No biopsy, straight to chemo - The Fate of Migrant Workers in Israel

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This is a particularly shocking story, by Ran Reznick of the Israeli daily, Haaretz (Feb 4, 2009) sourced from the website of Kav Laoved, Workers Hotline, which defends the rights of migrant and Palestinian workers in Israel. Of course Histadrut, the racist Zionist trade union, refuses to defend or support in any way such workers. That is why trade union activists in Britain are committed to severing links between this racist settler union and British trade union. It is also a salutary lesson to those who think that insurance cover is an alternative to the UK's National Health Service, which New Labour is busily trying to dismantle.

Tony Greenstein

Last October, 32-year-old Arlyn Rose Malyonas, a caregiver from the Philippines, came to Ichilov Hospital in Tel Aviv with severe abdominal pains. She was hospitalized in the gynecology ward, and doctors suspected she was suffering from cancer that had metastasized. However, in order to obtain a conclusive diagnosis, they determined she would need a biopsy. But Malyonas' insurer, Med Health Services for Foreigners, a subsidiary of the Phoenix Insurance Company that serves foreign workers, decided this was not necessary.

"It can be said with a high level of certainty that this is a matter of a metastasized malignant cancer ... even without a certain tissue diagnosis," the company's Dr. Ronit Barak and Dr. Motti Bachar wrote on November 16. "There is no call for surgical intervention, and it is best avoided."

The company refused to fund the surgery and added, "Since [Malyonas] will not be able to return to work within 90 days, it is best she return to her home country."

The insurance company's refusal led Ichilov's doctors to apply to the non-profit Physicians for Human Rights, which also urged that the patient be given a biopsy. The issue also received coverage on Army Radio, in a report by Lana Bond. At that point, the insurance company arranged an examination with surgeon Dr. Avinoam Shkolnick, the general manager of Laniado Hospital in Netanya, at his private clinic in Tel Aviv on November 9. "There is no doubt" that she had ovarian cancer, he wrote. He rejected the possible diagnosis of tuberculosis, and added that performing a biopsy was superfluous, "and is liable to cause complications such as bleeding and infection." Ichilov's Professor Yossi Lessing contacted Shkolnick to stress the importance of diagnostic surgery, but to no avail.

In November, the patient began chemotherapy at Laniado Hospital. Only then did her insurance company agree to let her undergo a biopsy - which showed that she did not have cancer, but rather tuberculosis that had spread to her abdominal organs.

Doctors stated that this means the she did not need chemotherapy - which can have side effects and severe medical implications - and the chemotherapy was given based on a mistaken diagnosis. Malyonas is now receiving daily antibiotic treatment at the League for the Prevention of Lung Disease in Tel Aviv, which will continue for at least half a year.

Even before the biopsy, the doctors from Med Health Services for Foreigners informed her that "she was suffering from ovarian cancer that had spread to her liver."

In the wake of this, the heads of Physicians for Human Rights complained to the Health Ministry about Dr. Shkolnick, Dr. Bachar and Dr. Barak. Five senior doctors who volunteer with the non-profit, along with Ran Cohen, the head of the department for emigrants and individuals without status at the association, signed on the complaint against Dr. Shkolnick.

Professor Yossi Lessing, head of the gynecology and obstetrics department at Ichilov Hospital, complained as well.

The case is currently being investigated by the Health Ministry ombudsman and the Israel Medical Association ethics bureau. Ethics bureau head Professor Avinoam Reches has already to written to Dr. Yael Merrick, the director of Laniado's oncology unit, stating that parts of the patient's file at Laniado, which stated that cancer had been diagnosed at Ichilov, are "in the best case fundamentally mistaken and in the worst case erroneous and deceptive," and that "taking into consideration the aggregate of events surrounding this patient, this is particularly grave."
Professor Reches also wrote to Dr. Merrick, stating he would like to know "whether [Laniado] usually gives chemotherapy treatment the way this patient received it, without a clearly histological diagnosis, and whether an Israeli patient would have been given chemotherapy under such circumstances."

Professor Reches also contacted Dr. Shkolnick and asked him to answer a series of "particularly distressing questions" concerning the affair, such as how "it appears that the insurance company 'expropriated' the patient from Ichilov and blocked essential medical measures, apparently for financial reasons," and "how it is possible to plan follow-up medical treatment in a clearly oncological case ... after a necessary diagnostic procedure has been prevented."

Oncologist Dr. Bella Kaufman told Haaretz that in this case, "there are doctors who have forgotten that that their supreme commitment is first of all to the patient. They took a foreign, weak woman and told her that she has cancer even though she did not receive all the necessary, customary diagnosis tools. This is shocking treatment."

Gynecologist Dr. Ilan Gal, one of the founders of the non-profit organization, said, "the state has placed, and sometimes abandoned, medical services for foreign workers in the hands of insurance companies with economic interests. We hope to revoke the existing law and transfer health services for foreigners to the health maintenance organizations."