Discovery Health acted illegally and a patient died - Medical law consultant

The family of the deceased KwaZulu-Natal woman are seeking legal advice regarding the issue with Discovery Health medical scheme.

According to the technologist who was administering dialysis to the patient, Discovery Health stopped paying her for claims which led to her being unable to administer dialysis to the patient and led to her untimely death

However, Discovery Health CEO Dr Jonathan Broomberg told Joanne Joseph on both Monday and Tuesday that the company suspended payments on the 24 May, which is 14 days before the patient died.

Joanne Joseph speaks to Medisyn Clinical Consulting medical law consultant Shafrudeen Amod on the matter. Dr Broomberg also took part on the Tuesday show.

READ: We've technologist on record saying she'll not treat patients - Discovery Health

For me, Discovery had a few options they could have exercised. Firstly they could have paid the patient directly and asked her to pay the healthcare practitioner.

Shafrudeen Amod, Medical law consultant - Medisyn Clinical Consulting

Discovery acted illegally, and unilaterally stopped payment to the practitioner. And unfortunately, a patient had to die.

Shafrudeen Amod, Medical law consultant - Medisyn Clinical Consulting

Amod says 14 days' statement by Discovery has to be confirmed.

For me, it is not the number of days. It is the fact that there is a contractual obligation that Discovery has to honour with their patient.

Shafrudeen Amod, Medical law consultant - Medisyn Clinical Consulting

He further states that, indeed, the patient was referred to a different centre, which was a distance from Mtubatuba.

They referred the son to a different centre which an hour away in Richards Bay. We have that on record from the health care practitioner and the son.

Shafrudeen Amod, Medical law consultant - Medisyn Clinical Consulting

What worries me is who made these decisions. I want to know who supervised the whole process. When we request information from Discovery, they are not forthcoming.

Shafrudeen Amod, Medical law consultant - Medisyn Clinical Consulting

Dr Broomberg maintained on Tuesday that they were not in the wrong.

We have the practitioner on record saying 'patients are dying and I will not treat them until you release my money.'

Dr Jonathan Broomberg, CEO - Discovery Health

The Medical Schemes Act requires that claims are paid within 30 days. So the provider has an obligation to treat the patient then submit the claim.

Dr Jonathan Broomberg, CEO - Discovery Health

The first call we have on the system is 6 June. Immediately we called the practice and begged her to treat and she refused. We called the second day and begged her.

Dr Jonathan Broomberg, CEO - Discovery Health

We have evidence that she was providing dialysis on the 6th and 7th June.

Dr Jonathan Broomberg, CEO - Discovery Health

Listen to both interviews below...


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