Man's life in balance as health policy debated

By REBECCA WALSH

The life of a Pacific Island kidney patient at Auckland Hospital hangs in the balance while health officials debate if he should be given Government-paid dialysis treatment.

The hospital intended to stop giving the life-saving treatment to the Tuvaluan man - said to be in New Zealand illegally - next Tuesday under a new, cost-cutting directive from the Ministry of Health.

But Health Minister Annette King told the Herald last night that this decision had been set aside in favour of talks between the ministry and the Auckland District Health Board on Monday because of the immigration status of the man's wife and family.

"My understanding is that he's married to a Cook Island New Zealander. Cook Islanders have rights as New Zealanders."

The man would be Auckland Hospital's first foreign patient to be denied dialysis under a tough new Government policy to limit the number of overseas patients who use the health system.

Before the latest reversal, the board's chief medical officer, Dr David Sage, said that if the hospital followed the ministry guidelines, dialysis treatment for the Tuvaluan man would cease on Tuesday.

"This patient, not having made any alternative arrangements, will die over the next week or two."

Dr Sage hoped an alternative could be found to stopping dialysis.

"It puts us in an extremely difficult position. We have to fall back on our ethical duty to provide the necessities of life, regardless of the directives from resource-based guidelines," he said.

The case of the man has thrown into sharp relief the debate about whether taxpayers should fund treatment for foreigners.

Guidelines introduced in December instruct hospitals to limit ongoing kidney dialysis to New Zealand residents and citizens. Foreign patients who need urgent treatment will receive it, but once stabilised, will be asked to find alternative care.

It costs about $600,000 a year to treat overseas dialysis patients, mostly Pacific Islanders.

Dr Colin Feek, deputy director-general of clinical services for the ministry, said yesterday that the man was not eligible for public health-funded services and should be treated under the new clinical guidelines.

"This would allow him to be stabilised and given the option of palliative care."

Ms King said the man was in New Zealand illegally and in such cases the new policy was to take patients off dialysis once they had been stabilised and only after their country's Government had indicated it would not pay for treatment.

The policy was needed because treating ineligible patients took healthcare dollars away from New Zealanders.

"We are obviously prepared to work with our Island nations but we cannot have people who come into New Zealand illegally jumping the queue over New Zealanders."

In 2000, the Government directed public hospitals to give dialysis to all foreign patients who needed it, even if payment had not been arranged, and to bill them afterwards. That left many hospitals with bad debts.

In February last year, Dr Feek said the Government had no plans to stop dialysis for such patients.

This week, he said the issue had been a "serious and longstanding problem" for some hospital boards. Renal dialysis patients sometimes required treatment for years.

"We're not just talking about dollars. This is about ineligible people taking away the capacity the health sector has to treat New Zealand citizens. Not all New Zealanders can get access to renal dialysis."

Dialysis treatment, usually with a kidney machine, purifies the blood of people whose kidneys are failing. It is generally given only to those expected to live at least 18 months.

Dr Sage said the man, who had been living in New Zealand "for some years", was first treated in an outpatient renal clinic in April last year.

His condition worsened and as doctors debated the option of a kidney transplant or dialysis, they discovered he was not eligible for treatment. He started dialysis last month.

Dr Sage said the man's immigration status was unclear but he had been granted a six-month stay by the Immigration Service.

The service will not comment on individual cases.