Uganda National Health Consumers' Organisation
UNHCO has repeatedly received reports of hospital detentions from patients and/or there caretakers. The media has also reported several cases of people being detained in private hospitals in Uganda for non-payment of hospital bills, despite the fact that hospital detention is a human rights violation.
Evidence gathered by UNHCO indicates that Ugandan’s are unaware of their rights or that detention in health facilities, for non-payment of fees, is both proscribed under domestic law and constitutes an interference with rights enshrined in international treaties to which Uganda is a party, notably under Article 3 of the Universal Declaration of Human Rights. The practice has become so commonplace that many Ugandans wrongly believe that hospitals have the right to detain them.
The detention of a patient is a violation of his/her right to liberty guaranteed under Article 23(1) of the Constitution and also amounts inhuman and degrading treatment which is prohibited under Article 24 of the constitution. It is also a criminal offence known as wrongful confinement under Section 248 of the Penal Code Act.
Patients that have reported to UNHCO share harrowing reports of highly abusive and degrading treatment during detention, possibly leading to psychological harm. It should be noted that hospital detention also has serious ramifications from a clinical viewpoint. It negatively impacts on the physical and/or mental health of detainees by exposing them to hazards due to, for example, overcrowded hospitals and increased risk of infection. It can trigger psychological trauma because of fear, the conditions of detention and the separation from family members. Further reports indicate that some patients have been denied emergency medical treatment because they cannot make an advance payment.
Nevertheless, medical services fall in the category of basic essential services because they sustain the most fundamental human right, which is the right to life as enshrined in Article 22 of the Constitution of the Republic of Uganda. Medical services are therefore not luxurious goods where prices can vary as and when the provider wishes and treating them as such is inconsistent with efforts towards Universal Health Coverage (UHC) whose aim is geared at ensuring that all people have access to the health services they need, when and where they need them, without financial hardship.
Whereas UNHCO is a health consumer organisation, it understands that a private hospital is a business with commercial goals. However, actions to ensure payment of bills should be legal in nature. Fortunately, the law entitles the medical practitioner to sue for recovery of his or her reasonable charges in any court of competent jurisdiction if they are not paid. The law is to the effect that when someone breaches a contractual commitment -then courts can come in to resolve the situation. Individuals and hospitals cannot turn into debt collectors, court and Judges at the same time.
Therefore in case a patient defaults, the hospital can sue and seek recovery. In the unfortunate event that a patient dies before settling a bill, then the hospital should follow the same procedure to recover from the estate of the deceased.
Not under any circumstances should a hospital pursue the easier and illegal procedure of detaining a patient in order to secure payment of medical bills.
The COVID-19 pandemic has also shone more light on the unfortunate practice of detaining dead bodies. The media reported several cases of bodies of covid-19 victims detained in several hospitals around Kampala at the height of the pandemic in 2021. A case in point was the detention of Kampala businessman Tom Kaya Kigonya’s body at TMR Hospital – a case that was only resolved after the Attorney General’s intervention.
This practice delays the respectful burial of the deceased and amounts to a criminal offence under Section 121 of the Penal Code Act.
Section 121 of the Penal Code Act provides that;
Whoever unlawfully hinders the burial of the dead body of any person, or without lawful authority in that behalf or otherwise than in accordance with rules made by the Minister disinters, dissects or harms the dead body of any person or, being under a duty to cause the dead body of any person to be buried, fails to perform such duty, commits a misdemeanor.
Perpetrators suffer, on conviction, a custodial sentence of two years in prison as provided under Section 22 of the Penal Code Act. It should also be noted that The Uganda Gazette provides a list of detention centers of which Hospitals are not included.
Hospitals may attract legal liability for false imprisonment and unlawful restriction of a person’s liberty if they do not desist from detaining indigent patients who are unable to pay their bills at the material time of asking or dead bodies which are not even aware of the bills they have left behind.
In resolving these issues Ugandan Courts can rely on the persuasive Kenyan case of Emmah Muthoni Njeri v. Nairobi Women’s Hospital, Constitutional Petition No. 352 of 2018, where the Court declared the detention of the petitioner (patient) for 6 months for failure to pay her medical bill a violation of her dignity, right to freedom and security of the person, and the right to freedom of movement.
These rights are similarly guaranteed under the Ugandan constitution. The Patient’s Rights and Responsibilities Bill (PRRB), now before Parliament, if passed into law can go a long way in giving effect to these Constitutional provisions. It proposes, under Clause 26 that the “management of a health facility shall not detain a patient or his or her body in case of death, in a health facility for failure to meet financial obligations of the health care received by the patient”. However this is not yet law thus posing a threat to the health of Ugandans and the Health Sector in general. The bill will only see the light of day if we as Ugandans actively demand its enactment into law. In the meantime, we need to ensure that all patients are aware of the safeguards provided by the constitution and international treaties to curb the growing vice.
By Aziz Agaba
Program Officer – Uganda National Health Consumers’ Organisation (UNHCO)
@azizagaba
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