Ten days after the Molina Orosa Hospital refused to attend to a pregnant woman at risk and five days after this medium made her story public, the Health Department still has not clarified what happened with this case. Meanwhile, other civil servants who belong to the same mutual insurance company as the affected woman, who ultimately had to catch a flight and leave the island in the 33rd week of gestation to receive assistance, fear facing a similar situation.
Initially, the management of Lanzarote Health Services defended the protocol applied last Monday, insisting that the patient did not belong to Social Security, that her insurer had to take care of finding her private care, and that she could only access the public hospital through the emergency room. However, at that time they could not answer whether there is an agreement to attend to patients from mutual insurance companies and insurers that cannot offer certain services in Lanzarote. Five days later, the hospital claims that they are still "studying" the case and have not answered that question, nor have they responded to the complaint filed on April 28 by the patient, who last week had to leave the island and be admitted to a private center in Madrid, given the vital risk to one of the two babies she is expecting.
In this regard, the General Health Law is clear, and recognizes the right of all Spaniards to receive public medical assistance. "All Spaniards are entitled to the protection of health and healthcare" and "the rules for using health services will be the same for everyone, regardless of the condition in which they access them," it states in two of its articles, which develops the article of the Constitution that recognizes "the right to health protection" of all citizens. The only difference is that in some cases, that assistance will be billed later to the interested party or their insurance company, which is exactly what this patient was asking for.
Regulated in the Canary Islands for more than a decade
The Law, in fact, expressly states that "users without the right to assistance from the Health Services may access health services with the consideration of private patients", under the same conditions and with the same rights as any other. And in those cases, it establishes that "the billing for the care of these patients will be carried out by the respective administrations of the centers, based on the effective costs."
In the Canary Islands, these costs are even regulated by decree for more than a decade, with rates that are set according to the type of intervention - including everything from medical consultations and diagnostic tests to operations or deliveries - and that have been updated in the following years. In that decree of the Government of the Canary Islands, of June 26, 2009, it is clear that what public centers should do when a patient does not belong to Social Security is to provide care and then "claim" payment, either from the insurance company if they have one or directly from the patient.
In this case, the affected woman is affiliated to a mutual insurance company due to her status as a civil servant and through it has private insurance with Mapfre. And when she suffered complications in the final stretch of her pregnancy, her gynecologist indicated that she required hospital monitoring that already exceeded her consultation, referring her to the General Hospital. And the same was indicated by Mapfre, which states that it is the usual protocol in Lanzarote, where they do not have another center to which to refer their patients for cases like this.
The insurer pledged to cover all expenses and even issued two vouchers, but the public center on the island refused to accept them. Almost ten days later, the affected woman has not even received a response to the complaint she filed on April 28, and which she was told would be answered "in 48 hours." However, they told her in advance that the response would be negative, although for the moment they have not issued that response in writing, and the affected woman has not received any calls from the Hospital again. The only ones she received were in the days prior to leaving the island, when Patient Care insisted that they could not give her an appointment for a consultation or schedule a cesarean section.
Mapfre claims that what happened is unprecedented
For its part, Mapfre claims that they cannot explain what has happened with this case, since they assure that they have referred other patients to the same hospital and other public centers in the Canary Islands without having had problems until now. In this regard, they refer, among other things, to the agreement they have with the General Judicial Mutual Insurance Company, to which this patient belongs, which obliges them to provide service to the insured in their own municipality of residence, either in private centers or in "the corresponding public services, directly assuming the expenses that may be billed." And that is what they also intended to do in this case, until the hospital denied that possibility, in circumstances that remain unclear.
The patient herself referred in her complaint to three other colleagues and partners of colleagues who had gone through similar circumstances and who had received care at the Molina Orosa through Mapfre, in one of the cases also with a scheduled cesarean section, which was precisely what was denied to her.
The hospital's position was to point out that they could only provide care for emergencies, but not schedule a cesarean section or do the prior monitoring and surveillance required by this case. However, her gynecologist had warned her that one of the babies she is expecting was running out of amniotic fluid and that constant monitoring was necessary. In fact, since she arrived in Madrid, she has been admitted and is now under permanent surveillance to control the evolution of the amniotic fluid. The goal is to delay the cesarean section as much as possible, because the growth of that baby had slowed down and the intention is to give it the maximum development time, but with constant monitoring to intervene as soon as necessary.
Meanwhile, she is still waiting for a response from the Health Department to see why she was denied that assistance at the Lanzarote Hospital, especially when she had delivered the Mapfre vouchers so that the insurer would cover the expenses. In addition, she has already warned that she will take legal action once she overcomes this situation and the twins are born, whom she wanted to have given birth to in Lanzarote but who will finally be born in Madrid, after an "anguishing" experience that forced her to catch a plane in the 33rd week of pregnancy and in the midst of a pandemic. And other civil servants of the same mutual insurance company are also waiting for that response, fearing that such a situation may happen again if there is any problem in their pregnancies.
