When Things Go Wrong, It's Better To Be at Home
By Suz Redfearn Special to The Washington Post  Tuesday, July 8, 2008; HE01

Betty Meisel really wanted plastic surgery. She wanted her 30-year-old breast implants out and maybe a tummy tuck to fix the loose skin that resulted from having delivered five kids. But she knew it wouldn't be smart to tap into her and her husband's retirement accounts for the $20,000 it would cost. After all, they were in their mid-60s.

So Meisel tried to put thoughts of cosmetic surgery out of her mind -- until she happened to catch "60 Minutes" one night three years ago.

That evening, the show was highlighting the phenomenon of medical tourism, showing Americans traveling to such places as state-of-the-art Bumrungrad International Hospital in Bangkok, having surgery (cosmetic and otherwise) and recuperating for a few weeks in a gorgeous, exciting environment.

Not only that, these patients paid only a fraction of what they would have paid in the United States. Bypass surgery that could have cost a patient more than $100,000 was about $12,000 in Thailand, according to "60 Minutes." Meisel went to the hospital's Web site to price some of the cosmetic surgeries she was thinking about.

Meisel, a former health insurance agent, signed up, letting the hospital pick a surgeon for her. In fall 2005, she and her husband were on a 20-hour flight to Thailand.

Three weeks later, back home in Portland, Ore., things weren't good.

At the Thai doctor's suggestion, Meisel opted for a few more procedures while there: an eyelid tuck and a chin tuck. As a result, she was under anesthesia for 11 hours. She barely woke up in the first three days after surgery. When she did come to, she was plagued, suddenly, with panic attacks, claustrophobia and acid reflux. When her husband tried to get her help, the hospital nurses didn't understand what he was saying.

When Meisel got the bandages off at home, she saw that her surgeries ranged from badly done to completely botched.

"My eyes looked like a cross between a bloodhound and a Shar-Pei," Meisel says now, referring to dog breeds with copiously loose skin. "There were rolls of skin that stretched across my eyelids to my temples. I was so depressed. I didn't want to leave the house. I didn't want anyone to see me."

Meisel's breasts contained no tissue below the nipple, a result that was clearly visible through her clothes. Her stomach was lumpy. An odd piece of skin hung from her chin as if that surgery hadn't been completed.

And the $11,000 she spent on the treatments and the $5,000 she spent on travel was gone.

Meisel set out to find a surgeon to fix what had been done. But when she'd try to make an appointment, most doctors wouldn't see her. Others took one look at her surgery sites and left the room making derisive comments about people who go overseas for surgery, she recalls.

After an extensive search, Meisel found two surgeons to do the work. It took four corrective surgeries and $12,500 more out of her retirement. But she still doesn't feel like herself, and she's embarrassed.

"I just don't look right anymore," she says.

Meisel wrote the hospital in Bangkok and the surgeon two months after her operations to tell them of her terrible outcomes, but said she didn't hear back. Contacted by a reporter this year, the hospital said it had not received her letter. The hospital then e-mailed Meisel and offered to reimburse her for her surgeries and hospital stay.

"I regret that communication problems have meant [the hospital has] not been able to assist you with your concerns earlier and you have sought and obtained care from doctors close to your home," Peter K. Morley, Bumrungrad's international medical director, said in the e-mail in April. She received a check for $11,000 the same month.

By anecdotal accounts, most medical tourism procedures do not go awry. Many overseas hospitals catering to patients like Meisel are new, clean and often staffed by doctors and nurses trained in the United States or other developed countries.

Bumrungrad Hospital, which is accredited by the Joint Commission International, reports a very small complication rate. Just 1.7 percent of the 2,469 cosmetic surgeries performed there in 2007 resulted in significant complications, according to Keith Mays, senior director of hospital marketing and business development for Bumrungrad. That's lower than at most U.S. hospitals. Bumrungrad is a big player in the medical tourism market and had 65,000 visits from Americans last year, 6 percent of its overall patient volume.

Nevertheless, when things do go badly after an overseas operation, a patient may be left facing a host of challenges: lack of access to follow-up care at home; doctors who won't get involved in corrective procedures; extra money that must be spent to undo what has been done; and a complicated legal picture if they want to try to recoup costs.

"Aftercare is one of the most important issues and problems in medical tourism," said Jonathan Edelheit, president of the Medical Tourism Association, a two-year-old trade group funded by hospitals, individuals and educational institutions. It is trying to raise standards and increase transparency in the now wide-open and unregulated field.

Edelheit said that his organization is trying to educate U.S. doctors so that they will not discriminate against patients who are coming home from surgeries abroad and may be in need of care. The group is speaking to large groups of physicians through medical associations and medical schools.

"Having them understand that these people can't afford the surgeries in the U.S. and that there is high quality of care overseas makes a big difference," Edelheit said.

"Without the necessary surveillance and research, it's impossible to judge a phenomenon like medical tourism," says John F.P. Bridges, an assistant professor in the department of health and policy management at Johns Hopkins School of Public Health. "How can one judge the quality of care by anecdote? One can't, and that's a real issue."