Imprisonments in hospitals in at least 30 other countries, including Nigeria and the Democratic Republic of the Congo, China & Thailand, Lithuania & Bulgaria, & others in Latin America & the Middle East

AP Investigation: Hospital patients held hostage for cash. MARIA CHENG. AP, October 25, 2018. https://apnews.com/daf47512c8f74e869b722782299b4a0e

NAIROBI, Kenya (AP) — The Kenyatta National Hospital is east Africa’s biggest medical institution, home to more than a dozen donor-funded projects with international partners — a “Center of Excellence,” says the U.S. Centers for Disease Control and Prevention.

The hospital’s website proudly proclaims its motto — “We Listen ... We Care” — along with photos of smiling doctors, a vaccination campaign and staffers holding aloft a gold trophy at an awards ceremony.

But there are no pictures of Robert Wanyonyi, shot and paralyzed in a robbery more than a year ago. Kenyatta will not allow him to leave the hospital because he cannot pay his bill of nearly 4 million Kenyan shillings ($39,570). He is trapped in his fourth-floor bed, unable to go to India, where he believes doctors might help him.

At Kenyatta National Hospital and at an astonishing number of other hospitals around the world, if you don’t pay up, you don’t go home.

The hospitals often illegally detain patients long after they should be medically discharged, using armed guards, locked doors and even chains to hold those who have not settled their accounts. Mothers and babies are sometimes separated. Even death does not guarantee release: Kenyan hospitals and morgues are holding hundreds of bodies until families can pay their loved ones’ bills, government officials say.

Dozens of doctors, nurses, health experts, patients and administrators told The Associated Press of imprisonments in hospitals in at least 30 other countries, including Nigeria and the Democratic Republic of the Congo, China and Thailand, Lithuania and Bulgaria, and others in Latin America and the Middle East.

The AP investigation built on a report last year by the British think-tank Chatham House; its experts found more than 60 press reports of patient detention in 14 countries in Asia and sub-Saharan Africa.

“What’s striking about this issue is that the more we look for this, the more we find it,” said Dr. Ashish Jha, director of the Harvard Global Health Institute, who was not involved in the British research. “It’s probably hundreds of thousands if not millions of people that this affects worldwide. It is not something that is only happening in a small number of countries, but the problem is that nobody is looking at this and it is way off the public health radar.”

Some examples:

—In the Philippines, Annalyn Manalo was held at Mount Carmel Diocesan General Hospital in Lucena City for 1½ months starting last December following treatment for heart problems. Administrators refused initially to allow her family to pay in installments — and the cost of each extra day in detention was added to the bill.

“We were treated like criminals,” said Manalo’s husband, Sigfredo. “The security guards would come and check on us all the time.”

—In Congo’s second city of Lubumbashi, the AP visited more than 20 hospitals and clinics and found that all but one routinely detained patients who failed to pay, even though the practice is illegal there.

—In Bangalore, India, Emmanuel Malagi was detained in a private hospital for three months after he was treated for a spinal tumor, according to his brother, Christanand. Prevented from seeing him, his family scrambled unsuccessfully to pay his nearly 1.4 lakh rupees ($19,281) bill — and when he died, the hospital demanded another 10 lakh ($13,771) to release the body.

—In Malaysia, a medical student from the Netherlands on a diving trip got the bends. He couldn’t afford his decompression treatment; the hospital locked him in a room for four days, with no food or drink, until he was able to get the money, according to Saskia Mostert, a Dutch academic who has researched hospital detentions.

—In Bolivia, a government ombudsman reported that 49 patients were detained in hospitals or clinics in the last two years because they couldn’t pay, despite a law that prohibits the practice.

During several August visits to Kenyatta National Hospital, The Associated Press witnessed armed guards in military fatigues standing watch over patients, and saw where detainees slept on bedsheets on the floor in cordoned-off rooms. Guards prevented one worried father from seeing his detained toddler. All despite a court ruling years ago that found the detentions were illegal.

Health experts decry hospital imprisonment as a human rights violation. Yet the United Nations, U.S. and international health agencies, donors and charities all have remained silent while pumping billions of dollars into these countries to support splintered health systems or to fight outbreaks of diseases including AIDS and malaria.

“It’s the dirty underbelly of global health that nobody wants to talk about,” said Sophie Harman, a health academic at Queen Mary University of London.

“People know patients are being held prisoner, but they probably think they have bigger battles in public health to fight, so they just have to let this go.”

[...]

Where patients are imprisoned, hospitals acknowledge it is not necessarily profitable. But many say it often leads at least to partial payment and serves as a deterrent.

Unlike many hospitals in developed countries, African hospitals don’t always provide food, clothing or bedding for patients, so holding onto them does not necessarily incur a significant cost. Detained patients typically rely on relatives to bring them food while those without obliging family members resort to begging for help from staff or other patients.

Dr. Festus Njuguna, a pediatric oncologist at the Moi Teaching and Referral Hospital in Eldoret, about 300 kilometers northwest of Nairobi, said the institution regularly holds children with cancer who have finished their treatment, but whose parents cannot pay. The children are typically left on the wards for weeks and months at a time, long after their treatment has ended.

“It’s not a very good feeling for the doctors and nurses who have treated these patients, to see them kept like this,” Njuguna said.

Still, some officials openly defend the practice.

“We can’t just let people leave if they don’t pay,” said Leedy Nyembo-Mugalu administrator of Congo’s Katuba Reference Hospital. He said holding patients wasn’t an issue of human rights, but simply a way to conduct business: “No one ever comes back to pay their bill a month or two later.”

At many Kenyan hospitals, including Kenyatta, officials armed with rifles patrol the hallways and guard the hospital’s gates. Patients must show hospital guards a discharge form to prove they’re allowed to leave and even visitors must sometimes surrender their identification cards before seeing patients.

[...]

“This is something that hospital authorities have been trying to keep under wraps,” said George Morara, vice chairperson of the country’s national commission on human rights. He said the number of Kenyans imprisoned in hospitals is “disturbingly high” and that the practice is “ubiquitous in public and private hospitals.”

He said patients have been held at Kenyatta for up to two years, and it was reasonable to suspect that hundreds of patients could be detained there at any time.

Kenya’s ministry of health and Kenyatta canceled several scheduled interviews with the AP and declined to respond to repeated requests for comment.

[...]

Although the court instructed the government to produce guidelines on how hospitals should waive fees for patients unable to pay, Opondo said the proposed fixes have not gone far enough. A program that provides free maternity care is only available at a select number of private hospitals and does not include post-delivery care.

Earlier this month, Kenya’s High Court ruled again that imprisoning patients “is not one of the acceptable avenues (for hospitals) to recover debt.” The case involved a man detained at Nairobi Women’s Hospital since June 25; the judge ordered his immediate release despite the outstanding bill. Kenyan politicians also will soon debate a proposed amendment to the country’s health law that will explicitly make patient detentions illegal.

The latest amendment was submitted by MP Jared Okelo, a member of Parliament who described the imprisonment of mothers as “rampant.”

Omuya is still scarred by her detention at Pumwani. She says she developed chronic pneumonia after being held in the damp, cold conditions there and has not been able to work full-time since.

Neither Omuya nor Oliele have been paid the damages awarded to them by the court: Omuya was to receive 1,500,000 shillings ($14,842) from the hospital while Oliele was to receive 500,000 shillings ($4,948).

[...]

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Desmond Tiro in Nairobi and Paola Flores in La Paz, Bolivia contributed to this report.