Patient dies amid payment row

● A payment dispute between Discovery and a private medical technologist took a fatal turn when a patient died of suspected kidney failure.

A 53-year-old woman from Mtubatuba, in northern KwaZulu-Natal, died on June 7, a day after medical technologist Nokwazi Promise Sithole allegedly told Discovery she could not treat its members because the medical aid owed her R20,000.

Discovery withheld money for 14 days after Sithole allegedly cancelled a meeting with its officials to discuss disputed claims. Discovery only had to pay within 30 days.

Discovery Health CEO Jonathan Broomberg told the Sunday Times the medical aid had earlier requested patient records for 135 claims submitted by Sithole’s practice. Of the 34 records provided, “we identified three claims in which there was no record at all of any treatment provided on the date submitted in the claim”.

“The balance of the records we requested have not yet been provided so we cannot validate those claims.”

A day before the patient died, Sithole told Discovery in a recorded conversation: “If these patients die, then it’s your fault. It’s Discovery’s fault. It’s not my fault.

“I’m not going to continue treating patients when you’re not paying me. These patients are dying here and have nowhere to go ’cause there is no nearby clinic.”

The deceased woman had missed three dialysis sessions at that stage. Her son called Discovery to explain her predicament after she missed her second session.

Broomberg said Sithole had a legal obligation to provide emergency treatment. “When dialysis has been missed for several days, a patient quickly becomes critically ill and this is a clear clinical emergency.

“The practitioner was very clear about this. She knew full well that this was not a chronic dialysis session that she was refusing, this was a life-saving dialysis session.”

Medscheme, the second-largest medical aid administrator, had also stopped payment to Sithole due to concerns about some cases. Both administrators said they were obliged to ensure members’ premiums were not wasted on suspected fraudulent providers, but that little action was taken when practitioners were reported to the Health Professions Council of SA (HPCSA).

Medscheme CEO Anthony Pedersen said: “They [the HPCSA] advise that ‘investigating a complaint is a lengthy process’, which raises the question whether a medical scheme is just expected to continue paying until a ruling is passed, even if they know the claims are invalid.”

HPCSA spokesperson Priscilla Sekhonyana said the council “acknowledges that previously its turnaround time for investigating and resolving complaints exceeded 18 months”.

She said the issue was being tackled through a turnaround strategy.

Sithole declined to comment. “Ma’am, as I have said, I have already spoken to another newspaper. The public already has my side of the story,” she said.

The deceased patient’s son did not want to speak, saying his family was still grieving their loss.

If these patients die ... It’s Discovery’s fault ... not my fault Nokwazi Promise Sithole Medical technologist