Govt ordered to set private hospital fees

This follows revelations that the majority of the private facilities usually overcharge patients to the point of detaining those who fail to raise all the medical bills.

In his January 16 landmark ruling, Justice Phillip Odoki of the Civil Division of the High Court in Kampala held that indeed private hospitals are in the habit of charging exorbitant medical bills. 

He noted that if this trend remains unchecked, the violation of the right to health of the citizens will continue.

The judge observed that the escalating costs of medical services offered by private medical facilities and the huge disparities in medical charges by the aforesaid entities are not in dispute.

“In my view, the duty which is placed on the State to ensure every Ugandan can access health services, cannot be achieved when private health facilities are left to charge for medical services as they please, without any guidance by the State,” he ruled, adding: “This is against the backdrop that private medical facilities constitute more than 40 percent of the health service providers in Uganda, as per the official website of Ministry of Health.”

He expressed his agreement with the Health Equity and Policy Initiative, the civil society organisation that petitioned the court.

“…in failing to make the necessary laws to regulate private medical facilities in as far as medical levies, charges and other related matters are concerned, the respondents (the Health minister and the AG) are complicit in the violation of the right of health of patients in Ugandan. This trend of violation is more likely to continue unless the respondents take corrective measures to avert the threatened future violation,” he disclosed.

“A declaration that the respondent’s omission and failure to regulate and standardise levies, rates, and pricing of medical services provided by private health facilities so that they are accessible and affordable violates and threatens to further violate the right to health of patients in Uganda,” he added.

Justice Odoki also held that his court takes judicial notice of the fact that in 2007, there was a Private Health Units (Regulations) Bill, 2007, and in 2019, there was the Patient’s Rights & Responsibilities Bill, 2019. He further noted that the legislations were tabled before Parliament clearly to address the very mischief which is the subject of the case in question but since then, no law to that effect has been made.

“I, therefore, find that there is sufficient evidence to support the contention of the applicant that private medical facilities charge varying amounts, sometimes detain patients and bodies of dead patients because of non-payment of medical bills,” ruled Justice Odoki.

Unconscionable medical bills
Core to the concerns of the civil society organisation that filed the case was that the Health minister and the government have a constitutional and statutory duty to regulate private health facilities and to protect the general public from unconscionable medical levies by private health facilities in a bid to realise the right to health.

“As a result, the private health facilities are overcharging patients, delaying the treatment of patients at their facilities on condition that they deposit some payment and detaining patients and dead bodies of patients over pending medical bills,” the applicant stated to court.

In his affidavit, Mr Anthony Odur, the executive director of the petitioning NGO, said a number of Covid-19 patients were being overcharged in private medical facilities, their treatment being delayed on condition that they deposit some money and being detained pending payment of exorbitant medical bills.

The applicant’s case was buttressed by an affidavit of Mr Tamale Toffa, who stated that his mother was admitted to a private hospital in Kampala with Covid-19, but was discontinued from oxygen in the intensive care unit in favour of another patient who was stated to be more critically ill.

Mr Tamale added that his mother’s health worsened. She eventually died and the facility demanded for Shs31m before they could release the body to the family for burial.

The applicant also cited a number of incidents where hospitals have detained patients, including lactating mothers over pending medical bills.

Arguments
Justice Odoki consequently ordered the Health minister and the Attorney General to ensure the necessary piece of legislation is put in place within a period of two years to, among others, regulate and standardise levies, rates, and pricing of medical services provided by private health facilities, restrain all private hospitals from detaining patients and holding bodies of deceased patients for pecuniary reasons, and provide penalties for exorbitant pricing of life-saving medical goods and services.

The judge also ordered the Attorney General in his capacity as the chief legal adviser of the government to report back to court at the end of every two years on whether its orders have been fully complied with.

The government had, in its defence, contended that a similar matter (Mr Moses Mulumba and another Vs AG and two others), had already been resolved by the courts of law and that the NGO in this matter was merely reopening a case already determined.

On July 7, 2021, the High Court in Kampala ordered the government to regulate the then skyrocketing medical fees that private hospitals were charging Covid-19 patients under their care. The orders of the court followed a consent agreement between government and Mr Moses Mulumba, then executive director of Centre for Health, Human Rights and Development, that had petitioned court over the exorbitant medical bills.

The court also ordered the Uganda Medical and Dental Practitioners Council to make recommendations to the Health ministry on reasonable fees for patients seeking Covid-19 treatment from hospitals.

Verdict
But on submitting on the contention that this particular case was a duplicate of the one determined in 2021, the counsel for the applicant argued that the Moses Mulumba case was specifically about the then skyrocketing Covid-19 medical bills charged by private facilities; yet this was about the general enforcement of human rights in health. 

The lawyers further argued that this particular case embodies broader prayers regarding general regulation of rates in private hospitals as far as treatment of all illnesses are concerned.

Further, the Attorney General had argued that each health practitioner is bound by the Code of Professional Ethics for Medical and Dental Practitioners, hence can’t do harm to patients.

But this argument was shot down by the judge who, in his ruling, reasoned that the Code of Professional Ethics for Medical and Dental Practitioners do not have punitive measures just like the Patients’ Rights and Responsibilities Charter, 2009, which are mere guidelines which have no binding force.

“They cannot be a substitute for a law which has to be enacted by Parliament. Furthermore, Section 42 of the Medical and Dental Practitioners Act, which was relied upon by the respondent, only provides for the right of a registered medical or dental practitioner to demand reasonable charges. The term ‘reasonable’ is a relative term, subject to abuse,” held the judge.

Asked last evening whether the Dr Aceng will abide by the court directives and prevail over the private hospitals that charge exorbitant medical bills, Mr Emmanuel Ainebyona, the Health ministry spokesperson said: “The matter is going to be presented in the top management meeting slated tomorrow (today) and the subsequent outcome will be communicated accordingly.”

The court made no orders as to costs in the public interest case as each party is to meet its own costs.

Dark days of Covid-19
The second Covid-19 wave, which hit the country in mid-2021, saw several private hospitals mainly around Uganda’s capital of Kampala, charge exorbitant medical bills in the range of Shs3m and Shs10m per day for cases in intensive care unit (ICU). The same hospitals were charging between Shs1m and Shs2.5m for moderately ill Covid-19 patients per day.

Medical activists criticised the government for just looking on when private health facilities were reaping off Ugandans, whose capita income was $777 (about Shs3m). 

Some of the health facilities could detain dead bodies until the families paid up the accumulated medical bills in hundreds of millions as a result of Covid-19, with many having been on the expensive oxygen machines.

Other hospitals conditioned treatment of Covid-19 patients with demands for collateral security such as car log books and land titles.