Medical Tourism Can Put Patients in Legal Limbo

Medical tourism is a booming industry, with millions of Americans traveling abroad for plastic surgery and other procedures at lower cost. But in addition to health dangers of undergoing surgery in a foreign country, patients may find themselves with little or no legal recourse in case something goes wrong, according to a special article in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"Medical tourism is a growing, unregulated industry," comments ASPS Member Surgeon Steven P. Davison, MD, DDS, of Georgetown University, lead author of the new article. "While patients may be attracted by the lower costs for plastic surgery and other procedures performed in other countries, they must also be aware of the potential risks – legal as well as medical."

Medical Tourism Carries Health Dangers, Limited Legal Recourse

Over the past decade, the number of patients traveling overseas for medical and surgical procedures. "Medical tourism...has evolved into a global healthcare phenomenon, with over 15 million US patients each year seeking medical care internationally, representing a $50 billion industry in 2017," Dr. Davison and coauthors write. For cost-sensitive and market-driven procedures such as cosmetic surgery, costs may be 40 to 50 percent lower in developing countries.

The ASPS and other professional organizations have highlighted the potential dangers of plastic surgery performed abroad. Domestic and international accrediting agencies have attempted to raise the standard of care, but regulation of the medical tourism industry in the United States remains "virtually nonexistent." Dr. Davison and colleagues add, "There is no concrete body nor governing institution to report to when things go wrong."

When complications or other problems occur after surgery abroad, patients are likely to find that they have limited legal recourse. Patients may find they have signed forms waiving their right to file a lawsuit, including against the medical tourism agency with which they booked their trip.

It is difficult to establish jurisdiction against foreign defendants in US courts. And even if they manage to file and win their suit, patients may find it difficult or impossible to enforce the judgment and collect financial damages.Medical tourism also raises ethical implications, given the inherent risks of surgery. A major question is who will provide necessary follow-up care after the patient returns home. There are also issues related to getting and paying for treatment of complications – recent reports have found that treatment for complications after medical tourism is most often paid for by Medicaid. While US physicians may have an ethical duty to treat patients with complications, any necessary revision plastic surgery would be the patient's responsibility.

Despite these legal and ethical issues, there is little doubt that the medical tourism industry will continue to grow. "Insurance providers trying to control costs will be the primary drivers of increasing tourism facilities that provide procedures covered in their benefit plans," Dr. Davison and colleagues write. One report has even suggested that Medicare could become the single biggest purchaser of tourism medicine.

"Succinctly put, the medical tourism patient has few rights, should not expect to be covered within US legal jurisdiction, and has little chance of recovery for damages," Dr. Davison and colleagues write. As demand continues to grow, the legal environment for medical tourism could change – arbitration might become a remedy for medical injury occurring outside the United States, while legislative action to address the public health burden of complications related to these procedures.

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "The Price of Medical Tourism: The Legal Implications of Surgery Abroad"

Article: "The Price of Medical Tourism: The Legal Implications of Surgery Abroad" (doi: 10.1097/PRS.0000000000004816)