These case studies are real complaints we've handled, with names and some details changed to protect privacy. They highlight the range of outcomes we can achieve in our voluntary process.
Complaints are most commonly resolved through advice from our staff or explanations from healthcare providers. Many are also resolved with apologies, refunds, partial refunds, quality improvements or access to records, while fewer complaints are resolved through compensation.
Case Study 1: Partial refund
Jenny complained after a myotherapist prescribed expensive orthotics for her two preschool-aged children, which he said she could claim on her private health insurance. However, as he was not a registered podiatrist, the health fund declined the claim.
Jenny then took her children to a registered podiatrist, who advised her that the children did not actually require orthotics.
What we did
We contacted the myotherapist to get a response to Jenny’s concerns about inappropriate treatment advice.
We spoke with them about the importance of operating within their scope of practice and referred to information from the Australian Podiatry Association and the Myotherapy Association Australia about appropriate use of paediatric orthotics.
The myotherapist offered to refund Jenny for the cost of one of the pairs of orthotics. She was satisfied with this outcome.
Case Study 2: Advice & explanation
Rania complained about the care she’d received at a major hospital and the bill she’d been left with at the end.
During an operation on her neck, Rania went into cardiac arrest and was resuscitated, taken to ICU and had five chest x-rays conducted.
After the incident, Rania wanted to complain about the care, if the anaesthetic may have caused the arrest or whether the surgeon had done something wrong, why it was necessary to take five separate x-rays in ICU and why she had to pay for the cost of them.
What we did
We gave Rania advice on how to break down the complex complaint against the hospital and clarify who each separate issue related to.
We helped her take her complaints to the relevant people to resolve it with them directly, outside of the formal complaint resolution process.
Rania received detailed responses from each practitioner - the anaesthetist, the surgeon and the ICU team - about what had happened during and after the operation and why they had made certain decisions including to take five chest x-rays.
The explanations made sense to Rania and addressed her concerns.
Case Study 3: Compensation
Antonio complained about persistent pain in his knee following a total knee replacement.
He told the surgeon of the pain one month after the operation, but was assured there was no cause for concern and to continue physiotherapy to strengthen the knee. Nine months later Antonio’s knee still hurt but was again told not to worry.
Antonio eventually got a second opinion and a full leg x-ray, which showed an abnormal distortion in his new knee requiring another total knee replacement to straighten the leg.
What we did
We presented the complaint to the original surgeon, who denied any wrongdoing. However, an independent opinion that we got concluded there had been a technical error in the original procedure, causing the distortion and pain, which now required corrective surgery.
The report was given to Antonio and the original surgeon. We then facilitated a negotiation that led to a significant amount of compensation to cover out-of-pocket medical expenses and loss of earnings for Antonio, who was satisfied that his complaint had been resolved.
To progress the complaint, in this case we suggested obtaining an independent report. Both Rania and the surgeon agreed.
Case Study 4: Access to records
Charlie complained that his local GP clinic would not give him a copy of his health records, which he wanted because he was moving house and planned to find a new doctor in the future.
The clinic receptionist told him they were the property of the clinic and if he wanted to access them he’d need to get a lawyer.
What we did
We contacted the clinic to explain that individuals have a right to access their personal health information, do not need a reason for doing so and do not need a lawyer.
We also showed them information about the maximum fees they can charge for providing copies of records.
Charlie received a copy of his health records and the clinic staff learnt about their responsibilities regarding access to health records.
Case Study 5: Apology
Vanessa and Joel complained that during the birth of their child at a large public hospital, their doctor came in several times with a medical student without their consent.
The couple knew the student personally and found their presence stressful but felt awkward asking them to leave.
A complaint made to the hospital had received no response.
What we did
We contacted the hospital to see what had happened.
Hospital staff said it was usual practice to seek consent and were unsure why it hadn’t happened in this case. They were aware of this particular complaint and said a personal letter of apology from the doctor was on file but had never been sent to the couple.
The letter apologised for not seeking consent and said the incident served as a reminder to keep the patient at the center of clinical care at all times.
The doctor’s apology was sent to the couple, along with an additional letter of apology from the hospital.
Case Study 6: Quality change & refund
Theo complained after a routine radiology procedure led to side effects he hadn’t been warned about.
The radiologist injected dye into Theo’s vein before a scan to check circulation, but Theo says he was rough when handling him and did not stop the procedure when he said it hurt.
Over the next day or two his arm swelled and continued to hurt, so Theo paid for other medical appointments and medication to treat this reaction. The side effect – known as extravasation, where medication leaks into tissue surrounding an intravenous injection site – hadn’t been mentioned on the consent form Theo signed.
What we did
We helped Theo explain his complaint to the radiologist, who replied that this side effect was not uncommon and had been treated appropriately when it happened.
The radiologist agreed to add extravasation to the list of side effects in the information sheet for patients, but declined the request for reimbursement. They referred us to their insurer to discuss this further.
The insurer agreed with the radiologist that the injury did not warrant compensation, but offered to cover Theo’s out-of-pocket expenses for follow-up treatment as a sign of goodwill.
Theo received his money to cover expenses and a copy of the clinic’s new consent form showing extravasation was now listed.