Curbing the detention of patients

On February 15, 2023, a judge in the Civil Division of the High Court of Uganda ruled on a case in which a child was detained in a private hospital in Kampala after the child underwent a lifesaving operation and the father of a child negated on his promise to clear the medical bills. 

The father of the child was to turn around and drag the hospital to court for illegally detaining his child. 

Judge rules 
The judge, in his ruling, noted that the participation of the private sector in the provision of health services was vital in a country where the disease burden remains a serious challenge. 

To the judge a patient who defaults to pay his or her medical bills commits an actionable wrong for which debt recovery is permitted under the laid down procedures.

The judge observed that a wreaked private hospital business negatively impacts on the country’s strained health sector. 

Do not detain patients 
The judge, however, ultimately ruled that hospitals should never detain patients who fail clear their medical bills.

Courts make pronouncements based on the evidence before them. In this particular case court was constrained to make further declarations on whether it is necessary for the government to adopt certain measures that may in future avert this illegal practice of detaining patients in hospitals, particularly in cases of medical emergency treatment.

To the court areas to be addressed include; 

• Uncompensated care in the cases of patients who for one reason or another completely fail to pay for their treatment. 

• The need for the central government to mobilise funds for, and support to, private care health care providers.

• The creation of specific funds to cater for treatment that is traditionally expensive.

• User fee exemption mechanisms.

• Considering health insurance policies.

To court these areas are pertinent in ensuring that private health providers have a smooth working relationship with the state to progressively move towards achieving the Universal Health Coverage and the national objectives on minimal social justice needs.

Survey findings 
A six-week survey was carried out in a maternity ward at the Jason Sendwe Hospital, a provincial hospital in Lubumbashi, in the Democratic Republic of the Congo in 2016 to, among others reasons, establish why patients were detained in the hospital.  

One of the reasons uncovered was the failure of the central government to honor its financial commitments to the hospital.

And this was coupled with extremely weak government structures in which the government progressively disengaged from financing the health care system and shifted the cost of health care to the users.

Further there was no provision of insurance that would distribute the payment burden.

The cases of detention of patients are widespread and there is agreement that the practice of hospital detention exists within and arises from a context of unequal resource distribution, inadequate funding of health care systems, and poor governance. 

Patients who are detained are those who are amongst the poorest in the community especially those whose sickness are complicated and have, therefore, attracted more than the average hospital bills.

In many of these areas where patients are detained the health care landscape is poorly regulated and difficult to navigate.

Remedy 
There are social as well as medical complications associated with the detention of patients detained at health units. To add insult to injury some of the patients charged for non-payment are charged for the additional days they are detained and also incur opportunity costs since they are unable to work when they are detained. They patients, in addition, are at the risk of developing hospital acquired infections. 

In these health care facilities where patients pay for the services, these payments make the largest portion of the health care workers’ salaries. In fact some of the health workers do not receive formal salaries.

In many of these health facilities the health bills are too high for the average patient to afford but in reality the revenue collected by these facilities are too low to support the operating costs and pay the workers.

The so called user fee has been described as the most inequitable method of financing health care services.

Violation of human rights 
One important way to curb the practice of detaining patients is to look at the practice as a violation of human rights and enforce these rights through national legislation and policies and respect international laws and charters that many of these countries are signatories to.

It has even been proposed that the detention of women should be regarded as gender-based violence as women have higher needs of health care because of their reproductive role.

Women also have fewer means to pay for health care making them more likely to be detained for non-payment.

Gender-based violence has been defined as violence that is directed against a woman because she is a woman or that affects women disproportionately and includes acts that inflict physical, mental or sexual harm of suffering, threats of such acts, coercion, and other deprivations of liberty.

In addition, detention especially penalises those women who are most biologically, socially, and financially vulnerable.  

To be continued
Bills are too high for the poor.

Dr Sylvester Onzivua
Medicine, Law & You