Delayed surgery authorization

BONITAS: URGENT COMPLAINT REGARDING DELAYED SURGERY AUTHORISATION

Patient and Medical Situation

I am lodging a formal complaint regarding Bonitas’s handling of my mother, Heather Ann Claassen’s, medical treatment.

My mother is experiencing severe, constant pain 24 hours a day. Her pain has significantly restricted her mobility, makes it difficult for her to eat and is now so severe that she requires morphine to manage it.

A specialist examined her, diagnosed a bulging disc and recommended surgery. We have already incurred approximately R17,000 in specialist consultation and related medical expenses to ensure that her condition was properly assessed.

Her current condition is medically urgent. She is in severe, ongoing pain and requires strong medication simply to cope with her symptoms. Any further delay in providing appropriate treatment risks prolonging her suffering and may result in further deterioration or complications.

Chronology of Events

1. My mother developed severe and persistent pain that substantially restricted her mobility and ability to eat. 2. She was examined by a specialist, who diagnosed a bulging disc and recommended surgery. 3. We incurred approximately R17,000 in specialist and related medical expenses. 4. Bonitas refused to authorise the recommended operation. 5. Bonitas advised that my mother must first attend a Bonitas back programme in George. 6. My mother lives in Still Bay, is in severe pain, has limited mobility and requires morphine to manage her symptoms. 7. We have lodged a complaint with the Council for Medical Schemes and requested an urgent independent review.

Main Concerns

We are deeply concerned that Bonitas’s decision is delaying treatment recommended by the specialist who examined my mother.

It is unclear why she is being required to attend a programme in George when she is in severe pain, has limited mobility and requires morphine. Travelling from Still Bay to George and participating in such a programme may be medically difficult or unsafe in her current condition.

We are also concerned that the specialist’s complete medical report, diagnosis and recommendation for surgery may not have been properly considered.

This is not a request for unnecessary or elective treatment. It is a request for urgent treatment recommended after a specialist assessment. My mother is suffering now, and further delay is unacceptable unless Bonitas can provide a clear, medically justified reason and an appropriate interim treatment plan.

Questions Requiring Urgent Answers

Please provide clear written answers to the following:

1. Why was the specialist’s recommendation for surgery not authorised? 2. Was the specialist’s complete medical report, diagnosis and motivation reviewed by an appropriately qualified clinical professional? 3. Why is the back programme considered clinically appropriate for my mother’s specific diagnosis, severity of symptoms and current medical condition? 4. Why is she expected to travel from Still Bay to George despite her severe pain, limited mobility and need for morphine? 5. Has Bonitas assessed whether travelling to George and participating in the programme is medically safe for her? 6. What alternative arrangements are available if she is medically unable to travel or attend the programme? 7. What interim treatment and pain-management support will be provided while this matter is being reviewed? 8. What is the expected timeframe for a final decision and appropriate treatment? 9. Who is responsible for reviewing this matter urgently, and how can that person be contacted?

Requested Next Steps

We request that Bonitas:

* Conduct an urgent clinical review of the refusal to authorise surgery. * Reconsider the decision in light of the specialist’s diagnosis and recommendation. * Confirm in writing whether all medical reports, clinical findings and supporting motivations were reviewed. * Provide the clinical basis for requiring the back programme before surgery. * Assess and confirm whether travel from Still Bay to George is medically appropriate and safe. * Provide an appropriate alternative if my mother cannot safely travel or participate in the programme. * Provide an interim treatment and pain-management plan while the authorisation decision is being reconsidered. * Escalate the matter to a senior clinical or authorisation manager. * Provide a written response and a clear resolution timeframe without further unnecessary delay.

My mother is suffering severe, constant pain and requires morphine to cope. She cannot simply be told to wait while her condition remains untreated and the recommended surgery is delayed. Every additional day without appropriate treatment prolongs her suffering and may increase the risk of further deterioration.

We urgently request that Bonitas consider her individual medical circumstances, properly review the specialist’s recommendation and ensure that she receives appropriate care as soon as possible.

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