A Filipina worker received "unnecessary and dangerous" chemotherapeutic treatment, after physicians employed by her insurance company refused demands by Tel Aviv's Ichilov Hospital to sponsor a biopsy that would have shown she was ill with tuberculosis rather than cancer, a recently submitted Ministry of Health report said. The investigation was prompted by complaints from Physicians for Human Rights and Professor Yossi Lessing, head of the gynecology and obstetrics department at Ichilov.
The head of the ministry's public complaints division, Professor Haim Hershko, recommended in the report to launch complaints at the ministry's disciplinary tribunal against surgeons Ronit Barak and Moti Bachar, of the Phoenix Insurance Company's subsidiary Med Health Services for Foreigners, as well Dr. Avinoam Shkolnick, the general manager of Laniado Hospital in Netanya, who made a similar diagnosis in his private clinic in Tel Aviv, and finally against Dr. Yael Merrick, the director of Laniado's oncology unit.
Hershko also said that the decisions of three of the physicians - Dr. Barak, Dr. Bachar and Dr. Shkolnick, "matched the financial interests of the insurer, but ran contrary to professional medical reason and the right of the patient to receive appropriate treatment regardless of any non-medical considerations... this is a case of a diagnostic process being stopped for irrelevant considerations, which led to the administration of the wrong treatment, one that has a considerable potential to harm."
Disciplinary complaints are launched against physicians suspected of conduct unbecoming of the medical professional, or of committing grave negligence while on duty. The report's recommendation to file such a complaint against a hospital director is considered extremely rare.
The investigation concluded that the patient, 32-year-old caregiver Arlyn Rose Malyonas, was suffering from symptoms that raised suspicions of a malignant metastatic tumor. In October 2008, Malyonas began treatment at the gynecology and obstetrics department at Ichilov, where her physicians told her a biopsy needed to be conducted for the diagnosis to be conclusive. However, Malyonas' insurance company refused to cover a biopsy procedure or to allow Malyonas to remain under care at Ichilov. She was directed to Dr. Shkolnick's private clinic for a secondary opinion. Shkolnick rejected the need for a biopsy and diagnosed Malyonas with metastatic cancer, adding that she would not be able to continue working.
The report noted that Dr. Shkolnick, as an advisor to a medical services supplier, "was supposed to have considered himself committed to the best medical interests of the patient. Such considerations would have prompted Dr. Shkolnick to recommend further tests to reach a conclusive diagnosis and enable the treatment... On the other hand, there were the considerations of an insurance company interested in cutting its costs and using regulations which allow them to deport patients who are not believed to be able to return to work...
"The decision not to carry out an essential diagnostic procedure," the report continued, "and insisting that the cancer diagnosis was complete without the procedure led to an unnecessary and dangerous treatment of a patient that was eventually diagnosed as suffering from tuberculosis. Following that last diagnosis, the patient was given the appropriate treatment and recovered within a few months."
Malyonas' lawyer Dori Caspi said in a statement that "this is a case of conscious, financially motivated conduct that had nothing to do with Arlyn's actual condition... We thank Physicians for Human Rights, the physicians of the gynecology and obstetrics department at Ichilov, and all others who came together to save her life, and wholly support the recommendation to submit disciplinary complaints."
Dr. Barak, who has since left the insurance company, and Dr. Bachar issued a joint statement, saying "We are the treating physicians, and our role was to be the long arm of the insurance company. Our sole role was to request a secondary opinion from Dr. Shkolnick... our involvement was purely administrative. We did not treat or diagnose the patient."
Phoenix Insurance said in a statement that, "As an insurer, we cannot and should not be involved in the decision to carry out certain diagnostic procedures upon a patient. She [Malyonas] was diagnosed in accordance with medical considerations, and by the authorized medical officials. Phoenix merely provided the insurance, and will continue to do so for any procedure recommended by the medical authorities."
Laniado Hospital said in a statement on behalf of Dr. Shkolnick and Dr. Bachar they had yet to receive the report, and would comment upon learning its contents.