Doctor Accountability

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Have you or a loved one been harmed by a doctor or medical staff person when seeking medical treatment? We would like to hear your story, or any other comment you may have about the experience.

(Your personal information will remain completely confidential unless you give us permission to use or share it below.)

Please answer the following questions to the best of your ability, with respect to either your own experience or the experience of your loved one about a doctor or other medical staff. Questions marked with an “*” must be answered, while other questions are optional. Thanks for taking the time to do this. Your personal experience can really help us on our work with doctor and staff accountability in the future!

  1. My experience is primarily about (we understand your story may be
    about several topics, but we ask that you pick a main category):
    A Doctor or Doctors
    Medical Staff (eg: nurse, radiology or other technicians)
  2. In what kind of facility did the event occur?
    Doctor’s office/outpatient clinic
    Hospital
    Rehabilitation facility
    Ambulatory/outpatient surgical center
    Dialysis Center
    Endoscopy Clinic
    Long-term care settings like a nursing home
    Other location (please specify in question 3)
  3. To the best of your knowledge did the doctor have a history of problems, such as having his or her license suspended or other disciplinary actions in your state or another state; drug or alcohol abuse; or some other impairment? If yes, please describe in your own words (the space below allows you to include as much detail as you like).
  4. In what year did the incident occur?
  5. Describe your experience in your own words (the space below allows you to include as much detail as you like):
  6. If yes, what was the Medical Board or Licensing Agency response?
    License suspended or revoked
    Probation (special restrictions placed on license)
    Board issued a fine
    Board dismissed as invalid complaint
    Board investigated and took no action
    No response from Board
    Don’t know
    Other
  7. To the best of your knowledge, did the incident increase the cost of your medical care?
  8. Your experience or that of a loved one resulted in:
    minor injury
    serious or life-threatening injury
    extended length of hospital stay
    permanent disability
    death
  9. How long did it take for you or your loved one to fully recover from the
    incident?
    Less than a week
    Less than a month
    Six months to a year
    More than a year
    Still not fully recovered
    Not applicable because the person died
  10. When you or your loved one was harmed, the doctor…
    Provided full information about the source of the problem
    Did not provide full information about the source of the problem
  11. Did your health insurance company refuse to pay or deny claims or any expense associated with the harm?
  12. Did the doctor bill you or your insurance company for care connected with the harm?
  13. What was the medical harm by your doctor connected to?
    surgery
    prescription medications
    diagnosis
    diagnostic tests
    procedures in the doctors office
    coordination of care
    sexual inappropriateness or assault
    other
  14. Please describe your experience with the medical board (the space below allows you to include as much detail as you like)
  15. Sharing your story helps Consumers Union of U.S., Inc. and Consumers Union Action Fund, Inc.[1] (“we” or “us”) to learn more about what is happening to real people. We use this information to explain consumer problems to policymakers, the media, and the public. When you give us your story, you agree that we may use, share, and make public your story, using only your first name, city and state. We will not share or make public your last name, address, phone number, or email address unless we contact you and gain your permission to do so.

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