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Procedure for Filing a Complaint against Health Care Received

A person has an absolute right to file a complaint against any healthcare services received if he/she feels that the level of care was inadequate, unreasonably delayed, or if care was denied. If a person is dissatisfied with the conduct of a physician or with his/her approach, if the patient feels they were given insufficient information or if there is a suspicion of malpractice or misconduct during an operation, a complaint may also be filed.

How to File a Compliant

Filing a complaint is usually one of the last steps to be taken by an individual in a situation in which they are dissatisfied with the way health care services were provided or with the outcome. Before filing a formal complaint, it is recommended that a patient exhaust all other options. The cause of the complaint may be a minor case of misunderstanding, a lack of ability or, in the worst case, a reluctance of health workers to explain something in sufficient detail. It is best to handle minor problems with a personal visit and to do so as soon as possible.

If you are not satisfied with the healthcare you have received, it is advisable to discuss your objection / complaint with the attending doctor. Complaints must also be heard by the respective chief physician – the head of the department and senior management personnel (the director or a deputy director).

In case of more serious problems, it is more effective to file a complaint in writing, which can assure a written reply within an adequate period. The filing of a complaint may also be done ​​by phone, fax or email.

Under The Act on Healthcare Services, a complaint is submitted to the respective provider – which could be a doctor or the management of a health care facility. If the person who filed the complaint does not agree with the way in which the complaint is resolved, the complainant may file their complaint with the responsible administrative authority that granted the provider with permission to offer health care services. In most cases, this is the regional authority in whose administrative district the respective facility is located.

In case of any suspected professional misconduct or unethical conduct on the part of a doctor, a complaint can be submitted to the Czech Medical Chamber or to the Czech Dental Chamber or, as applicable, to another relevant professional organization. The Czech Medical Chamber, the Czech Dental Chamber and these other professional organizations act as guarantors of the professionalism and they are required to look into any complaints received.

The Act on Healthcare Services does not expressly provide for the ability to file a complaint with a health insurance company, but it also does not preclude the filing of such a complaint. A health insurance company can follow up the misconduct, if it has a contract with the respective hospital, clinic or doctor. A health insurance company uses one of its supervisory or review physicians to certify the appropriateness of a treatment process, with particular attention to the course of treatment, to the prescription of certain drugs and other health care services provided and to whether the care provided was the same as that billed to the health insurance company, whether only necessary procedures and services were billed and whether the type of healthcare provided is appropriate to the patient's medical condition.

Competent Authorities Where Complaints Can Be Filed

  1. Health Care Services Provider – i.e. a physician, head physician, hospital director, etc. The provider will look into the complaint and send the patient a response. The complaint must be processed within 30 and no later than 60 days after its receipt.
  2. Responsible administrative authority that issued the respective health care provider with an authorization to offer its health care services (Regional Authorities, the Prague City Hall, the Ministry of Justice, Ministry of the Interior and Ministry of Defense – if responsible for establishing the health care provider). This administrative authority is filed by a complaint in case of patient´s unsatisfaction of the initial resolution.
  3. The Czech Medical Chamber, Dental Chamber or other professional organization which looks into complaints about professional misconduct doubts or suspicion of a doctor´s unethical behavior.

    It is possible to submit a complaint against a physician for unethical behavior or professional misconduct within one year of the incident. The complaint does not have to be submitted by the affected patient – it can be filed by anyone (such as a relative). The complaint must be in writing and it should be responded to within six (6) months of being received.

    If a patient does not agree with the resolution of his/her complaint, they have fifteen (15) days from the date on which they received a decision from the review committee to submit an objection, which will be decided upon by the Honorary Board of the Czech Medical Chamber. Any decision reached by the above parties can also be appealed by the affected doctor or by an authorized member of the review committee.

  4. A health insurance company, if it has a contract with a respective hospital, clinic or doctor, especially when it is necessary to examine the rationale for the treatment received with particular attention to the course of treatment, to the prescription of certain drugs and other health care services provided, whether the care provided was the same as that billed to the health insurance company, whether only necessary procedures and services were billed and whether the type of health care provided was appropriate to the patient's medical condition. It is also possible to contact the health insurance company in situations in which a physician or other health care staff refused to carry out a medical procedure that falls within the covered care.

    Handling the complaints is governed by the Administrative Procedure Code, which provides a maximum period of 60 days for a resolution or decision.

Source: http://www.mzcr.cz

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