Rights Related to Complaints, Grievances, Advocacy and Resolution Process

If we have not met a patient’s needs, we ask that they share their concerns with us, especially regarding treatment, safety or quality of care. A patient or their legally authorized representative has the right to share these concerns at the time of service with their care provider, nursing or department leader or Hospital Supervisor. Our desire is to resolve matters as soon as possible, so that patients receive the best care possible.

Patient procedures related to initiation, review and resolution of complaints, grievances, and advocacy may be filed with the following:

• HSHS WI Hospitals: (HSHS St. Vincent Hospital – Green Bay, HSHS St. Mary’s Hospital Medical Center – Green Bay, HSHS St. Clare Memorial Hospital – Oconto Falls, HSHS St. Nicholas Hospital – Sheboygan, HSHS Sacred Heart Hospital – Eau Claire, or HSHS St. Joseph’s Hospital – Chippewa Falls)
  • Quality, Safety or Discrimination grievances: Call (920) 884-5719
  • Financial Grievances: Call (920) 884-5637
  • Privacy Grievances: Call (920) 433-8513
• HSHS Corporate Office
  • Civil Rights, Discrimination, or Privacy Grievances:
    • Corporate Compliance/Privacy Officer & 1557 Coordinator, (217) 492-6590 | 4936 Laverna Road, Springfield, Illinois 62794
• Community Resources
  • Abuse, Neglect, or Safety Grievances:
    • Brown County Human Services (920) 448-6000 | 111 North Jefferson St., Green Bay, WI  54301
    • Sheboygan County Human Services (920) 459-6400 | 1011 North 8th Street, Sheboygan, WI  53081
    • Oconto County Human Services (920) 834-7000 | 501 Park Ave., Oconto, WI  54153
    • Eau Claire County Human Services (715) 839-2300 | 721 Oxford Ave., Eau Claire, WI 54703
    • Chippewa County Human Services (715) 726-7788 | 711 N. Bridge Street #1, Chippewa Falls, WI 54729
• State
  • Report any concern or grievance:
    • Wisconsin Department of Health Services – Bureau of Health Services of the Division of Quality Assurance (800) 642-6552 | DQA/Bureau of Health Services Complaint Coordinator, PO Box 2969 Madison, WI 53701-2969
• Federal
  • Privacy or Patient Rights Grievances:
    • U.S. Department of Health & Human Services Office for Civil Rights (800) 368-1019 | 233 North Michigan Avenue Suite 240, Chicago, IL 60601
• Healthcare Accrediting Organization
  • Report any concerns or grievance:
    • The Joint Commission (800) 994-6610 or fax: (630) 792-5636)
    • Office of Quality and Patient Safety – The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181
    • Online at www.jointcommission.org (“Report a Patient Safety Event” under “Action Center” on the website home page).
• Medicare beneficiaries who are inpatients must be provided a standardized notice, “An Important Message from Medicare” (IMM) within two (2) days of admission and within two (2) calendar days before discharge, which informs Medicare patients of their right to file a complaint regarding quality of care, if they disagree with a coverage decision or if they wish to appeal a premature discharge.
  • Patients will receive written notice of the hospital decision that contains the name of the hospital contact person, the steps taken on behalf of the patient to investigate the grievance, the results of the grievance process, and the date of completion.
• Patients shall have the right to access protective and advocacy services. Staff from the Hospital Case Management Department act as patient advocates:
  • Case Management Department at HSHS St. Vincent Hospital – Green Bay; HSHS St. Mary’s Hospital Medical Center – Green Bay; HSHS St. Clare Memorial Hospital – Oconto Falls; or HSHS St. Nicholas Hospital – Sheboygan: (920) 433-8575.
  • Case Management Department at HSHS Sacred Heart Hospital – Eau Claire; HSHS St. Joseph’s Hospital – Chippewa Falls: (715) 717-1613.

Rights Related to Plan of Care

• Patients shall have the opportunity to participate, to the fullest extent possible, in the development and implementation of their inpatient, outpatient, discharge, and pain management treatment/care plan and in decisions regarding continuation or discontinuation of care.

• Patients or their representative (as allowed under State law) shall have the right to make informed decisions regarding their care, including being informed of their health status, being involved in care planning and treatment, and being able to request or refuse treatment. This right must not be construed as a mechanism to demand the provision of treatment or services deemed medically unnecessary or inappropriate.
• Patients or their legally authorized representative shall have the right to receive a copy of and review their current list of medications per the hospital medical record.
• Patients or their legally authorized representative shall have the right to review their medical record related to their care and have it explained to them.

Rights Related to Advance Directive

• Advance Directives are written statements, such as a living will or durable power of attorney for healthcare, recognized under State law, naming a person of the patient’s choice, who shall make healthcare decisions, should the patient become physically or mentally unable to do so, independently. Patients have the right to formulate advance directives and to have hospital staff and providers comply with these directives. The patient’s wishes will be honored to the extent of the law and hospital policy.

Rights Related to Notifying of Admission

• Patients shall have the right to have a family member or representative of their choice, and/or their primary care provider, notified promptly of an admission to the hospital.

Rights Related to Privacy, Confidentiality or Medical Records

• Patients shall have the right to personal privacy.
• Patients shall have the right to access information contained within their medical record, within a reasonable time frame.
• Patient’s medical record, including all computerized medical information, shall be kept confidential.
• DHS 124.05(3)(a)1.d. Patients or any legally authorized person shall have access to the patient's medical record as required by law.
• Patients shall have the right to give or withhold informed consent, related to the hospital using or producing recordings, films, or other images of the patient, served for purposes other than their care.

Rights Related to Safety

• Patients shall have the right to receive care in a safe setting that has an effective abuse prevention plan, which contains elements of abuse prevention, screening, identifying, training, protecting, investigating, reporting and responding.
• Patients shall have the right to be free from all forms of abuse (i.e., physical, mental, neglect, verbal, sexual), corporal punishment, exploitation or harassment.

Rights Related to Consent, Treatment or Research

• Patients, the patient's legally authorized representative, or any person authorized in writing by the patient, shall receive, from the appropriate person within the facility, information about the patient's illness, course of treatment and/or prognosis for recovery, including outcomes that were not expected, in terms the patient or their authorized representative can understand.
• Except in emergencies, the consent of the patient or the patient's legally authorized representative shall be obtained before treatment is administered.
• Patients or the patient's legally authorized representative shall give prior, informed consent for the patient's participation in any form of research or experimental trials.
• Patients are protected and their rights are respected during research, investigation, and clinical trials.
• Patients or the patient’s legally authorized representative shall have the right to be informed about any proposed procedures or treatments.
• Patients or the patient’s legally authorized representative may be asked to sign an Informed Consent before the start of a procedure.
• Patients or the patient’s legally authorized representative shall have the right to ask questions and be listened to.
• Patients or the patient’s legally authorized representative shall have the right to transfer care to another facility, if the hospital is unable to provide the care they need or as they request. Patients shall have the right to know if and why such transfer may be necessary. The hospital cannot transfer the patient unless the receiving hospital accepts them as a patient.

Rights Related to Patient Billing

• Patients or the patient’s legally authorized representative are permitted to examine their hospital bill and receive an explanation of the bill, regardless of source of payment. Every patient or patient’s legally authorized representative shall receive, upon request, information relating to financial assistance that is available through the hospital.

Rights Related to Restraints

• Patients shall have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by hospital staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others and must be discontinued at the earliest possible time.

Rights Related to Psychiatric and Chemical Dependency

• Patients who receive treatment for mental illness, a developmental disability, and/or alcohol or drug abuse shall be recognized as having, in addition, the rights listed under Wisconsin s. 51.61, Stats., and ch. DHS 94.

Rights Related to Visitation

• Patients may designate persons who are permitted to visit the patient during the patient's stay, in accordance with hospital policy, as well as refuse any visitors.
• Patients shall have the right to choose a support person who can determine, who may visit the patient, if the patient is unable to indicate visitors. Support persons and visitors are not entitled to the same rights as the patient’s (legally) authorized representative.
• The hospital reserves the right to limit visitors as medically necessary or for safety reasons. Patients or their support person, where appropriate, are informed of the visitation rights, including any clinical restriction or limitation on such rights, at the time they are notified of their other rights under this section.
• Patients or their support person, where appropriate, are informed of their right, subject to their consent, to receive visitors whom they designate (i.e., a spouse, domestic partner, family member, or friend), and their right to withdraw or deny such consent at any time.
• Patients are not restricted, limited, or otherwise denied visitation privileges on the basis of race, creed, color, national origin, ancestry, sex (including gender identity), sexual orientation, marital status, age, newborn status, handicap or source of payment.
• Patient visitors have the right to enjoy full and equal visitation privileges consistent with patient preferences.

Rights Related to Staff and Patient Rights

• Staff assigned to direct patient care have the responsibility to be informed of and demonstrate their understanding of patients’ rights and responsibilities, through orientation and appropriate in-service training activities.

  Responsibilities of Patients

• Patients shall be responsible for showing mutual respect and consideration to providers, staff and hospital property, as well as, other individuals and their property.
• Patients shall be responsible for following the hospital’s policies and procedures, instructions, and rules and regulations to support quality of care and a safe environment.
• Patients shall be responsible for asking questions when they do not understand their care, treatment, or services, or what they are expected to do.
• Patients shall be responsible for following instructions for their plan of care, treatment, or services, and expressing concerns about their ability to follow the proposed plan of care, treatment, or services.
• Patients shall be responsible for accepting certain outcomes of care, treatment, or services, if they do not follow the planned care, treatment, or services.
• Patients shall be responsible for providing to the hospital, the necessary information for processing payment of services.
• Patients shall be responsible for meeting financial commitments and obligations in a timely manner.
• Patients shall be responsible for sharing expectations of, and satisfaction with, the organization.
• Patients are responsible for providing an Advance Directive or Living Will, if they have one.
   

Swing Bed Patients are Provided Additional Rights

Additional Resident Rights for Critical Access Hospital - Swing Beds

Swing Bed Resident Rights are provided in addition to the Hospital Patient Rights and Responsibilities 

1. Patients shall have the right to be informed of, and participate in, their treatment, including the right to be fully informed, in a language that they can understand, of their total health status, including but not limited to, their medical condition.
2. Patients shall have the right to request, refuse and/or discontinue treatment.
3. Patients shall have the right to participate in or refuse to participate in experimental research.
4. Patients shall have the right to formulate an advance directive.
5. Patients shall have the right to be informed, in advance, of changes to their plan.
6. Patients shall have the right to choose an attending physician. Patients have the right to be informed if the physician they have chosen is unable or unwilling to be their attending physician, and to have alternative physicians discussed with them, and to honor their preferences, if any, in identifying options.
7. Patients shall have the right to be informed of the name, specialty, and way of contacting your physician and other primary care professionals responsible for their care.
8. Patients shall have the right to retain and use personal possessions, including furnishings and clothing, as space permits, unless to do so would infringe upon the rights or health and safety of other residents.
9. Patients shall have the right to share a room with their spouse when the spouse resides in the same facility, and both the patient and their spouse consent to the arrangement.
10. Patients shall have the right to immediate access by immediate family and other relatives, subject to their right to deny or withdraw consent at any time.
11. Patients shall have the right to immediate access by others who are visiting with their consent, subject to reasonable clinical and safety restrictions, and their right to deny or withdraw consent at any time.
12. Patients shall have the right to be informed in writing, if they are Medicaid-eligible at the time of admission or when they become eligible for Medicaid, of:
    1. The items and services that are included in nursing facility services under the State plan and for which they may not be charged;
    2. Those other items and services that the Hospital offers and for which they may be charged, and the amount of charges for those services; and
    3. Changes that are made to items or services identified in (a) and (b) above.
13. Patients shall have the right to be informed before, or at the time of admission, and periodically during their stay, of services available in the facility and of charges for those services, including any charges for services not covered under Medicare/Medicaid or by the facility’s per-diem rate.
14. Patients shall have the right to personal privacy in their accommodations.
15. Patients shall have the right to personal privacy in their medical treatment and personal care.
16. Patients shall have the right to personal privacy for written and telephone communications, visits and meetings with family and resident groups. This does not require the facility to provide them with a private room.
17. Patients shall have the right to privacy in their oral (spoken), written, and electronic communications, including the right to send and promptly receive unopened mail and other letters, packages and other materials delivered to the facility for them, including those delivered through a means other than a postal service.
18. Patients shall have the right to access stationery, postage, and writing implements at their own expense.
19. Patients shall have the right to secure and confidential personal and medical records. Patients have the right to refuse the release of personal and medical records except as required or provided by Federal or State law. The facility must allow representatives of the Office of the State Long-Term Ombudsman to examine their medical, social, and administrative records in accordance with State Law.
20. Patients shall have the right to remain in the facility, and not be transferred or discharged unless:
    1. The transfer or discharge is necessary for their welfare, and their needs cannot be met in the facility.
    2. The transfer or discharge is appropriate because their health has improved sufficiently so that they no longer need the services provided by the facility.
    3. The safety of individuals in the facility are endangered due to their clinical or behavioral status.
    4. The health of individuals in the facility would be endangered.
    5. The patient has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Non-payment applies if the patient does not submit the necessary paperwork for third-party payment or after the third party, including Medicare or Medicaid, denies the claims and the patient refuses to pay for their stay.
    6. The facility may not transfer or discharge a patient while an appeal is pending, unless the failure to discharge or transfer would endanger the health or safety of the patient or other individuals in the facility.
21. Patients shall have the right to choose their medical, dental, and other licensed independent practitioner care providers and communicate with the providers.
22. Patients shall have the right to arranged transportation services, as appropriate, for his or her care.

Home Health & Hospice Patients are Provided Separate Rights

• Refer to Home Health and Hospice – Patient Rights.

 

References

• Wis. Adm. Code, Chapter 50, Section 50.36 (1) Rules and Standards
• Wis. Adm. Code, Chapter DHS 124, Section 124.06 Patient Rights and Responsibilities in Critical Access Hospitals
• 42 CFR § 482.13 Condition of Participation: Patient’s Rights
• Joint Commission – Rights and Responsibilities of the Individual
• Wis. Adm. Code, Chapter DHS 124, Section 124.06 Patient Rights and Responsibilities in Critical Access Hospitals
• 42 CFR § 485.645 – Special Requirements for CAH Providers of Long-term Care Services (“Swing Beds”)
• 42 CFR § 483.10 – Resident Rights