Urgent! Hospital Recomendation Needed.Life And Death Case!

[dick]

Here is the situatuon: Friend of mine,lady of 48 years ,fell from the stairs of Prasat temple in Cambodia ,from the height of 7 meters.She has been operated twice in Royal Rattanak hospital about 10 days ago.The accident happend about 2 weeks ago.By now the hospital bills are nearly 2000 000 baht which was way over her travel insurance limit.We,group of friends have managed to raise some money but she is still in coma and we realising that we can't raise all money necessary.We are looking for much cheaper hospital who actually will do the job putting her back on her feet rather than maintaining medically induced coma and racking 90000 baht a day.Can anybody give any tip about any hospital with indication of the fee per day>?Her condition being described as heavy but stable.Medical evacuation plane to Bangkok from Phnom Penh would cost us about 500000 baht .Any good tips are welcome because we feel that we exhausted all our resorces for this very expensive hospital.Diplomats of her country were contacted,some promises were made but still no movement.Every day counts because one day in Royal Rattanak cost almost 90000 baht.

[Mario2008]

Given the costs and insurence issues, have you considered flying her to her home country? I presume she will be covered there by insurence.

[dick]

Given the costs and insurence issues, have you considered flying her to her home country? I presume she will be covered there by insurence.

yes we did.It would cost us 98000$ usd.We rather try to do it here ,also hoping that later government would take over some of the bills.

[Sheryl]

Unfortunately you are already in what passes for the best hospital in Cambodia and it is a steep step down from there. You really should get her to Bangkok. A less expensive alternative to air evacuation is overland, you can get an ambulance (with medical accompaniment) to bring her to the Poipet/Aranyaprathet crossing and there be met by another ambulance, similiarly equipped. I've arranged this myself in the past and it went quite smoothly with the immigration authorities allowing the two vehicles to directly meet up in the "no mans land" area e=between the 2 checkpoints. Royal Rattanak should certainly be able to provide a fully equipped ambulance and attendants.

Would probably be most easily arranged with Bangkok Hospital in Bangkok as they have an affiliation with Royal Rattanak Also, BH has an excellent neuro department.

Although the travel time will be about 12 hours, she'd be under medical care the whole time.

This really is my best advise. Bangkok Hospital is also expensive, although probably a bit less so than Royal Rattanak. However if need be, onc e stabilized there you can easily arrange transfer to a government hospital like Chulalonghorn or Siriraj, both of which are excellent.

If you insist on keeping her in Cambodia then the Bayon Hospital has a neurosurgeon on staff, but the care she'll get there would be quite minimal. Calmette hospital (government) also has neurosurgeons and the capacity to do monitoring of intracranial pressure (which she needs) however accessing that depends on being connected, most people end up neglected in back wards. And it is also very expensive.

[Sheryl]

P.S. I forgot to ask if she is on a ventilator, if so, scratch Bayon as a possibility. It is Royal Rattanak or Calmette only within Cambodia and I really can't advise Calmette...serious lack of medical ethics to put it mildly and not that much less expensive.

[Sheryl]

P.P.S. You mention her being in a "medically induced coma". If so this is for the purpose of preventing/minimizing brain damage and you should rethink the stated aim of "putting her back on her feet rather than maintaining medically induced coma " it is just not that simple.

Not only her life but her brain function is very much at stake here.

[SteeleJoe]

Sorry Off-topic:

As a relatively new member, I wonder if the members of TVF generally realize how fortunate we are to have Sheryl's contributions. Honestly, due to her knowledge and the way she imparts it and where...you can't find a better example of the positive side of the net.

[rodentwarrior]

I absolutely agree with you Joe. And I know this is not really the right time, but this clearly shows - yet again - how vitally important it is to have proper health insurance.

When it comes to your health, you have nothing else to lose.

[dick]

P.S. I forgot to ask if she is on a ventilator, if so, scratch Bayon as a possibility. It is Royal Rattanak or Calmette only within Cambodia and I really can't advise Calmette...serious lack of medical ethics to put it mildly and not that much less expensive.

Yes she is.. We are now in the limbo because we owe the money to Rattanak,and they won't let her be transferred anywhere else unless the bills are all paid.Any delay cost us more and more.Calmette supposedly gave an estimate about 10% less than Rattanak.

[dick]

P.S. I forgot to ask if she is on a ventilator, if so, scratch Bayon as a possibility. It is Royal Rattanak or Calmette only within Cambodia and I really can't advise Calmette...serious lack of medical ethics to put it mildly and not that much less expensive.

You see,i am not a medic,i just convey what i have been fed by Rattanak doctors.I suspect the main purpose of this establishment is extraction of maximum profit instead of qucik recovery of the patient.They drove her 6 hours from SR to PP in first few days after an accident instead of driving her to the border where she could get some help in Si Saket or Buriram.Unfortunatelly,we have learned about the accident only 5 days later so we could not have influenced this decision.

[Sheryl]

She would not have been able to get what she needed in Si Sa Ket or Buriram. Would have had to travel to at least Kon Kaen. Expensive though it was/is, Rattanak Hosp in PP was indeed the best place to bring her. Time was of the essence, she needed surgery to relive pressure on the brain immediately. that is not something a small hospital across the Thai border could have done.

It sounds like at this point your problem is not so much medical as financial i.e. how to settle the bill at Rattanak and arrange transfer. For that I can only suggest her family back home and the relevant Embassy.

I assume you have already done so but if not should carefully check the provisions of the Travel Insurance. usually the coverage for medical evacuation is separate from the hospital cover altogther so should still have that. Also it is very odd to me that the coverage would be so low, 2 million baht is only around US $70,000. I've never seen a travel insurance package that low.

For the benefit of others: the travel insurance policy I just took out covers 100% of hospital and outpatient costs, no limit,for a premium of less than $200 for 2 months. (World Nomads).

[dick]

She would not have been able to get what she needed in Si Sa Ket or Buriram. Would have had to travel to at least Kon Kaen. Expensive though it was/is, Rattanak Hosp in PP was indeed the best place to bring her. Time was of the essence, she needed surgery to relive pressure on the brain immediately. that is not something a small hospital across the Thai border could have done.

Does anyone know an estimate of the cost per day in private facility such a BH in Bkk?

Basically the lady was not covered at all by insurance.Family has managed to arrange backdated coverage of 15000$ only,the rest we raised amongst of friends.Unfortunatelly the issue is not entirely financial because we can't verify by independent doctors wether she is getting an adequate treatment.The only doctor who'd visited her from outside was the one provided by insurance company.Does anyone know good neurologist in PP who is not affiliated with Royal Rattanak?

[Sheryl]

Places like Bumrungrad, Bangkok hospital etc (large private "international" hospitals) are going to run about 9,000 baht/day just for an ICU bed, and there may be add-ons related to the use of the ventilator, plus physician fees, medication etc, in other words as much or more than where she is now. Clearly not an option under the circumstances.

Non-profit hospitals such as Bangkok Christian Hospital and Saint Louis Hospital will be about 1/3 of that. Contact info for these:

http://www.saintlouis.or.th/main_page.php

http://www.bkkchristianhosp.th.com/main_service.asp?lang=E

Thai government hospitals would be still less but maybe not that much so. Only major tertiary facilities like Chulalonghorn and Siriraj should be considered.

The above assumes the patient requires ICU care. If/as stabilized, costs would go down considerably and also the range of hospitals with suitable capacity would widen.

As for neurologists in Cambodia, I do not know the names but there are only a handful in the hwokle country and they are at Calmette and Bayon. (I think it is just 1-2 docs at Bayon). Of the two places, Bayon is the easier to deal with as it is private and small. Located on Norodom Blvd across from the Chbar Ampov bridge, best would be just to go there in person. I believe the neuro docs are there only late afternoon/evenings as they also work at Calmette during the day.

It should be easy enough to get them to provide an assessment, whether they are as knowledgable and up to date as the staff at Rattanak is another matter altogether and doubtful. You could also discuss this issue with the staff at SOS. They will not have a neurologist or neurosurgeon, but they will have physicians capable of determining if usual standards of care are being met.

For what it is worth, in every contact with Rattanak that I have had/observed, the care has been appropriate, and I have not observed the kind of exploitation for financial gain that you are concerned about -- quite the opposite, I have known them to send home people more than happy to pay for admission when the medical condition did not warrant it. Can't say as much for Calmette.

[janverbeem]

Places like Bumrungrad, Bangkok hospital etc (large private "international" hospitals) are going to run about 9,000 baht/day just for an ICU bed, and there may be add-ons related to the use of the ventilator, plus physician fees, medication etc, in other words as much or more than where she is now. Clearly not an option under the circumstances.

I read in the OP that his current costs are Ninety Thousand Baht a day,compared to nine thousand for Bumrungrad.

[Sheryl]

Places like Bumrungrad, Bangkok hospital etc (large private "international" hospitals) are going to run about 9,000 baht/day just for an ICU bed, and there may be add-ons related to the use of the ventilator, plus physician fees, medication etc, in other words as much or more than where she is now. Clearly not an option under the circumstances.

I read in the OP that his current costs are Ninety Thousand Baht a day,compared to nine thousand for Bumrungrad.

Yikes, I missed a zero..!

Should note though that the 9,000 is the charge for the bed only. Tiotal daily charghe will easily double that. But still not to level of 90,000 baht a dfay if that is really what it is now costing her at Rattanak, unless there is some extremely costly treatment being provided I don't know the details of.

A less expensive alternative to Thailand is Viet Nam. cho Rai Hospital in Ho Chi Minh. That's where the Cambodian middle class tend to go themselves. Not as "user friendly" for foreigners as the bangkok hospuitals (in terms of language etc) but much less epxensive. Would also be a much quicker triop, and ambulances go between Phnom Penh and Ho chi Minh all the time.

[dick]

Sheryl,thank you very much for your input! We are currently talking to both of proposed hospitals.

[remiss]

In my limited experience (twice with other people successfully treated) the government hospital in Sisaket is quite competent.

Btw, in my not so humble opinion the minium insurance level for doctors, hospitals, medical care and repatriation is 'unlimited' -- inappropriate and too late, I know, but let it be a warning to others. You don't want to be on your deathbed worrying about or unable to cough up money..

[lopburi3]

As to costs can add that in my overnight stay in ICU/CCU at Vejthani Hospital in March (basic room cost 3,800) the next room had a head gunshot wound patient in coma and cost of 7 or 8 days had totaled 800,000 baht at that point (according to mother) so per day cost about the same 90,000 baht range (for one week). Obviously this included operations and intensive care by a team of doctors but believe the Cambodia example is also an all inclusive daily total rather than a basic charge for ICU. So indeed the 2,000,000 sounds very high, but perhaps not too much out of line, but really have no idea what was done so any comparison could be invalid.

[Sheryl]

In my limited experience (twice with other people successfully treated) the government hospital in Sisaket is quite competent.

Government provincial hospitals are indeed quite competent for common medical problems. However this is a highly specialized situation requiring a level of care that is not found at that level of the Thai public health system. If she had gone there she'd have had to be referred to Bangkok, losing valuable time in the process.

Dick: sent you email re physician to assess care. If this is not an insurance requirement then I don't know that it is worth bothering with, since in any case the next steps are the same. But I'm happy to help if you feel it is needed.

FYI between Bangkok Christian and St Louis, my first choice would be Saint Louis.

[Sheryl]

As to costs can add that in my overnight stay in ICU/CCU at Vejthani Hospital in March (basic room cost 3,800) the next room had a head gunshot wound patient in coma and cost of 7 or 8 days had totaled 800,000 baht at that point (according to mother) so per day cost about the same 90,000 baht range (for one week). Obviously this included operations and intensive care by a team of doctors but believe the Cambodia example is also an all inclusive daily total rather than a basic charge for ICU. So indeed the 2,000,000 sounds very high, but perhaps not too much out of line, but really have no idea what was done so any comparison could be invalid.

Yes, 2 mill baht for ICU care for that length of time inclusive of long distance emergency transport and two neurosurgeries is about what it would have cost in a for-profit private hospital Thailand. presumably the 90,000 a day is an average and not the charge every day minus the surgeries etc. That said, Royal Rattanak has only 4 ICU beds which are often empty and yet have to be staffed and equipped 24/7. (The entire population of Cambodia is less than that of Bangkok). So the hospital suffers greatly from lack of economies of scale and this pushes costs way up especially for things like ICU. They are never inexpensive, but for things like normal delivery where they get a better volume of traffic the costs are not as disproportionate as they are for ICU.

[dmerchent]

You should definitely check out FV Hospital in HCMC, we have used them before and they are a very professional and provide quality health care. They have an office here in Phnom Penh that you could go speak to and find out more information to see if they would be a fit for your friend. Very good English also. Here is a link to there homepage, they even have a daily bus that goes from Phnom Penh to the hospital. FV Hospital Best of luck to you and your friend.

[smokie36]

Sheryl,thank you very much for your input! We are currently talking to both of proposed hospitals.

Its a long shot I know dick but my bank provides a certain amount of travel insurance as standard with my account. Might be worth checking with her bank to see if she has this. Her travel insurance must have been dreadfully poor otherwise.

Best wishes.