File picture. Picture: Independent Media

RIGHT OF REPLY: We are profoundly saddened by the very unfortunate death of a member of one of our medical schemes after she was refused critically needed dialysis treatment by a medical technologist two weeks ago. We feel deep sympathy for this family and are providing them with assistance to the fullest extent.

It is absolutely clear that in refusing to treat this severely-ill patient, this medical technologist’s conduct was illegal and unethical.

Section 27(3) of the SA Constitution and Section 5 of the National Health Act stipulates that no one may be refused emergency medical treatment. This practitioner had an absolute legal and ethical obligation to treat this patient, and had no right to refuse treatment regardless of the patient’s ability to pay, or the payment arrangements between the patient’s medical scheme and the practice.

We will be reporting this conduct to the Health Professions Council (HPCSA) immediately, and are taking legal advice regarding possible criminal charges and civil action against this medical technologist. We will also assist the family in taking legal action should they wish to pursue it. We are also taking urgent action to ensure the safety of our other members being treated at this centre, to ensure they receive safe and high-quality treatment from an alternative practice.

The facts of this matter are:

An investigation into this medical technologist’s practice in April 2019 confirmed a number of serious concerns in respect of both patient safety and fraud claims. We found clear evidence staff with no experience were providing dialysis treatment, without direct supervision of a qualified practitioner. We also found evidence of false claims, and were not able to verify the validity of a further 779 claims.

Discovery Health has a legal and ethical obligation to ensure the safety of all members, and to address all fraud and abuse of members’ funds. We cannot continue paying claims to a practice that may be endangering patient safety and committing fraud.

For these reasons, we informed the practice on May 24 that we were suspending payment for prior claims, pending resolution of these issues.

We then arranged a meeting with the medical technologist for May 30, 2019, hoping to resolve the issues. However, the medical technologist cancelled the meeting. We have since learned other medical schemes had identified similar concerns and already suspended payment to this practice.

On June 6, we were informed by the family that our severely-ill member was being refused dialysis treatment because payments to the practice had been suspended. We spoke with the medical technologist within an hour of learning this. However, she continued to refuse to treat our member, indicating she was aware that “patients were dying”, but threatened she would not treat the patient until funds owing to her practice were released.

At the time this medical technologist refused to treat this severely-ill patient, payments had been suspended for only 14 days, well short of the 30 days within which a medical scheme must pay a valid claim. The fact that payment of past claims had been suspended for 14 days in no way prevented this medical technologist from providing the critically needed dialysis.

Rather than attempting to blackmail the medical scheme while risking the life of a very ill patient, she should have provided treatment immediately, and then engaged with us to address our serious and valid concerns.

The extent of corruption and fraud in the medical schemes environment is extensive, accounting for up to R28billion of members’ funds fraudulently claimed each year, and we will continue to root out corruption.

Our conduct in this matter, as in all of our fraud investigations, is entirely in line with all applicable legislation, and adheres to the very strictest standards of fairness and transparency.

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