Due to the complex nature of certain ailments, clinicians often had to make difficult, but important, decisions that might be difficult for patients and their relatives to understand. The Sunday Tribune reports that this was according to KwaZulu-Natal Health spokesperson Noluthando Nkosi, who was reacting to an earlier Sunday Tribune report that as many as 60 patients with organ failure were no longer being treated at Durban’s specialist hospital Inkosi Albert Luthuli Central. Addington, RK Khan, Prince Mshiyeni and Wentworth hospitals were also turning away sick patients.
“The exclusion of certain patients from dialysis or other medical interventions is not unique to the public health-care sector, but is a global practice,” Nkosi said. She said the suggestion that patients were “sent home to die” was a symptom of an attempt to oversimplify cases that tended to be complex.
She said medical exclusion criteria from dialysis might include: active, uncontrollable malignancy or short life expectancy; an advanced, irreversible progressive disease of vital organs such as – cardiac (heart), cerebrovascular vascular disease advanced cirrhosis and liver disease medically or surgically irreversible coronary artery disease lung disease unresponsive infections; and Hepatitis B and C.
“Patients with proven habitual non-compliance with dialysis treatment and lifestyle modification will be excluded or removed from chronic renal dialysis programme,” she said. Nkosi said that patients and relatives who did not understand the rationale behind exclusion from dialysis were urged to seek clarity from health-care workers.
The Sunday Tribune had earlier reported that it is believed that the lack of funding, equipment and skilled personnel were among the reasons patient were being turned away. It said hospitals were unable to keep patients indefinitely as this prevented new patients from receiving treatment. Treatment was provided on the basis that patients were “ideal candidates” for transplants and dialysis would keep them alive long enough to receive an organ.
The report says the sheer volume of patients in need of dialysis and the finite resources of the healthcare system left patients hopeless after being turned away. The majority of the patients interviewed could not afford private health care.
A doctor from Inkosi Albert Luthuli said patients could not be treated indefinitely. “If you are not viable for a transplant, you cannot stay. Space has to be made for others. Patients have to be referred to us. They are assessed by their local hospital who would send results to us.”Full Sunday Tribune report (subscription needed) Full Sunday Tribune report (subscription needed)