Vuyo Mkize
JOHANNESBURG: A woman is losing the use of her left leg while Discovery Health Medical Scheme quibbles over whether to pay for her surgery.
Forty-three days ago, Beverley Smith, 58, started experiencing pain in her lower back while on holiday with her husband, Basil, in Scottburgh. She visited a doctor and was urged to see a specialist as her condition was serious.
Fast forward to July 5. Smith was admitted to the casualty ward at the Life Bedford Gardens Hospital – where she had an MRI of the lumbar spine and an X-ray.
The results of the MRI revealed that a disc had herniated into the spinal column and, among other things, was weakening the nerve to her left leg. Immediate surgery was recommended.
But despite neurosurgeon Dr Percy Miller and an orthopaedic surgeon writing urgent letters of motivation to Discovery saying that Smith – a premium minimum benefits patient – needed urgent surgery, the medical scheme refused to authorise the surgery.
By mid-July, her condition was becoming worse. Smith’s left leg had weakened significantly, resulting in her not being able to walk on it.
In one of several letters her husband wrote to Discovery, pleading that it authorise the surgery, he stated: “My wife is unable to dress herself, she cannot bend down to pull on her stockings, she is in constant agony, she is taking massive amounts of painkillers and anti-inflammatory medication, she has to sit on her right buttock.”
However, the application for authorisation for the surgery was declined and the scheme recommended that Smith have six months of “conservative treatment” (non-surgical treatment such as physiotherapy and medication).
When the Cape Times’s sister newspaper The Star visited Smith, she was bedridden, a white bucket stood beside her bed for when she was overcome with nausea and several boxes of pain tablets she was taking to manage her pain were on the dressing table.
“Anywhere in the world a patient with this condition would have an operation,” Miller said.
“Discovery is an awful… scheme that manipulates doctors and patients.
“It’s nonsense that Beverley should have six months of conservative treatment. Her leg is getting weaker and she could lose the use of it without surgery.
“Discovery turns down patients when it thinks it can get away with it… it has a sort of social discrimination.”
Responding to queries on Friday, Discovery Health chief executive Dr Jonathan Broomberg said cover for spinal surgery was provided according to the benefits of a member’s plan type.
In some instances, these benefits were also subject to clinical guidelines. In the case of spinal surgery, the guidelines applied by the scheme were based on those of the South African Spinal Society.