The Director of the Multiple Sclerosis Center at the Sheba Hospital in Tel Hashomer, Professor Anat Achiron, warned her Maccabi insured patients that the health insurance fund is seriously endangering their lives because it has not been performing the special blood test for them for about six months, which must be done for anyone who receives one of the multiple sclerosis drugs that it has Risk of a fatal and incurable neurological complication, which may lead with high certainty to disability and death from brain inflammation.
Professor Ahiron, who is considered one of the top and best doctors in Israel for the treatment of sclerosis, raised the harsh warnings against Maccabi in a special letter that was personally delivered to all the sclerosis patients who are members of Maccabi in Sheba.
Senior officials in the health system told "Israel Today" that "such serious accusations against the health insurance fund for actually endangering the health and lives of the patients have never been raised by such a senior doctor in Israel."
The accusations caused an uproar
"Israel Hayom" has learned that Professor Ahiron's accusations caused a great uproar between Maccabi, the Ministry of Health and Shiba.
Professor Ahiron was even unusually summoned as a doctor in her capacity for a hearing by the hospital's management, headed by Professor Yitzhak Kreis.
Professor Ahiron's accusations join the accusations of the Ministry of Health, that unusually the General Health Insurance Fund, the largest insurance fund in Israel, prevents hundreds of multiple sclerosis patients from receiving essential drugs that are included and budgeted for hundreds of millions of shekels per year in the drug basket, contrary to the government's decision, to the State Health Insurance Law, to the instructions of the CEO The Ministry of Health and even contrary to the agreements of the fund itself during the deliberations of the basket committee for 2022.
Maccabi: "Prof. Ahiron's letter contains incorrect information and we have nothing but to express our regret for that; we congratulate the fact that the hospital did not pass on the distribution of the letter in silence"
Multiple sclerosis is a chronic inflammatory disease that affects the central nervous system in the brain and spine and causes severe neurological damage including limb weakness, vision impairment, speech and sleep disorders and more.
The drug in question, photo: Public Relations
"arbitrary decision"
The serious accusations against Maccabi refer to the drug TYSABRI, which was introduced to the drug basket back in 2008 and is currently given to about 500 MS patients a year, of which about 200 are members of the Maccabi Health Insurance Fund, at an annual cost of tens of millions of shekels to the four health insurance funds.
The drug is given by infusion and is considered one of the best and most effective for the disease, and it delays the physical disability and attacks of the disease.
However, according to the instructions of the Ministry of Health, the administration of the drug requires close monitoring through a special test that is conducted every six months of a patient's blood sample, to detect carriers of a virus that may cause multiple sclerosis patients who take the drug to develop a rare and fatal brain disease (PML disease) that has no cure and causes paralysis. Blindness and death within a year in half of the patients.
The blood test is conducted for patients before receiving the medicine, every six months it is sent to a laboratory in the Netherlands and there is no laboratory in Israel that tests these samples.
Professor Ahiron warned that "since January, we have been fighting Maccabi's arbitrary decision to stop the sequence of your treatment at the hospital, and the fund continues to create administrative difficulties that pose a health risk especially for patients with the Tisbari drug, and it is not possible to disconnect the treatment with the drug from the required proper follow-up, as Maccabi does.
Prof. Achiron: "Maccabi continues to create administrative difficulties that pose a health risk; we hope that this letter will help bring about a change in this reality"
"Treatment with the drug is complex and requires experience and skill, and is not like every treatment. In addition, an integral part of the correct medical treatment and follow-up is the frequent and regular performance of the blood test to diagnose the presence of the virus, and taking the necessary measures if the test is positive.
"These tests are performed by a central laboratory abroad and we at the scleroderma center in Sheba have been responsible for many years for performing the tests, verifying the answers and making the medical decisions regarding the continuation of the treatment.
However, since January, Maccabi refuses to approve many of you receiving the drug treatment at the Sclerosis Center in Sheba, and therefore many of you receive the treatment at the cash register without neurological supervision and certainly without the supervision of multiple sclerosis specialists.
This means that the antibody tests are not performed continuously for the patients, and any of the patients who are infected with the virus without their knowledge because there are no follow-up blood tests at Maccabi, may develop a serious neurological complication up to the loss of life.
We warn you that failure to perform the test, as has been happening for the past six months following the conduct of the fund, constitutes a serious medical risk, contrary to the proper medical follow-up that we made sure to allow at the sclerosis center, and we, the team of doctors, doctors and nurses at Sheba, have found it appropriate to bring to your attention and to the knowledge of the Ministry of Health the health danger that you are are exposed to it due to the conduct of the Maccabi Health Insurance Fund.
We regret that the conduct of the fund creates a reality in which the health of the insured is not at the forefront of its attention, and we hope that this letter will help bring about a change in this reality."
"misleading letter"
About a week after Professor Ahiron delivered the letter to the patients, Dr. Miri Mizrahi-Rauvani, head of the health division at Maccabi, wrote to them that the information provided by Ahiron in her letter was "misleading and was sent without the knowledge of the hospital management," and that it was Sheba Hospital that refused to accept the commitment form to perform the special blood test. She also wrote that "Unfortunately, he conditions the performance of the test on receiving the drug infusion at the hospital itself."
The heads of the Multiple Sclerosis Association, which represents about 10,000 patients with the disease in Israel, said that "if the claim is true that Maccabi patients are denied the opportunity to perform the blood test continuously or that their results cannot reach the specialist treating them in time, then this is indeed serious and may cause a health hazard. Very sorry For the fact that thousands of patients in Israel, whose lives in the shadow of the disease and its limitations are not simple, frequently encounter various refusals to receive a proper response to their many needs, while causing severe and unnecessary anxieties and hardships and even risking their health. On top of that, they become playthings in struggles that are not theirs."
The response was given by Dr. Ron Milo, chairman of the association's medical advisory board, and Janine Vosberg, the association's executive director. The Ministry of Health stated: "Maccabi is responsible for the health of its insured and in our understanding is acting as required.
There is no obstacle for the fund to give the transfusion to the insured in the community clinics, while at the same time allowing the blood test to detect infection in various hospitals before sending it to a laboratory abroad, including at the Sheba Hospital. Naturally, the results of the tests arrive regularly at the hospital for the continued follow-up of the patients. According to what is known To the ministry, in the coming period Maccabi intends to complete evaluations for carrying out blood collection at the fund. Until this procedure is completed, the fund allows any insured person who wishes to receive the transfusion at Shiba to do so."
Maccabi stated: "Professor Anat Ahiron's puzzling letter contains incorrect and misleading information and we have nothing but to express our regret for this. Contrary to what is stated in the letter, Maccabi is issuing commitment forms for examination at the Sheba Hospital. We welcome the fact that the hospital did not distribute this letter in silence and made statements about their accuracy, since he announced that he agrees to honor the commitments on behalf of Maccabi to carry out the laboratory test."
From Sheba it was reported: "The Sheba Hospital and the Maccabi Health Insurance Fund have reached an agreement according to which the tests required for sclerosis patients to ensure the continuation of the therapeutic sequence, its quality and safety, will be carried out in coordination."
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