EXPERTS warned about the dangers of having weight loss surgery abroad during inquests into the deaths of two women.
A surgeon and a coroner issued stark warnings during probes into the deaths of two women, one who died on returning home and the other while in the ICU of a Turkish hospital.
The daughter of one of the women told how she and her mum, Estelita Hamelin, travelled to Istanbul to have liposuction and a tummy tuck in the Avrupamed Hospital.
They arrived on October 18, 2021 after initially hearing about the successful procedure carried out on their beautician, who put them in contact with a representative of the hospital.
They were collected from the airport and driven to the hospital where blood was taken, and the following morning they returned to the hospital where the 46-year-old from Fermoy, Cork was given a file of documents.
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Hazel told the Cork City Coroner’s court: “They were pushing her to sign those which she did without reading them.
“The doctor put marks on her body where the surgery was to being done. I was told she would be in the hospital for a few nights.
“I went to the hotel to get mum’s clothes and that was the last time I saw her alive, as when I returned she had gone into surgery”.
As the hours passed Hazel despite asking got no update on her mum’s condition. After a long time she was told something had gone wrong, there was massive blood loss and she was in ICU.
The following day she was brought to the ICU where she was told doctors tried to revive her mum, but she passed away.
Difficulties getting information
Hazel said the hospital offered to return the money they had paid, pay for cremation in Turkey and have the ashes sent back if she left the country straight away.
Coroner Philip Comyn outlined the difficulties his office had getting any medical information from the hospital and had made representations to the Turkish Embassy and the Department of Foreign Affairs about it.
He said he had to record an open verdict as he did not have enough information to bring in a verdict of medical misadventure, which he believed was the right one.
The other case he heard was that of Pamela Canty from Commons Road in Cork who had gastric bypass surgery done in a Turkish hospital on October 17, 2022 after which she was discharged just a day after.
Double operation
She went out for a gastric sleeve procedure but because they found a hernia, they could not proceed with the original surgery.
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They performed a completely different procedure and also operated on the hernia.
Her husband Finbarr said he was shocked on hearing this at the inquest.
Pamela was unwell in the hotel and her husband expressed concerns about her condition to the hospital, who did not call her back in.
Kitchen collapse
They flew back home on October 21 and Pamela was unwell.
She collapsed in her kitchen on October 22 suffering cardiac arrest, and was rushed to the Mercy Hospital where she died the following day.
The coroner ruled her death from septic shock was medical misadventure.
Professor Colm O’Boyle, Consultant Laparoscopic Surgeon in the Bons Secours hospital, warned: “There are many hazards related to pursuing surgical intervention in a foreign country.
Selection 'based on ability to pay'
“Most medical tourism is based in non-English speaking countries and is encouraged by attractive low tariffs and shortened waiting times for surgery.
“The selection process for surgery appears to be based on ability to pay rather than medical appropriateness, despite many patients being vulnerable psychologically and/or having complex medical co-morbidities.
“The emphasis is on the surgical procedure and often very little advice, or care is given regarding the appropriate pre-operative selection and work-up and the post- operative follow-up.
“There appears to be little in the way of clinical governance, evidence of surgical or bariatric team accreditation or evidence of outcomes in these institutions.
'Very little accountability'
“Furthermore, there appears to be very little accountability when things go wrong.”
This, he said, places patients at increased risk of harm - regardless of the ability of the operating surgeon.
He said money exchanged early in the process puts the patient under pressure to proceed despite reservations.
Previous patients are offered financial remuneration to promote the institution, resulting in positive bias of their experience.
'Standard practice'
Patients are offered reductions for increased numbers.
He explained: “There is no evidence of multidisciplinary team discussion (of bariatric surgical intervention) or referral to a psychologist or dietician, which would be standard practice in all reputable centres Internationally.
“Pre-operative work-up in the foreign hospitals was performed on the day before or the day of surgery with only basic blood tests performed.
“Patients met the surgeon for the first time on the day of surgery.
Huge dangers
“Patients (for obvious financial considerations) return home very early during the post-operative period at a time when it is contra-indicated to fly due to the increased risk of DVT (deep vein thrombosis) and PE (pulmonary embolism), which are further increased for patients undergoing major surgery, especially if they are overweight or obese.”
For this reason, it is recommended not to fly for at least a month following major surgery.
He said there was a concern that the mortality from surgery in certain centres abroad could be many times higher than it is in Ireland.
Coroner Comyn said there were huge dangers relating to going abroad for weight loss procedures for people who contact agents to find them hospitals, some of which do not take the necessary steps to look after the well being of the patients.
