Hospitals barred from charging for blood

DUBAI/SHARJAH — The Department of Blood Transfusion and Research Services, Ministry of Health issued a ministerial decree yesterday banning private hospitals from making any profit on blood units dispensed to patients after Khaleej Times brought the ongoing illegal practice to its notice.

By Asma Ali Zain And Meraj Rizvi

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Published: Thu 1 Jun 2006, 11:01 AM

Last updated: Sat 4 Apr 2015, 7:19 PM

This move was taken by the ministry after Khaleej Times presented an investigative report to the head of the transfusion centre, following up complaints by patients last week who alleged that private hospitals were charging them for blood — whether transfused to a patient or not.

According to Khaleej Times investigation, almost 90 per cent of private hospitals in the UAE extorted money from unsuspecting patients on the pretext of administering blood. The malpractice did not end here as the wastage of blood was rampant in most hospitals due to lack of clear directives and stringent measures by the health authorities.

The malpractice surfaced when a pregnant woman, who recently went to Sharjah's Zulekha Hospital, was asked to arrange for blood before undergoing a Ceasarian surgery. The hospital doctor categorically asked Rahma Al K (name changed upon request) and her husband to organise one blood unit prior to the surgery. The couple was advised by the doctor and laboratory in-charge at the hospital to arrange for the blood unit which, if required, would be administered in case of any emergency situation during the surgery.

Clueless to the procedures how to arrange for the blood unit, the couple checked with Dr Amin Hussain Al Amiri, Director of Blood Transfusion and Research Services (BTRS), who informed them that "blood is not a consumer product sold openly in supermarkets in the UAE." He disclosed that the blood bank deals directly with hospitals and not with any individual, unless the individual intends to donate blood to the Centre."

Acting on his advice, the couple reverted to the hospital which then agreed to arrange for the blood. However, it asked them to pay in advance for the blood units and lab testing to be carried out by the hospital. "According to hospital authorities, a minimum of two blood units is normally dispensed by the blood bank for any case," said Rahma, disclosing: "Although I was advised about one unit being the requirement in my case, I ended up paying Dh1,000 (Dh500 per unit) for two blood units only two days prior to the surgery."

Rahma was informed that if the blood units were not administered to her, the hospital will refund the total amount subject to its re-use within a period of 30 days. "Failing its re-use within the validity period of the blood units, no refund will be made."

"The hospital authorities, however, refused to disclose how transparency of procedures will be maintained between the patient and the hospital on blood re-use," Rahma complained, saying how could she have learnt about either re-use or wastage of the blood units dispensed by the blood bank for her case. "Almost a month has passed and I have yet to receive a refund or advisory from the hospital whether the blood units dispensed for my case was re-used by another patient."

"In fact, during a call made to the hospital administrator recently, I was informed that the blood units remained unused and that Dh1,000 will not be refunded," she said, adding that the receipt issued by the hospital against the payment for the blood units, does not specify that the payment accepted is towards the cost of two blood units. The receipt states that it is a deposit receipt only, Rahma pointed out, blaming lack of transparency and accountability by the hospital, in addition to alleged wastage of precious life-saving commodity by private hospitals for lack of clear directives by the Ministry of Health.

According to the rules then laid out by the Blood Transfusion and Research Services Centre, Sharjah which is an integral part of the Ministry of Health, no hospital could charge patients for the blood units — administered or unadministered to a patient — as the blood is provided 'free' by the blood bank. The hospitals can only charge patients for the extra processes carried out in their laboratories.

Khaleej Times report reveals that several private hospitals in the UAE are either violating the rules knowingly or are unclear about the whole procedure. Most hospitals — normally in favour of publicity — when contacted on the issue, either refused comment or skipped out answering on important details. Surprisingly, all behaved with utmost caution while replying to the questionnaire.

During the investigations, the matter was brought to the notice of Dr Amin Hussain Al Amiri, Director of Blood Transfusion and Research Services who asked Khaleej Times for a report regarding the issue, saying: "This is a disagreement of the rules and policies between private hospitals and the blood bank. We will take up the issue seriously, and a proper solution will be found." Any blood unit dispensed to the hospital by the blood bank is not taken back due to chances of mishandling and contamination.

In an interesting twist, it was also learnt that most hospitals informed patients — while preparing them for surgery — to pay in advance for each blood unit in case they needed it during the surgery. In most cases, a refund was probably never made because the hospital procedures were never transparent enough for the patients to follow.

When asked whether the patients would be charged for the blood unit even if the blood is administered, or not, during the surgery, the reply given by the Director of Administration, Zulekha Hospital, Dr S F A Abidi and his team was: "Of course. Who do you think will be responsible for the money spent on the blood unit?" They also tried to skirt around the question when asked as to how they satisfied the patient on whether they had used/or not used the blood during the surgery. The reply was: "We are not a dishonest hospital."

The hospitals also said that they did not keep a record of the blood units used on patients in a month, and therefore, they were also unable to comment on how many units might have been wasted during the same period. The cost of a single blood unit may vary from Dh100 to Dh400 depending on the blood type and its components, but according to the investigations, hospitals are still charging patients for the blood unit as well as laboratory procedures.

Most hospitals also assured that all blood units brought from the blood bank after following the required procedures were stored in proper containers. Blood units also have a shelf life of 30 to 40 days, therefore it can be used on other patients, but if such is not done then they are discarded using the proper methods. Hospitals were also asked on what they thought about the establishment of a system to link all hospitals with each other so that wastage of blood could be nil.

What the hospitals say

The following are replies from the hospitals that were contacted regarding the issue:

A spokes person from Jebel Ali Hospital said: "The management is very sure that we do not charge any additional money on blood. We simply charge what we paid to the government, and we strictly follow the government policy. At present, there is no internal hospital link, we would appreciate such a link but again the most important point is the blood can get contaminated through transport or improper preserving method, hence no interest has been shown by any private organisation. If the blood is not used for same or any patient we give it to professional companies who discard it as per the standard methods.

The Department of Pathology at NMC said: "The patient is charged for the blood unit which we acquire at a price of Dh400 from the blood bank at Al Wasl Hospital. The shelf life of the blood varies and could go up to 40 days. We can administer a unit to a second patient if the need arises, the remaining units — which are one to two in a month — are disposed of as per the rules of the blood transfusion centre. Though no record has been kept, on an average 30 to 50 blood units are used at the hospital."

Dr S F A Abidi, Director Administration at Zulekha Hospital said: "The hospital charges the money for the blood unit in advance from the patient, but it is paid back if the blood is not used." He said blood is arranged as per the requirement of the patient and type of surgery, and the patient is briefed about the procedure including the charges. He ruled out the need for a system to link hospitals saying that they could only trust blood units brought directly from the blood bank.

Welcare Hospital Dubai did not respond at all saying that the person responsible for issuing details was on leave.

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