The Commissioner received 398 complaints related to care delivered in public hospitals in 1998, 254 of which (64%) related to an episode of care in which the patient had experienced an adverse event. For 51% of the complaints the adverse event was judged to be preventable. The NZQHS review identified 850 adverse events, as previously reported,5
of which 315 were preventable, 124 were serious, and 48 were both serious and preventable.
Patients themselves instigated 105 (41%) of the 254 complaints involving adverse events (fig 2). Third party complaints were commonly laid by family members, primarily the patient's child (17%), parent (16%), or spouse (13%). A total of 79% (313/398) of complaint letters and 75% (191/254) of the adverse event complaint letters expressed concern about a health professional's attitude or communication either during the index admission or after the adverse event.
There were seven matches between the complaint sample and the full NZQHS sample (n
6579). NZQHS reviewers judged three of these matches to involve adverse events (one preventable death, one preventable permanent disability, and one unpreventable temporary injury); the rest did not involve adverse events. (Besides injuries, the Commissioner also has jurisdiction to hear complaints relating to informed consent, discrimination, and a variety of other bases of dissatisfaction with care.) Hence, 0.4% (3/850) of the patients in the NZQHS sample who experienced adverse events complained. Among NZQHS patients judged to have experienced adverse events that were serious and preventable, 4% (2/48) complained.
Box 1 Case studies of injured patients who did and did not complain
Adverse event with no subsequent complaint
Mrs A, an elderly woman with a history of hyperthyroidism, asthma, left ventricular failure, hypertension, and gastro‐oesophageal reflux disorder was admitted to hospital with dizziness and vomiting. She was dehydrated with low sodium (113 mEq/l, normal range 135–145). Her list of 13 medications prescribed by her general practitioner included frusemide 80 mg a day and spironolactone 100 mg twice a day. She was diagnosed with hyponatraemia secondary to an excessive dose of diuretics. She was rehydrated and discharged 8 days later on a reduced frusemide dose of 40 mg/day. Mrs A did not complain.
Complaint following adverse event
Mr D, a middle aged farmer, sustained a penetrating injury to his right eye while cutting firewood. As a result of this injury Mr D suffered a detached retina. He was referred to an ophthalmologist who offered to reattach the retina using an operation he had recently learned in the United Kingdom. The scrub nurse was unfamiliar with the proposed operation which involved the use of diluted SF6 gas. The theatre supervisor was on a meal break because the operating schedule was running late. Due to a breakdown in communication between the nurse and the surgeon, the gas was not diluted and 100% gas was administered to Mr D's eye, resulting in total blindness in that eye. He is no longer able to run his farm due to the loss of depth perception. Mr D's complaint was upheld and his claim for no‐fault compensation was accepted.
Complaint with no adverse event
Mr N, a young man, was admitted to hospital with a severe crush injury to his right middle finger. A senior orthopaedic registrar with extensive plastic surgery experience assessed Mr N and discussed the case with his consultant. They agreed that it would be appropriate for the registrar to attempt to preserve Mr N's fingertip. The registrar stabilised the soft tissue with loose sutures and administered an antithrombotic prophylactic, dextran, to try to prevent thrombosis of the artery. Another orthopaedic registrar, who had not been involved with Mr N's initial care, told Mr N that crush injuries should never be sutured, causing him considerable anxiety. Following discharge, the hospital tried to arrange a follow up appointment for Mr N but he insisted on going on holiday to a remote region of New Zealand and did not contact a general practitioner as had been agreed. His fingertip became infected and later required partial amputation. The Commissioner found that Mr N had received an appropriate standard of care.
Box 1 provides case studies of three patients. The first patient complained following an adverse event. The second patient suffered an adverse event and did not complain. The third patient complained but, because the poor outcome he experienced was attributable to the condition for which care was sought rather than the medical care itself, it was not an adverse event.
Table 1 shows the characteristics of the patients in the full NZQHS sample, the subset of patients who experienced adverse events (except for the three who complained), and the complainants who experienced adverse events. The average age of the complainants was 47 years and 59% were female. Among complainants for whom ethnicity data were available, 14% were Maori and 3% were Pacific. In general, complainants' injuries involved were quite severe, with 31% resulting in permanent injury and 28% in death. Most of the injuries (79%) were preventable. 44% (110/254) of complaints involved an injury that was both permanent and preventable.
Table 1Characteristics of all patients, non‐complainants, and complainants
Bivariate analyses showed several significant differences between injured complainants and injured non‐complainants (table 1). Compared with complainants, non‐complainants were significantly older (52 v
47 years, p
0.003) and more likely to live in deprived socioeconomic areas. Complainants, on the other hand, were significantly more likely to have sustained injuries that led to permanent disability or death, and preventable adverse events were twice as common in this group (79% v
These differences persisted in multivariate comparisons of the complainants and non‐complainants (table 2). Injury severity was a strong predictor of complaining, with odds of complaining increasing with injury severity. Compared to patients with temporary disability, the odds of complaining for patients with a permanent disability resulting in >50% impairment were 11.4 times greater (95% CI 5.9 to 22.1), and for patients who died they were 17.9 times greater (95% CI 9.3 to 34.2). There was also a strong independent correlation between preventability and odds of complaining (odds ratio (OR) 7.6, 95% confidence interval (CI) 5.0 to 11.6).
Table 2Multivariate odds of complaint among patients who experienced an adverse event
In addition, several sociodemographic factors were associated with propensity to complain after an adverse event. Odds of complaining for patients in the most deprived quintiles were one third those for patients in the most privileged quintile (OR 0.3, 95% CI 0.2 to 0.6). Elderly patients were significantly less likely than their younger counterparts to complain following an adverse event (OR 0.2, 95% CI 0.1 to 0.4). Odds of complaining for patients of Pacific ethnicity were lower than for non‐Maori/non‐Pacific patients (OR 0.3, 95% CI 0.1 to 0.9). The difference was not statistically significant for Maori patients, perhaps because of the relatively small numbers in this category.