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Hope for patients detained in hospitals over unpaid bills

Sunday January 13 2019

Jaramogi Oginga Odinga Teaching and Referral Hospital

A patient lies on the floor along the corridors of Male Ward 2 at the Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu on September 16, 2018. PHOTO | ONDARI OGEGA | NATION MEDIA GROUP 

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Mercy Muthoni, 34 (not her real name) sits motionless on a bench outside the children’s cancer ward at the Kenyatta National Hospital (KNH), lost in thought.
She has been at the hospital for the past nine months, nursing her baby who is suffering from the terminal disease.
Doctors have since discharged her baby but she cannot leave because she has not paid a mounting bill that now stands at Sh700,000.
She has on many occasions contemplated abandoning her baby at the facility and sneaking out to “freedom” but each time she thinks of it, her motherly instincts get the better of her.

“Even if they keep me here for a year, I will not be able to pay the money. I cannot afford it. All I am requesting is that they release my child so that I take care of him at home. If I get money, I will always send it to the hospital,” she pleads.
The hospital only provides food for the child but not the mother. In the ward, “detainees” sleep on bedsheets spread on the floor in cordoned-off rooms. Guards manning the wards monitor each of their movements, lest they escape without paying the bills. They even escort them to the washrooms.
Mr Elvis Omondi, a construction worker, suffered a similar ordeal at the Coast General Hospital last year.
He was admitted to the facility from October 28 after a wall he was erecting fell on him. When he recovered, the hospital could not release him as he was unable to pay a Sh236,560 bill.
Not even the intervention of Mombasa Governor Hassan Joho, who waived all the bills for detained patients last Jamhuri Day, could free him from the “detention”.
“My family, friends and officials from the construction firm did a harambee before I was finally discharged on December 31,” he added.
Health experts term hospital imprisonment as a human rights violation. The detention, according to health experts, comes with risks.
“When a patient who has been discharged stays for longer in the hospital, they may get hospital-acquired infections which are not always easily treatable, more so in children and women who have just delivered,” said Dr Paul Mitei, a gynaecologist.
This practice by hospitals could be something of the past if proposed changes in the Health Laws (Amendment) Bill 2018 to outlaw detention of patients and bodies over pending hospital bills is adopted.

Nyando MP Jared Okelo, in his amendments, wants all hospitals, both public and private, not to detain anyone over bills but instead to reach a mutual agreement on how to settle the bills.
The proposed law is currently in its second reading and the MP wants a relook of the Medical Practitioners and Dentists Act 253 to compel any health personnel or facility to pay up to Sh5 million fine or serve a jail term of up to five years for detaining bodies or patients.
“No health institution in the country shall detain or otherwise cause, directly or indirectly, the detention of the body of a patient who died after or during treatment for reasons of non-payment, in part or in full, of hospital bills or any other medical expenses,” reads part of the proposed amendments.
“Patients who have fully or partially recovered and who are discharged or wish to leave health institutions but are financially incapable to settle their hospital bills or other medical bills shall be allowed to leave the health institution,” adds the bill.
Last year, the Auditor-General accused KNH of failing to seal loopholes that saw it lose Sh47.5 million in unpaid medical bills in the 2015-2016 financial year.
The report showed that the hospital has over the years lost more than Sh500 million, as patients sneak out without paying their bills.
In August 2017, a patient at the KNH committed suicide by jumping off the seventh floor after he was unable to pay the medical expenses.
Mr Maurice Chege had been discharged but could not be allowed to leave due to the medical bills. He died on the spot.
Moi Teaching and Referral Hospital in Eldoret was forced to waive unpaid bills amounting to Sh1 billion.

Most of the bills had been pending for years, some dating back to the time the hospital was elevated to a referral facility in 1998.
Chief executive officer Wilson Aruasa said the hospital’s board had recommended the waiving of accrued bills.
The hospital gives a 50 per cent waiver to those who are unable to clear their bills.
Dr Aruasa said that the policy of the hospital does not allow it to detain any patient or body because of bills.
“If a patient has National Hospital Insurance Fund cover, they will pay and for those who don't have, we encourage them to get one and clear the bill or those who are unable, we have no otherwise but to release the patient or body,” he said.
Many Kenyan human rights advocates lament that hospitals continue to hold patients despite what was seen as a landmark judgment in 2015.
Then, the High Court ruled that the detention of two women at Pumwani Maternity Hospital who couldn’t pay their delivery fees — Maimuna Omuya and Margaret Oliele — was “cruel, inhuman and degrading.”
Ms Omuya and her newborn were held for almost a month next to a flooded toilet while Ms Oliele was handcuffed to her bed after trying to escape.

Additional reporting by Samuel Owino