Grievance Process

Patient Grievances

Grievance: A written or oral communication from an ESRD patient, and/or an individual representing an ESRD patient, and/or another party, alleging that an ESRD service received from a Medicare-certified provider did not meet the grievant’s expectations with respect to safety, civility, patient rights, and/or clinical standards of care.

If you, the grievant, have a grievance regarding ESRD treatment, you may exercise your right through the grievance process. The purpose of the grievance is to address concerns alleging that ESRD services were not provided or that they did not meet recognized levels of care. If you would like to file a grievance you may fill out the grievance packet provided below and send it to the Network, or you may contact the Patient Services Department toll-free at (800) 637-4767.

Upon receipt of a grievance the Network shall classify the case as one of the following:

1. Immediate Advocacy- utilized for non-clinical concerns that do not require complex investigation- resolved in 7 days or less
2. General Grievance- concerns that are non-clinical in nature, but require complex investigation and records review- resolved in 60 days or less.
3. Clinical Quality of Care- concerns that involve clinical or patient safety issue and require clinical record review, by an RN and/or, the Medical Review Board- resolved in 60 days or less.

Grievance Brochure     English – Spanish
Grievance Toolkit         English – Spanish
Grievance Packet         English – Spanish

Patient Roles and Responsibilities

• Carefully review the ESRD Network 18 statement of Patient Rights and Responsibilities
• Make every attempt to work out the concern informally with facility staff
• Understand and try to use the facility grievance process first
• May file the grievance in writing using the attached form or by placing a phone call to the Network’s Patient Services Department at 800-637-4767
• May designate, in writing, another individual to act on his/her behalf
• May talk to the Network 18 Patient Services staff for assistance
• May withdraw a grievance at any time
• Carefully read what the Network can and cannot do through the grievance process
• Save a copy of grievance forms filed

Network Role

• Keep communication open between patients and their ESRD healthcare providers
• Help patients feel comfortable taking their concerns to an appropriate person without fear of mistreatment or retaliation
• Facilitate a resolution of the concern as quickly as possible
• Assist in the handling of the grievance by acting as expert investigator, facilitator, referral agent, coordinator, and/or counselor and educator. In an attempt to resolve a grievance, the Network may gather information by telephone, site visits, medical records review, and/or interviews with involved parties.

What Network 18 CAN and CANNOT Do

We CAN

• Investigate claims filed by patients, family members, or patient representatives in an effort to resolve any existing issues the patient is experiencing at the dialysis facility or transplant center
• Provide individualized interventions and recommendations to both treatment teams and patients on how to rebuild a positive patient-provider relationship
• Advocate for patient rights
• Assist with locating a facility if necessary through Dialysis Facility Compare
• Provide resources such as educational materials and contact information for kidney-related organizations

We CANNOT

• Require a dialysis facility, transplant center, or physician to accept a patient
• Change or become involved in facility or personnel policies and procedures
• Facilitate in the firing or transfer of a physician or staff member
• Directly provide patients with monetary compensation, payment of bills, or transportation arrangements
• Override State or Federal licensing/certification requirements
• Assist in the pursuit of legal action

If you have a concern about your physician, contact the:
Medical Board of California
California toll-free line: 1-800-633-2322
Phone: (916) 263-2424 / Fax: (916) 263-2435
TDD: (916) 263-0935

Department of Health Services

Updated 10/31/2019