RIYADH, 14 February 2007 — Public and private hospitals are increasingly resorting to holding in-patients as virtual hostages in order to get families to pay the bill. Sayidaty magazine, a sister publication of Arab News, recently investigated the issue and came out with disturbing details.

Jihad Muhammad, a Saudi resident of Riyadh, said that despite having a good relationship with a local hospital for over 12 years, the staff would not sign over a set of twins that his wife gave birth to until he settled a SR25,000 bill, which was the total cost of the procedure including a Caesarian section.

“I have four other children; the oldest is 12 years old while the youngest is three years. All of them were born at this hospital,” said Muhammad. “For each delivery I paid them 2,500 riyals.”

Muhammad said that during the course of the pregnancy his wife made several visits to the hospital for pre-natal care. After giving birth, however, the hospital gave Muhammad a much larger bill than he expected.

“It was a huge amount and I didn’t have the money,” Muhammad said. “I asked them to allow me to pay the bill in installments. I thought that being a loyal customer would help. However, I was asked to consult the manager and that was not of help either.”

Muhammad said the hospital administration offered to reduce the bill to SR22,000.

“I thought of selling my car,” he said. “I consulted my friends who are all of my same financial status. My wife was in a total depression.”

Muhammad said that even when his wife would go breastfeed the twins, hospital staff accompanied her, as if they were concerned that she would try to leave the hospital with her children.

It wasn’t until Muhammad sought the help of the Ministry of Health that he was able to get his children out of hospital.

“I had to sign a paper that states that I will pay the money back through installments or any other way,” he said.

Failure to honor an agreement is a criminal offense in Saudi Arabia and Muhammad’s signature amounts to a situation where he could potentially end up a debt prisoner should he fall behind on his contractual obligation.

Khalid Al-Musa, another Saudi father, said that his wife had to give birth in her eighth month through an emergency procedure. Though he had planned to take his wife to a public hospital, due to the condition he thought it more prudent to go to a higher quality private health care center. After the procedure, Al-Musa was hit with a SR20,000 bill.

“I tried to explain my financial status to the manager of the hospital, but that did not help. He said that the hospital was going to keep the child and charge me SR1,000 for each day the child was in their custody,” said Al-Musa. He said he sold many of his belongings and eventually managed to pay off his bill. “I then decided I would never got to a costlier private hospital again.”

Othman Abdullah, a Sudanese living in the Kingdom for many years, said his uncle came for the Umrah pilgrimage and fell down a flight of stairs that put him into a coma.

“After a few weeks (of treatment) the hospital called us and said that they would prematurely discharge my uncle if we didn’t pay the outstanding balance of SR40,000. They were very open and direct with this threat.”

Shortly thereafter the uncle passed away, but when Abdullah and other family members went to claim the body, the hospital staff said it would not release the body until the bill was settled.

Like Muhammad, Abdullah complained to the Ministry of Health, which facilitated the release of the body after he signed a pledge agreeing to pay back the money owed in installments.

A hospital manager who asked not to be identified pointed out that private hospitals are for-profit institutions.

“We are providing a vital and humane service, but we also have many payments ourselves that we must fulfill,” said the manager.

“If we treat people for free we won’t be around for very long. I have a long list of patients who never paid their bills, and we are compelled to let them walk out the door without knowing when and if they’ll ever pay in order to fulfill the bylaws of the Ministry of Health.”

The manager said one way hospitals write off defaulters is to collect these outstanding bills by deducting them from the annual zakah payment.

“The government has built many public hospitals for citizens and expatriates,” said the manager.

“I just wonder why some people still insist on getting treatment at private hospitals while they cannot afford to pay the bills.”

Malpractice and medical mistakes may be playing a role in people’s aversions to public hospitals, which are universally perceived to provide lower quality care than private hospitals.

For its part, the Ministry of Health has rules on how hospitals can deal with deadbeat patients, and that hospitals can face penalties for skirting the law by holding newborns or bodies as bargaining chips in settling bills.