La. Admin. Code tit. 48 § III-309

Current through Register Vol. 50, No. 11, November 20, 2024
Section III-309 - Patient and Consumer Complaint Policy and Procedures
A. Policy Statement. It is the policy of the Office of Mental Health to promote and protect the rights of patients consistent with a concern for human dignity, respect, and quality care; to respond promptly and effectively to consumer concerns, inquiries, and complaints; and to promote and evaluate consumer satisfaction with services provided.
B. Definitions

Agency- Office of Mental Health.

Assistant Secretary- the Assistant Secretary of the Office of Mental Health.

Chief Executive Officer- the manager of an inpatient facility.

Complaint- verbal or written expression of concern or statement challenging patient care, behavior, action or inaction on the part of the facility staff and/or facility, an allegation of a rights violation, or an expression of dissatisfaction with services which requires further action. This may include dissatisfaction with departmental or agency policy.

Complainant- an individual who expresses dissatisfaction.

Consumer- patient; parent, friend, relative, or guardian of a patient; advocacy group; or other interested citizen and/or agency.

Facility- any inpatient or outpatient structure under the management or through contract with the Office of Mental Health.

Designee- an individual who has been designated the responsibility to resolve patient and consumer complaints by the chief executive officer or facility manager who reports directly to the chief executive officer or facility manager.

Facility Administrator- chief executive officer, facility manager, or executive administrator, as applicable.

Mental Health Advocate- an attorney from the Office of the Governor, Mental Health Advocacy Service, who is either housed or rotates to a facility.

Regional Office- the administrative unit that has the responsibility for managing the service delivery system with an assigned geographic area consistent with agency policies.

State Office- the executive office of the agency where the assistant secretary and his staff is located.

C. Process of Resolution
1. The employee who is initially made aware of a complaint should attempt a resolution and advise supervisor of action.
2. The facility administrator or his designee shall discuss the nature of the concern with the complainant. If it is determined that the complaint requires further formal action, a complaint form (see Appendix B) will be completed which describes the situation in detail. The form shall be signed by both the complainant and the facility administrator.
3. The facility administrator or his designee will take whatever action is appropriate: investigative; corrective; or educational.
4. The complainant will be requested to acknowledge in writing his/her satisfaction or dissatisfaction with the resolution.
5. If the complainant is satisfied, the record will be closed and filed at the facility for future reference. All records shall be confidential.
6. If a resolution is not reached at the facility level, a copy of all compiled information shall be forwarded to the regional manager who will address the problem by repeating Steps 2 through 5. (Inpatient facilities will proceed to Step 7.)
7. If, at this point, there is no resolution, all information shall be forwarded to the assistant secretary of the Office of Mental Health.
D. Reporting Mechanisms and Documentation. Reporting and documentation requires time and attention, but it is necessary to ensure accountability for promoting the rights of patients. Each facility is to establish documentation and reporting mechanisms which provide for:
1. Inquiry/Complaint Logging (see Appendix B). Every contact with a complainant or client which will require formal action shall be recorded on a log. Administrator/designee shall complete the date and name of the person contacted. A check mark is to be used to indicate if the contact represents a complaint or inquiry. The administrator/designee shall summarize in a few words the nature of the complaint or inquiry. If a complaint has been made, the administrator/designee records the complaint record number (CR#) after the complaint record form is completed.
2. Complaint Record Form (see Appendix C). A complaint record form shall be completed for all complaints requiring formal action. If a number of clients complain about the same condition or situation, only one form needs to be completed, but the number of clients affected shall be noted under "nature of the complaint." A number is assigned to the form, and these forms are filed by month.
3. Progress Report Form (See Appendix D). A progress report form shall be completed on every complaint which represents a major risk to a patient or which remains unsolved after 30 days. Additional progress reports are to be completed every 30 days after the initial report until the final progress report which reflects resolution of the complaint. Progress reports should be attached to the appropriate complaint record and filed accordingly.

La. Admin. Code tit. 48, § III-309

Promulgated by the Department of Health and Human Resources, Office of Mental Health, LR 13:246 (April 1987).
AUTHORITY NOTE: Promulgated in accordance with R.S. 28:171.