Know before you go: Medical tourism and patient safety

The file download for the latest radio program, “Know before you go” with Ilene Little is available.  It’s from the Christmas broadcast with Dr. Freddy Sanabria.

Image courtesy of Ilene Little

Image courtesy of Ilene Little

(I am on the periphery of the show – introducing Dr. Sanabria and talking about safety guidelines and intra-operative safety protocols.  (Same stuff I talk about here – just a different medium.)

Sanabria, breast implant

Dr. Sanabria, plastic surgeon

Dr. Sanabria joined us to talk about his experiences, and his clinic in Bogotá, as well as his ongoing projects and  patient safety protocols.  It was nice to be able to share some of my observations from my visits to his operating room.

safety checklist

Click here to connect to the Radio show archives


New venture with Colombia Reports

While I have written several books about surgery and surgeons in Colombia, much of this information I’ve obtained from my research has been consigned to sitting on the shelves of various bookstores.

But, now with the help of Colombia Reports, I am hoping to change that.  As I mentioned in a previous post, Colombia and it’s founder, Adriaan Alsema have been amazingly supportive of my work, ever since they printed my first article on Cartagena in 2010.

Since returning to Colombia, I have kept in touch with Colombia Reports while we discussed ways to bring more of my research and work to the public.  Colombia Reports is a perfect platform – because it serves a community of English-speaking (reading) individuals who are interested in/ and living in Colombia.   With this in mind, Colombia Reports has created a new Health & Beauty section which will carry some of my interviews and evaluations.

It is an ideal partnership for me; it allows me to bring my information to the people who need it – and continue to do my work as an objective, and unbiased reviewer.  We haven’t figured out all of the details yet – but I want to encourage all of my faithful readers to show Colombia Reports the same dedication that you’ve shown my tiny little blog, so that our ‘experiment’ in medical tourism reporting becomes a viable and continued part of Colombia Reports.

This is more important to me that ever – just yesterday as I was revisiting a surgeon I interviewed in the past (for a new updated article), I heard a tragic story that just broke my heart about a patient that was recently harmed by Dr. Alfredo Hoyos.  While I was unable to obtain documents regarding this incident – this is not the first time that this has happened.

Previous accusations of medical malpractice against this surgeon have been published in Colombian news outlets including this story from back in 2002.

The accusations are from Marbelle, a Colombian artist regarding the intra-operative death of her mother, Maria Isabeth Cardona Restrepo (aka Yolanda) during liposuction.  These accusations were published in Bocas – which is part of El Tiempo, a popular Colombian newspaper, in which the singer alleges that Dr. Hoyos was unprepared, and did not have the proper equipment on hand to treat her mother when she went into cardiac arrest during the surgery.

story about the death of one of Dr. Alfredo Hoyos' patients.

story about the death of one of Dr. Alfredo Hoyos’ patients.

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Now – as many of you remember, I interviewed Dr. Alfredo Hoyos back in 2011, and followed him to the operating room, giving me first hand knowledge of his surgical practices.

Readers of the book know he received harsh criticism for both failure to adhere to standard practices of sterility and patient intra-operative safety (among other things.)  I also called him out for claiming false credentials from several plastic surgery associations – and notified those agencies of those claims..   In the book, readers were strongly advised not to see Dr. Hoyos or his associates for care.

But – as I mentioned, my book is sitting lonely on a shelf, here in Bogotá – and in the warehouses of and other retailers.. So, people like that patient – didn’t have the critical information that they needed..

This is where Colombia Reports – and I hope to change all that.   So in the coming weeks, I am re-visiting some of surgeons we talked to in 2011, and interviewing  more (new) surgeons, more operating room visits..

In the OR (and back again!)

It sounds awful to say but it’s a good thing my husband has been out-of-town this week – after all, considering my week in the operating room, he wouldn’t have seen much of me anyway!  But it always drives him a little crazy to see me racing from interviews to operating rooms – stumbling home late, with aching legs and a rumbling tummy, only to climb out of bed and the crack of dawn just to do it again.. then worry that I somehow won’t have time to write it all down – and round and round..  (That being said – he is phenomenal about understanding this driving motivation I have to interview, and to write – even when I’m not quite sure I understand myself.)

So he wouldn’t have complained about my whirlwind tours of the operating rooms this week – or the long days of back-to-back surgery but I would have felt bad about not seeing him all the same..

Instead with my husband thousands of miles away, I hear him smiling in the phone, laughing at my exploits, though I sometimes picture the wrinkle he gets in his brow when he thinks I’m not eating right, or getting enough sleep.. He currently serves as my remote editor for my articles at – calling to give feedback before submission.  He’ll be home soon – and he’ll be patient with me, as always.

Dr. Victor Ramirez, plastic surgeon

Had some great interviews and operating visits this week – including Dr. Victor Ramirez, and most of the plastic surgery community here in Mexicali – but to be fair, I will break it all up into a couple of posts.

Demonstration of techniques for breast reconstruction at Mexicali General

Back in my ‘home’ OR in thoracic surgery – which felt good.  I love meeting and seeing all the different specialties like bariatrics, urology and plastics, but it sure does feel good to come back home again..

back in thoracics (and trying to hang from the rafters)

I could wax some eloquent nonsense about the beauty of a muscle-sparing thoracotomy but then again – the good doc does almost everything minimally invasive, so I never see any.. (and you’ve heard me crow about dual port thoracoscopy.)

with more to come..

UK surgeons add their voices to speak out against Medical Tourism

As we’ve written before, local plastic surgeons are fighting the loss of income from medical tourism.  In the UK, where 1 in 20 patients (in one poll) have used medical tourism, are adding to the dissentThis isn’t the first time British plastic surgeons have spoken out against medical tourism – in fact, British physicians were the first ones to publish commentaries against the practice of traveling overseas for surgery in professional journals.   Last year, they released a statement condeming this practice.

Now, these surgeons are speaking out in the popular press.  The irony is, while these statements are primarily aimed at people travelling to India – as readers of our sister site know, they just as easily could apply to the United States (and our large contingent of ‘phony docs.’

But how much of this is real?  and how much of this is hype to boost their own sagging practices?  It’s hard to know since much of the ‘data’ is based on polls of UK plastic surgeons.

In related news, Las Vegas has started a new task force to weed out phony/ fake doctors operating in the hispanic community after several highly publicized incidents – including several deaths.

More stories from Cartagena Surgery:

How to investigate a potential surgeon

Busting a fake clinic in Los Angeles

Unqualified Arizona doc heads to trial after several patient deaths

The ‘fix a flat’ doc

The original fix a flat doc story

Follow cartagena surgery for more stories..

American plastic surgeons lash out against medical tourism

As I’ve mentioned in a few of our older posts – medical tourism makes many American plastic surgeons very, very unhappy.   While many of their complaints are legitimate (patients could get inferior care, infections etc..) all of these complaints or comments apply to their American peers as well.  (On my sister site, we tackle many of the dubious practices in the USA (eye doctors performing liposuction, ‘fake’ doctors injecting people with fix-a-flat, and all those dentists, and hair salons injecting Botox.)

But today I take issue with Dr. Michael A. Bogdan, a plastic surgeon currently practicing in Southlake, Texas.  (Hope everyone is impressed in his degree in Zoology.) But back to the serious issues..

Dr. Bogdan recently authored an article published on Medscape questioning medical tourism in light of the PIP implant scare.  (The full article is re-posted below.)  While he makes some legitimate points in the article, (points that we have discussed here) about the lack of scrutiny on the medical travel agencies themselves, and the lack of data about complications from medical tourism surgeries – he grossly oversteps when he attempts to place the blame for the PIP implants on the feet of the medical tourism industry.

When you consider the THOUSANDS of medical devices (including different versions of breast implants) that have been recalled in the United States in the past 25 years – it undermines his whole premise.  I also find it somewhat offensive that he a.) dismisses all foreign surgeons as using faulty/ inferior equipment – that’s a wide, wide brush to use, Dr. Bogman.. 

and more importantly, b.) that in a small way – he almost sounds to me like he thinks that people who travel abroad for their surgical care – deserve to have these kinds of problems and complications.  Very uncool, and shame on you, Dr. Bogman.

In reality, Dr, Bogman and many other plastic surgeons here in the USA are lashing out at the bad economy which has dampened the public’s enthusiasm for surgical self-improvement.  (Though this article indicates the economy is recovering.)  It’s likely that as a plastic surgeon in Texas (a border state) that Dr. Bogman, seller of such procedural combinations as the ‘mommy makeover’ is feeling the loss of patients more than, let’s say a surgeon in Virginia..

More tellingly, and surprisingly, he doesn’t suggest that patients should research their surgeon wherever and whoever they are.

But read the article from yourself and decide:

The Cost of Medical Tourism by Michael A. Bogdan, MD

Complications From International Surgery Tourism Melendez MM, Alizadeh K Aesthet Surg J. 2011;31:694-697

Summary Medical tourism (ie, traveling outside the home country to undergo medical treatment) is a rising trend. An estimated 2.5 million Americans traveled abroad in 2011 to undergo healthcare procedures. This results in a significant direct opportunity cost to the US healthcare system. Complications from these procedures also affect the US healthcare system because patients often require treatment and have no compensation recourse from insurance. For cosmetic or other procedures that are not covered by insurance, economic motivators are driving medical tourism because some international clinics offer procedures at significantly lower costs, possibly by compromising the quality of care.

Very little data have been available to assess the outcomes, follow-up, and complication rates for patients undergoing cosmetic procedures abroad. The authors of this study distributed a 15-question survey to 2000 active members of the American Society of Plastic Surgeons about experiences treating patients with complications from procedures that they underwent during medical tourism. The response rate was acknowledged to be low, at 18%. Of the respondents, 80% had treated patients with complications arising from surgical tourism. Complications included infection (31%), dehiscence (19%), contour abnormalities (9%), and hematoma (4%). The majority of respondents reported not receiving any compensation for the care delivered to these patients.

Viewpoint Some patients travel to other states or countries seeking specialized care from surgeons who are experts in their field. In these cases, the patients understand that they will be paying a premium for the expertise, as well as the added expenses incurred for travel and lodging. These patients would be paying significantly more than they would have by undergoing the same procedure locally, but they consider the additional cost worthwhile due to the expected higher level of care.

The majority of patients who are attracted to medical tourism have a different motivation — they are trying to attain an equivalent level of care for a lower cost. Consumers are traditionally driven by price rather than quality and generally do not consider issues regarding follow-up and potential complications. Although reputable international clinics that offer high-quality care do exist, the greater majority that are trying to attract medical tourism patients are doing so by offering low prices. Overhead costs may be lower in other countries, but the level of regulation is also lower. Thus, the accepted standards of care tend to be lower as well.

A recent example of this issue is the current crisis involving breast implants manufactured by Poly Implant Prothèse (PIP).[1] Instead of using medical-grade silicone to manufacture these implants, PIP used substandard industrial-grade silicone as a cost-saving measure. Probably because of this, the implants have a markedly higher rate of rupture than other available breast implants. The International Society of Aesthetic Plastic Surgery recommends removal or exchange of these implants to avoid further health risks.[2]

PIP implants have not been used in the US since 2000, owing to the Food and Drug Administration’s (FDA) decision that the premarket approval application was inadequate.[3] In addition to blocking the use of these implants in the United States, the FDA sent a warning letter to the manufacturer discussing inadequacies in the manufacturing process.[4]

PIP implants have a significantly lower price point than implants approved for use in the United States and are therefore competitive in countries with less stringent regulation. International surgeons trying to entice patients with lower costs could easily justify using PIP implants. In my own practice, I have met patients who were lured overseas for less expensive surgery and ended up with PIP implants. These patients are now faced with additional expenditures for surgery to address complications.

If you have influence over a patient’s decision on where to undergo surgery, advise them of the adage: Buyer beware; you get what you pay for.

Looks like Panama may bite off more than they can chew..

In a recently published story, the government of Panama is now offering medical  insurance for all tourists to Panama for free.  This insurance is not  ‘Complication Insurance’ which is offered by private surgeons in Colombia and other countries for patients traveling specifically for medical tourism.  Complication insurance covers all possible medical complications resulting from medical procedures at the designated clinic or destination..

No – Panama is taking the European and socialized medicine approach and is offering general medical coverage for ALL short-term travelers to Panama.  (The long-term exclusion is a wise move given the numbers of Americans and other overseas residents who make Panama their retirement home.)  This insurance resembles typical travel policies in that it covers injuries, accidents and other medical situations that may occur while on vacation..  I just hope the Panamanian government hasn’t underestimated its tourists and their injury/ illness potential.

Now readers – don’t get any wild ideas.. This is not the time to stress that ‘trick knee’ while hiking to visit the Naso-Teribes..

Meanwhile, Costa Rica is making a pitch for more corporate clients such as Pepsi-Cola.  These multi-national corporations can potentially bring hundreds of millions of healthcare dollars by diverting their employees to medical tourism destination such as Costa Rica.  (Like Colombia – Costa Rica is an ideal destination for North Americans due to proximity, quality and diversity of services available.)

BBC, Dr. Celso Borhoquez and Breast Implants

In this story from BBC, Dr. Celso Borhorquez, media spokesperson or the Colombian Society of Plastic and Aesthetic Surgery  (and previous interviewee here at Bogotá Surgery) talks about breast augmentation in the wake of the PIP scandal.  Dr. Borhorquez reports that many Colombian women are reconsidering their options, and electing to forgo breast implantation procedures after widespread media reports on the defective french implants.  (More on the defective implants can be found here.)

And for the estimated 14,000 women in Colombia who already have PIP implants – Thanks to the Colombian government, implant removal is free..