Ebola and medical tourism

Posted on October 24, 2014 by K Eckland

There’s a new editorial over at the IMJT on Ebola, medical tourists and the medical travel industry. In the article, “Ebola: a hot topic for the next medical tourism event?” by Ian Youngman, he explores the potential pitfalls from medical tourists who are seeking treatment overseas. As an insurance expert, who makes his living by preparing for “What if?” scenarios, the author offers valuable insight on a topic that has provoked wide speculation and fear-mongering among the general media.

Mr. Youngman explores current medical screening at airports, the impact on current medical tourists as well as the potential impact of a global pandemic/panic on the medical tourism industry. Mr. Youngman urges for a clear, reasoned and cohesive discussion and response from leaders in the medical tourism industry.

Death of young patient raises questions of safety

IN other news, the BBC is reporting on the recent death of a 24 year old British medical tourist. While the BBC article offers few details on the patient who died during a liposuction procedure in Thailand, a more in-depth report from the UK Mail reports that the woman stopped breathing after receiving anesthesia at the private medical clinic. The article reports that this was a repeat visit for the patient, who had previously undergone another plastic surgery procedure at the clinic.

Now questions are being raised about the doctor’s qualifications to perform the procedure, as well as the lack of availability of life-saving medical equipment at the medical clinic. The doctor at the clinic, Dr. Sombob Saensiri has been arrested while this case is being investigated.

Note: There are conflicting reports regarding the exact circumstances of this patient’s death. An Asian story reports that the patient had returned after a recent surgery with complaints of a developing infection.

Related posts: Plastic surgery safety archives

Plastic surgery safety: Know before you go radio interview

Is your cosmetic surgeon really even a surgeon?

Liposuction in a Myrtle Beach apartment

Plastic surgery safety & Buttloads of Pain

Posted on January 24, 2014 by K Eckland

Long time readers are familiar with our plastic surgery horror story archives. These archives (mainly) consist of cases of illegal/ unlicensed surgeons and botched plastic surgery procedures but there is also information on how to find a board certified surgeon. Most of these cases take place in the United States where both clever marketing and underground clinics flourish due to the high costs of plastic surgery.

Buttloads of Pain

Now there is a new documentary that explores the dangers of unlicensed operators and ‘booty enhancement’.

Thanks to my friend, Matt Rines for sending me the link to the Vice documentary,”Buttloads of Pain” which talks about and talks to victims of unlicensed (and illegal) gluteal augmentation procedures (such as direct injection of silicone and other substances).

Gluteal Augmentation Procedures

For more information on legitimate gluteal augmentation procedures, read our interviews with licensed plastic surgeons.

Gluteal implants – Interview with Dr. Gustavo Gaspar

Fat transfer : Dr. Luis Botero

Update: February 2014

For readers that have been asking about the background, history and the profound psychological and sociological impact of the ‘big booty’ and other Colombian influences on (global) plastic surgery trends & beauty ideals – this article by Mimi Yagoub at Colombia Reports may be a bit of an eye-opener.

Just another reason for Latinamericansurgery.com

Posted on June 29, 2013 by K Eckland

Colombian plastic surgeons operating

because you need someone who is objective (and informed) that is looking out for you, the patient..

In this article, at International Journal of Medical Travel, Kevin Pollard talks about the need for regulation of medical tourism in cosmetic surgery. I wholeheartedly agree – in fact, Mr. Pollard and I conversed about this very topic in a series of emails last week.

After all – it is why I do what I do, and publish it here for my readers. The industry does need to be regulated – medical tourism companies shouldn’t pick providers by “lowest bidder” and patients need to be protected (from unsanitary conditions, bad surgeons, and poor care). But what form will this regulation take?

Will it be Joint Commission certification – which covers facilities and not the physicians (and their surgical practices themselves)?

Will it require facilities to pay a lot of money for a shiny badge?

Or will it be someone like me, low-key and independent, going into facilities at the behest of patients; interviewing surgeons and actually observing the process and talking to patients?

and who pays for this? The beauty of what I do – is that I am independently (read: self) funded. True, it hurts my wallet but I have no divided loyalties or outside interests in doing anything but reporting the unvarnished truth.

and ultimately – will this be done in a fair, open and honest way? Or it is really a witch hunt led by disgruntled American and British plastic surgeons? Will they bother to discriminate between excellent surgeons and incompetent ones who will it be by geography alone?

I guess we will just have to wait and see.

Colombian plastic surgeons answer back

Posted on June 23, 2013 by K Eckland

Chairman of International Society of Aesthetic Plastic Surgery questions the ethics of medical tourism, Colombia responds.

Colombia is now 11^th in the world for plastic surgeries by volume according to the International Society of Aesthetic Plastic Surgery (ISAPS) but that may change if Dr. Igor Niechajev, Chair of the Government Relations Committee of that same organization gets his way. ISAPS, who ranked Colombia among the top 25 countries for plastic surgery also printed an article by Niechajev in the spring edition of its newsletter condemning medical tourism.

Chairman discourages medical tourism, stating that medical tourists are victims of inferior care

The strongly-voiced piece accused surgeons outside of European and North America of providing inferior medical care, inadequate pre-operative evaluations and operating in substandard facilities.

States bad outcomes wouldn’t happen at home

In his editorial, Dr. Niechajev provides anecdotal evidence of a botched procedure that occurred in Asia, and stated that “such a tragic outcome” of [procedure cited] “is highly unlikely had the patient not been a medical tourist.” Dr. Niechajev cites these concerns, not as a surgeon losing business to his competitors but states that he is concerned about the costs of caring for patients with possible complications once they return home.

Not limited to national borders

His concerns don’t stop at national borders, Dr. Niechajev also suggests that surgeons limit themselves to their immediate local vicinity. What this may mean for a rural patient requiring extensive reconstructive surgeon is not addressed by Dr. Niechajev.

Statements based on limited data

He bases the majority of his opinions on the shoulders of Dr. Ritz, the Australian National Secretary for Health, who cites one specific incident as the trigger for changing Australian legislature to prohibit this practice. Additional evidentiary support of gross episodes or a mass epidemic of malpractice by international surgeons appears to be limited to 11 cases in the United Kingdom. No other data was cited.

International Society debating the issue; Niechajev recommends financial sanctions against patients

These concerns have the officers of ISAPS considering changing the code of ethics of the organization to discourage the practice of medical tourism by its member surgeons. However, Dr. Niechavej does not seem content to stop there, instead he advocates for governmental announcements advising the public about “increased risks associated with medical tourism” and that “surgery overseas practically means that they [patients] are giving up all their rights.” He also advocates for financial penalties for patients who experience post-operative complications after surgery overseas, stating, “No preventative measure is as effective as hitting someone’s purse.”

Colombian plastic surgeons respond

In an exclusive interview with the President of the Colombian Society of Plastic Surgery, he answered many of the allegations by Dr. Niechajev.

Regarding Dr. Igor Niechevaj’s statements on the lack of regulations and substandard facilities in countries that are popular medical tourism destinations, the President of the Colombian Society of Plastic, Esthetic and Reconstructive Surgery, Dr. Carlos Enrique Hoyos Salazar replied that, “All facilities, and hospitals in Colombia are regulated by the Ministry of Health. There are minimum standards that must be met. Any facilities that are interested in participating in the medical tourism business have additional standards and qualifications for certification by national agencies. Anesthesiologists, and medical doctors are required to have additional training to perform pre-operative evaluations for International plastic surgery patients”.

Reports safety and patient protections for medical tourists

He refutes claims that patients receive minimal post-operative care before returning home. In addition to medical advice from Colombian physicians, he cites agreements with Colombian and international airlines to encourage international patients to stay a minimum of 15 days after their surgical procedures to ensure optimal recovery.

Additionally, several plastic surgeons specializing in medical tourism and medical tourism companies offer ‘complication policies’ to pay for any expenses a medical tourist may incur in both the destination and home country should they develop complications post-operatively. In fact, an advertisement for one of these policies shares space with Dr. Niechevaj’s article. These policies effectively negate one of Dr. Niechevaj’s (and Dr. Ritz’s) strongest arguments, that medical tourism incurs costs in the home country when patients develop post-operative infections or other problems after returning home.

ISAPS Chairman defending his own wallet?

When asked about Dr. Niechevaj’s position on medical tourism and possible changes to the ISAPS code of ethics, Dr. Hoyos stated, “This is not right. This has nothing to do with the quality of surgery in Colombia and other countries. This is about the expensive costs of surgery in Europe and the United States. If a surgery costs $6,000 (USD) over there and only $3,000 – $3,500 in Colombia, then those doctors are losing money due to medical tourism.”

Good and Bad is a global phenomenon

As we’ve pointed out here on our site (and related work) – good and bad surgical outcomes are certainly not limited by geography, and Dr. Niechajev certainly seems to paint the rest of the world with a wide brush with his call to action.

A more reasonable, and fair response would be continue to encourage work such as mine – using outside, independent and unbiased observers to evaluate surgeons wishing to participate in medical tourism.

In an ideal world, companies such as Blue Cross/ Blue Shield who wish to broaden their international physician base would hire independent medical professionals to review surgeons who wished to be included under their health plan. This way both consumers and third-party payers would have more information before patients went ‘under the knife’ so to speak.

Patients wouldn’t be shuttled to surgeons who submit the lowest bid (to insurance companies, and private parties) but to surgeons whose qualifications had been authenticated. All parties would know about the quality of hospital facilities, anesthesia, pre-operative evaluation and post-operative care.

Doing my part

Readers know that I do what I can, in a very small way, to add to the body of knowledge about the quality and care of patients who receive treatment from the surgeons who consent to let me observe, evaluate and report my findings.

Now we just need this on a large-scale, multi-national level.

Is your ‘cosmetic surgeon’ really even a surgeon?

Posted on March 11, 2013 by K Eckland

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.)

Medical Tourist death under inquest

Posted on February 24, 2013 by K Eckland

Was it a medical mistake/ an accident of fate / or…. was it the Cocaine? An inquest is held on the intra-operative death of an Irish medical tourist..

In a recent inquest, the wife of an Irish tourist who died while undergoing liposuction with a well-known Colombian plastic surgeon talked about her husband and his decision to pursue plastic surgery with Dr. Ricardo Lancheros Pedraza.

In a published story by Gareth Naughton of the Irish Independent, the wife of Pierre Christian Lawlor detailed her husband’s decision to undergo cosmetic surgery with the Bogotá surgeon due to unhappiness with his physique.

During her testimony, she also conceded that her husband had taken cocaine in the days and hours immediately prior to surgery – despite being advised specifically to refrain from smoking, alcohol or taking medications.

In a story published in Irish Central – Ms. Andrea Galeano, the Venezuelan-borne wife of Mr. Farrell reported that her husband had taken cocaine on several occasions after arriving in Bogotá for his surgical procedure.

Mr. Farrell is believed to have died from intra-operative myocardial infarction (heart attack during surgery).

Additional Information

This Daily Mail article from 2012 describes how the use of cocaine can cause heart attacks, and sudden cardiac death.

Medical News Today article

Scholarly articles:

Finkel JB, Marhefka GD. (2011). Rethinking cocaine-associated chest pain and acute coronary syndromes. Mayo Clin Proc. 2011 Dec;86(12):1198-207. doi: 10.4065/mcp.2011.0338.

Schwartz BG, Rezkalla S, Kloner RA. (2010). Cardiovascular effects of cocaine.

Circulation. 2010 Dec 14;122(24):2558-69. doi: 10.1161/CIRCULATIONAHA.110.940569. Review.

Know before you go: Medical tourism and patient safety

Posted on January 17, 2013 by K Eckland

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

(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.)

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.

Click here to connect to the Radio show archives

The case against ‘extreme makeovers’

Posted on February 26, 2012 by K Eckland

While extreme plastic surgery makeovers (or multiple plastic surgery procedures at once) make for great television – they aren’t safe. Prolonged (multi-hour, multi-procedure) surgeries place patients at greater risk of complications from anesthesia, bleeding, etc. These ‘Mommy Makeovers’ sound like a good idea to patients – one surgery, less money and faster results – but the truth is – they just aren’t a good or safe idea.

Now an article by Laura Newman, [originally published in Dermatol Surg. 2012;38:171-179] and re-posted at Medscape.com drives home that fact.

Combination Cosmetic Surgeries, General Anesthesia Drive AEs

February 9, 2012 — The use of general anesthesia, the performance of liposuction under general anesthesia, and a combination of surgical procedures significantly increase the risk for adverse events (AEs) in office-based surgery, according to reviews of statewide mandatory AE reporting in Florida and Alabama. More than two thirds of deaths and three quarters of hospital transfers were associated with cosmetic surgery performed under general anesthesia, according to an article published in the February issue of Dermatologic Surgery.

The study, derived from 10-year data from Florida and 6-year data from in Alabama, “confirms trends that have been previously identified in earlier analyses of this data,” write the authors, led by John Starling III, MD, from the Skin Cancer Center, Cincinnati, and the Department of Dermatology, University of Cincinnati, Ohio.

In a companion commentary, C. William Hanke, MD, from the Laser and Skin Surgery Center of Indiana, Indianapolis, presses for 3 patient safety practices: “(1) Keep the patient awake!… 2) Think twice before supporting a patient’s desire for liposuction that is to be done in conjunction with abdominoplasty under general anesthesia…. 3) “[B]e advocates for prospective, mandatory, verifiable adverse event reporting…[that] should include data from physician offices, ambulatory surgical centers, and hospitals to define and quantify problems that can be largely prevented and eliminated.”

The authors and editorialist are especially critical of liposuction performed under general anesthesia. The study revealed that although liposuction is perhaps one of the most common cosmetic surgical procedures, no deaths occurred in the setting of local anesthesia. “Liposuction under general anesthesia accounted for 32% of cosmetic procedure-related deaths and 22% of all cosmetic procedure-related complications,” the researchers write.

The researchers analyzed mandatory physician AE reports in ambulatory surgery submitted to their respective states, encompassing 10-year data in Florida and 6-year data in Alabama. A total of 309 AEs were reported during an office-based surgery during the 10-year period in Florida, including 46 deaths and 263 reportable complications or transfers to hospital. Cosmetic surgeries performed under general anesthesia accounted for the vast majority of deaths in Florida, with liposuction and abdominoplasty the most frequent procedures.

Six years’ worth of data from Alabama revealed 52 AEs, including 49 complications or hospital transfers and 3 deaths. General anesthesia was implicated in 89% of reported incidents; 42% were cosmetic surgeries. Pulmonary complications, including pulmonary emboli and pulmonary edema, were implicated in many deaths in both states.

Plastic surgeons were linked to nearly 45% of all reported complications in Florida and 42.3% in Alabama, write the researchers. Office accreditation, physician board certification, and hospital privileges all revealed no clear pattern.

One limitation acknowledged by the authors is that case logs of procedures performed under general and intravenous sedation are required in Florida, but are not public domain, and so were unavailable for analysis. In addition, investigators were not able to obtain data on the total number of liposuction procedures performed in either state. The lack of those data prevented them from calculating the overall fatality rate.

As readers of my previous publications know, the majority of surgeons I interviewed expressly do not perform multiple procedures during one surgery. Also, many of them perform the majority of their procedures under conscious sedation with local anesthesia (which means you are awake, but you don’t care – and you don’t feel anything).

Questionable injections, and fake doctors at a Motel 6

Posted on December 10, 2011 by K Eckland

In news out of Greensboro, North Carolina – another woman has been charged with several cases (dating back to 2007) of practicing medicine without a license.

Like the woman quoted in the article says, if you are going to a Motel 6 for a ‘medical procedure’ – what do you really expect?

This isn’t a way to skirt ‘the system’ or save money.. But it is a really good way to get hurt or killed.

Crimes of New York – another ‘butt-injecting’, superglue using phony kills patients in the Hispanic community in New York.

More criminal malpractice, and patient deaths: in my own backyard…

Posted on September 16, 2011 by K Eckland

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

Another fraudulent surgery clinic

Posted on August 16, 2011 by K Eckland

this time in Los Angeles, where several individuals were posing as licensed physicians. A sting operation was conducted after several patient complaints – and injuries. The story in the Manila paper is here. The LA Times initially broke the story.

Notably, the clinic operators had posted fake degrees and credentials on the walls. (This is why it’s important to independently verify credentials with state licensure boards). Anyone with a scanner, and basic computer literacy can print up and fake any document they want..

I’ll keep posting these stories as a reminder for people to use credible sources for information about their doctors (such as well researched books like mine) or licensure boards.

(While most of the stories appear to originate in the United States I think this is probably just a result of our media interests – and what makes national and international headlines. There are frauds everywhere, who just want people’s money – they don’t care if people get hurt or die in the process.

Unfortunately, many of these people operate for years before they get caught, if ever.

In international news, the need for investigation and medical scrutiny of medical tourism is becoming more and more apparent. (I told you that Cartagena Surgery was a trendsetter.) Now, if only we could translate that into book sales.

Love, Life and Surgery in Latin America is now Colombian Culture & Cuisine

Tag Archives: plastic surgery safety