Private Medical Healthcare - "It would seem big businesses like to bully patients" By VM Chandran

An ailing 65 year man suffering from cancer was given the opportunity by a well meaningful philanthropist to finance his cancer treatment by a renowned Oncologist at one of the best managed private hospitals in the country.

Initial treatment was 4 cycles of chemotherapy with Immunotherapy. The drug used for Immunotherapy was "Keytruda". The precondition of using "Keytruda" is that a particular protein from the biopsy results must be greater than 50%.

He commenced treatment for both chemotherapy and Immunotherapy in October 2018. After completion of 4 cycles of chemotherapy, a PET scan revealed the disease was still at status quo. 

At this point, other than  paying for the chemotherapy treatment, the Keytruda used for Immunotherapy was a standard vial of 100 mls being charged at around RM 12,303. This was for every 3 weeks. In late December 2018, apparently the manufacturers of Keytruda made an offer that for every 2 vials the cost shall be around RM 18,765 ie a discount of just short of RM 6000.There was a precondition that the RM 18,765 must be paid upfront. The offer was accepted as it was a significant saving.

With another additional 4 months on Immunotherapy (total 7 months completed), in April 2019, upon the patient's insistence, another PET scan was undertaken. The purpose was to check if the Immunotherapy as a stand alone treatment was effective.

The result was shocking as the cancer had new lesions in the primary area and in the liver. This was a clear indication that the Keytruda treatment had not been working.

It was agreed with the Oncologist to do another biospy, but this time it was to be extracted from the new metastasis in the liver. This whole matter and the Laboratory tests related to this seems to be another story worth writing about but, for the moment, the delayed Laboratory results ie after 3 weeks, showed the protein level needed for Keytuda treatment was now reflected as  nil. This was a major variance ie. prior to starting Immunotherapy, it had stood at more than 50%. No suitable explanation was given and the peculiarity was that the 2nd biospy team may not have been informed of the 1st biospy results. So nothing further took place. The issue found its natural demise.

The impression given is that Medical Science had baffled everyone. Interestingly enough after paying nearly RM 200,000 the patient was worse off,  Also, the recommended treatment mode to follow thereafter did not seem to address the core issue ie which were the target cells. 

In all this the patient had not only suffered financially but also the agonising delays in various processes due to miscommunication within the Hospital and Doctors. There was one thing for sure and this was what I refer to as the "one way flow" that is the Hospital and Doctors were just quite happy to bill him like a "business" without an understanding of the predicament of the whole episode. He was just another patient with the notion that such things could happen and sometimes cannot be explained.

The ultimate test was when the patient asked for the refund  for the remaining one vial of Keytruda that was not used. The stories that were told is of a shocking nature including that the drug is specific for the patient and cannot be used by others and so forth. When such matters did not hold argument, it finally was stated that the manufacturer is the one who refuses to refund the said amount of around RM 6372,  the concept being "buy one get one free". This in itself is a fallacy. If held to be truthful then the chargeable vial should be the original charge ie RM 12,303 and not an overcharge amount of RM 18,765. Strange happenings!!!!!

The bottom line in this case is that the Oncologist stopped the Immunotherapy treatment because it had not worked,  reasons still unknown, while the Hospital and Manufacturer hold one vial and keep the extra of RM 6372. It seems the defination of  fairness even in business has loss its meaning!!!! Especially as the patient did not refuse the treatment but was told not to continue.

Ironically, the patient is the ultimate loser ie. his money and his life, while the rest seem to benefit out of such an episode. A strange business model?

Now the question is where is there a platform for this patient to voice his predicament? He cannot take it up with the manufacturer because his dealing is only with the Hospital. The Hospital hears him and smilingly nod as though they were sympathetic to his case. Yet!!!! Nothing happens.

This is  another example which begs for the creation of an independent Tribunal to hear such grievances. To many such issues are swept under the carpet and are not permitted to surface. It is important that the Ministry of Health must take cognizance of such things and move urgently to set it up.

Similarly too the idea of a  Directorate to monitor Private Hospitals. The list  for complaints is inexhaustible and it is timely that the enforcement through this independent self-financing Directorate becomes a realty. It seems  that the Hospitals' self-regulation process is questionable when you look at their charges and level of services including transparency. It is the patients who face the brunt of all these. It is fundamental that such matters be enforced properly by the Authorities. 

Currently, there is this huge "gap" that permits such things to take place. It becomes essential that the deterrent measure of a proper infrastructure like the self-financing Directorate be put in place to regulate such matters  efficiently and properly.

The Minister of Health has a great opportunity to do something and I hope he does not "miss" this moment. The framework put togather for the Tribunal and Monitoring Directorate would be a clear affirmation of  the Government being aware of the people's pulse rate. This is a fundamental ingredient in the "People and Government" relationship. 

It is you, YB Minister, who needs to provide the nod!!!

V  M Chandran

June 2019.