Archive for the ‘Domestic Medical Tourism’ Category

The answer is “NO” for several disfigured patients in Australia, who later found out that a loophole in Australian licensing laws allowed Dentists and other medical (nonsurgeons) professionals to claim use of the title of ‘cosmetic surgeon’ without any formalized training or certification in plastic and reconstructive surgery (or even any surgery specialty at all).

In this article from the Sydney Morning Herald, Melissa Davey explains how dentists and other nonsurgical personnel skirted around laws designed to protect patients from exactly this sort of deceptive practice, and how this resulted in harm to several patients.

As readers will recall – we previously discussed several high-profile cases of similar instances in the United States, including a doctor charged in the deaths of several patients from his medical negligence.  In that case, a ‘homeopathic’  and “self-proclaimed” plastic surgeon, Peter Normann was criminally indicted in the intra-operative deaths of several of his patients.  The patients died while he was performing liposuction due to improper intubation techniques.

But at least, in both of the cases above – the people performing the procedures, presumably, had at a minimum, some training in a medical/ quasi-medical field..

Surgeon or a handyman

More frightening, is the ‘handyman’ cases that have plagued Las Vegas and several other American cities – where untrained smooth operators have preyed primarily on the Latino community – injecting cement, construction grade materials and even floor wax into their victims.

How to protect yourself from shady characters?  In our post, “Liposuction in a Myrtle Beach Apartment” we discuss some of the ways to verify a surgeon’s credentials.  We also talk about how not to be fooled by fancy internet ads and the like.  (Even savvy consumers can be fooled by circular advertisements designed to look like legitimate research articles as well as bogus credentials/ or ‘for-hire’ credentials*. )

*We will talk about some of the sketchy credentials in another post – but the field is growing, by leaps and bounds..More and more fly-by-night agencies are offering ‘credentials’ for a hefty fee (and not much else.)


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Note:  I owe Dr. Vasquez a much more detailed article – which I am currently writing – but after our intellectually stimulating talk the other day, my mind headed off in it’s own direction..

Had a great sit down lunch and a fascinating talk with Dr. Vasquez.  As per usual – our discussion was lively, (a bit more lively than usual) which really got my gears turning.  Dr. Vasquez is a talented surgeon – but he could be even better with just a little ‘help’.  No – I am not trying to sell him a nurse practitioner – instead I am trying to sell Mexicali, and a comprehensive cardiac surgery program to the communities on both sides of the border..  Mexicali really could be the ‘land of opportunity’ for medical care – if motivated people and corporations got involved.

During lunch, Dr. Vasquez was explaining that there is no real ‘heart hospital’ or cardiac surgery program, per se in Mexicali – he just operates where ever his patients prefer.  In the past that has included Mexicali General, Issstecali (the public hospitals) as well as the tiny but more upscale private facilities such as Hospital Alamater, and Hospital de la Familia..

Not such a big deal if you are a plastic surgeon doing a nip/tuck here and there, or some outpatient procedures – okay even for general surgeons – hernia repairs and such – but less than ideal for a cardiac surgeon – who is less of a ‘lone wolf’ due to the nature and scale of cardiac surgery procedures..

Cardiac surgery differs from other specialties in its reliance on a cohesive, well-trained and experienced group – not one surgeon – but a whole team of people to look out for the patients; Before, During & After surgery..  That team approach [which includes perfusionists, cardiac anesthesiologists (more specialized than regular anesthesia), operating room personnel, cardiology interventionalists and specialty training cardiac surgery intensive care nurses]  is not easily transported from facility to facility.

just a couple members of the cardiac surgery team

That’s just the people involved; it doesn’t even touch on all the specialty equipment; such as the bypass pump itself, echocardiogram equipment, Impella/ IABP (intra-aortic balloon pump), ECMO or other equipment for the critically ill – or even just the infrastructure needed to support a heart team – like a pharmacy division that knows that ‘right now’ in the cardiac OR means five minutes ago, or a blood bank with an adequate stock of platelets, FFP and a wide range of other blood products..

We haven’t even gotten into such things such as a hydrid operating rooms and 24/7 caths labs – all the things you need for urgent/ emergent cases, endovascular interventions – things a city the size of Mexicali should really have..

But all of those things take money – and commitment, and I’m just not sure that the city of Mexicali is ready to commit to supporting Dr. Vasquez (and the 20 – something cases he’s done this year..) It also takes vision..

This is where a company/ corporation could come in and really change things – not just for Dr. Vasquez – and Mexicali – but for California..

It came to me again while I was in the operating room with Dr. Vasquez – watching him do what he does best – which is sometimes when I do what I do best.. (I have some of my best ideas in the operating room – where I tend to be a bit quieter.. More thinking, less talking)..

Dr. Vasquez, doing what he does best..

As I am watching Dr. Vasquez – I starting thinking about all the different cardiac surgery programs I’ve been to: visited, worked in – trained in.. About half of these programs were small – several were tiny, single surgeon programs a lot like his.. (You only need one great surgeon.. It’s all the other niceties that make or break a program..)

All of the American programs had the advantages of all the equipment / specialty trained staff that money could buy***

[I know what you are thinking – “well – but isn’t it all of these ‘niceties’ that make everything cost so darn much?”  No – actually it’s not – which is how the Cardioinfantils, and Santa Fe de Bogotas can still make a profit offering world-class services at Colombian prices…]

The cost of American programs are inflated due to the cost of defensive medicine practices (and lawyers), and the costs of medications/ equipment in the United States****

the possibilities are endless – when I spend quality time in the operating room (thinking!)

Well – there is plenty of money in Calexico, California** and not a hospital in sight – just a one room ‘urgent care center’.  The closest facility is in El Centro, California – and while it boasts a daVinci robot, and a (part-time?) heart surgeon (based out of La Mesa, California – 100 + miles away)– patients usually end up being transferred to San Diego for surgery.

Of course, in addition to all of the distance – there is also all of the expense..  So what’s a hard-working, blue-collar guy from Calexico with severe CAD going to do?  It seems the easiest and most logical thing – would be to walk/ drive/ head across the street to Mexicali.. (If only Kaiser Permanente or Blue Cross California would step up and spearhead this project – we could have the best of both worlds – for residents of both cities.. 

 A fully staffed, well-funded, well-designed, cohesive heart program in ONE medium- sized Mexicali facility – without the exorbitant costs of an American program (from defensive medicine practices, and outlandish American salaries.)  Not only that – but as a side benefit, there are NO drug shortages here..

How many ‘cross-border’ cases would it take to bring a profit to the investors?  I don’t know – but I’m sure once word got out – people would come from all over Southern California and Arizona – as well as Mexicali, other parts of Baja, and even places in Sonora like San Luis – which is closer to Mexicali than Hermasillo..  Then Dr. Vasquez could continue to do what he does so well – operate – but on a larger scale, without worrying about resources, or having to bring a suitcase full of equipment to the OR.

The Mexican – American International Cardiac Health Initiative?

But then – this article isn’t really about the ‘Mexican- American cross-border cardiac health initiative’

It is about a young, kind cardiac surgeon – with a vision of his own.

That vision brought Dr. Vasquez from his home in Guadalajara (the second largest city in Mexico) to one of my favorite places, Mexicali after graduating from the Universidad Autonomica in Guadalajara, and completing much of his training in Mexico (D.F.).  After finishing his training – Dr. Vasquez was more than ready to take on the world – and Mexicali as it’s first full-time cardiac surgeon.

Mexicali’s finest: Dr. Vasquez, (cardiac surgeon) Dr. Campa(anesthesia) and Dr. Ochoa (thoracic surgeon

Since arriving here almost two years ago – that’s exactly what he’s done.. Little by little, and case by case – he has begun building his practice; doing a wide range of cardiovascular procedures including coronary bypass surgery (CABG), valve replacement procedures, repair of the great vessels (aneurysm/ dissections), congenital repairs, and pulmonary thrombolectomies..

Dr. Vasquez, Mexicali’s cardiac surgeon

Dr. Cuauhtemoc Vasquez Jimenez, MD

Cardiac Surgeon

Calle B No. 248 entre Obregon y Reforma

Col. Centro, Mexicali, B. C.

Email: drcvasquez@hotmail.com

Tele: (686) 553 – 4714 (appointments)


*The Imperial Valley paper reports that Calexico makes 3 million dollars a day off of Mexicali residents who cross the border to shop.

***In all the programs I visited  – there are a couple of things that we (in the United States do well..  Heart surgery is one of those things..)

**** Yes – they charge us more in Calexico for the same exact equipment made in India and sold everywhere else in the world..

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Looks like ‘domestic medical tourism’ is the hot phrase for 2012 – and a new article on Forbes.com displays this in fourteen point font.  Unfortunately, the article is the same old rehash of healthcare statistics with little to no new information on the topic.

But is there are glass ceiling on the medical tourism industry?

In overseas news – this article out of India (UK Daily Mail) portrays a different view of the medical tourism industry – one of grand dreams and schemes but a much less glamourous and glittering reality.

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Just got back from spending a day at John Hopkins looking at ‘domestic medical tourism’. While the terminology is new, the concept isn’t. Who doesn’t know someone, a friend or family member, who has traveled outside of their own community for treatment? We all do – any many of those people have travelled to those big name facilities that we are all familiar with; the Mayo Clinic, Duke, the Cleveland Clinic and John Hopkins.

John Hopkins, is in fact – a leader in both domestic and international medical tourism. John Hopkins has also ranked #1 for US Hospitals for the last 21 years. While there is some discussion as to the real validity of these rankings, they are still impressive.  As we have discussed before on our sister site, Bogotá Surgery.org  – Hopkins has international affiliations and collaborations with facilities throughout the globe (including Santa Fe de Bogotá)**.  Hopkins directly manages several other facilities – in places such as Turkey and the Middle East.  They truly are a global healthcare organization.

I visited the International Patient Center and observed the services available for out-of-state patients.  These departments make special efforts to provide convenience and familiarity to their out-of-town patients.  As part of these, patients are escorted to appointments, and appointments are grouped (when patient needs more than one service.)

They also have translators for over twenty different languages, and special accommodations to enable respectful, culturally competent care to patients with special religious or cultural needs.

Many of these out-of-town patients stay at the McElderry House, which is a pleasant, and affordable option, located just across the street from the hospital.    I stayed there during my visit – and the staff are charming, helpful and accommodating.  The rooms are spartan, but the accommodations are homey and comforting.  With full kitchens, these townhouses are perfect for potential long-term visitors.

The story behind McElderry house is sweet and inspiring.

Theresa, the owner, is a former nurse, who worked at John Hopkins as a travel nurse twenty years ago.  During her travel assignment, her daughter was diagnosed with osteosarcoma (a particularly virulent cancer).  Instead of returning to their native Michigan – they stayed in Baltimore for treatment.

Yesterday, I met her daughter – who is doing wonderfully, thriving in fact.

Later, Theresa started McElderry House for patients and families in situations like hers.  She started small and now has multiple townhouses spread over two streets kitty-corner from John Hopkins.  She welcomes patients, families and medical / health professionals like myself.

During my visit – I also managed to interview a wonderful, inspiring surgeon, Dr. Daniela Molena.  I’ll be posting a longer article about her and her work at Hopkins soon.

Yesterday was just a quick peek at John Hopkins  – I hope to be back soon to take another look.

*For patients requiring in-patient care; John Hopkins maintains elegant, luxury upgraded accommodations at the Marburg Pavilion within the John Hopkins facility. (Read here for an article on Forbes about Marburg Pavilion, and other upscale patient facilities).   When these amenities accompany excellent medical care, such as in this case, it’s a plus.  It’s when the accommodations trump the care when it becomes a problem.

** There is some concern over the sudden increase in facility ‘branding’ since the onset of the medical tourism phenomenon and as to whether this is truly a mark of quality – or just a reflect of services (logos) ‘bought and paid for’.  As someone who previously worked in a ‘branded’ facility myself – there is some truth to the notion that it’s more of a rented logo than anything else.

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It’s what I call ‘the big lie’*.  As a former resident of Canada – the notion of universal healthcare as a realistic health care solution for people in the United States is laughable.   (Because, as everyone knows – lots! of Canadians come here, to use our extremely expensive, unwieldy and complicated health care system..)

Why do they come to the USA?  Canadians come to the United States because despite all these problems – we still receive our care in a timely fashion..  It’s a reminder – that while the system doesn’t work well for the many underinsured, and uninsured in our country – medical tourism remains a two-way street.

For those who can afford it, Duke, Mass General, Sloan-Kettering, the Cleveland Clinic and several other hospitals in the United States are the destinations of choice.

These massive institutions have the money, power and resources to fund / staff and produce some of the world’s greatest medical discoveries..

For the rest of us – these facilities may be out of reach.. But does that mean we are destined to receive substandard or less than cutting-edge care?

No.  As I’ve seen from my travels – state-of-the-art facilities exist outside of these hallowed academic grounds.  Amazing medical breakthroughs, treatments and surgical techniques are not confined to American medicine.  Doctors around the world are doing great things – developing new technologies and demonstrating medical successes that truly benefit patients.  The only questions are Where? and Who?

Those are the questions we (at Cartagena Surgery) plan to try and continue to answer – one city at a time.



* I call it “the Big Lie” for many reasons (which could be another whole post) but mainly because Canadians continue to smile and pretend that their healthcare system is ‘the perfect solution’  – all while fleeing south to the USA at the first sign of serious illness.  In fairness – I offer this article from NPR as a rebuttal to my opinions of Canadian healthcare.

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The latest issue of Medical Tourism Magazine is devoted to in-bound and domestic medical tourism while HealthNews.com touts medical tourism as a solution to the health care crisis..

At the same time, proposed cuts to Medicare reimbursement schedules for physicians are predicted to further impact health care access for seniors.  (Before you start blaming the doctors – remember that the majority of health care dollars – including medicare spending is tied up in the bureaucratic paperwork shuffle back and forth from doctors and government or third-party payers.. Not to mention all the uncollectable fees from uninsured and underinsured patients.   The medicare reimbursement system is so convoluted that even simple procedures and office visits become an incomprehensible billing mess.. Right now, I think quite a few doctors would look fondly back on the days of bartering a chicken, eggs or a homemade pie for services..)

This new proposal is viewed as a solution to the previous proposed cut of 29.5% which is set to take effect on January 1, 2012.  Instead – they propose a reimbursement rate freeze for the next TEN years (for primary care, while cutting reimbursement for specialists by almost six percent per year for the next three years..)  Either plan – is bad news as we consider the out-of-control health care inflation..

Of course, the real solution is as unpalatable as fixing the tax code.. Streamlining – or simplifying the process is the obvious solution until we remember that this grossly bloated, unwieldly and inefficient system employs hundreds of thousands of people… (Just like the IRS)..  And its political suicide to suggest cutting out the real source of waste in the middle of next great depression..  Instead of eliminating these massive bureaucracies – we’ll end up with some sort of New ‘New Deal’ – with further mortgaging and hemorrhaging of our children’s economic futures..  Doctors aren’t happy, patients aren’t happy..

Is it any wonder that we have to look outside the United States for solutions to our medical crisis?

And Finally, this article in a local paper demonstrates that not all hospitals are equal in quality and care.  In this story  – a family complains about the care their mother received after developing a sternal infection following bypass surgery.  Sternal infections such as mediastinitis can be very serious – and are one of the outcome measures rated and reported as part of the Society of Thoracic Surgeons (STS) international database.  This is why potential medical travellers should use caution and research destinations (using the Hidden Gem series or similar investigative medical writing) and facilities prior to arranging for surgical care (domestic or overseas.)

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Phoenix, Arizona –

In a case of criminal malpractice that sickens and horrifies health care personnel like myself – ‘self-proclaimed’ plastic surgeon, Peter Normann was able to delay sentencing after being found guilty earlier this summer in the deaths of three of his patients  – in three separate incidents.

The details of each of the cases are quite frightening, and highlight reasons why trained observers like myself are critical for objective and unbiased evaluations for potential patients.  In one case, another ‘homeopathic’ doctor working with Mr. Normann (not a licensed plastic surgeon) participated in a liposuction case that resulted in the death of a patient.  In two cases – patients died because Mr. Normann failed to intubate the patients correctly (and tore the esophagus of one of the patients.)

In all cases,  there was no intra-operative monitoring during cases – and Mr. Normann’s only assistant was a massage therapist (not an anesthesiologist, not a surgical nurse or trained surgical team.)  Horrifying – completely criminal, and unforgivable and unacceptable.

Additional Links on this case:

Homeopathy in Arizona covered for doctors’ mistakes

‘Homeopathic’ doctor kills patient performing liposuction.

The Times: Surgical Roulette

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