Working public hospitals are the remedy — KMPDU

The stories published in the Nation over the past two days about healthcare in private hospitals have elicited various reactions from medics and other Kenyans, who have shared harrowing experiences at some of the facilities.

The reactions are evidence that there has been an erosion in the bond of trust between doctors and patients over the years given the strict guidelines set by hospital administrators to admit patients.

Norbert Wakisa, for example, says he lost his wife at Nairobi Women’s Hospital.

He came forward to describe how the hospital admitted his wife in July 2019 for three days despite his objection.

“When she died, I had a bill of Sh1.3 million and it took about a month-and-a-half to bury her, since the bill was high. Despite making a payment plan and leaving a title deed with them, they still asked me to make increments to clear it,” he said.

Another man, who lost his sister at the facility, said that it all pointed to negligence on the hospital’s part, and their insistence on a caesarean delivery, even when it was unnecessary.

DRIVEN BY PROFITS

The doctor-patient relationship ought to be sacred since patients rely on doctors to help them make life-saving decisions.

But, as the first two parts of this series showed, global finance trained its eyes on Kenya’s private healthcare system and went on an acquisition and expansion spree over the past decade and a half, deeply eroding the relationship in its wake.

While these investments have always been seen as a positive thing, the private equity firms that invested in private healthcare were driven purely by profits, and hospital management translated this to pushing medical staff to do unsavoury things.

These recent revelations show that there have been multiple instances of unnecessary admissions, and unethical acts to drive revenues up by private hospitals staff, who are pushed by hospital owners to make money from patients by any means necessary.

VICTIMS SILENT

Not many patients who feel and say they are aggrieved follow up to have their cases investigated, says Daniel Yumbya, the CEO of the Kenya Medical Practitioners and Dentists Council (KMPDC), the body that regulates all aspects of healthcare in Kenya.

For example, only 103 people have come forward to officially complain about being overcharged at health facilities.

This constitutes only 8.85 per cent of the total number of complaints received by KMPDC despite the numerous complaints forwarded through social media.

On billing, for example, the regulator is guided by the Medical Practitioners and Dentists (Professional Fees) Rules, 2016, and can determine whether there has been overbilling, no matter what the mode of payment was.

KMPDC is now urging patients who have been forced to undertake unnecessary procedures and feel they have been duped while seeking health services at Nairobi Women’s Hospital — and other hospitals — to come forward and help with investigations.

PATIENT AWARENESS

During an interview at his office on January 22, Mr Yumbya said that should no one come forward with a formal complaint, KMPDC’s legal department will act as the complainant.

“I requested the facility to respond and they did that on Friday. Our legal department will present the findings to the committee. The responses will be looked at by the legal team and, if there is a particular person of interest, we will have them fill a complaint form.

“If that does not happen, then our legal team will act as a complainant in the matter because it is a matter of public interest and we would like to make the hospital accountable to the public.”

He did not, however, divulge whether KMPDC would go after the facility for allegedly pushing employees to work harder and increase admissions.

“It is too soon to say and we do not want to give them the upper hand by saying this. Give us about a month to complete everything,” he said.

He said that patients should be aware of their rights as stipulated in the patients’ rights charter, which gives them the option of seeking a second opinion and giving consent before any procedure is done.

“A practitioner must explain to the patients the length of treatment as well as the costs and, while the patient should adhere to medical advice, they can also decline treatment in writing,” he said.

HIPPOCRATIC OATH

He added that doctors are supposed to ensure a patient’s best interest takes precedence no matter the situation.

“With this in mind, it is a doctor’s prerogative to determine whether a patient needs certain procedures or not. The council has handled cases where some patients have complained of not undergoing certain tests, while others complained that too many tests were done,” he said.

He said that while administrators should be worried about being penalised for inappropriate admissions, doctors should also be keen on how they admit patients as their priority should always be ensuring the patient receives quality treatment.

These conversations are at the heart of frustration at many hospitals with the boom in inpatient care in the country.

On January 23, Kenya Association of Private Hospitals chairman Abdi Mohamed told the Nation that the buck stops with the doctor, who admits a patient for profit-making purposes and not clinical-related matters.

“No one has control over the clinical decisions of a doctor — whatever they decide should be put in writing, and when people do anything contrary to what the doctor has said, then they are culpable,” he said.

PUSH FACTORS

While he agrees that doctors are responsible for their patients, Dr Ouma Oluga, the secretary-general of the Kenya Medical Practitioners, Pharmacists and Dentists Union, says that Kenyans should be in a position to tell the difference between doctors who work at a hospital and hospital management who are not doctors, adding that medics are just workers like any other.

“Inasmuch as doctors are professionally mandated and responsible for taking care of patients, they also get instructed by the hospital management that employs them,” he said.

"This is the nonsense that has been advanced in this country for so long. Inasmuch as we take the oath, the accountant and the administrator in a hospital do not, so everyone wants to hide behind the oath of a doctor and manipulate them.”

He added that as much as medics are responsible for taking care of patients, other forces such as insurance and hospital management are pushing them to advance their interest.

“No doctor should be forced to do their work or instructed on how to handle their parents,” he said.

Dr Oluga said that most doctors who work for private hospitals are under pressure; in that they are responsible for the patients, but also within the hospital some processes frustrate them.

“For instance, a doctor would want to admit a patient, but they cannot since the insurance has not approved. Then, there are a lot of patients who want to be admitted by force through the management, yet the doctors are against the admission. This happens a lot in private hospitals,” he said.

PROBE ONGOING

He added: “If the patients insist and involve the management, why would I refuse? I am an employee; I depend on a salary and can be sacked any time. If the admission is not harmful to the patient, I will diligently do it.”

In a phone interview, the national chairman of the Kenya Union of Clinical Officers, Mr Peterson Wachira, said that generally, clinical officers work in outpatient and not inpatient services at hospitals.

“The Health Act, 2017, allows clinical officers to work as per our scope of practice, and we are not unqualified to work in hospitals. However, we mostly work in outpatient except for those who have specialised,” he says.

Mr Wachira said that regarding Nairobi Women’s Hospital, they are still trying to find out if it is true that clinical officers at the hospital have been engaging in unethical practices.

“It is wrong for anyone to exploit people and, when found culpable, I will not make a case for them just because they are my people. The council is carrying out investigations and so are we, and we will work with them on that front,” he said.

When asked whether Nairobi Women’s Hospital should be held accountable if found guilty of setting admission targets arbitrarily, Dr Mohamed, who is also the co-founder of Ladnan Hospital, said that the matter needs further investigations and cannot be judged based on the WhatsApp messages.

MEDIC'S DISCRETION

(In 2017, Ladnan Hospital was bought out by Metropolitan Hospital, which counted the now disgraced Abraaj Group as an investor, and is now under US private equity firm TPG Group).

“We are not certain about what exactly happened from the messages, and so we cannot discuss. In every sector, some people will do something that is not within the confines of the law and so the association tries to ensure that private hospitals adhere to the code of conduct,” he said.

Dr Mohamed did, however, say that it is normal for private hospitals to want to admit patients, unlike public hospitals that often do not have space and hence do not strictly adhere to guidelines on the admission of patients.

“If the private sector were to follow the clinical guidelines on admission, there would be so many other admissions. Sometimes doctors take so many risks by not admitting a patient because of certain circumstances, like maybe the patient cannot afford or the beds are full and they tell you to go home.

If we follow the strict guidelines, like you come with a baby whose temperature is 37 or 38 degrees and the guidelines say we admit you, then we will admit you,” said Dr Mohamed.

PUBLIC VERSUS PRIVATE

Dr Oluga, on the other hand, says that private hospitals are in business and Kenyans should not demand businesses to take care of them but instead ask for better public hospitals.

“The best regulation for private hospitals is working public hospitals so that it is a choice to go to private hospitals because you either want privacy or for cosmetic services and not the basic ones,” Dr Oluga said.

Private hospitals, he said, add no value to the healthcare system and only exist for the simple reason that they fill a gap that the public health system is not able to.

“If the public healthcare system was working, then we would be a better country. We would pay less for the services, have them at the right time and force the private hospitals to behave better and stop making healthcare a business,” Dr Oluga advised.

The Nation tried several times to reach Dr Felix Wanjala, the CEO of Nairobi Women’s Hospital Group, but our calls and text messages went unanswered.