Global efforts to end hospital detentions

Detentions of patients in hospitals have been reported in various countries for some time. Hospital detention for no-payment of bills occurs when hospital staffs refuse to release patients after they have been clinically judged to be fit to go home from the hospital. 

Another form of hospital detention is refusal by hospital staff to release the bodies of deceased patients to their families when bills remain unpaid.  

A number of patients have been detained in public and private hospitals world over for non-payment of hospital bills, despite the fact that hospital detentions are violations of fundamental human rights and inconsistent with efforts towards Universal Health Coverage (UHC). 

UHC means that all people should receive needed health services of sufficient quality, without fear that access to these services will expose the user to financial hardship. 

UHC is part of the 2030 Agenda for Sustainable Development which specifically includes provision and utilization of quality health services in line with need, also known as equitable access, as well as financial protection for these services

The detention of patients for non-payment of hospital bills occurs mainly in low and middle income countries, especially in sub-Sarahan African countries although the practice has also been known to occur in a few countries in Asia.

These detentions take place despite legal provisions prohibiting the practice and national commitments to work towards UHC. Hospital detentions also occur in relation to high end treatments such as cancer treatment  

Hospital detentions create situations of significant hardship for the patients, often enduring poor and degrading conditions during their forced stay. There are reports of detained patients being locked in a room or handcuffed to a bed. 

There are also reports of highly abusive and degrading treatment during these detentions, including sexual abuse and psychological harm. It has been reported that women have been pressured to have sex with hospital staff in exchange for cash to pay bills.

Clearly such detentions contravene the right to be free from torture and cruel, inhuman or degrading treatment, which is protected explicitly by several international and regional conventions. 

Detaining patients separates them from their family members and exposes them to the risk of infections in the hospitals.

The fear of detention may prevent patients from seeking and accessing much needed health services and the most affected are the vulnerable.

The practice of hospital detention can deter patients from seeking care if they do not have sufficient means to pay for the treatment. 

Hospital detention for non-payment of bills primarily affects the poorest population groups who have the weakest voice in society. 

International laws, especially laws on fundamental civil and political rights, prohibit the practice of hospitals and other health units detaining patients for non-payment of medical bills. One article is specific on this; everyone has the right to liberty and security of person and no one should be subject to arbitrary arrest and detention.

Another article states that no one shall be imprisoned merely on the ground of inability to fulfill a contractual obligation. This provision prohibits the deprivation of personal liberty for failure to pay a debt, either by a creditor or by the State.

The World Health Constitution states that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, and political belief, economic or social condition. 

The right to health has also been affirmed as a human right and is relevant to all countries; every State or government has ratified at least one international human rights treaty recognizing the right to health.

And many of these countries have committed themselves to protecting the right to health through international declarations, domestic legislation and national policies.

Hospital detentions violate the right to health as it compromises the patient’s autonomy and their entitlement to equal opportunity in accessing health care. 

The detentions themselves are discriminatory and violate the principle of equity. Payment for health-care services, as well as services related to the underlying determinants of health have to be based on the principle of equity, ensuring that these services, whether privately or publically provided, are affordable for all, including socially disadvantaged groups.

Countries that are signatories to international laws and conventions are required to take the necessary steps to adopt such laws or other measures as may be right to give effect to the rights recognized and protected by what they have committed themselves to.

These countries and States are required to take steps, individually and through international assistance and cooperation, to achieve progressively the full realization of the rights recognized in these conventions by all appropriate means, including particularly the adoption of legislative means.

Some countries have, as a result, recognized the right to health in their national constitutions. And some have even passed laws or issued government directives to expressly prohibit the practice of hospital detentions.

Philippines passed the Hospital Detention Law in 2007 and the law specifically declares that the act of detaining patients in hospitals is illegal.  

The law introduced sanctions, in the form of fines and/or imprisonments, for non-compliance with this provision of the law. 

To be continued
Bills are too high for the poor.

Dr Sylvester Onzivua
Medicine,  Law & You