While legal specialists agree that detaining a patient over a medical bill violates their fundamental rights and freedoms, many hospitals are turning into detention centres for people who cannot pay.
Trans Nzoia medical services director John Kisiangani said this habit is rampant in private and public hospitals, and that such cases are easier to deal with in a public hospital rather than a private facility.
“In public hospitals we have a waiver system, whereby if a patient is unable to pay their bills, first we send a social worker for background check of the patient, to ascertain if truly they cannot pay. Then the patient is released and the bill is waived off,” he said.
However, most private hospitals do not have an opt-out system. “When it comes to a private facility our hands are tied, because it is a reality that the owners have spent their resources, they are in business, and you cannot just tell them to release a patient,” Kisiangani said.
A study published by Chatham House’s Centre on Global Health Security in the UK last year ranked Kenya among the most
notorious countries in detaining patients unable to settle medical bills. It fell in the same
ranks as DR Congo, Ghana, Liberia, Nigeria, Uganda and Zimbabwe.
“Patient detention deters healthcare use, increases medical impoverishment, and is a denial of international human rights standards, including the right not to be imprisoned as a debtor and the right to access to medical care,” the study reads.
It noted that victims tend to be the poorest members of society, who have been admitted to hospital for emergency treatment. Many of them are subject to verbal or physical abuse while being detained
in health facilities.
“At the root of this problem is the persistence of health financing systems that require people to make high out-of-pocket payments when they need healthcare, and inadequate governance systems that allow facilities to detain patients,” the report states.
CASE STUDIES
Trans Nzoia is one of the most affected regions by hospital detentions in Kenya. Early this year, the Star reported that Kelly Wanjala, a
12-year-old standard four pupil at Koykoy Primary School in Kiminini constituency, was detained for a full year at the Crystal Cottage Hospital because his parents could not pay Sh47,000 during discharge, which had risen to Sh855,000.
Wanjala was admitted at the facility during the medics’ strike last year, when services in all public hospitals were
paralysed. His father,
Edward Makhanu, said even if he were given 10 more years to clear the amount, he would not because he doesn’t have any stable income.
“I have already sold the piece of land I had to raise the Sh47 000. I don’t have a stable job and I have nothing more to sell,” Makhanu said. Wanjala has since been released after well-wishers cleared the money claimed by the hospital.
The county Children’s department, through the director Aston Maungu, and Education executive officer Isaac Kogo distanced themselves from the issue, claiming they have no jurisdiction to handle the case or demand the boy’s release. This is after the Trans Nzoia Women Leaders reported Wanjala’s issue to the Children’s department.
When reached for comment, Maungu told the Star: “We cannot handle that as that is somebody’s business. It’s upon the parents to reach an agreement with the hospital,” he said.
Elsewhere, Veronicah Nyangai was also a prisoner at Nairobi West Hospital. She was admitted on December 16, 2016, while pregnant. She hoped to have a normal delivery but three days later, she developed complications and a caesarean operation was done. Unfortunately, the baby died. At this time, her bill stood at Sh410,333. She was discharged on December 23, 2016, and moved to the general ward, where she became a prisoner. She was released in March last year after a lawyer took her case to court.
And Rehema Katana, 12, was held at Kenyatta National Hospital after she accrued a bill of Sh179,884. She was admitted at the referral hospital after she was misdiagnosed with TB. Her family was only given the option of paying the full amount or penning down how it would be cleared.
Kisiangani said private hospital owner should get insurance cover that will take care of such cases. During the doctors’ strike last year, Trans Nzoia county set aside an emergency kit of Sh5 million, where they paid bills for patients who were sent for treatment to various private hospitals.
“The money was not enough. Within three months, we had to stop the scheme as it had gotten to Sh20 million,” Kisiangani
said. “As a county, we still owe some of the hospitals as we were not able to clear the bills at once.”
As many Kenyans cannot raise the National Hospital Insurance Fund monthly premium of Sh500, Trans Nzoia county is partnering with Moi University through Ampath to create a social scheme, where the community will be contributing for the premiums of the vulnerable.
Kisiangani said the programme is still at the preliminary stage, and they have started to do piloting in Saboti and Matunda. “We are still at a discussion point to see the way forward. The programme will encourage the community to raise premiums for the vulnerable. We shall also be looking for partners who can come chip in to what the community would have raised,” he said.
He said more effort is needed to educate the community on the importance of NHIF. “This a scheme that will cover all family members, but you find most Kenyans are so reliant on the government. It’s not because they cannot raise the amount,” he said.
In 2012, two women, Margaret Anyoso and Maimuna Awuor, sued Pumwani Maternity Hospital for illegally detaining them in hospital for not paying their bills – despite a government policy of waiving the charges for poor patients.
The petitioners argued that government-owned Pumwani Maternity Hospital subjected them to inhuman and degrading treatment and violated their rights to dignity, health and liberty.
The case was filed on their behalf by Nairobi-based Centre for Reproductive Rights. It ended successfully in September 2015 when High Court Judge Mumbi Ngugi, ordered the Nairobi County government to pay Margaret Sh500,000 and Maimuna Sh1.5 million for their suffering, in addition to footing costs of the suit. The court also directed the government to take necessary measures to eliminate the practice of detaining patients who cannot pay their medical bills.
KNH DISTANCES ITSELF
In Nairobi, Kenya National Hospital management said they no longer detain patients who cannot pay.
“Every year, we have been writing off about Sh700 million in bills owed by patients,” suspended KNH CEO Lily Koros said.
Nairobi-based human rights lawyer Laura Young said detaining patients is the worst kind of attack on vulnerable people — those who are sick, in pain, are under the influence of medication or have a new baby. She said not only does it violate medical ethics — the key principle of do no harm — but it is prohibited by the constitution and international law, as affirmed in numerous Kenyan judicial decisions.
Laura said non-payment of bills is, however, a critical problem facing hospitals. “Medical professionals have an ethical duty to provide treatment, even to those who cannot pay. But failure to pay puts the entire medical care system at risk by undermining the financial stability of healthcare institutions,” she wrote in a recent opinion in the Star.
She said some hospitals take patients’ ID cards as collateral for debt payment. “This is an ineffective solution, as it violates civil and political rights,” she said. She said a better solution is ensuring any patient who walks into a hospital is aware of their opportunity to enrol in NHIF.
“In partnership with the government, hospitals should be effectively facilitating this process for all their patients. Moreover, public and private hospitals should be supported by the philanthropic sector to create funds to assist with payment of bills for indigent patients,” she said.
The Chatham House report also noted that
universal health coverage cannot be achieved while people are experiencing financial hardship through their inability to pay for healthcare. “Health financing systems should be reformed by moving towards publicly financed UHC, based on compulsory progressive pre-payment mechanisms. This would enable hospitals to become financially sustainable without the need to charge significant user fees,” the report states.