A 38-year-old woman with advanced breast cancer was denied potentially life-saving chemotherapy for nearly six weeks after the UK’s Home Office deemed her ineligible. The Guardian reports that Kelemua Mulat, who has metastatic breast cancer in her abdomen and bone cancer in her spine, was refused urgent hospital treatment on 27 April after a Home Office official decided her asylum claim did not meet strict criteria. Doctors at the internationally-renowned Christie Hospital in Manchester were extremely concerned by the decision, the report says, as consultants believed chemotherapy was “immediately necessary”.
The report says, however, that the mother-of-one, who fled Ethiopia during political violence in 2010, has begun chemotherapy after the Christie took the rare step of applying to treat her on the grounds that she requires urgent treatment, making her exempt from charges for overseas patients. The treatment started six weeks after she had been due to have her first consultation at the hospital.
Mulat is quoted as saying she felt she had been “left to die”. “There’s too many unlucky people on Earth but I feel like the worst one,” she said through tears. “I came here for a better life but it’s not happened. I’ve no hope. I just wait to die. Anybody at the age of 38, waiting for death – how can you feel?”
Jeremy Bloom, Mulat’s legal representative at the law firm Duncan Lewis, said: “We are delighted that our client will be receiving the life-saving cancer treatment that she so urgently needs, but it is shocking this treatment was delayed by nearly six weeks.”
According to the report, lawyers and charities said Mulat’s case was an egregious example of the government’s “hostile environment” policy, which puts hospitals under a legal duty to check patients’ eligibility for most forms of care. Hospitals are obliged to seek money upfront from patients deemed ineligible for free care, sometimes because they do not have the necessary paperwork to prove their entitlement.
The report says doctors, health charities and organisations working with migrants have criticised this regime as unfair, inhumane and likely to deny National Health Service (NHS) care to people in urgent medical need. And, the report says, there is growing opposition from NHS staff, who claim the policy threatens to break the bond of trust between staff and patients by turning them into border guards and debt collectors.
Mulat’s spreading cancer causes crippling pain in her back and she is unable to retain any food or drink beyond water and a dry biscuit, according to her friend and interpreter, Sara Jackson. “She’s been in horrendous pain, day and night; her skin has changed colour because the cancer is all over her abdomen,” she said. “She would have died if it wasn’t for the kindness of the doctors and nurses.”
The report says Mulat arrived in Britain in July 2015, five years after fleeing Ethiopia when her partner – the father of her daughter – was shot dead, she said, by pro-government forces after he took part in protests. She was diagnosed with breast cancer in 2013 in Greece, where she underwent a mastectomy paid for by the UN refugee agency. Her first asylum claim in Britain was rejected in August 2016 and her section 4 asylum support, which includes NHS healthcare and a £35.39 weekly support allowance, was stopped in February this year.
Since then, she has been surviving on food parcels and supermarket vouchers from the British Red Cross destitution service, while living in Home Office accommodation in Salford with four other female asylum seekers. On 25 April Mulat’s lawyers submitted fresh evidence arguing she faced political imprisonment if she was forced to return to Ethiopia.
However, the Home Office classified the evidence as “further submissions” instead of a fresh application; a small but crucial difference which meant that, in the eyes of government bureaucrats, Mulat was not entitled to free healthcare. The report says had her evidence been seen as a fresh asylum claim, she would have been allowed chemotherapy immediately.
A spokesperson for the Christie said: “When Ms Mulat attended the Christie, we sought and acted upon advice from the Home Office which advised that Ms Mulat was not eligible for free NHS care. This resulted in a delay to the start of her treatment.
“We subsequently reviewed the case in line with the NHS (Charges to Overseas Visitors) Regulations 2015 and decided to treat Ms Mulat immediately. Our staff are committed to treating patients in need with compassion and the very best care.
“Ms Mulat had a consultation at the Christie on 6 June and started her treatment immediately. We appreciate that this must have been a very anxious and stressful time for Ms Mulat and we hope that she can now focus on her treatment.”
The report says Mulat, who is being supported by the charity RefuAid, is legally unable to work because of her asylum status but volunteers at a charity shop and is on a waiting list to learn English at Salford College.
Anna Jones, the co-founder of RefuAid, said the charity was appalled at the situation. “Increasing evidence of a hostile environment facing asylum seekers with terminal and acute illness is incredibly concerning and having a devastating impact on the lives of those suffering,” she said.
After being turned away initially from the Christie, Mulat was prescribed a “stop-gap treatment” of a daily Letrozole tablet and a monthly Zoladex injection. She was invoiced £3,379 for this, causing significant distress.
Bloom said the myriad rules about the charging of overseas patients had led to confusion across the system and that seriously ill people were being left in the dark as a result. “Hospitals, the Home Office and the Department of Health don’t seem to understand how to apply the relevant eligibility and exemption criteria, and what evidence to seek from people in situations like this,” he said.
“Communication with patients is also totally unclear; patients are rarely told in writing whether they will be charged or refused treatment under the regulations, or what evidence they need to provide.
“The NHS charging regulations are another part of the ‘hostile environment’ which is having unintended consequences for vulnerable people in need of protection.”
The Home Office is quoted in the report as saying: “This government is committed to doing everything necessary to protect the rights of asylum seekers and ensure those who would other be destitute are supported while applications are considered.
“Asylum seekers are provided with free, fully furnished accommodation while applications are considered. We also cover utility costs and provide a cash allowance to cover other essential living needs, including free access to NHS healthcare.”
The report says the Home Office has refused Mulat’s latest asylum claim despite evidence about the threat she would face in Ethiopia. She is a member of Ginbot 7, the same pro-democracy group as the British citizen Andargachew Tsige, who spent four years on death row before he returned recently to Heathrow after the British government campaigned for his release.
In January, an Ethiopian court sentenced more than 30 alleged members of the group – which is banned by the state – to between 15 and 18 years in jail.
An investigation has, meanwhile, been launched in the UK after an ill and heavily pregnant woman was illegally removed from her GP’s list, told she was not entitled to NHS treatment in Scotland and wrongly charged more than £4,000 for treatment she had already received.
The Guardian reports that Amber Hussain (not her real name), who has lived in the UK since 2012 and already had a British-born child, was in the process of applying for leave to remain as a spouse when she was told she was not entitled to NHS services.
The report says it is illegal for NHS Scotland to remove a patient from a GP list, irrespective of their nationality or immigration status. It is also illegal to charge someone for health services they have already received on the basis that no charges would be made. NHS Scotland’s own rules state that: “No woman should ever be denied maternity services in Scotland, or have such services delayed, regardless of her liability, or ability, to pay when charges apply.”
Amber was not able to visit her GP in the weeks leading up to her second child’s birth earlier this month. She had to diagnose her symptoms herself with the help of the internet and guess which medication she needed to purchase from her local pharmacy.
While trying to persuade the Scottish government to overturn its decision, Amber also received an invoice for £4,186 for NHS treatment she had received between 2016 and 2017. The bill noted she was an “overseas patient” and that the sum was due immediately.
The report says after questioning her treatment, NHS Greater Glasgow and Clyde reimbursed her for the money she had already paid and the remaining debt has been paused while the investigation is conducted. NHS Scotland’s Practitioner Services Division has announced an investigation into the case, but has not contacted Amber, who is still waiting to be told that she can visit her GP or access care without fear of being charged.
“The birth of our beloved daughter was completely overshadowed by the stress and anxiety caused by the first bill and the second, similar bill we expected to get to cover the costs of her birth and my wife’s postnatal care in hospital,” said her husband, Ali Hussain. “We couldn’t enjoy our new baby because we were expecting bailiffs to turn up at our door at every moment.”
Amber suffered complications after the birth and was kept in hospital on a pay as you go scheme, where every item was charged for. “The birth of a new child should be the most happy thing in the world,” said Ali (not his real name). “But I couldn’t stop myself counting each nappy the baby used and each blanket, and imagining the bill going up and up.”
The report says Ali, who has two master’s degrees from UK universities, was a sales and service officer at a UK bank, earning £21,000. In 2015, his accountant realised that an error made by one of his employees in the 2010-11 accounting year had resulted in Ali under-declaring his self-employment income by £8,000. “Straightaway, my accountant sent a revised return to HMRC and all taxes were paid,” said Ali. “HMRC accepted the correction and never imposed any penalty.”
The Home Office, however, said the tax amendment was sufficient evidence that Ali should be deported under paragraph 322(5) of the immigration rules, designed in part to deal with terrorists and those judged to be a risk to national security. “During the course of my 12 years’ stay in the UK I never claimed any kind of benefit, I’ve always been a taxpayer, never broken any law and never even committed a traffic offence,” he said. “How can the Home Office classify me a ‘threat to national security’ based on this one minor tax amendment?
“Their effort to link tax correction with ‘national security’ is entirely unjustified and a blatant mockery of the principles of fairness and justice,” he added. “The pain my wife and I have, and the stress and suffering we are going through is beyond measure and perhaps beyond imagination.”
The report says in March, Ali was called to report to an immigration centre. He attended with his heavily pregnant wife and believes an official he dealt with then forwarded his wife’s details to the NHS. “A few days later, we received a letter from NHS Scotland saying they had been informed by the UK Home Office that my wife was a visitor to the UK and not entitled to NHS services. The letter said she had been removed from the NHS list at her GP surgery with immediate effect.”
With their baby due weeks later and Amber’s health condition worsening, Ali employed solicitors to reverse the Home Office’s decision. The solicitor wrote repeatedly to the Home Office, as did the family’s MP, Paul Masterton. “We repeatedly tried to get the Home Office to admit its mistake, stressing the urgency of my wife’s condition,” said Ali. “But they refused to answer letters from me or from our solicitor, and they lied to our MP, too, by wrongly telling them that my wife’s appeal had been refused and then that it was out of time, neither of which are true.”
Ahsan Mustafa from RH & Co Solicitors said: “A counter clerk from the Home Office in Brand Street erroneously informed the NHS that our client was not entitled to access NHS services without charge on the grounds that she is a ‘visitor’ to the UK. This is categorically untrue. The Home Office clerk provided erroneous information to the NHS … As a result, our client was delisted from (her GP).”
A Scottish government spokesperson is quoted in the report as saying: “Regardless of residency status, everybody in Scotland is entitled to receive immediate and necessary treatment at a GP practice. On that basis, this case is being reviewed by NHS Scotland’s practitioner services division to ensure that the correct procedures are followed.”
A Home Office spokesperson said they could not comment on individual cases.
[link url="https://www.theguardian.com/uk-news/2018/jun/07/home-office-prevented-asylum-seekers-urgent-cancer-treatment"]The Guardian report[/link]
[link url="https://www.theguardian.com/society/2018/jun/10/pregnant-womans-removal-from-gp-list-prompts-investigation"]The Guardian report[/link]