here) to ensure that all required information is collected, including your signature and, if you are the patient, a completed Patient Release Form. Experience has shown from previous investigations that there is often information that is missed at telephone intake which either lengthens the process to allow collection of the missed information, or the missed information had a detrimental influence on the outcome of the review of the complaint.
- 10. Will I be able to speak to the consultant and/or attorney?
- No. Each complaint is reviewed by a clinical consultant, who is licensed in that particular profession and approved by the Board to review the complaint, and a staff attorney who is assigned by the Department of Health. The consultant and attorney will do a paper review of the Allegations Report and any supplemental documents you have submitted. If additional information is necessary to determine if a violation has occurred and can be proven, they will request a field investigation. The investigator will contact you to obtain any additional information requested by the consultant and/or attorney. If you need legal advice, you need to seek the advice of a private attorney. The attorneys assigned to work on behalf of the health related boards represent the interests of the State and the boards to protect citizens from harm or potential for harm at the hands of a practitioner who may have caused you harm. They do not represent your personal interests.
Top 10 Most Frequently Asked Questions for the Practitioner Under Allegation
- 1. Who filed the complaint?
- Pursuant to T.C.A. §63-1-117, the identity of the complainant is confidential and cannot be disclosed. Complaints can be filed by patients, family members, peers, facilities, law enforcement, pharmacists, and by individuals who request to remain anonymous. (Likewise, complaint information about a practitioner is confidential. If a complaint leads to formal discipline by the professional licensure board, then information against a practitioner will no longer be confidential.)
- 2. Can I get a copy of the complaint and/or investigation findings?
- No. The complaint, usually filed using an Allegations Report form available on the Board’s web site, contains information made confidential under T.C.A. §63-1-117 and cannot be disclosed. The investigation report is also confidential and the same confidentiality statute attaches. However, when the investigation findings are returned to the Office and a review has been held, you will receive a written notification of the outcome and, if appropriate, guidance on how to improve your practice. If the investigation findings rise to the level that requires the filing of formal charges against you, written notice and an opportunity for a hearing will be provided to you.
- 3. Who will review the complaint and investigation?
- Each complaint will be reviewed by a clinical consultant who is licensed and in good standing with the relevant licensure board. The clinical consultant will sit in consultation with a staff attorney assigned by the Department of Health on behalf of the relevant health related board. Together, the reviewers conduct a paper review to determine if a potential violation of a statute and/or rule governing your profession exists, based on the allegations provided. If a potential violation is identified, the file is forwarded to a field investigator for collection of witness statements and documentation to prove or disprove the allegations. The investigation file is then returned to the Central Office, located in Nashville, where the review team will analyze the statements and documentation to determine if, and which, statutes and/or rules have been violated.
- 4. How can I verify that the Investigator is actually with the Department?
- The Investigator assigned to investigate the complaint allegations will present an identification badge for your inspection and will be able to produce a business card to match the identification badge. If additional verification is needed, you are encouraged to contact Central Office in Nashville at 615.741.8485 for verbal verification.
- 5. Can my office staff/designee call to get a status update?
- No. Complaint information and the identity of both the complainant and the practitioner against whom the complaint has been filed are confidential by statute. Staff processing these confidential documents has been trained to employ the strictest measures to ensure that confidentiality is maintained. Therefore, only the practitioner will be given information related to the complaint, including complaint status, in order to maintain strict adherence to the confidentiality requirements.
- 6. Will I get to talk to an investigator?
- As the named practitioner, you will normally be asked to participate in an interview, if an investigation has been requested by the review team. The reason for the interview is to allow you the opportunity to provide an explanation with regard to your decisions, actions and/or behaviors related to the issue(s) under investigation. Issues under investigation may range from malpractice and/or negligence in the treatment of patient(s) to situational behaviors, impairment, drug diversions, abuse and neglect, supervisory responsibilities, or prescribing.
- 7. How will the decision be made?
- After the Allegations Report is filed with the State, the matter becomes part of a legal process. The Board’s Consultant and the assigned attorney with the Department of Health will be ascertaining whether or not the collected evidence (e.g. witness statements, medical records, business records) from the investigation support a finding of one or more statutory or rule violations. If no violation is found, you will be notified in writing. If a violation is found, the nature, severity, and the position of the board in disciplining like and/or similar violations will be considered in determining whether an informal letter of correction will be issued by the Board’s Consultant, or whether the file will be referred to the legal office for consideration of formal disciplinary charges.
- 8. When/how will I know the outcome?
- If the complaint filed against you is closed with no violation and/or a violation which does not rise to the level of formal disciplinary action, written notification will be issued to you in the form of either a letter signed by a staff member from the Office of Investigations or a letter of correction (i.e. letter of concern or letter of warning) signed by the Board’s Consultant. If your complaint file is referred to the legal office, you will receive communication from the attorney who has been assigned to your file.
- 9. If disciplined, will the discipline stay on my licensure record?
- Yes. Formal disciplinary action, which can only be taken by your licensure board after notice and an opportunity for a hearing, will become a part of your disciplinary history and your licensure record indefinitely. The discipline will stay on your licensure record, which is a publicly available document.
- 10. Can I appeal the decision?
- The statute allows for an appeal of formal disciplinary actions within a fixed amount of time in accordance with statutory mandates. Informal letters of correction (i.e. letter of concern and/or letter of warning) are not considered discipline and are not made part of the licensure file; therefore, they are not matters subject to appeal. NOTE: Complaint history, which includes informal letters of correction, is retained separate from licensure file documentation and is not subject to a public records request, pursuant to T.C.A. §63-1-117. The Department views this process as confidential and takes steps to ensure that confidentiality is maintained at all phases, having taken action to successfully defend requests for access to complaint documentation when appropriate.
The Review Process
Upon receipt of the complaint form, the designated board consultant (who is a practitioner from the particular health profession) and an attorney review the complaint thoroughly to determine whether there has been a violation of the Practice Act.
The board consultant and the attorney examine the details of the complaint. The practitioner may be contacted and relevant records may be studied. The review process may also involve the review of practitioner files, both public and confidential. Through the review process, the consultant and attorney will reach a decision whether to investigate the complaint or not. This process may take several months to complete. This is determined by the complexity of the complaint.
Throughout the process, the practitioner’s due process rights are assured. The final decision that is reached by the Board will be based on the findings of an investigation. In some cases, a formal public hearing is held.
You may call the Complaint Division from time to time to inquire about the progress of the complaint. While state law does not allow the staff to give details of an investigation, you may request a general status report. Due to the nature of complaints and complex legal and medical issues that are involved, your patience, cooperation and understanding is appreciated.
When a decision is reached, you will receive a letter from the board consultant. The specific content of such letters varies depending upon the circumstances of the complaint. However, they are generally one of the following types.
1. There was no violation of the Practice Act that would lead to disciplinary action, but the practitioner has been informed of the concerns that lead to the complaint.
2. There was a violation of the Practice Act and a formal disciplinary action was taken, made part of the public record, and reported statewide and to the national data bank.
All complaints received are taken seriously and a thorough and fair evaluation under the law is conducted.