Doctors to face jail for failure to treat

By ALEX NDEGWA

Hospitals that turn away poor patients seeking emergency treatment will soon face stiff financial penalties, we can report.

A draft law intended to improve emergency care also proposes stiff fines and jail terms for medical professionals who refuse to treat those in need.

Anyone convicted of the offence could be fined Sh1 million or jailed for a year, or both. The proposed law is intended to deter professional negligence, which has occasioned the loss of lives in the past. Offending institutions will also be fined Sh3 million and any other penalty imposed in the law.

Discrimination against poor and uninsured patients is a common occurrence in Emergency Rooms (ERs). However, even affluent Kenyans have been victims of demands of hefty cash deposits before treatment. A study by three senior doctors shows this is acommon occurrence at private hospitals in Nairobi. Titled Dumping of Orthopaedic Trauma Patients at Kenyatta National Hospital, it details how the hospitals turn away patients who cannot pay in advance.

On Friday, the Kenya Medical Practitioners Pharmacists and Dentists Trade Union welcomed the proposed law saying it reflected proper medical ethics. KMPDU secretary general Boniface Chitayi said the proposed penalties would deter errant members and health service providers.

“Our union supports that legislation including the penalties that go with failure by medical professionals or institutions to provide emergency medication,” Dr Chitayi said. “This would ensure all patients brought to hospitals in emergency circumstances are stabilised. It is in line with proper medical ethics.”

Comprehensive insurance

Members of Parliament’s Health committee urged the speedy enactment of the law to punish those who have caused families anguish after their loved ones died because they couldn’t raise prohibitive deposits.

In the US, several states have enacted rules requiring hospitals to provide emergency care regardless of ability to pay and requiring that patients be stabilised before transfer to another hospital.

The draft law is meant to enforce the constitutional provision of the right to emergency medical treatment.

“No person shall be denied emergency treatment by the health service provider of first contact,” it states. This includes pre-hospital care, stabilising the health status of the individual; and/or arranging for transfer.

Friday, the lawmakers stressed a comprehensive health insurance scheme is the best remedy rather than passing laws to police the sector.

Although the National Health Insurance Fund (NHIF) unveiled a medical cover for civil servants this year, it has since stalled in scandal, which saw the chief executive officer and board members suspended.

After an investigation into the loss of hundreds of millions NHIF funnelled to ghost clinics, the parliamentary health committee is expected to present its report to Parliament next week. Nyando MP Fred Outa, a member of the Health Committee, termed the proposed penalties long overdue to curb profiteering at the expense of saving lives.

“The stiff sanctions should serve as a deterrence to all the health service providers who have routinely turned away patients over the lack of advance payments,” Mr Outa said. “The life of an individual is far more important than the money.”

Kimilili MP Eseli Simiyu, a doctor by profession, said the lethargy by the Medical Practitioners and Dentists Board had abetted “crimes against humanity.”

“They should enforce the Hippocratic oath which does not tolerate patients being denied emergency treatment. People are committing crimes against humanity,” Dr Eseli said.

Ikolomani MP Boni Khalwale, a gynecologist, said it was immoral for hospitals to put the lives of patients on the line because of money. But even before the draft law, which is before the Commission for the Implementation of the Constitution, is debated in Parliament, the blanket punishment proposed has prompted different views. Some MPs argue the sanctions should be limited to the institutions since it is the employers who instruct their ‘helpless’ staff to enforce the draconian measures.

“To punish the medics, be they doctors or nurses, is to miss the point. Such sanctions should be slapped on the institutions alone,” Dr Khalwale said. He explained: “It is the employers who issue the directives to their staff. I know of cases where outstanding payments have been recovered from the salaries of doctors whose only undoing was that they were compassionate enough to offer emergency medical attention before payments.”

Punitive suits

Simiyu concurred saying the health professionals are systematically underpaid such that they are at the mercy of the hospitals.

“It is the institutions that should be fined heavily because the medics belong to these institutions,” Outa added.

Chepalungu MP Isaac Ruto differed saying: “They are all guilty. Everyone must obey the law. It is no excuse to say I was instructed to disobey the law.” Rooting for a comprehensive medical insurance cover so there is no excuse for not treating patients, Ruto said: “We can’t go about policing everything, everybody, everywhere.”

Simiyu added: “It is like legislating against culture. It can’t work. You must let culture evolve. We need to revamp the whole medical care system. Invest in equipment, proper remuneration of staff and a comprehensive social health insurance scheme so that no one is turned away for lack of funds.”

“But Kenyans should also stand up for their rights to report cases to the police and file punitive suits against the institutions,” Outa said.