Private Medical care - "Kept waiting for procedure and results with questionable billings" - By VM Chandran.

I have the privilege of assisting a philanthropic  businessman who is currently helping a patient who has cancer. The latter was initially treated with a mix of chemotherapy and Immuno-therapy and then subsequently solely on Immuno-therapy for the last 4 months.

The treatment seems not to have  been effective despite the expense of almost RM200,000. The latest PET scan results seem to indicate new lesions in the primary area and also secondaries in the liver.  

Clinically the patient looks good and it is  difficult to believe that the cancer has metastasised. An Intervention was requested to take a new biopsy of the liver for pathological analysis. In the process, an Immuno-histochemistry (IHC) test was undertaken.

The above-mentioned scenario took place at a private hospital that I personally regard to be one of the best in the country. The way the building is structured and the interconnectivity of the various blocks right from the drop-off point or car park, and the location of  the specialised units with its services, inclusive of the pathways for flow of people, seems to reflect a well-designed and purpose-built hospital. 

Indeed as one walks towards the reception, the welcoming porters are ever-ready to help. They are part of a unique "Porter Service" team that move around  with the patients and their respective files in aiding and abetting the medical diagnostic work. The Nurses are perpetually busy like "working ants" always on the move. 

Indeed this Hospital has so much  "space" that it is not "cramped" in nature  with ample food and beverage outlets of a good quality. It is also superbly clean with cleaners constantly at work keeping it looking spick and span.

The Management of this Hospital deserve praise, as they seem to be committed to high quality standards. 

My comments of the standards of this Hospital are not based on a one-off visit. A member of my family has frequently utilised numerous aspects of this Hospital services,  and i have always been the accompanying party. Hence the compliments.

Notwithstanding the high standard this Hospital strives for,  there are certain matters that the Hospital Management must be made aware of. In a hierarchical system of Management,  at times some matters may not reach the top management unless it becomes a public issue. This does not mean that the matter is not resolved at the appropriate level but rather  it gets "buried". Hence it is not used as a basis of  information to alert others to be aware so that there is no repetition of the same problem.

It was totally shocking and disheartening when one was billed for a procedure that did not take place. More disheartening where there are numerous  Consultant charges on a procedure performed by the same Doctor within a spell of 2 hours at the same place. Charges were for initial assessment, then for administering a local anaesthetic (LA), followed by the procedure itself and finally post procedure.

Perhaps this was done within the MMC guidelines,  but is it "morally" right?  Money-making seems to be  fashionable and so perhaps the Doctors' Hippocratic oath must be changed to accommodate this! 

This issue is being raised as part and parcel of a series of events that has created anger and frustration. The patient I speak of was given an appointment for a procedure for 8 am on 4th May and we can confirm such an  arrangement, as we were witness to the conversation between the primary "originating" Doctor and the "procedure" Doctor. 

Yet on the procedure day the Department denied knowledge of such an appointment as the Doctor was not in. The patient, who had been fasting overnight, had to make his case for the Doctor to come in. Finally it was done at 11.30 am ie 3 1/2 hours later. It was an unnecessary wastage of time for a 65-year old patient who had been fasting and who had to leave his home at 6.30 am to be on time for the procedure. How do es one measure the patient's suffering????

This leads me to another interesting development. The patient's request for the use of another Pathologist outside the Hospital was completely ignored. So the various laboratory  tests were done in-house. 

One may choose to overlook this aspect but on the "purported appointment" date of 15th May (11 days later) to discuss the results,  only the liver biopsy report was available. The Immuno-histochemistry report (IHC) was not ready and the reason given was that the laboratory received the sample late. 

The storyline becomes even more interesting as the "defence" that was offered was that the patient was not listed on the official appointment list on what i earlier referred to as the "purported" date. This is like attempting a "technical knockout" punch. Unfortunately, it did not work as  the "defence" was caught out when the appointment card and the Blood test form was produced as proof  that an appointment was formally granted. This was a very sad episode culminating with unwarranted defence of a situation that could have been  easily avoided.

Yet there was no concen for the patient, who, once again, had to leave his house at 6.30 am for a totally wasted trip of nearly 3 hours at the Doctor's. How does one measure his suffering?

This is not a perfect world and  mistakes will be made. To create storylines at various service areas is trying to defend the indefensible. When the truth is known it gives a distinct view that this is the "modus operandi" prevailing in the hospital. Sadly, this distorts the reputed image of a good hospital. 

Now i cannot end this article without indulging on the issue of hospital charges levied on this patient. Some of these are:

1. The Hospital not only charged around RM 1,464 for IHC test but on top of it there is another RM 600 for the report. Obviously a very expensive Report, wonder if it is prepared with "special" ink.

2. The 1st time the patient did the PET scan the charge was around RM 3,680. The 2nd time, about 4 months later the charge was RM 2,630. It would seem there is great flexibility on the charges without a change of scope. 

Maybe after a few  more PET scans, the charges could be FOC!!!! Who knows????

3. The chemotherapy and Immuno-therapy treatment was done on a day-care basis.

The patient first saw the Specialist with the blood test result before the treatment proper commenced. For this, the patient paid a Consultation fee. 

Thereafter the treatment began. which is about 3 to 4 hours  but does not meet the Specialist. Yet there was a significant Specialist Procedure fee charged for every session!

Again it seems strange as patient's procedure for treatment  was not handled by the Specialist in any of the sessions at the day care.

That aspect is baffling us.

4. The cancer treatment itself is a costly affair. Originally, the patient was on a 4 cycle of chemotherapy together with Immuno-therapy on keytruda. When the treatment started in Oct 2018, the charges per session for a 100 ml vial of Keytruda was RM 12,303. Then in the beginning of December 2018 a package offer was made that for every 2 sessions of keytruda treatment the charge would be RM 18,765 with the condition precedent that the full payment shall be made at the 1st session itself. 

Interestingly at the 1st session of the package deal a further discount of RM 938 was provided but did not continue thereafter.

The most peculiar aspect was that when the Specialist stopped the package keytruda treatment, the full payment had been made for both sessions but the 2nd one remained unused. A refund was requested for that portion and it was denied on the following grounds:

a. The manufacturer disagrees to do so.

b. The keytruda is specially constituted for the concerned patient and cannot be used on others.

A check of point (b) shows a difference of opinion provided by people who handle such  vials in other places.

I state strange because it was not the patient who did not want the treatment. Rather it was the Doctor who did so and the patient is to be "punished".

I am not raising these issues to embrass anyone or the hospital  but rather to draw attention of the anomalies and the suffering people go through when such things happen. Big businesses solely safeguard their own interests leaving patients in the lurch. This patient's time was wasted and he had to suffer delays that could have been avoided. His pain and suffering had to be individually borne. As for the hospital and specialist, it was yet another day and they walk away with payment despite putting the patient through stress. 

My call for an Independent Commission to monitor Private Hospitals is becoming an imminent requirement. Together with this,  a Tribunal for aggrieved patients to channel their grievances is so essential as a "check and balance" to the abuses that are taking.place in Private Hospital medical care.

The Government of Malaysia (GOM), especially the Ministry of Health must not hesitate to implement both the ideas if it wants Private Medical costs to be at sustainable levels. A deterrent system must be put in place to monitor and ensure such abuse are stories of the past. 

V M Chandran.