Self-Advocacy Guide: Filing a Patient / Client Grievance

Sometimes you do not feel right about treatment or services you get. You can voice your concerns and try to make your situation better through the Patient/Client Grievance Process. This guide goes through the patient rights complaint or grievance process under Wisconsin Statute § 51.61 and DHS 94.
This resource is a general guide for people with disabilities and their families, not legal advice. For legal advice on your specific situation, please talk with a lawyer.

I think my provider violated my rights. What can I do?

You can file a patient rights grievance about any service you get for mental illness, intellectual disability, or alcohol/substance use. “Grievance” refers to the Patient Rights Grievance Procedure from Chapter 51 of Wisconsin’s State Statutes. Wisconsin’s Department of Health Services (DHS) has a webpage on client rights with more information.
You file this type of grievance with your provider agency. A formal grievance starts an initial investigation and ends in a report summarizing the agency’s decision and recommendation, called “findings.” You can appeal to county and state agencies if you disagree with the agency’s findings.

What are my patient/client rights?

When you get any service for mental illness, alcoholism, drug abuse, or a developmental disability, you have rights from Wis. Stat. § 51.61 and Wisconsin Administrative Code Section DHS 94. These rights include:

Personal Rights

• To be treated with dignity and respect

• To be free from verbal, physical, emotional, or sexual abuse

• To fair and reasonable staff decisions about your treatment and care

• To not be treated unfairly based on race, national origin, sex, age, religion, disability, sexual orientation, funding source, or marital status

• To not be filmed, taped, or photographed unless you agree

• To a phone to make and get calls (within reasonable limits)

• To reasonable privacy when toileting or bathing

• To see visitors every day

• To spend your money how you choose, except when someone else has that right – like your parent if you’re a minor, a court-appointed guardian of your estate, or a representative payee

Treatment Rights

• To prompt and adequate treatment

• To treatment in the least restrictive way and place

• To be free from restraint or seclusion used for force, control, or punishment

• To participate in planning your treatment and care

• To be informed about your treatment, care, and medications – including other options and possible side effects

• To agree, in writing, to treatment and medication – unless it is:

  • Needed in an emergency to prevent serious physical harm,

  • Court-ordered, or

  • Your guardian agrees for you

Records Rights 

(see Wis. Stat. Section 51.30 and Wis. Admin. Code Section DHS 92)

• To have information about your treatment and records kept confidential unless you or the law allows sharing

• To ask to see your records

  • Your provider must show you records about your physical health or medications

  • While you’re getting services, staff may limit which other treatment records you see – but they must tell you why

  • After discharge, you may see your whole treatment record (see Wis. Stat. Section 92.05)

• To challenge something in your records that you believe is wrong

  • If staff won’t change the record, they must allow you to put in a written statement about why you disagree

Grievance Rights

• To information about your patient rights and a copy of the grievance procedure, before starting treatment or services

• To staff who know about your patient rights and how to help if you want to file a grievance

• To not be threatened or punished by staff if you ask about your rights or file a grievance

• To choose to sue in court during, after, or instead of filing a grievance

Patient Rights Grievance Procedure

All community and inpatient mental health, intellectual disability, and drug/alcohol provider agencies must have a written Patient Rights Grievance Procedure.
All provider agencies must also have a trained Client Rights Specialist (CRS). The CRS will talk with you about your concern(s) and help you file a grievance. They will also investigate your grievance and write the initial “findings.”
The grievance procedure will follow these steps:

1. Informal process (optional)
   Before filing a formal grievance, you can talk to staff, a CRS, or manager about your complaint(s) and why you think there’s a violation of your patient rights. This may clear things up and fix the problem(s). But this step is optional; you don’t have to do this before filing a formal grievance. You can use the Grievance Process Worksheet on page 11 to organize your thoughts for this step. 

   • Advocacy Tip
     If you use this step and have an informal discussion, keep track of the 45-day deadline to file a formal grievance. You don’t want to accidentally lose your right to file because this step takes longer than you thought.

2. Filing complaint/grievance
   File your formal grievance with the CRS as soon as possible, when the details are easiest to remember.
   You can raise more than one issue in your grievance.
   Write your grievance, if possible. If you file it verbally or with a different communication method, the CRS should help you write or type it.

   • Advocacy Tips

     • You can file verbally instead of writing your grievance; but a paper trail creates evidence that you asked the provider about your concern. You can use DRW’s Form Letter for grievances to write your grievance.

     • You must file within 45 days of when you learned about the rights violation.

     • If you know it has been more than 45 days (or if you think it might have been), explain the reason for your delay and why you think there’s “good cause” for a later deadline. For example, there’s “good cause” if failing to investigate the grievance would cause substantial injustice or if investigating the grievance will result in better care for you or others in the program.

3. Investigation

   • The CRS will investigate your grievance and try to resolve it.

   • The CRS will write a report within 30 days of when you filed the grievance. You and the program manager will get copies of the report. This manager must be someone other than the CRS who has authority to decide on your grievance.

   • If you and the program manager agree with the CRS’s report and recommendations, the recommendations should go into effect over a timeframe you agree to.

4. Program Manager’s decision

   • If the CRS’s report doesn’t resolve your grievance, the program manager must write a decision within 10 days of getting the report. You should get a copy of this decision.

   • If you disagree with the program manager’s decision, you can appeal to the next level. You can use the Request for Review/Appeal Worksheet on page 12 to keep track of this process and important dates.

5. County Level Review Level II (only for certain cases)
   *NOTE: If you’re getting services directly from a clinic or program and the county isn’t paying for them, you skip this level and go right to the State Grievance Examiner level. The county gives or pays for many mental health services, so appeals about those services go to the county.

   • If a county agency is giving or paying for your services, you can appeal the program manager’s decision to the County Agency Director (usually the County Human Services’ Department director). You must appeal within 14 days of getting the program manager’s decision. You can ask the program manager to forward your grievance or send it yourself.

   • You can use the Request for Review/Appeal Worksheet on page 12 to help with this stage.

   • Your appeal must say why you disagree with the program manager’s decision. You may also suggest a solution.

   • The County Agency Director must send their written decision within 30 days of your appeal request.

6. State Grievance Examiner Level III

   • If your grievance went through the county review level and you disagree with the decision, OR if you skipped Step 5, you may appeal to the State Grievance Examiner.

   • You can use the Request for Review/Appeal Worksheet on page 12 to help with this stage.

   • Your appeal must say why you think the earlier decision was wrong.

   • You must appeal within 14 days of getting the decision from the last appeal level. You can ask the program manager to forward your grievance to the State Grievance Examiner or send it yourself to:
     State Grievance Examiner
     Wisconsin Department of Health Services, Client Rights Office
     P.O. Box 7851
     Madison, WI 53707-7851

7. Final State Review Level IV

   • If you disagree with the State Grievance Examiner’s decision, you have one more appeal option. You can ask for a final state review by the Division of Care and Treatment Services (DCTS) Administrator. You have 14 days after getting the State Grievance Examiner’s decision to appeal.

   • You can use the Request for Review/Appeal Worksheet on page 12 to help with this stage.

   • Again, your appeal must say why you think the earlier decision was wrong.

   • You can send your request to:
     DCTS Administrator
     PO Box 7851
     Madison, WI 53707-7851

How to Write a Grievance

Grievances should be simple and clear. They can include what happened, when, why it violated one of your rights, and what you want done to fix it. You can use the grievance worksheet on page 11 to organize your thoughts. You can also use DRW’s Form Letter for Grievances to write your grievance.

• Break down the problem and explain what happened.
  Example: First this happened, then that happened. As a result, [NAME] told me [_]. Then I was denied [__].

• Explain why you believe what happened shouldn’t have happened. Say what right you believe was violated.

  • Example: I believe this violated my right to access treatment.

• Say what you want to fix things with the provider. Be clear about what you want.

  • Example: I should be given access to this treatment: [__].

  • Example: I want it in writing that my provider won’t show my treatment records to anyone else without my permission.

• Is there anyone who saw or heard what happened?

  • Example: My friend [NAME] was with me when the staff yelled at me.

• Say you are writing a formal grievance and you want a response in writing.

• Keep a copy of the grievance and write down when you sent it. You can write this date on your calendar or use the Grievance Process Worksheet. The CRS has 30 days to investigate your grievance and respond to you in writing.

• Link your grievance to one of the Patient Rights listed above. Once you decide which right you think was violated, it will be easier to tell the story in a way that supports your view of the violation. You do not have to quote the law, but you can say “this violates my patient rights.”

• It is generally better to be brief. If the grievance is too long, you may give more information you need to, and that is not always helpful.

Examples: Simple Ways to Write a Grievance

Prompt and Adequate Treatment Example

My psychiatrist recommended I see a therapist twice a week. I talked to my case manager, but they didn’t schedule therapy or tell me how to schedule it. It’s been 6 months. I believe my right to prompt and adequate treatment has been violated. I want the county to arrange for me to get therapy.

Confidentiality Violation Example

My counselor talked to my mom about concerns I raised in my counseling sessions. I never signed a release for this, and I didn’t want my mom to know about these concerns. I feel my counselor violated my right to confidential treatment. I want the counselor to know they violated my rights and to be told never to do it again.

Right to Privacy Example

Staff at my group home take pictures during outings and I think they are putting them on social media. I asked them not to take my picture, but they just laughed. The last time they took my picture was last Thursday. I believe my privacy right and my right not to have my picture taken are being violated. I want the staff to stop taking my picture and be ordered to remove any picture of me they posted from social media.

Right to Use Your Own Money Example

I never have my own spending money when I go on outings. Staff hold it for me and then want to see what I buy before I buy it. My right to use my money how I choose is being violated. The last time this happened was a month ago, when we went to Walmart and staff wouldn’t let me buy a video game and a candy bar I wanted. They would only let me buy a “word-find” book and a banana. The video game I wanted wasn’t dirty or violent and I don’t have any diet restrictions. They were just being mean. I want them to be told I can spend my money on things I want.

Frequently Asked Questions About the Grievance Process

1. Why should I use this process? The person I’m complaining to works for the agency I’m complaining about – how could this possibly help?
   You must give the provider a chance to fix its own problem. Even though the CRSs work for the agency you are complaining about, they are supposed to be fair. They must follow the procedures outlined above and help you prepare your grievance and understand the process. You also have the right to appeal to the state examiner if you disagree with the CRS’s findings and recommendations to resolve your grievance.

2. I have questions and I want to talk with someone about my rights, but I don’t think my guardian will let me. What can I do?
   Even if you have a guardian, you always have these rights:
   Access and communicate privately with the court / government.
   Access, communicate privately with, and retain legal counsel.
   Access and communicate privately with the Protection & Advocacy agency (Disability Rights Wisconsin) and the ombudsmen (Board on Aging and Long Term Care).
   Challenge a placement and review the need for guardianship/protective services.
   File a grievance with help from a friend, advocate, or CRS.

3. The CRS just wants to “talk it out.” I tried that, and it didn’t work — now what?
   You can explain that you want this to be a formal grievance. Write your request and ask for the written response. If you don’t get a response in 30 days, you can move on to the next stage of the procedure. If the county is not paying or contracting for your service, you can contact the State Grievance Examiner.

4. The CRS said they won’t accept a complaint unless it’s in writing or on a certain form. Is that right?
   No. Grievances don’t need to be in writing or on a specific form. It may be best to write your complaint because then you’ll have written proof and it can prompt the agency to take your concerns seriously. Agencies often mistake oral grievances for informal complaints that don’t require a formal investigation or decision.

5. I sent a written grievance, but the CRS never contacted me. I called, but the facility didn’t know who their CRS was. Then I got a “thank you for contacting us, we have decided your grievance is unfounded” letter from somebody I’ve never heard of from the provider’s home office in Chicago. What does that mean?
   Many providers and agencies know less about this process than you would expect. Some don’t have CRSs or know they need them. Generally, if the provider doesn’t follow the procedure, you can go to the next level of appeal. You can explain you are appealing because the provider didn’t follow the procedure it should have.
   You can do the same if the provider or CRS don’t follow the required timeframes. No response is the same as a negative one. You can wait to see if they eventually send you something, but you don’t have to.

6. I’m confused about whether my first appeal should go to the County or directly to the State Grievance Examiner. How do I know where to appeal?
   Who you appeal to depends on who pays for the service. If the county pays for (or directly gives) the service, appeal to the County Agency Director. Otherwise, go directly to the State Grievance Examiner.

7. What if I file my appeal with the wrong place?
   If you file it with the county and it should have gone to the state, the county should forward it to the State Grievance Examiner or return it to you with an explanation. Same thing should happen if you send it to the State and it should have gone to the County.
   If refiling it in the right place causes your appeal to be late, you can ask for the Examiner or County Agency Director to find you had “good cause” to file it late. The same applies if you are late with other deadlines in this process.

Conclusion

Having your voice heard when filing a grievance can be rewarding. Navigating the system, though, can be frustrating. Remember to stay focused on your goal. Key points to remember:

• If you are not pleased with the result of your grievance, you can appeal the decision up to the Final State Review Level IV.

• Some grievances are settled quickly, but others take longer and go through all appeal levels.

• Try to keep copies of your written grievance, responses, and appeals. Keep track of who you talk to about your grievance and what they said would happen next. You can use the Contact List and the Contact Log to keep track of these things.

Grievance Process Worksheet

1. What is the problem? If there’s more than one, focus on one at a time.

2. What happened?

3. What patient right(s) do you think were violated?

4. Did anyone else see or hear what happened?

5. What do you think would fix the problem?
    

Date you sent your written grievance: ___/___/______
Who you sent or gave your grievance to: _______
If this person doesn’t fix the problem by (add 30 days to today’s date) ___/___/_______, then you’ll call / meet with / write to: _______

Request for Review / Appeal Worksheet

You can use this worksheet for any part of the appeal process – appealing a program manager decision, County Director decision, or State Grievance Examiner decision.
Date you got decision from the program manager or State Grievance Examiner:___/____/_______
Add 14 days. Date you need to appeal:_____/_____/_________________
Are you appealing the finding (no rights violation)? Why do you think the finding was wrong?
Do you need to send more documentation? Describe what you need and how you plan to get it.
Are you appealing the proposed resolution (how to fix the problem)? Why is it wrong?
What do you think should happen instead?

Grievance Process Contact List

• Name & Organization
• Phone & Fax Numbers
• E-Mail
• Job Title

Grievance Process Contact Log