The death of a Northern KwaZulu-Natal woman after a “blackmailing” medical technologist refused to provide dialysis, citing suspended payments by Discovery Health, has drawn a strong response from the medical scheme. “This was illegal and unethical and we will be reporting this conduct to the Health Professions Council immediately, and are taking legal advice regarding possible criminal charges and civil action.”
In its reaction Discovery Health said a statement carried in the Daily News: “We are profoundly saddened by the very unfortunate death of a member of one of our medical schemes after she was refused critically needed dialysis treatment by a medical technologist two weeks ago. We feel deep sympathy for this family and are providing them with assistance to the fullest extent.
“It is absolutely clear that in refusing to treat this severely-ill patient, this medical technologist’s conduct was illegal and unethical.
“Section 27(3) of the SA Constitution and Section 5 of the National Health Act stipulates that no one may be refused emergency medical treatment. This practitioner had an absolute legal and ethical obligation to treat this patient, and had no right to refuse treatment regardless of the patient’s ability to pay, or the payment arrangements between the patient’s medical scheme and the practice.
“We will be reporting this conduct to the Health Professions Council (HPCSA) immediately, and are taking legal advice regarding possible criminal charges and civil action against this medical technologist. We will also assist the family in taking legal action should they wish to pursue it. We are also taking urgent action to ensure the safety of our other members being treated at this centre, to ensure they receive safe and high-quality treatment from an alternative practice.
“The facts of this matter are:
An investigation into this medical technologist’s practice in April 2019 confirmed a number of serious concerns in respect of both patient safety and fraud claims. We found clear evidence staff with no experience were providing dialysis treatment, without direct supervision of a qualified practitioner. We also found evidence of false claims, and were not able to verify the validity of a further 779 claims.
“Discovery Health has a legal and ethical obligation to ensure the safety of all members, and to address all fraud and abuse of members’ funds. We cannot continue paying claims to a practice that may be endangering patient safety and committing fraud. For these reasons, we informed the practice on 24 May that we were suspending payment for prior claims, pending resolution of these issues.
“We then arranged a meeting with the medical technologist for 30 May, 2019, hoping to resolve the issues. However, the medical technologist cancelled the meeting. We have since learned other medical schemes had identified similar concerns and already suspended payment to this practice.
“On 6 June, we were informed by the family that our severely-ill member was being refused dialysis treatment because payments to the practice had been suspended. We spoke with the medical technologist within an hour of learning this. However, she continued to refuse to treat our member, indicating she was aware that ‘patients were dying’, but threatened she would not treat the patient until funds owing to her practice were released.
“At the time this medical technologist refused to treat this severely-ill patient, payments had been suspended for only 14 days, well short of the 30 days within which a medical scheme must pay a valid claim. The fact that payment of past claims had been suspended for 14 days in no way prevented this medical technologist from providing the critically needed dialysis.
“Rather than attempting to blackmail the medical scheme while risking the life of a very ill patient, she should have provided treatment immediately, and then engaged with us to address our serious and valid concerns.
“The extent of corruption and fraud in the medical schemes environment is extensive, accounting for up to R28bn of members’ funds fraudulently claimed each year, and we will continue to root out corruption.
“Our conduct in this matter, as in all of our fraud investigations, is entirely in line with all applicable legislation, and adheres to the very strictest standards of fairness and transparency.”
The family of the woman are seeking legal advice about pursuing a civil claim against Discovery Health for allegedly suspending payments for her dialysis treatment. According to a Daily News report, the 53-year-old died earlier this month after missing four dialysis sessions. She had been on dialysis for two years.
Discovery Health had apparently stopped paying her dialysis practitioner, who is based in Mtubatuba. It had suggested going to another centre in Richards Bay for treatment, but the family apparently refused, saying it was too far away from their home.
The report says the practitioner, who did not want to be named, said she had regularly informed the woman about paying cash, because Discovery was the second medical aid scheme to suspend payments to her practice after conducting audits. She believed these clinical audits were not random, but part of racial profiling medical aids were accused of. She said in April, Discovery had stopped making payments to members she was treating, and she was asked for these members’ confidential clinical files and blood samples.
The report says after getting patients’ consent, she forwarded the information to Discovery. “I sent three out of the six files I had. They said I had given them incomplete information and wanted me to come to their offices. I told them I don’t have the money to as I also hadn’t been paid since February by Medscheme medical aid. I asked that we reschedule,” she said. She was running out of consumables, equipment and other items used to perform dialysis and had to borrow from other facilities. At some point she also treated patients pro bono.
“When the patients returned to me, Discovery told me it would move them to other facilities and it was going to claim back the money it had paid to me,” she said. On 3 June she was still treating patients, including the woman that died. With her consumables running low, the next day she sent a text to her patients asking if they could pay in cash.
The report says dialysis sessions cost about R2,000 per session – up to R6,000 a week for some patients. She said on 5 June, the woman did not come for treatment and the next day the doctor had a conference call with the medical aid and the woman’s son, who wanted to know why the doctor could no longer treat his mother. “(Discovery) told him to take his mother to a facility in Richards Bay, which is more than an hour’s drive for the family. They said I should phone back alone. On the Friday the woman stayed home and did not get treatment. On that day the family contacted the medical aid, telling them the woman was getting worse,” she said.
The report says she, too, contacted Discovery, asking it to intervene. Discovery apparently asked her to resume treating patients, saying it would find another way of conducting its audit. “I asked for this to be sent to me via email, but little did I know the patient had already died by then.”
The report says with 10 days left for the public to make submissions on the Section 59 investigation into allegations of racial profiling against black doctors by medical aids schemes, Discovery Health and Medscheme have denied racial profiling.