PATIENTS will pay even more; needy might face complications.
On October 17, a man in his early sixties died in the city of Trnava, in western Slovakia, after being denied access to hospital treatment for four days, a report by the TASR news agency said.
"An autopsy has been done - the homeless person died of hypothermia. He came to the hospital on October 13 in an acute condition, which required hospitalisation. However, he was not hospitalised until October 17," said Health Ministry spokesperson Alexandra Novotná.
An investigation initiated by the Health Ministry found "serious shortcomings" in the Trnava doctors' approach to the case, according to an official press release from the ministry. Health Minister Rudolf Zajac also ordered the immediate recall of Rynald Šimanský, the hospital's director.
Police are investigating whether any member of the hospital's staff should be charged in connection with the death.
"The homeless man had been treated; I stand behind our doctors 100 percent," Šimanský told the SME daily and added that the inspection was done in great haste and was a "hunt for doctors".
Experts say many individuals encounter the problem of being denied the aid of a doctor.
"It happens pretty often. According to our estimates, in as many as 30 percent of all cases," said Katarína Jirešová, head of Odyseus, a Bratislava-based NGO working with drug users and prostitutes.
Jirešová explained that there are a number of arguments medical staffers use when rejecting patients from the ranks of the target group her organisation works with.
"Firstly, it is that their condition is not acute. For example ,we've learned of a person with a broken arm being sent away from the emergency room with nothing but a bandage and a recommendation to visit his local doctor," she said.
"Secondly, it is that these people don't have insurance cards," she continued. Insurance cards are handed out by insurance companies and prove that their holders have coverage.
"The third most commonly used argument is that patients should be treated by their local doctors," Jirešová added.
Other experts from the field share Jirešová's experiences.
"Our experiences with medical care for the homeless are mixed," wrote Sandra Tordová in a statement provided to The Slovak Spectator. Tondrová is project manager at the NGO Proti prúdu, publisher of the street magazine Nota Bene, which is distributed by, and in great part focuses on the lives of, homeless people.
"We have had some very positive experiences with doctors who have been very forthcoming and have provided great care," she said.
"But it has also happened that an ambulance refused to take a man with diabetes after they found that he didn't have an insurance card," she continued.
Representatives of the medical community say that doctors are in part being blamed for things for which they should not be. Firstly, doctors cannot supplement the functions of other bodies, experts say.
"Doctors are obliged to provide medical treatment to people who need medical treatment. It's not their role to provide social care," Marián Boča, a member of the presidium of the Slovak Doctors' Chamber (SLK) in charge of the organization's legal division, told The Slovak Spectator.
Boča said that people often try to get into a hospital not to be medically treated, but to find company or simply warmth.
"There are many people, and not only homeless people, but also lonely people or pensioners, that try to get into hospitals. That's a legacy of communism," he said.
"I think we are lacking a solution to social problems. A solution that would enable a person in social need to seek a social institution and not a medical one," Boča added.
Some Trnava doctors used a similar argument after the recent events at their hospital.
"The homeless person was treated and hospitalised. He died as a result of his way of life, which caused hypothermia," a doctor who wished to remain anonymous told the daily SME.
However, many people from vulnerable social groups seeking professional medical aid do have a real health problem. Under Slovak legislation, all doctors have a duty to treat any patient, even one without any insurance coverage, if that patient has an acute and life-threatening condition.
"In acute and urgent cases, people are being treated. Always," said Boča, who strongly opposes the claim that some people in life-threatening conditions are being denied access to medical care.
"However, there is a difference between acute, life-threatening conditions and chronic conditions," said Boča. The already much-indebted medical institutions have to be cautious when taking an uninsured patient into hospital care, according to Boča.
"A hospital can suffer losses in the thousands, or even hundreds of thousands of crowns," he said.
The socially weak are entitled to receive free-of-charge medical care if they are registered with the social-care authorities in the place where they last officially resided. However, many of these people are far from their former homes and are unable to get the formalities sorted out with the official social authorities. Legislative changes may pose even more problems.
"Starting next year, people in social need will have to pay for health care. For most of them, that will be an obstacle they will not be able to overcome," Zuzana Csontosová Šedíková, director of Proti prúdu, told The Slovak Spectator.
NGO representatives say the fate of patients who are unable to get proper help is worrying.
"They get better by themselves or with the help of close ones, or they go on untreated. Some try to turn to other institutions, or attempt to get treatment by offering bribes," said Jirešová.
"The doctors have a duty to treat uninsured patients who are in life-threatening conditions. But often it's too late by then and therapy is very expensive," said Tordová.
10. Nov 2003 at 0:00 | Lukáš Fila