A widow’s cry

It is the most painful feeling known to man, to lose a loved one due to illness, particularly if that loved one is neither so old nor so infirm and suffering that their passing would be more humane. But what adds to the depths of grief is the family not getting the due help it needs at the time they need it most.

This is the dilemma of the widow of Ajay Pathak, the beloved tennis official who passed away from a variety of illnesses late last year. Ajay was a selfless man, an Indian national who called the Philippines his home for three decades until his passing, who rose from a national Philippine Lawn Tennis Association (Philta) official to an ITF Asia junior tennis official. A devout Catholic later in life, Pathak often used his own money to support tennis programs he believed in. At the time of his death, he was personally financing a start-up junior tennis academy out of his home in Subic with his son-in-law.

Pathak is also known as the father of champion former national swimmer Em-Em Velasco, who fought through the lonely separation from her parents while training and studying in Australia. Pathak married Em-Em’s mother, Amanda when she was a child, and treated her as if she had always been his. They loved swimming, tennis and each other, and he even named the family export business after Em-Em.

On June 12, 2012 while the country celebrated Independence Day, Ajay was admitted to Medical City with “severe acute exacerbation of chronic obstructive pulmonary disease”. But unfortunately, during his stay there, according to a letter from the Pathak family lawyer, Atty. S.P. Armamento III, “he developed recurrent nosocomia or health care associated pneumonia. That other medical conditions managed during her late husband’s confinement were: acute decompensation of post hepatitic chronic liver disease, with secondary server hypoalbumenemie, jaundice, edema and hepatic encephalopathy, hypertension, hypertensive cardiovascular disease and congestive heart failure functional classification III-IV; and diabetes mellitus, uncontrolled.”

Imagine having to read that imposing list of illnesses that sound more like a dictionary of complicated medical terms referring to a family member. Looking at that roster of unpronounceables is terrifying when you realize just one person had them all, and their chances of recovery grew smaller with each additional condition. That is what the Pathak family endured for weeks.

According to the Expanded Health Care Services Program entered into by Pathak with Caritas Health Shield signed and sealed on November 11, 2011, the family is entitled to a coverage of P 450,000 per illness per year. Pathak was supposedly entitled to the maximum coverage because the policy was in its tenth year. Therefore, upon his death, Pathak’s family was entitled to P 2,250,000 in health care and hospitalization benefits.

However, Caritas Health Shield allegedly claimed that all his illnesses were related to his original diagnosis, denying that no unrelated illnesses arose while he was confined. Caritas remitted P410,626.01 to the hospital as what it considered the due coverage amount, an amount short by P1,839,373.99 according to the family’s legal representation.

On September 14, 2012 the family obtained a certification from Dr. Liza M. Llanes-Garcia, FPCP, FPCCP attesting that all the other diseases were not related to his admitting diagnosis, and therefore were all distinct illnesses that came about during his confinement. The family forwarded the certification, a letter-demand and all other pertinent documents to Department of Health Assistant Secretary Nicolas N. Leuterio III of the Bureau of Health Facilities and Services. On April 26 of this year, Leuterio in turn officially endorsed the documents to Carlos D. Da Silva, executive director of the Association of Health Maintenance Organizations of the Philippines (AHMOPI) for the proper action.

“Our client had already informed Caritas Health Shield of their obligation through a demand letter, which Caritas, through its Vice President for Corporate Affairs, Mr. Manuel S. Reyes acknowledges but until now still refuses to settle their outstanding obligation,” Armamento continues.

“Imagine how hard this is for us,” cried a distraught Em-Em Velasco to The STAR. “We already lost our Papa due to all these illnesses after such a long confinement. Now we have to find a way to pay for these expenses while they refuse to pay us. It’s depressing.”

Copies of documents mentioned here have been furnished The STAR. Ajay Pathak was one of the first people this writer met as a sports journalist over a quarter of a century ago. He was also one of the few who visited my mother in the hospital before she passed away two years ago. He kept his illness to himself, most of his closest friends only knew he had been ill upon his passing. He was soft-spoken, kind, noble, selfless, and never wanted to burden anybody, especially not his family. It is sad that, in his passing, his efforts to protect them from these problems have gone unaided. They (Pathaks) deserve better.