Medical Tourism: Passport to Cheaper Health Care?

When Things Go Wrong continued...

"I am very disappointed in Wockhardt," says Rupak. "She should never have been accepted by them. It just wasn't safe." Planet Hospital no longer sends patients to the Wockhardt hospital in Mumbai, which is still JCI-accredited.

Two months after Jarvis's death, another medical tourist died, this time in a Brazilian hospital following a gastric reduction duodenal switch surgery, an alternative to gastric bypass surgery. Her family doesn't wish to publicize her name, so she is referred to in this article as Nancy.

According to a blog she kept on Obesityhelp.com, Nancy, 44, weighed 360 pounds and had been considering weight-loss surgery since 2001. In her blog, she wrote about problems getting health insurance coverage for the procedure, which would cost $29,000 to $35,000. Then Nancy, who lived in Roseburg, OR, learned about overseas operations. "I just can't justify $34,000 here in the States when I can get it done for $10,000 to $15,000 elsewhere," she wrote. She ended up seeing João Marchesini, M.D., who operates in Curitiba, Brazil. His Website claimed that more than half of his duodenal switch surgery patients were American or Canadian. As of May 2007, almost a year after Nancy's death, the Website continued to boast, "The mortality rate related to duodenal switch is zero percent." (The site has since been taken offline.)

On July 1, 2006, Nancy wrote: "Oh my God, this is so flipping real. In 13 days...I can finally join the [weight] losers bench!" On July 12, she wrote: "Well, I'm about ready to leave for the hospital...I will e-mail after surgery...probably not for at least a couple of days." Three days later, Nancy was dead. According to her niece by marriage, Allison Rudolf of Ione, OR, Nancy, like Jarvis, was killed by a pulmonary embolism.

Neither family holds the doctors responsible, so they never considered suing. But even if they had felt differently, legal action would have been difficult. Foreign laws are different, the court systems operate in the local language, and settlements are considered low by American standards. Suing overseas is also expensive, assuming you can find a U.S. lawyer familiar with the host country's legal system.

And then there are cultural differences. "Most countries don't have the litigious environment we do, and that's something every medical tourist needs to consider," says David Boucher, assistant vice president for health-care services for BlueCross BlueShield of South Carolina, which has a subsidiary that covers medical care abroad. Experts speculate that one reason surgery overseas is so much less costly is that hospitals and doctors don't pay as much for malpractice insurance as their counterparts do in the United States.

The lack of legal recourse is a real problem for West Virginia Delegate Ray Canterbury, who has proposed a bill in the legislature that would provide state employees and their families coverage for overseas medical care. (A similar bill has been proposed in Colorado; neither has yet passed.) "The potential for malpractice is one of the biggest hurdles we need to overcome before pushing through legislation that would offer foreign medical care to state employees," says Delegate Canterbury. His plan proposes third-party insurance, which would offer compensatory damages to patients who are disfigured or maimed.

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