Cape Town - Thousands of patients with kidney failure are being denied life-saving dialysis treatment every year in the Western Cape due to massive health care funding shortages and rising demand.
And doctors at Tygerberg and Groote Schuur hospitals are often forced to turn away the poorest and sickest sufferers under criteria dictating whom they are allowed to treat.
Fewer than one in 10 patients suffering from kidney failure are receiving the treatment, which is estimated to cost R120 000 each.
More and more sufferers are facing death as the percentage of patients being treated has fallen from 12.5 percent in 2010 to 7.8 percent in the latest figures.
More than 2 000 people are now being turned away each year, with the old, the obese and those with mental disorders, cancer or HIV infections unable to access dialysis.
In addition, patients with access to running water and electricity, effective social support and the means to pay for their own transport had more chance of accessing the life-saving treatment than poor people without these advantages who lived far from the renal units at Tygerberg and Groote Schuur.
According to a circular distributed to medical specialists at the two hospitals, which are the only ones offering dialysis to public health-care patients locally, only 300 people in the province are receiving the treatment, with nearly 60 patients undergoing transplants every year.
This means that about 1 100 people are presently having to seek help in the private sector or are facing death because they are being denied the treatment.
The confidential review of draft guidelines dated September 16, which the Cape Argus has seen, outlines criteria for the one in 14 patients who will receive dialysis which favours better-off and physically fitter candidates.
Doctors forced to adhere to this policy said they were not happy about having to decide who lived and who died in this way.
A doctor, who wished to remain anonymous, said medical practitioners at Tygerberg and Groote Schuur were turning away between five and 10 patients from each facility every week.
“It is heartbreaking for many of us to send these patients away.
“As clinicians we are trained to save lives and not send people home to die. It’s really tough for us, especially when there are alternatives for saving these patients. Many can live for long if they are offered dialysis.”
The policy states that only category 1 patients are guaranteed treatment. A category 1 patient is under the age of 50 with a body mass index of less than 30, HIV negative and Hepatitis B-free.
Category 2 patients may also be eligible for treatment “if resources allow”. These patients may include those with diabetes, high blood pressure and stable ischaemic heart disease. They also include those who are HIV-positive with a CD4count of 200 or more, have been on anti-retrovirals for six months, and have been adhering and responding well to treatment.
Social factors such as access to running water and electricity, good social support, close proximity to a renal unit and the financial means to pay for transport are defined as added advantages when considering treatment for category 2 patients.
If a patient fails to meet any of these criteria and falls within category 3, they stand no chance of receiving dialysis. Category 3 patients often suffered from other conditions like obesity, diabetes, mental disorders, cancer, HIV-infection, had a history of substance abuse, or were over 60.
These patients should only be offered conservative treatment with social support in the form of grants and palliative care, according to the criteria.
The Western Cape’s public sector was only able to treat 30 percent of patients with end-stage kidney disease, according to the Western Cape Renal Registry which was set up last year. Some 70 percent were sent home to die due to lack of resources.
Lack of treatment centres in other provinces also meant that people travelled from their homes to better-equipped provinces like the Western Cape and Gauteng to seek treatment.
Such measures inconvenienced patients and placed extra strain on the better-equipped provinces.
While doctors were often accused by the public of “playing God” when making decisions regarding those receiving dialysis, it was the policy that dictated the terms, the anonymous doctor said.
“Doctors would like to help… these patients, but we are forced by the policy to make these dreadful decisions. It’s really sad sending people away… you always think of a family behind the patient, but we don’t have much choice.”
Mark van der Heever, spokesman for the provincial Health Department, said the circular was part of a routine procedure for re-evaluating policy.
“Once these inputs have been included, it will it be sent to various stakeholders for comment. The review is a lengthy process and is still in the consultation phase… comments are being received.
“Only once the policy has received inputs from all parties will it be finalised, adopted and made(publicly) available,” he said.
Cape Argus