PETALING JAYA, Sept 12 — A patient is contesting Pantai Hospital Kuala Lumpur’s RM611 charge for a screening for antibiotic-resistant bacteria prior to his admission last July after he was previously admitted at another hospital.
Leong Chiew Why, 58, was charged a total of RM668 for the methicillin-resistant Staphylococcus aureus (MRSA) PCR test (including an RM57 laboratory after-hour surcharge) last July 20. His total hospital bill, including a 1.5-day stay, came up to RM3,805.35, which he paid out of pocket with a credit card.
Leong was referred to Pantai Hospital KL by Cardiac Vascular Sentral Kuala Lumpur (CVSKL) after one night’s admission at the latter private hospital, after it was discovered that his abdominal pain was due to an inflamed gallbladder.
After registering and waiting for about an hour at Pantai Hospital KL’s emergency department in the evening of last July 19, Leong, accompanied by his 55-year-old wife, Sheryn Kok Lai Ping, was finally seen by a medical officer. He was not admitted to the ward until two hours later.
While waiting in the emergency room, a nurse performed a nasal swab on Leong and left. In pain and unaware of its purpose, Leong said he didn’t think much of it and assumed it was routine, similar to having his blood pressure taken.
The next day, after consulting with two different specialists about his condition – unhappy with the advice from the first and seeking a second opinion from the second – Leong decided to discharge himself from Pantai Hospital KL and move to Beacon Hospital in Petaling Jaya for surgery. He ultimately had his gallbladder removed due to gallstones.
For this entire episode costing RM37,484.50, Leong paid RM4,679.15 for his initial CVSKL visit (including one night’s admission, and scope and ultrasound procedures); RM3,805.35 for his Pantai Hospital KL visit (including 1.5-day admission, medication, and consultations, but no procedures); and RM29,000.00 for his Beacon Hospital bill, where he underwent surgery.
With no medical insurance, all of Leong’s hospital bills amounting to nearly RM37,500 were paid out of pocket.
Leong and Kok – who live in Kuala Lumpur – are semi-retired and run a business selling and marketing automotive rubber parts. They have two children, both of whom are working and living independently.
At 58, this is Leong’s first-ever medical issue involving hospitalisation. He exercises regularly; he also goes for annual medical screenings, and scopes and heart scans every five years.
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Upon scrutinising his medical bills, one item in his Pantai Hospital KL bill stood out: RM611 for an MRSA rapid screening (PCR) and a RM57 laboratory after-hour surcharge.
MRSA, or methicillin-resistant Staphylococcus aureus, is a type of bacteria resistant to several antibiotics. An MRSA screen test is used to identify if MRSA is present in a person so they can be treated to eliminate the superbug and prevent its spread to others.
Some hospitals implement MRSA screening to control the spread of these antibiotic-resistant bacteria by screening patients deemed at risk of colonisation or all new admissions.
“CVSKL didn’t conduct a test, and neither did Beacon. So, why did Pantai need to conduct one? That’s the only billing item we disagreed with. The rest of the charges are hospital, doctor, or medical-related – we don’t fully understand the itemised details, but we did recognise the PCR charge,” Leong told CodeBlue in an interview last Monday.
Pantai Tells Patient’s Wife: MRSA Testing Policy Is ‘Confidential’
Leong’s wife, Kok, subsequently emailed Pantai Hospital KL on July 25 to clarify the MRSA test charge and determine if it was a compulsory requirement from the Ministry of Health (MOH).
In their initial response on the same day, Pantai Hospital KL’s billing manager explained that the MRSA screening was ordered by the treating doctor.
Upon further clarification, the hospital on July 26 said the charge for the MRSA rapid screening (PCR) was applied because Leong was transferred from another hospital, and it is the “hospital’s policy” to screen patients for MRSA in such cases.
The laboratory surcharge was due to the test being ordered after office hours, around 7 pm.
Kok requested a copy of the hospital’s policy and sought clarification on what constitutes a “transferred” patient, noting that Leong was merely “referred” by CVSKL and had walked into Pantai Hospital KL’s emergency department like any other patient, rather than being transported by ambulance.
She also mentioned that they were not informed of this policy in advance, and it was not explicitly communicated to patients. “The charges are also exorbitant,” Kok said.
Pantai Hospital KL’s head of customer service and patient experience later responded by describing MRSA as a multidrug-resistant “superbug” and emphasised the importance of preventing its transmission between hospitals and patients.
“This test is commonly done in situations where a patient was admitted to one hospital and then goes to another hospital for admission. It is our hospital policy,” Pantai Hospital KL told Kok in an email dated August 6. A group call was arranged the day before on August 5 between Pantai Hospital KL’s customer service and patient experience head, the head of emergency services, Kok, and Leong.
Kok made multiple requests for a copy of Pantai Hospital KL’s policy, but was denied access. The response by the hospital owned by IHH Healthcare Berhad last month was, “We cannot share the policy because our policies are confidential and for internal use only.”
Her email correspondence with Pantai Hospital KL was shared with CodeBlue.
Kok said that as a consumer, she believes hospitals should only charge for necessary treatments and that non-essential charges should not be imposed without patient consent.
“If the policy is confidential and cannot be shared with the patient, how are patients supposed to know about tests or charges that are not directly related to their treatment?
“We haven’t been consulted, informed, or given the opportunity to consent for any non-essential or unrelated charges. We feel seriously ripped off by a private hospital that took advantage of patients already in pain to make decisions,” Kok told CodeBlue.
Kok also inquired about the MRSA “superbug”, asking about its rate of transmission and whether the screening was necessary.
Pantai’s Statement: MRSA Screening ‘Clinical Best Practice’ Based On MOH Guidelines
CodeBlue sought comments from Pantai Hospital KL regarding the necessity of the MRSA test, whether it is part of the hospital’s admission policy, and if the hospital should cover the cost.
“Our top priority is always the safety and wellbeing of our patients. MRSA is a global issue affecting all health care facilities; therefore, prevention of transmission is essential. Screening is done in various situations, including when there is movement of patients between hospitals. This is considered a clinical best practice based on our MOH guidelines,” Pantai Hospital KL said in an emailed statement to CodeBlue last September 6.
“We recognise that health care costs are a significant concern, and we want to assure the public that any tests recommended by our doctors are done with patient safety in mind. We remain committed to delivering high-quality care to all our patients.”
The MOH’s guidelines on MRSA screening are part of a broader infection control strategy to manage antibiotic-resistant infections.
According to the 2023 National Antibiotic Resistance Surveillance (NSAR) Report, the MRSA rate dropped from 14.9 per cent in 2020 to 5.5 per cent in 2023, with most cases coming from medical, surgical, and orthopaedic wards. The report analysed 404,270 bacterial isolates from 45 public and university hospitals and one public health lab.
MOH guidelines recommend MRSA screening based on risk factors, including for high-risk patients at admission and discharge, as well as contacts of MRSA cases. Screening is also suggested for moderate-risk patients with prior MRSA infection or frequent hospital stays.
For moderate to minimal risk areas, screening is advised if there is evidence of contact with MRSA, and admission screening is recommended for patients with a history of MRSA infection, frequent hospital admissions, or transfer from hospitals affected by MRSA.
Couple Demands Regulatory Oversight, Third-Party Mediation For Hospital Billing
Leong and Kok reached out to CodeBlue after CodeBlue’s story about Life Insurance Association (LIAM) chief executive Mark O’Dell’s private hospital bill amounting to nearly RM19,000 for a minor hernia surgery went viral.
The couple wanted to share their experience in light of Bank Negara Malaysia’s (BNM) new policy decision mandating health and medical insurers to offer at least one co-payment product with minimum 5 per cent copayment, effective last September 1. This policy decision, according to the central bank, is designed with the intent to encourage consumers to be more responsible and mindful of their medical expenses.
“It’s not that we cannot afford it,” Leong said. “The point is to make sure that hospitals do not simply slap consumers with charges that have no justification just because they have swiped our credit card.”
“We know we won’t get the money back,” Kok added. “I said, ‘it’s okay’, but we want to spread the word and hold them accountable. There should be a process where hospitals submit their cost policies for approval by Bank Negara or the MOH.”
Leong and Kok essentially want transparency from private hospitals on how they charge patients. They are calling for the establishment of a third-party body to handle billing disputes and regulation from MOH to monitor private hospital charges.
“The only thing I know is that the room costs RM225. There are many other items on the bill – how many gloves, how many injections, how many monitors, clinical waste disposal – I also don’t know. I just take it as it is,” Kok said.
Currently, private hospital charges are largely unregulated, with the exception of doctors’ fees, which are governed by the Private Healthcare Facilities and Services Act (PHFSA) 1998.
LIAM CEO O’Dell previously suggested regulating private hospital charges with Diagnostic Related Groups for bundled payments, instead of the current practice of ala-carte billing.
