No pay, you stay

At Kenyatta National Hospital and at an astonishing number of other hospitals around the world, if you don’t pay up, you don’t go home.

The hospitals often illegally detain patients long after they should be medically discharged, using armed guards, locked doors and even chains to hold those who have not settled their accounts. Mothers and babies are sometimes separated. Even death does not guarantee release: Kenyan hospitals and morgues are holding hundreds of bodies until families can pay their loved ones’ bills, government officials say.

Dozens of doctors, nurses, health experts, patients and administrators told the Associated Press of imprisonments in hospitals in at least 30 other countries, including Nigeria and the Congo, China and Thailand, Lithuania and Bulgaria, and others in Latin America and the Middle East.

The AP investigation built on a report last year by the British thinktank Chatham House; its experts found more than 60 press reports of patient detention in 14 countries in Asia and sub-Saharan Africa.

“What’s striking about this issue is that the more we look for this, the more we find it,” said Dr. Ashish Jha, director of the Harvard Global Health Institute, who was not involved in the British research. “It’s probably hundreds of thousands if not millions of people that this affects worldwide. It is not something that is only happening in a small number of countries, but the problem is that nobody is looking at this and it is way off the public health radar.”

Some examples:

In the Philippines, Annalyn Manalo was held at Mount Carmel Diocesan General Hospital in Lucena City for more than a month starting last December following treatment for heart problems. Administrators refused initially to allow her family to pay in installments — and the cost of each extra day in detention was added to the bill.

“We were treated like criminals,” said Manalo’s husband, Sigfredo. “The security guards would come and check on us all the time.”

In Bangalore, India, Emmanuel Malagi was detained in a private hospital for three months after he was treated for a spinal tumor, according to his brother, Christanand. Prevented from seeing him, his family scrambled unsuccessfully to pay his nearly $20,000 bill — and when he died, the hospital demanded another $13,700 to release the body.

In Malaysia, a medical student from the Netherlands on a diving trip got the bends. He couldn’t afford his decompression treatment; the hospital locked him in a room for four days, with no food or drink, until he was able to get the money, according to Saskia Mostert, a Dutch academic who has researched hospital detentions.

In Bolivia, a government ombudsman reported that 49 patients were detained in hospitals or clinics in the last two years because they couldn’t pay, despite a law that prohibits the practice.

During several August visits to Kenyatta National Hospital, the AP witnessed armed guards in military fatigues standing watch over patients, and saw where detainees slept on bedsheets on the floor in cordoned-off rooms. Guards prevented one worried father from seeing his detained toddler.