‘Sentenced to horrific death’
Family slams medical aid for refusing to cover life-saving op
WHEN Anton van der Westhuizen signed up for medical aid on January 1, he thought he was covered.
Yes, it came with strings attached: a general three-month waiting period, as he had not been on medical aid since 2003, and another year-long waiting period for heart disease. The 51year-old had had a triple bypass in 1998, but he had gone 15 years without complications.
Then, in March, he felt two lumps in his stomach.
“I thought it was a hernia or something, so I left it,” he said. “And then, within days, my stomach just started bloating and bloating.”
Van der Westhuizen of Johannesburg was diagnosed with gross ascites, a build-up of fluid in his abdomen. But what was causing it, the doctors couldn’t tell. X-rays themselves were blocked by the fluid.
His doctor recommended a LeVeen shunt, a procedure which involves inserting a small plastic pipe into his body to drain the excess fluid, before doctors could determine what caused the ascites.
On April 3, he checked into the Vereeniging Mediclinic.
Two days later, he was asked to leave.
His medical aid, Resolution Health, would not cover his stay. His condition was related to his pre-existing heart condition, they said. Instead, they referred him to their own choice of specialist.
He confirmed the original diagnosis: gross ascites. Van der Westhuizen’s liver was hard and enlarged, and he showed signs of wasting due to an underlying liver disease.
“He has right cardiac failure, but the global picture is that of heart and liver failure combined,” said the specialist.
“The LeVeen Shunt should in my opinion be allowed… the state cardiologists should get involved.”
That night, Van der Westhuizen received a phone call from Resolution Health.
“They refused totally to cover the procedure. They said it’s because my condition had to do with my heart,” he said.
In a statement to the Daily News’ sister paper, The Star, the medical scheme said: “The specialist confirmed a diagnosis which included the 12month exclusionary condition and other organ involvement that was not declared by the member at the time of applying for membership.
“Given that the patient requires prompt medical attention, his cardiologist has referred him to a state facility for treatment, which he is urged to seek.”
Having lost two sisters in state hospitals, Van der Westhuizen is reluctant.
His family are rallying for support, adamant that the specialist’s diagnosis did not solely blame Van der Westhuizen’s heart condition for his ascites.
In a complaint to the Council for Medical Schemes, his brother, Chris, said: “It is very unfortunate that (Anton) is now suffering from combined heart and liver failure – however, very fortunate for Resolution Health, enabling them to use the cardiac failure as reason for refusal for treatment… they effectively sentenced my brother to a horrific, gruesome death.”
But Resolution Health says while it is “committed to meeting its obligations to each and every member and endeavours to ensure that every one of its members receives the finest treatment possible within their respective medical aid plan”, it had a duty to ensure funds were used correctly for the benefit of all its members.
Meanwhile, Van der Westhuizen’s condition continues to deteriorate. With the pressure on his lungs, he can’t sleep at night.
Walking even 100m is difficult and causes coughing and wheezing. Painful shingles have broken out across his body. His doctor says his kid- neys have started failing. If the cavity bursts, he will die.
“It’s terrible. I feel like I’m dying every day,” Van der Westhuizen said.