It is illegal for hospitals to detain patients over bills

Patrick Obiga was detained at International Hospital Kampala (IHK) for more than a week for failing to pay Shs19.5m. It took the intervention of the media and a civil society organisation Centre for Health, Human Rights and Development (CEHURD) before Obiga could be released.
Should medical facilities detain patients for failing to settle medical bills with their facilities? Deputy Registrar of the Uganda Medical and Dental Practitioners Council (UMDPC), Dr Fred Nyankori, an association that protects society from abuse of medical and dental practices, says its illegal for a given health facility to detain a patient for failure to pay the outstanding medical bills.
Dr Nyankori explains that for a patient to be treated in a given health facility, there is an agreement between the patient and the health facility.

That means if either party breaches the agreement, the aggrieved party can seek legal redress in courts of law.
To that effect, Dr Nyankori says when a patient fails to clear the medical bills, the hospital should not detain him/her since the hospital is not a gazzeted detention centre but can use legal means to recover the outstanding bill.
He adds: “You are the offended party, now you want to turn yourself into the complainant, prosecutor and judge in your own case by detaining a patient in a non-gazzeted detention centre. It is like detaining a dead body for unpaid medical dues. How long will you detain that body? It is appropriate to release the body and then do the follow up later.”

In further exploring this issue, Dr Nyankori points out that majority of these embarrassments arise because patients are not given appropriate information by the hospitals.
He explains that such vital information includes how much their bill could be at the time of discharging them so that they can make an informed decision on whether they can afford such a facility or look for cheaper alternatives.
“Holding a patient goes back to the integrity of the doctor because they would have provided information to the patient and the patient should have made a decision on whether they will be able to pay the medical bills or not and with such information, the patient is able to make a sound decision,” Dr Nyankori says.

When asked what happens in emergency situations when a patient is taken to an expensive hospital in critical condition another medical practitioner, Dr Ivan Kisuule, says in such scenarios, medical officers are mandated to give first aid regardless of whether the patient can afford it or not.
Dr Kisuule, who is also the chairperson, Publicity and Communication Committee of the Medical Council, adds that when the patient gets out of the emergency situation, then the hospital can avail him/her with information regarding the payments and if they cannot afford, then they can be moved. But that is after saving a patient’s life.

Dr Kisuule’s explanation is in line with Article 1 of the Patients’ Charter that states that in a medical emergency, a person is entitled to receive emergency medical care unconditionally in any health facility without having to pay any deposit or fees prior to the medical care.
Speaking on behalf of the Ministry of Health, Dr Martin Ssendyona, a senior medical officer, Quality Assurance Department, says as the line ministry, they don’t intervene in matters that happen in private health facilities unless the affected patient lodges a formal complaint with them.
Dr Ssendyona adds that by the time a patient goes to a certain hospital, he/she should be able to afford their services to avoid being detained for failure to pay bills.
Weighing in on this issue, Makerere University lecturer Prof Ben Twinomugisha, argues that the Patients’ Charter is against detaining of patients by health facilities for failure to clear the hospital bills.

However, Prof Twinomugisha stresses, “The patient has the right to health but the challenge comes in when the health service provider is a private one. Here, the government needs to come in and regulate the private service providers so that patients’ rights are not violated...”
He adds: “when a hospital detains a patient that amounts to unlawful detention or false imprisonment. What we have suggested is that government comes up with a reasonable charge including the private hospitals so that the medical billing is not entirely left to private individuals.”

Section 2 and 3 of the Prevention of Torture Act says detaining a patient over nonpayment of medical bills amounts to torture.
The Constitution which is the supreme law in Uganda under Article 23 states that detaining a person is a violation of their personal liberty and Article 24s and 44 state that detaining someone amounts to inhumane degradation and that it is cruel.
Moses Mulumba, the executive director of CEHURD says, “We have a challenge in our health system, a number of private health providers (more than 60 per cent) are detaining patients,” says Mulumba.

He continues: “But legally, health facilities are not supposed to detain patients over nonpayment of medical bills.
However, many people have forgotten this rule of law and are detaining others at will. I am not saying that people shouldn’t pay the medical bills because they have corresponding responsibility but a hospital is not a detention centre.”
Dr Ian Clarke, the proprietor of IHK in an earlier interview with this newspaper explained that the hospital was getting tough on the issues of nonpayment of outstanding medical bills since the facility had lost a lot of money (estimated in hundreds of millions of shillings) in failed payments of medical bills by some patients.

Patients’ charter provisions

According to the Patients Charter, patients have a right to;
Medical care
Prohibition of discrimination
Participate in decision making
A healthy and safe environment
Proper medical care
Be treated by a named health care provider
Training and research
Safety and security
Receiving visitors
Informed consent
Medical care without consent
Refusal if treatment