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Hospital, medical aid denies man lifesaving dialysis

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The couple have been in and out of both state and private facilities trying to get him access to kidney treatment.

IN A FIX: Jerome Roberts needs dialysis, but is being refused treatment by his medical aid and Groote Schuur Hospital. Picture: Cindy Waxa/African News Agency(ANA)

Cape Town – A Mitchells Plain woman said she feared losing her ailing husband after he was denied kidney dialysis treatment by both her medical aid and a state health facility.

Blanche Roberts, 37, and Jerome Roberts, 44, from Portlands have been in and out of both state and private facilities trying to get him access to kidney treatment.

Jerome was diagnosed with polycystic kidney disease, an inherited disorder causing cysts in the kidneys, in 2014. He was treated at Melomed Hospital in Mitchells Plain where he was given a six months’ prescription.

After that he had no other health issues until May 1, when he started feeling lame in his legs. Tests by a private physician indicated he needed urgent dialysis.

“The doctor called and told me I needed to take my husband to the intensive care unit at Melomed, where I would be met by a kidney specialist. He told us my husband needed urgent dialysis,” said Blanche.

Jerome and Blanche are on a Discovery LA Health plan where she pays R1 400 and is subsidised the rest of the amount by her employer. She got back on the medical aid in January after taking a one year gap.

“The receptionist informed me the medical aid was refusing to pay. She asked if I had a R50 000 upfront payment which would be returned if the medical aid changed its mind. I didn’t have it,” she said.

Jerome was transferred to Groote Schuur Hospital where he was given one session of dialysis and a month’s supply of medication. Doctors at the hospital said they would not continue giving him dialysis as he had defaulted on treatment before.

“Jerome never defaulted on medication. He was told to return if he felt ill. He never felt ill again, as the six months prescription they gave him helped,” said Blanche.

Western Cape Health spokesperson Mark van der Heever said the department could not dialyse every patient and therefore had developed criteria to determine those patients who would qualify for renal dialysis.

“One of these criteria is that the patient should qualify for renal transplant. Similar to this criterion, all the others have been defined based on evidence and expert inputs. The criteria follow a utilitarian approach and define three categories, and are applied at every service across the province to ensure fairness and equity of access. The Department wishes to assure the family and the public that making these decisions is not easy, and more so for clinicians in the front line of care,” he said.

Blanche said a private specialist gave a quote of close to R10 000 for the first month and R8000 from the second month onwards. She said in addition to this she would be making a monthly medical aid contribution. According to the medical aid’s policy, Jerome will only be able to get funds for treatment in December.

Discovery chief executive Dr Jonathan Broomberg said there was material information about a prior medical condition that was not disclosed when Blanche joined the scheme. “We made an exception and instituted a 12-month waiting period,” he said.

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Cape Argus