Discovery Health’s CEO Dr Jonathan Broomberg accused Dr Daleen Geldenhuys of “dishonest conduct and apparent negligence” in her treatment of Thobeka Xaba.
Discovery had refused to cover 23-year-old Xaba’s medication, informing her in a letter that she was not entitled to Paclitaxel because it was a “tier two” medicine and her medical aid only covered cheaper “tier one” medicines.
Xaba, with the help of advocacy organisation Campaigning for Cancer, appealed to the Council on Medical Schemes, which ruled in her favour and ordered Discovery to pay for the medicine.
Discovery then appealed and at the appeal hearing last month, it changed tack. Instead of disputing the treatment on the basis of its tier, it argued that Paclitaxel was an “inappropriate drug”.
Although it is standard protocol in treatment disputes to consult SAOC, the recognised expert body on cancer, Discovery failed to do so.
Instead, it consulted oncologist Professor Paul Ruff telephonically a few days before the appeal hearing, and he described the medicine as “inappropriate” for treating soft tissue cancer.
In an about turn at the hearing, Discovery offered to cover “tier two” drugs, Docetaxel and Gemcitabine for Xaba. As these are from the same “family” of medicine as Paclitaxel, Dr Geldenhuys agreed to this.
Last week, the Council upheld Discovery’s appeal against Paclitaxel, and ruled that Xaba be treated with Docetaxel and Gemcitabine.
But SAOC, which represents all cancer doctors and academics, said this week that the medicine Geldenhuys prescribed for Xaba was a “reasonable active treatment option”.
SAOC chairperson Dr Waldemar Szpak said that Paclitaxel (prescribed by Geldenhuys) and Docetaxel and Gemcitabine (Discovery’s solution) are all appropriate to treat Xaba’s fibromyxoid sarcoma.
However, Paclitaxel is a “less toxic” treatment than the combination offered by Discovery, said Szpak.
“The fibromyxoid sarcoma occurs very rarely and therefore its treatment is not yet definitively defined. In such cases, it is reasonable to start with a significantly less toxic treatment modality, keeping in mind that the patient may need extended, long term treatment,” Szpak said.
Following the CMS ruling, Broomberg again publicly attacked Geldenhuys, accusing her of lying about Xaba’s health and about her not being on treatment to force an urgent hearing.
Yet Xaba had not had any chemotherapy for the massive, life-threatening tumour on her arm and shoulder for at least two months because of the dispute.
Geldenhuys “strongly denies misleading anybody about the seriousness of [Xaba’s] condition to get a hearing with the CMS”.
“I am relieved that Tier 2 medication was approved for her, which previously was denied prior to the appeal hearing,” added Geldenhuys.
“As a result of the appeal committee’s decision, I have started the alternative therapy suggested by Discovery, with the patient’s permission as it is in her best interest to be treated with a taxane. Paclitaxol and Docetaxol can be used and substituted for one another depending on the individual circumstances.
“She has only completed one cycle of therapy and it is too early to comment on her response to treatment or future treatment options.
Meanwhile, Szpak said “SAOC has no record of an official request from Discovery Health, for the supposedly anonymous review by five oncologists, of the proposed treatments with Taxol [trade name for Paclitaxel] or any other previous treatment in this patient”.
Broomberg said Discovery usually consulted SAOC on clinical issues concerning patients on higher medical aid plans than Xaba’s basic Keycare plan.
“In terms of the SAOC’s views on the appropriateness of the treatment, I do not believe it is appropriate comment on or to debate the relative merits of different views,” said Broomberg.
“After our comprehensive review into published clinical evidence on the efficacy and appropriateness of Paclitaxel for this specific condition, we found no evidence to support its use in these particular circumstances. Prof Ruff conclusively confirmed this. The Council for Medical Schemes upheld this view.” – Health-e News Service.