As patients default in settling bills, hospitals hold on to them
In many government hospitals in Lagos, the preferred method is to treat emergency and critical cases and then hold on to the patients until they pay up.
Can’t go home after delivery
It is a past she wants to forget. In April 2017, Risikat (original identity withheld on request) had high hopes of becoming a mother. It was her first and she was expectedly excited. Then the unexpected happened. The baby decided to come earlier than scheduled. She was rushed to Lagos State government-run Ifako/Ijaye General Hospital for an emergency Caesarean Section (CS). Though her life was saved, the premature baby was lost. Risikat delivered her baby prematurely in April, but lost the baby in May in the course of blood transfusion.
While battling with the trauma of losing the baby, the hospital management came with a bill that got her spinning. For more than six weeks, Risikat, family and relations could not raise enough money to pay the bill. For the duration, she was held in the hospital’s special facility for defaulting patients. Risikat, who should have been discharged in May, was in the hospital till the first week of June when her family was eventually able to pay the bill. For her, nothing in her entire life compares to that experience.
While Risikat was undergoing her experience, she witnessed another drama she said was like a movie to her.
Another debtor-patient, a male, decided to play smart by stealing away from the facility. Posing as if strolling. Risikat said that the man who appeared to have been abandoned by family and other relations due to the huge hospital bill, suddenly bolted towards the entrance of the hospital and almost made it out before he was caught by nurses and security men he tried to outwit.
More bizarre tales
The two stories above are not isolated cases in many government-owned hospitals in the state. Patients of private hospitals are also testifying that the “craze” for revenue generation, for which government hospitals are known, is also afflicting their counterparts in private practice. Checks revealed that the senior medical personnel in state hospitals are the main promoters of the private hospitals, although they reportedly operate behind the scene.
Saturday Tribune’s discreet findings, however, unearthed happenings in many hospitals around the state that challenge the reported reforms in the sector. Many insiders were also willing to talk about the things going on in their respective hospitals but the fear of losing their jobs made them to volunteer information only anonymously.
From hospital with tears
Risikat added that there were many other patients who suffered the same fate as her, particularly women who just put to bed through Caesarean Section but could not pay are confined to the hospital premises with their babies.
This group of patients is equally closely monitored by the nurses, at least one of whom is assigned to follow a given patient everywhere, even to the toilet to prevent any escape from the hospital. Nevertheless, some debtor-patients cleverly escape sometimes. However, those caught in the act are subjected to other harsh treatments.
Another patient, Yemisi (not real name), who witnessed the case when she was at the Ifako/Ijaiye hospital to give birth, revealed that at a point, “detained” patients who were mostly delivered through Caesarean Section became so many that there was no space to accommodate incoming pregnant patients. At that juncture, the then-CMD had to slash the bills to enable them pay and vacate their bed spaces for new patients but not before some had been confined to the hospital for weeks or months.
From investigations, another state-run hospital in Igando is also involved in the practice. Many respondents described the hospital as a no-go area for their family members because of the stories coming from there.
It is the same story at the Lagos State University Teaching Hospital (LASUTH) as patients who cannot readily pay their bills are not allowed to leave. This is very common at the Emergency Ward of the hospital.
However, at LASUTH, findings showed, such debtor-patients are allowed to still occupy their bed spaces until they are able to pay but the arrangement is reversed whenever there are fresh emergency cases.
The situation is not much different at the Federal Government-owned Lagos University Teaching Hospital (LUTH) where debtor-patients are not allowed to go home also.
‘Why we hold on to patients’
Between emergencies and deposits
In May 2017, a building under construction collapsed at 2/4, Richard Abimbola Street, Ilasamaja, Isolo. Four out of the 18 labourers working at the site died on the day of the incident. Twin brothers from the Republic of Benin had a mixed fortune. While Kehinde Olaniyi survived the crash, his brother, Taye, did not. It was a distraught Kehinde who told Saturday Tribune a story of how his injured colleagues were refused treatment at Isolo General Hospital over inability to make advance payments for their treatment.
“We were 18 labourers working on the site. Majority of us were plastering the outer part of the building, while others were inside when the building came down. I was part of those plastering the outer part, while Taiye and three others who died were inside when the building came down. Out of the 18 working during the collapse, two, including myself, escaped unhurt. Four, including my twin brother, died while the rest sustained varying serious injuries.
“When the incident happened, those taken to hospital were rejected as we were asked to bring money for treatment which we didn’t have. We had to take them to Benin Republic (the morning after the accident). We raised money among ourselves and got a bus to take them home.
“During the plastering of the building, Lagos State Town Planning came to the site and said the structure was too big for the land and asked us to stop work, which we did. I don’t know what transpired between the engineer and the officials but we were told to continue work after they left,” Kehinde said.
When asked if anything exchanged hands between the engineer and the Town Planning officials, Kehinde said he was not aware. “I don’t know if he gave them anything or not but I know they came, complained about the structure being too big for the land and asked us to stop but after they left, we were asked to continue. That was when the building was at three-storey level and it was after they left we added another, which I believe was the reason the building collapsed,” he added.
Kehinde pleaded with the government to release the body of his twin brother and those of the others who died in the collapsed building for burial.
“The engineer ran away and we can’t seem to get hold of him since the incident happened. We want government to release our brothers’ bodies to us so we can go and bury them. I have lost my twin brother. I don’t even know what to do again. He is married with three children. I don’t even know where to start, as everything is now on my neck,” he pleaded.
It is not true —Hospital source
Our reporter confronted an official of the hospital with Kehinde’s story. The story was denied by the lady who wanted her identity protected. “This is wrong. We treated and helped all those who were brought here from the collapsed building. All those claims that we demanded money from them are nothing but lies. We never did and will never act in such a way. Moreover, it is against the ethics of our profession,” she said.
A doctor to whom Saturday Tribune was directed for further reaction said he was part of those who handled the emergency. He corroborated his colleague’s claim that professionalism was put before money.
“Concerning what you just told me, anyone saying that is being economical with the truth. Even the TB Joshua building collapse that had a lot of casualties, we accepted all of them and treated them even without asking for any identity. Anyone whose case is beyond our power, we transfer to Ikeja General Hospital.
“So, for them to say we rejected them because they are from Benin Republic is wrong and unacceptable. It is very wrong for someone to say that and I am saddened by it, as I partook in the treatment of those that were brought here,” the doctor said.
Private hospitals’ malaise
Although private hospitals are profit-oriented, the extent they go in the name of recouping investment can still be shocking.
A mother of twins who did not want to be named recalled her trauma in a private hospital after she could not pay upfront her medical bills.
“I put to bed in a private hospital in Ketu sometime in 2012. The doctor had earlier told me that it would be a natural birth. Along the way, during labour, I developed complications and I was quickly rushed to the theatre after my husband was made to sign the consent forms.
“After the Caesarean Section, which was successful, my twin babies and I were moved to the maternity ward. After a few days, the stitches became so uncomfortable. I called the doctor and asked when the stitches would be removed. He told me that normally, the stitches would be removed after seven days. After the seven days, I called him again that the stitches were quite uncomfortable. It was then that he politely told me that they would not remove the stitches until my husband paid the N150,000 balance of the bill.
“Those extra five days I spent in the hospital trying to raise the money were really a trying period for me. It was so bad that I could not sit up. All the nurses were just doing was clean the area while encouraging me to tell my husband to be quick with the payment. The stitches were finally removed after we paid the money in full. What I went through medically and psychologically are better forgotten,” she said.
At a private hospital located at New Garage in the Gbagada area of the state, a novel policy takes care of debtor-patients.
Saturday Tribune observed that the management of the hospital, which has two sections for general and private VIP wards, always locks the exit doors except one for everyone present at any given period to use.
The general section has four exit doors at the ground floor but the three other doors with the tag “Emergency exit only” written on them are locked. All visitors, patients, workers and their relatives who, on a busy day, could number well over 500 are now restrained to the only exit door.
Saturday Tribune was told by a couple of hospital staff that the closure of the doors was to allow for easy monitoring of patients so that they would not run away and dodge paying the balance of their bills.
At the hospital, regardless of any kind of emergency, it is a standing rule that deposits must be made before any form of treatment can commence. Patients are not finding being “quarantine” funny but they appear helpless as regards whose help should be sought.
Chairman, Nigeria Medical Association (NMA), Lagos State branch, Dr Olumuyiwa Odusote, in his reaction, advocated a middle-of-the-road approach to the vexatious issue.
“There is code of medical ethics to the effect that there should be emergency service at least for the first 24 hours, because the priority is to save human lives. But when it goes beyond 24 hours, the patient will be required to pay for the service rendered because you should realise that the materials to use are consumables that should be replaced so that more lives would be saved, because if that is not done, it is the same people that would start referring to such hospitals as mortuary.
“It is not detention per se but means of working out the modalities for payment because the cost for treatment must be settled somehow, so that more lives could be saved. In the United States of America, there is a payment system that will not require the patient staying back in the hospital, because there is a national database. So, when you are treated and a bill is issued to you, there is a system through which the patient gets to pay the bill, either by deduction or other means. But there is no such system in Nigeria, so certain methods of getting bills paid would have to be worked out. But just like I said, the guiding principle is to save lives and used consumables must be replaced for more emergency situations to be saved. In the Igando hospital that you mentioned, they even do emergency surgery without payment, but the patients must just find ways of paying,” Dr Odusote said.
We will commence investigation
—Federal Ministry of Health
However, the Federal Ministry of Health, reacting to the situation at the Lagos University Teaching Hospital (LUTH), Idi Araba, through the head of Public Relations, Mrs Boade Akinola, said the ministry would commence investigation of the situation as soon as possible. She stated that the ministry would make the matter public once it had legitimate cause of action.
LUTH
When contacted, the Chief Medical Director, Lagos University Teaching Hospital, Idi-Araba, Professor Bode Chris, said he was in a meeting and being asked to comment on the sensitive issue just like that would amount to an ambush. He gave a Monday next week appointment to Saturday Tribune.
Lagos State Ministry of Health keeps mum
The state Ministry of Health refused to comment on the issues despite definite cases made known to it with dates. The Public Relations Officer, Mrs Adeola Salako, who earlier promised to come up with the ministry’s position, did not pick subsequent calls put through to her phone lines from Saturday Tribune.
LASUTH
When the Public Relations department of Lagos State University Teaching Hospital (LASUTH) was reached, two principal staff in charge said only the CMD could give the go-ahead to engage the media critically on the matter, considering the numerous layers involved in bill processing and payment in the hospital. A not-too-distant future appointment was assured.
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