Hospitals' Unethical Practices: Exploitation and Inhuman Behavior

Involuntary Detention of Patients for Settling Exorbitant Bills
March 30, 2024

Hospitals' Unethical Practices: Exploitation and Inhuman Behavior

Involuntary Detention of Patients for Settling Exorbitant Bills
March 30, 2024

Investigation by: Mohammed Omar – Muneera Ahmed Al-Tayar

Involuntary detention led to the death of the patient Abdullah Al-Masrouhi, as he couldn't bear the weight of being confined due to financial obligations to the hospital until he suffered a stroke while in intensive care. This unethical practice resulted in memory loss and speech impairment, leading eventually to his death two weeks later. Meanwhile, his only daughter bore the burden of paying the costs for the hospital to release his body.

The war has burdened Yemenis at all levels, affecting essential service sectors like healthcare, causing its deterioration, depleting the medical workforce, and prompting specialists to migrate. This exacerbated patients' suffering, squeezing them significantly as their quest for medications often ended in failure, costing them their lives while traveling on roads seeking an appropriate medical care to avoid death.

The daughter of the patient, Al-Masrouhi, from the Abs district in Hajjah governorate, recounts to "Khuyut" how she fell into the hospital's trap when her father suffered from a weak heart muscle: 'My elderly father was exhausted due to a weak heart muscle and experienced sudden dizziness, so I rushed him to a government hospital. However, we couldn't find a bed for him.'"

She then met someone at the hospital who, as she narrated, advised her to go to "Uni Max" Hospital in Sana'a, which would help them in reducing the costs.

She continued, "He was admitted to the hospital, and I informed them of our financial circumstances from the beginning. They agreed and admitted him to the intensive care unit (ICU) on the condition that we transfer him the next day to a government hospital." However, when she tried to transfer him to a government hospital, she was surprised to find out that she had to pay a bill of 150,000 riyals, despite informing the hospital administration in advance about their difficult financial situation. Still, they refused to release her sick father unless she paid the full amount.

Thus, the economic situation, which has not been spared from the war and its repercussions, adds more burdens to Yemenis, making the citizens the weakest link, especially with the interruption of salaries for civil employees. As soon as a patient feels pain, he realizes that he is entering a drain for his finances, as revealed by this investigation conducted by " Khuyut," in hospitals and commercial healthcare sector that disregards any consideration for the current economic situation; their sole concern is the profits they will gain.

This is clearly evident in the exorbitant prices set by hospitals for surgeries (surgical interventions). The cost of a cesarean section ranges from 500 thousand to one million Yemeni riyals, while open-heart surgeries exceed 10 million riyals, varying from one healthcare facility to another.

“It is illegal to sell or possess the pledged collateral; but rather, the sale of the collateral must be conducted through the court by filing a lawsuit that includes the sale of the "pledged asset," in order to settle the debt of the patient or the person who pledged the asset to the medical facility. Accordingly, a court judgment is issued for its sell and then deliver it to the hospital.”

Not only surgeries burden the patient, but also hospital stays and medications that make the patient unable to cope with those prices in the midst of a tragic economic situation.

Under what legal authority are hospitals allowed to detain patients, and according to which law is a patient's freedom restricted because they cannot afford to pay a medication bill?  If this bill were presented to a medical committee, it would determine that 79% of the prescribed medications were unnecessary for the patient. However, instead, patients are turned into customers for the sake of illegitimate profit.

The matter requires immediate settlement, and it is imperative for security authorities to intervene to prevent the unlawful detention of any patient and to protect their freedom. One of the catastrophic consequences of private hospitals' actions is the practice of admitting patients to the intensive care unit for cases that are medically deemed as clinically dead. Thus, the patient's death is announced after days, and the hospital bill reaches millions. Consequently, for the patient's family, it becomes a situation of "death and destruction of homes," as some hospitals detain the deceased body until the bill is paid.

Pressure Tactic

This issue isn't limited to adults only; even children fall victims to hospitals greed, being detained as a lucrative pressure tactic on families until they pay the amounts owed, in exchange for the hospital's fees.

Activist Abdulazim Qahtan, in a Facebook post, shared the tragedy of a child under the age of five who was detained alone for days at Azal Hospital in Sana'a due to his father's inability to pay the treatment costs, as the father's daily income does not exceed 2500 Yemeni riyals. The hospital insisted on calculating each day of delay in paying medical expenses as burdens that were unforeseen. This is because the child was injured in a traffic accident, and the driver who hit him fled immediately after the accident, leaving the father to bear all the costs and sorrow without mercy.

According to the international human rights law, every citizen has the right to access healthcare. However, in Yemen, healthcare is often accessible only to those with financial means and connections. Those who cannot afford treatment costs may face detention. Regarding the stance of the Ministry of Human Rights on this issue, their legal advisor, Hameed Al-Rafeeq, stated: "There is a complaints department at the Ministry of Health. So, if the patient is not treated fairly, he should go to the complaints department at the Presidency Office, and he will receive justice."

Likewise, according to Yemeni law, hospitals are not authorized to detain any patient at all, and such action can only be taken with a judicial order through the court," as stated by legal lawyer Abdulqader Al-Rada’i, who spoke to "Khuyut". This viewpoint is also supported by lawyer Anwar Al-Mashrae, stating that such actions fall under the crime of "restriction of freedom", according to the Law of Crimes and Penalties.

Lawyer Anwar Al-Mashrae further adds to " Khuyut ": It is illegal to sell or possess the pledged collateral; but rather, the sale of the collateral must be conducted through the court by filing a lawsuit that includes the sale of the "pledged asset," in order to settle the debt of the patient or the person who pledged the asset to the medical facility. Accordingly, a court judgment is issued for its sell and then deliver it to the hospital.

On the other hand, the patient or the person who provided the collateral has the right to claim the remaining amount if it exceeds the required amount from them. Similarly, this applies to the hospital as well, as the purpose here is not for profit or trade.

For his part, the Governing Board president at Community pharmacy owner syndicate (CPOS), Mohammed Al-Nuzaily, explains to "Khuyut" that the syndicate is in line with the law that prohibits detention. Health is a human right for everyone, as clarified by the law. It is not permissible to abandon the treatment of a person who has resorted to a healthcare facility, nor is it allowed to detain or restrict their freedom. Al-Nuzaily emphasizes that this is a "crime," while also confirming that the hospital should ensure its rights properly.

To curb the spread of this phenomenon that has become a concern for society, the Governing Board president at Community pharmacy owner syndicate (CPOS) suggests that health authorities should coordinate with the public prosecutor's offices and the hospitals' union to ensure rights and guarantee people's freedom in healthcare.

Exploitation and Plunder

Um Mohammed found herself in a situation where she lost her gold (17 grams) after her husband, Nasser Salim (a pseudonym) from the governorate of Amran (north of Yemen), mortgaged it to the hospital to admit his eight-month-pregnant wife, who had suffered from pregnancy poisoning. The doctors at Zaid Hospital in Sana'a decided to perform an urgent childbirth operation for her at a cost of one million riyals, in addition to the costs of treatments, hospital stay, and the incubator and neonatal care for their daughter. He had to pledge his wife's gold and his own "Jambiya" — a traditional Yemeni dagger worn by men in Yemen — to cover the required amount.

Nasser tells "Khuyut": "As soon as I saw my wife unconscious at home, I rushed her to the hospital like a madman, only thinking about her safety and the baby's. I drove to the nearest hospital to us until I reached the emergency room, and I only had 150,000 Yemeni riyals with me."

The hospital refused to perform the surgery operation for her until the full amount was paid, prompting this citizen, as he stated, to offer his "Jambiya" that he was wearing as collateral, which was not sufficient. He said, "I contacted a relative (my wife's brother) to bring her gold and to come quickly so that the surgery could be performed."

After his wife underwent a cesarean section, Nasser's newborn daughter needed the incubator as she was born in the eighth month. Meanwhile, baby's mother needed hospitalization and staying in the hospital, leading to the accumulation of the bill and the financial costs on him, reaching approximately two million Yemeni riyals, according to his statement.

According to his account, this citizen was forced to sell a piece of land he owned in his rural area to settle the hospital bill and reclaim what he had pledged at this medical facility, which he estimates to be around one million eight hundred thousand riyals, in addition to his wife's gold (jewelry) valued at approximately 900 thousand riyals.

Nasser further elaborates, "I was taken aback by the procrastination and evasiveness when I asked them to return the collaterals. One day they inform me that the accounts manager is traveling and not available, and another day they claim they need management approval, prolonging the process. Then I was shocked to receive a bill from them containing an account statement exceeding 4 million Yemeni riyals, under the pretext of performing another surgical operation for my wife alongside the cesarean section, coupled with late payment charges, until I realized that it was a conspiracy to take the collaterals."

He continues, "A friend advised me to file a complaint and take legal action, but I hesitated. Because I know that I would lose multiples of the amount to reclaim my rights. My wife and I continue to pray for divine justice and that God will avenge on them, as they exploited our fear and panic while we were in need of medical treatment."

In this regard, Luay Al-Az’azi, a human rights activist, believes, in his interview with "Khuyut," that hospitals' stubbornness is a heinous exploitation and an inhumane act. This is exacerbated by the absence of deterrent laws, which has also led this phenomenon to extend to government hospitals. The greed of private hospitals does not allow them to treat patients humanely as a medical institution.

It is considered a disaster when a hospital refuses to admit patients except with a collateral or a financial amount, often resulting in the death of these patients, with no accountability for the hospitals.

Article 55 of the 1990 law guarantees citizens' right to healthcare, a right for all citizens. The state ensures this right by establishing various hospitals and healthcare institutions and expanding them. The law regulates the medical profession and the expansion of free healthcare services, as well as spreading health awareness among citizens.

“The Yemeni Private Hospitals Union confirms that there are no cases of detention, in the legal sense, for any patients in private hospitals contrary to the common beliefs. These hospitals do not have any locations or places to keep the patients in a detained status.”

Regarding the issue of refusal to admit poor cases and detention, Mohammed Al-Kurdi, a criminal research director in one of the police departments in Sanaa, tells "Khuyut" that hospitals in Yemen have become purely commercial enterprises aimed at making money, rather than serving patients, whether they are government or private hospitals.

This is due to the lack of guarantee to cover hospital costs, emphasizing that investments in hospitals and private schools have reinforced the lack of service equality for everyone, as they always look primarily into the citizens' pockets.

Money in Exchange for Death

Amid the tragic circumstances, Um Abdulghani also lost her life after being rushed to Al-Thawra Hospital in the capital, Sanaa, due to some complications. Her son Abdulghani says, "My mother was rushed to Al-Thawra Hospital after Dhuhr prayer, and when we arrived, we couldn't afford the operation costs (1.6 million Yemeni riyals). We managed to gather part of the amount and tried to pay it to the accounts, but they refused and insisted on paying the full amount or putting collateral equal to the amount. After that, we went to a neighbor, and he gave us his car to present it as a collateral to the hospital."

However, that was not sufficient, as another collateral in the form of "gold" was offered alongside the car. He elaborated, "Despite the critical condition of his sick mother, they proceeded with the collateral procedures, making her wait until late at night for the surgical operation, resulting in complications from the stroke, and she passed away as a consequence. The collateral remains with the hospital to this day."

Payment Under Account

Maher Mohammed, a financial accountant at a hospital in the capital Sanaa (the hospital's name is withheld by "Khuyut" ), explains the hospital's procedures regarding treatment costs and emergency cases admission. He tells "Khuyut" that some patients are rushed to the hospital urgently without sufficient amounts of money. Upon the patient's registration and examination, his family members are requested to pay a specific amount based on the diagnosis and the doctor's instructions.

He adds that some patients undergoing surgeries incur treatment costs exceeding one million riyals. In cases where their financial situation is difficult, and there is still time for them to leave the hospital according to the doctor's instructions, they are asked to settle the bill or provide collateral in return.

In addition, there are collaterals for patients, some of which include gold that has been held for over a year without their owners coming to pay the bill. He continues, " Likewise, many citizens who don't have money are sent back, and some of them need medical care urgently. However, we cannot go against the hospital's instructions to pay money first (under the account)."

The Yemeni Private Hospitals Union affirms that it is working to enhance the roles of private hospitals and provide comprehensive medical services. Further, it grants membership to private hospitals that have obtained licenses from the relevant authorities, in accordance with the provisions of the law and the union's bylaws.

The CEO of the Union, Sami Al-Humaidi, stated to "Khuyut" that hospitals provide over 80% of the medical services offered to patients. The private hospitals bear a significant burden of increased operational expenses due to the current situation, including building rents, salaries, occasional fuel crises due to complete power outages, and the doubling of prices for medicines, solutions, and medical supplies.

Despite all these difficulties, challenges, and costs, Al-Humaidi believes that hospitals still accept the collection of debts that have passed long periods. He added that there are medical cases where the treatment costs have reached substantial amounts, and they have received significant discounts and payment facilities, even by providing guarantees or collaterals. Nevertheless, these cases refuse to leave the hospital till now even though they no longer need to stay there, as hospitals remain open due to investors' reluctance to close them despite their significant losses.

Furthermore, according to his statement, private hospitals are committed to fulfilling their legal obligations such as zakat, taxes, and other levies, in addition to providing free and discounted medical grants, therapeutic camps, and free life-saving services in emergency departments.

The Yemeni Private Hospitals Union confirms that there are no cases of detention, in the legal sense, for any patients in private hospitals, contrary to what is often rumored. These hospitals do not have any locations or places to keep the patients in a detained status.

Al-Humaidi explains that some patients and their families exploit such misleading statements contrary to reality to evade paying their dues or to blackmail hospitals for significant discounts unjustifiably and without valid reasons. Moreover, this may even escalate to attempting to obtain financial amounts from those hospitals.

He believes that patients have rights to access medical care, which is countered by rights for hospitals and healthcare facilities to collect the due amounts for the medical services they provide to the patient.

However, there are those who disagree with this, arguing that the investments in the healthcare sector and medical facilities are purely commercial without any commitments to providing adequate medical services. This is confirmed by Dr. Nahla Al-Areeqi, a general medicine consultant, in her interview with "Khuyut," where she points out the evolution of money-making methods, even if through extortionate means. These methods include colluding with the medical staff to implement this investment policy and obliging them to request money for medications and medical examinations (check-ups) conducted on patients.

She further indicates that this proves many of these facilities and hospitals are not concerned about the patient or their circumstances. Therefore, they rely on practicing this mechanism of detaining patients and demanding 'collaterals' to ensure their financial rights and use it as leverage against the patient and their family.

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