Hospital Policy Puts Poor Kidney Patients At Risk

by Kobakila News

MANILA – Patients go to hospitals to prolong their lives. Not to die.

On Thursday morning, Oct. 30, a number of angry peritoneal dialysis patients and their relatives gathered in front of the National Kidney Transplant Institute (NKTI) to voice out their disgust after the hospital refused to honor guarantee letters issued by the Philippine Charity Sweepstakes Office (PCSO).

Poor patients use guarantee letters to avail of dialysis service and medicines.

Since Oct. 3, the NKTI has refused to honor guarantee letters. According to the Peritoneal Dialysis Society of the Philippines (PDSP), seven peritoneal dialysis patients have died and 66 were sent to the emergency room because they failed to get the life-saving medicine they needed.

“The NKTI management arbitrarily decided to punish more than 1,000 peritoneal dialysis patients by refusing to honor guarantee letters from PCSO. For almost a month now, many of us have ceased to get treatments,” said Maximino Tabancora, president of the PDSP who has been undergoing dialysis for four years.

Patients lamented that it is only through the PCSO guarantee letter worth about P30,000 ($670), that they were able to continue dialysis, which is too expensive for the poor.

Louie Cordero, liaison officer of PDSP, whose wife has been undergoing dialysis for three years said, PhilHealth’s PD (peritoneal diseases) First Z Benefits where peritoneal dialysis patients’ medication is covered is still not enough.

“That is why we are really angry with what the NKTI is doing to patients who solely rely on the PCSO grant. It’s like killing the patients slowly,” said Cordero in an interview with this reporter adding that a peritoneal dialysis patient should not miss a dialysis because in a matter of a few days, the patient will acquire infection that can lead to death.

A peritoneal dialysis patient is suffering from a kidney failure, meaning their kidneys are not functioning and they are prone to infection. According to Mayo Clinic website, peritoneal dialysis may be done to manage kidney failure until a kidney transplant is possible. “Kidney failure itself usually results from a long-term (chronic) disease, such as diabetes, that causes kidney damage over a number of years.

‘Do not punish us all’

The NKTI stopped honoring peritoneal dialysis patients’ guarantee letter from the PCSO after a staff of the social services department found out that a patient has been selling peritoneal dialysis solutions (used for dialysis) because the patient did not have money for transportation.

Cordero said that when NKTI’s social services arbitrarily refused to honor the guarantee letter, they asked PCSO what happened. “We were told that the PCSO got a call from NKTI to stop granting guarantee letters and that those who have their guarantee letters will not be honored by NKTI because of what the social services have found out.”

Candy Nisnisan, 37, whose husband is undergoing dialysis was fuming over what had happened.

After her interview at the PCSO, she was about to get the guarantee letter on Oct. 3, but, she was told that it was on hold. She said she had lined up and provided the needed papers to avail of the PSCO medical assistance. She went through the long procedure with hope that the PCSO guarantee letter be released.

She said the NKTI should not punish all the peritoneal dialysis patients when only one has committed a mistake.

“The PCSO’s guarantee letter is all we have to have my husband undergo dialysis. I have no income to help with his medication because I have no work,” an emotional Nisnisan told in an interview. Because she had no other means to provide for her husband’s medication, she has been going to politician’s offices in Congress to ask for medical assistance. However, Nisnisan said, even the medical assistance from politicians is not enough.

“Sometimes I do not eat because I have to save the money that I have. We really have no one to turn to,” she added.

Tabancora said their group has written letters to the NKTI administration but they got no response.

Cost of dialysis

Cordero said there are no free procedures for the poor patients of NKTI. He said they pay for almost everything in what should be a public hospital like NKTI.

“Although there is a discount, we pay for our patients’ medication. From the oral medicines to the solution needed for the dialysis,” he said in an interview with this reporter.

“For patients under the case rate scheme, a patient has to buy 26 bags of solution in exchange for the 36 bags of solution that the NKTI will give to a peritoneal dialysis patient; plus P500 ($11) as counterpart (or as payment) to the 36 bags of solutions given by the hospital,” Cordero said.

He explained that one bag of solution is worth P250 ($6). A patient who undergoes dialysis four times a day needs four bags, meaning a patient must have P1,000 ($22) a day.

“You multiply it by 30 days (equivalent to one month) that means a patient spends P30,000 ($666) a month for his dialysis,” Cordero said, and that’s for the bags of solution alone.

The expense does not stop there, Cordero said, “If a patient’s hemoglobin is low during his dialysis, they have to be injected to increase their hemoglobin count. That is worth P750 ($17).”

“Plus a roughly P8,000 ($179) a month for supplements like calcium and potassium, among others, that has to be maintained by a peritoneal dialysis patient. And another P199 ($4) for milk as an alternative to food.”

“Imagine such expenses? Can ordinary people afford that?” said Cordero.

In the case of the PhilHealth’s First Z Benefits program, patients have to shell out money for the dialysis solutions and other expenses. Afterwards, the patient can reimburse their expenses by presenting their receipts.

A patient’s suffering

Robert Mendoza, secretary general of the Alliance of Health Workers (AHW) said patients do not have to suffer from the expensive medication only if the government gives the proper allocation for health.

“The NKTI is built during the time of then president Ferdinand Marcos to service poor patients. Now, NKTI has become a hospital only for the rich who can pay for their expensive services. In fact, a patient does not have to go to politicians or foundations to ask for medical assistance because health services should be provided for free by the government,” Mendoza said at the protest at the NKTI.

With the high cost of services in NKTI, the medication of poor patients like Elsa Alvarez, 51, is sacrificed. Alvarez has been undergoing dialysis for about a year. She said has to undergo four dialysis a day, but because the procedure is expensive she only undergoes twice or even once a day. “I have to save what I have so that I can somehow sustain the dialysis,” she said in an interview with this reporter.

She added that she budgets the P30,000 worth of medical assistance from the PCSO to two months because a patient can get another medical assistance only after two months. She too has no other means to pay for her medication but the PCSO guarantee letter. She has a daughter who is working as a teacher but only earns P5,000 ($112) a month. She also goes to the politicians who can give medical assistance to augment her needs. But sometimes help is elusive.

Tabancora also said there are cases that poor patients are left in the emergency room sitting on a wheelchair for three days waiting for dialysis. While some have their peritoneal dialysis insertion only in the emergency room when it should be done in an operating room.

A peritoneal dialysis insertion is a procedure where a peritoneal catheter is placed through an open surgical technique.

‘We mean no harm’

Tabancora said they decided to go to the street and protest because they are also fighting for future peritoneal dialysis patients. “The NKTI management and the Department of Health must do something about this. Our members have died and many more will be dead if they continue to disregard our grievances,” Tabancora said in the program.

The PDSP has called on the Senate and House of Representatives to conduct an investigation on why the social services arbitrarily disregarded the PCSO guarantee letter.

“The PCSO too should look first into the matter before they decided to comply with the request of the NKTI. The PCSO should not let NKTI dictate to them because many patients’ health have been put at risk because of what they have done,” said Cordero.

The patients vow to continue their protest if the NKTI administration refuses to heed their calls. (

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