Ill. Admin. Code tit. 77 § 515.450

Current through Register Vol. 48, No. 50, December 13, 2024

Section 515.450 - Complaints

a) For the purposes of this Section, "complaint" means a report of an alleged violation of the Act or this Part by any System Participants or providers covered under the Act, or members of the public. Complaints shall be defined as problems related to the care and treatment of a patient.

b) A person who believes that the Act or this Part may have been violated may submit a complaint by means of a telephone call, letter, fax, or in person. An oral complaint will be reduced to writing by the Department. The complainant is requested to supply the following information concerning the allegation:

1) Date and time or shift of occurrence;

2) Names of the patient, EMS Personnel, entities, family members, and other persons involved;

3) Relationship of the complainant to the patient or to the provider;

4) Condition and status of the patient;

5) Details of the situation; and

6) The name of the facility where the patient was taken.

c) All complaints shall be submitted to the Department's Central Complaint Registry or to the EMS MD. The substance of the complaint shall be provided in writing to the System participant or provider no earlier than at the commencement of an on-site investigation pursuant to subsection (e).

d) The Department and the EMS MD or Trauma Center MD shall not disclose the name of the complainant unless the complainant consents in writing to the disclosure.

e) The Department may conduct a joint investigation with the EMS MD, EMS Coordinator or Trauma Center MD if a death or serious injury has occurred or there is imminent risk of death or serious injury, or if the complaint alleges action or conditions that could result in a denial, non-renewal, suspension, or revocation of licensure or designation. If the complaint alleges a violation by the EMS MD, EMS Coordinator or Trauma Center MD, the Department shall conduct the investigation. If the complaint alleges a violation that would not result in licensure or designation action, the Department shall forward the complaint to the EMS MD or Trauma Center MD for review and investigation. The EMS MD or Trauma Center MD may request the Department's assistance at any time during an investigation. In the case of a complaint between EMS Systems, the Department will be involved as mediator or lead investigator.

f) The EMS MD or Trauma Center Director shall forward the results of the investigation and any disciplinary action resulting from a complaint to the Department. Documentation of the investigation shall be retained at the hospital in accordance with the Resource Hospital record retention policy and shall be available to the Department upon request. The investigation file shall be considered privileged and confidential in accordance with the Medical Studies Act [735 ILCS 5/8-2101 ].

g) Based on the information submitted by the complainant and the results of the investigation conducted in accordance with subsection (e), the Department will determine whether the Act or this Part is being or has been violated. The Department will review and consider any information submitted by the System participant or provider in response to an investigation.

h) The Department will have final authority in the disposition of a complaint. Complaints shall be classified as valid, invalid, or undetermined.

i) The Department will inform the complainant and the System Participant or provider of the complaint results (i.e., whether the complaint was found to be a violation, no violation, or undetermined) within 20 days after its determination.

j) The EMS System shall have a policy in place requiring compliance with this Section.

k) An EMS System participant or provider who is dissatisfied with the determination or investigation by the Department may request reconsideration by the Department within seven business days of the determination.

l) The investigative files of the EMS System and the Department shall be privileged and confidential in accordance with the Medical Studies Act [735 ILCS 5/8-2101 ], except that the Department and the involved EMS System may share information. The Department's final determination shall be public information subject to FOIA.

Ill. Admin. Code tit. 77, § 515.450

Added at 27 Ill. Reg. 1276, effective January 10, 2003

Amended at 42 Ill. Reg. 17632, effective 9/20/2018

Amended at 48 Ill. Reg. 16159, effective 11/1/2024