Man's death, Sh65m bill big test for SHA's promise to ease medicare pain

John Kamau Gichatha fought for his life for eight months and six days at the Aga Khan University Hospital’s Intensive Care Unit, but he did not make it.

His story, and the predicament the family faced owing to a huge medical bill, became public after the private institution moved to court to force the family either to transfer him to a public health facility or taken home.

By the time Aga Khan was moving to court, it indicated that the 63-year-old man had accrued around Sh52 million. It claimed that the family had promised to do a harambee to defray Sh 7 million, but nothing was forthcoming. The Standard exclusively documented this.

Justice Roselyn Aburili directed the hospital to allow Dr Paul Wangai to assess whether it would be possible to have Kamau transferred from the critical care unit. This was in April this year.

Days after the court’s order, he died on May 16. But his bill has now risen to Sh65 million.

His family has now filed a fresh case. His son James Gichatha and daughter Agnes Wanjiku claim that the hospital has declined to release the body.

Kamau is now a poster boy for Kenya’s failed promises in critical healthcare. When President William Ruto launched the new medical scheme, the Social Health Insurance Fund (SHIF), he promised Kenyans that the Social Health Authority (SHA) framework would eliminate out-of-pocket medical poverty and community-funded hospital drives.

Kamau was admitted at the hospital’s High Dependency Unit (HDU) for about nine days. According to the court record, after observation, he was transferred to the Intensive Care Unit (ICU) where he remained until his death.

His children narrated that the Aga Khan had requested them to pay Sh400,000 as a deposit as they awaited the SHA to confirm his status.

“The family could not raise and the respondent accepted Sh 265,000,” court papers read in part. However, the amount was paid in three tranches, on October 11, 13, 15 and 22, 2025.

According to them, they believed that SHA would foot the bill as the deceased was active, having paid for the government-owned insurance scheme.

“At the time of admission, it was agreed and/or understood that the medical expenses would be covered under the Social Health Authority (SHA) scheme. The deceased’s SHIF policy was active at the time of his admission on October 10, 2025, as a patient at the respondent’s medical facility,” explained Gichatha.

He alleged that the hospital, on May 15, insisted that his father should be transferred immediately, adding that this was contrary to the consent order before Justice Abrurili.

“On May 16, 2026, I received a call from the respondent informing me that the patient had deteriorated and he was in a critical condition presenting with hyperventilation and low blood pressure. Within a few minutes, I was informed that the patient had died while receiving treatment,” said Gichatha.

 He stated that they wrote to the medical facility, seeking to collect his body for burial on May 21. However, according to Gichatha, the facility’s management indicated that they would only release it if they allegedly offset the bill, got collateral or had an undertaking from a qualified lawyer guaranteeing settlement of the bill.

They followed the request with a demand on May 22, this time demanding release by May 27.

Gichatha claimed that Aga Khan went quiet.

“The continued withholding of the body subjects the family to psychological anguish and emotional suffering. Hospitals must pursue lawful debt recovery mechanisms and cannot resort to holding bodies as collateral. The respondent’s conduct undermines the constitutional framework to accessible healthcare, given the treatment was undertaken under a public health scheme under the Social Health Authority and the Social Health Insurance Fund, which is contrary to Article 34 (1) (a) of the Constitution of Kenya ,” he argued.

Initially,  Aga Khan claimed that Kamau was out of danger, but the cost of taking care of him was still shooting up. It further alleged that Gichatha had allegedly refused to have him moved to the Kenyatta National Hospital ICU or any other health facilities or a nursing home.

Aga Khan’s clinical liaison officer, Dr James Njenga, swore an affidavit in support of forcing the family to take him home or transfer him to Kenyatta. He explained that Kamau’s blood circulation was now okay, and no longer needed tube feeding or an oxygen system to live.

He, however, said that he needs continuous care. According to Njenga, the services Kamau needed could also be offered at public health facilities.

“I know the patient does require continuous medical treatment and such treatment is available at subsidized costs in public health facilities such as Kenyatta National Hospital and/or several other health care facilities at the level of nursing homes, but the respondent has declined to consent and insists on having the Patient stay at an acute care facility,” argued Njenga.

From the court record, Aga Khan indicated that Kamau had been admitted as a self-paying patient. In its letter to the family, it claimed that SHA would only pay in accordance with the contract it has with the medical facility and not the patient.

Further, it stated that the authority also footed the bed rebate for a maximum of 180 days. This, according to the hospital, left the family with Sh 1.088 million to pay.

 Aga Khan said it had notified SHA about Kamau’s admission. It pointed an accusing finger at Gichatha, whom it claimed had hindered the deceased from being transferred to another facility.

“The deceased met almost all the guidelines for referral in many instances, but the son to the deceased was not cooperating... Be it as may be, a computation of the total rebate that would be paid by SHA in relation to our deceased patient has been provided above. The said amount will be a drop in the ocean given the total outstanding bill is Sh65.387 million. Whenever the patient and/or the family requires SHA to exceed its limits when settling a bill, a conversation between SHA and the patient or family is often patient-led and/or family-led but never hospital-led,” the letter by the hospital’s head of legal Valentine Achungo to Kamau’s family lawyer read in part.

The highest cost in the bill was the chest CT scan, charged at Sh52,020, followed by a head one at Sh49,500. The hospital also charged Sh7,300 for X-rays to the chest. Kamau was also charged Sh43,000 for the bed at the HDU.

For the medicine, the most expensive one was Zavicefta, an intravenous antibiotic which is used to treat severe multi-drug resistant bacterial infections. It is used to treat complicated intra-abdominal and urinary tract infections and hospital-acquired pneumonia. This was billed at Sh20,000. The hospital also charged Sh11,000 for vancomycin, a glycopeptide antibiotic which is used to stop bacteria from making their protective cell walls and Vitamin B1, which was billed at Sh15,580.

The most expensive consumables included a non-invasive ventilation (NIV) mask, which was charged at Sh16,000, a ventilator at Sh13,000 per day, and an arterial line insertion at Sh15,150 and a central venous line insertion done twice at Sh36,700. The hospital also charged Sh50,000 for a biofire respiratory panel, which is a molecular test for common viruses and bacteria that cause breathing infections.

In their letter to the hospital, Kamau’s family argued that he fitted in the chronic conditions category, which the SHA was allegedly supposed to sort. Nevertheless, they claimed that there was no claim that had been sent by the facility. They insisted that they were willing to assist with documentation to facilitate the process, which they said would be done even online.

“These mechanisms are intended to ensure that the eligible medical services are reimbursed directly by the fund, thereby reducing the need for recovery from patients or their families in respect of covered services. In the circumstances, we respectfully urge your institution to initiate, regularize, and prioritize the reimbursement process through the statutory claims framework,” the letter reads in part, adding that the widow was also insured under SHIF, in which he was a beneficiary.

“We are of the humble view that this approach accords with the spirit of the constitution, the Social Health Insurance framework and the broader principles of dignity and compassion that underpin healthcare delivery in Kenya,” they added.

In response, the hospital said that although the family suggested that the wife’s cover could also defray part of the money, the cover’s model was a household-based one.

“Consequently, the existence of a spouse or other household members does not confer additional or supplementary inpatient benefits beyond those already allocated to the household unit. The benefit entitlement therefore remains as per single household allocation and does not accrue cumulatively,” claimed Mr. Achungo.

The family wants the court to order the hospital to release Kamau’s body for burial.