The necessity of Developing Patients Skills
There has been a lot of attention given to the new field
of medical tourism and the significant benefits and
risks it presents to hotels and resorts
By Joseph McDonough
The hospitality industry cannot escape the fact that
there is an ever increasing need to provide medical care to its
best market, ageing baby boomers. If planned correctly this need
not be a burden but a great opportunity. Part of that planning
process will be to develop the appropriate legal strategies that
will protect hoteliers from the array of potential liabilities
that come with providing medical care. In addition to being a
member of a law firm with a global reputation in both
hospitality and health care law I am one of those ageing baby
boomers who loves to travel.
My own parents looked forward to a retirement in which they
could see more of the world and get away from the miserable and
cold New England winters. The time share and warm weather resort
brochures were always present in the house. A series of medical
problems for my father put a halt to these plans. None of them
were that serious or life threatening but enough that he needed
a home health aide and physical therapy. While to medical
professionals, his problems were minor, just easily treated
rehabilitative care, to my father and his primary caregiver, my
mother, these were life changing and serious enough that travel
plans were cancelled. For the hotels and resorts they planned on
visiting it was one more empty room and as you look at the
hundreds of thousands of families like them across the US,
Europe and the Middle East that loss of revenue multiplies into
millions of dollars.
Medical Tourism Versus Medical Care
There has been a lot of attention given to the new field of
medical tourism and the significant benefits and risks it
presents to hotels and resorts. There is a significant
difference in legal risk depending on how one defines “medical
tourism”, and how it varies from “medical care” while being a
tourist. Wikipedia defines medical tourism as “… a term
initially coined by travel agencies and the mass media to
describe the rapidly-growing practice of travelling across
international borders to obtain health care.” It goes on to
state, “Services typically sought by travellers include elective
procedures as well as complex specialised surgeries such as
joint replacement (knee/hip), cardiac surgery, dental surgery,
and cosmetic surgeries.” This describes some very complex,
invasive and, from a liability lawyers point of few, some very
risky activities. We will look at how to quantify, predict and
minimise those risks later in this article.
There is a much larger universe of clients and potential
clients that need some medical care but are not travelling
because of medical reasons but despite medical needs. The ageing
baby boomer population creates an ever-growing market of
potential clients. Many will stay at home because they think
travel will deny them the simple medical care to treat diabetes,
colostomies, strokes and a long list of other ailments, readily
available by relatively lower paid semi-skilled health care
aides and therapists. However, for more involved procedures, it
is far more likely that they will want to travel not for the
surgery touted by the medical tourism industry but to recuperate
and get simple rehabilitative care from surgery done at their
local hospital. Targeting this market is especially attractive
in place like Oman which has undertaken a major effort to train
health care workers and to become a center of destination
Medical tourism has become highly reliant on “facilitators”.
These middlemen perform a variety of functions: arranging for
medical and travel related services, advising in the selection
of the destination provider, arranging for the forwarding of
medical records and information, facilitating the payment of
fees, setting up aftercare facilities and functions, liaising
with insurance companies and other relevant participants.
Hoteliers may wish to utilise some type of facilitator to assist
with some of the medical tourism arrangements listed above, but
for most medical maintenance care, even for rehabilitative
services, a paid liaison is not necessary.
From a liability aspect working without a facilitator arguably
makes things much more straight forward as there is a great deal
of legal uncertainty regarding which parties are exposed to
risk. However having a written contract with a facilitator that
is experienced, well qualified, fully insured and financially
solid will significantly reduce but not eliminate the hotel’s
risk. Because this is a new industry and multiple jurisdictions
are involved with any transaction as well as the numerous
opportunities for miscommunication of medical information,
eliminating risk is an impossible dream. The key task in medical
tourism is to reduce and manage the risk. Key principles to
consider when choosing a facilitator would include:
Medical tourism facilitators are not travel agents, they need to
understand health care.
They will be able to clearly in all needed languages communicate
to the client; they must be transmitting medical information but
have to understand that they are making no medical decisions.
Do they have the client and client’s family play an active
role in communicating with care givers at home and in the
Do they make it clear who they represent as an agent and what
risks they assume?
What are the language differences, written and spoken, among all
the parties and what is the plan and back up plan to be sure
these terms, often medical and scientific and fraught with
emotion, are truly understood by the parties.
What is their system for maintaining, updating and backing up
records and communications?
Are they using a legal counsel in the home and visiting country
and are they giving the client an opportunity to do the same?
Do they recognise the “Murphy’s Law” (If anything can go wrong
it will and at the worse time”) factors? Is there cancellation
insurance? Avenues for a second opinion? Emergency trauma and
evacuation plans? Back up lists of caregiver? Health care
workers get sick too.
I am sure there are many additional points of caution that can
be added to this list in merely having a role in the medical
tourism venture. An area of concern in some destination
countries are the medical procedures that are banned in many
jurisdictions and therefore force patients to travel for stem
cell treatment, experimental drug use, invitro-fertilisation
etc. These areas may have criminal risks and merely being a
participant, if another is offering these treatments or
procedures, could open a Pandora’s box of risk. The MENA region
has seen very little of this activity but caution is advised
One of the purposes of this article is to have hospitality
professionals consider the benefits of offering some basic
medical care and rehabilitation without undertaking the risks
and activities accompanying what we’ve defined as “medical
The legal principles needed to assist consumers with their
health needs are far fewer than in medical tourism. Here are
some points to keep in mind:
Work with governmental health regulatory agencies to develop
lists of licensed health care entities or individuals and keep
this list up to date. Have the governmental tourism agency
liaise with their health colleagues if possible.
Retain an international law firm that will understand the laws
in the customer’s country and host country and that can draft
agreements with local health providers and disclaimers of
Make it clear to all parties that these health care providers
are not the hotel’s agents, employees or have any relationship
in which you guarantee their work. Provide license number of the
provider and the contact information of the licensing agency.
Have the customer agree that they understand this disclaimer.
If the hotel has a health care concierge be sure that all print
materials have a disclaimer and there is a sign posting at his
desk. Hotels are not responsible for the non affiliated
restaurants and recreation services they arrange and be sure the
customer know this and where he can contact with inquiries or
If health care providers have an office on hotel property, be
sure it is distinct from hotel offices & facilities and there
are similar disclaimers. Rental car companies may be using or
leasing space from the hotel but it is clear the hotel is not a
party to the rental relationship.
If caregivers are providing nursing, personal or physical
therapy at the hotel facility, they require a picture
identification badge distinct from hotel IDs.
The hotel should not be the keeper of records however it should
have an emergency care plan and note specific medical issues
such diabetics. Many jurisdictions have significant and complex
patient privacy laws and hotels should avoid receiving
information and have steps in place to safeguard any information
they do receive. Notice should be given that this information is
being kept as a courtesy and not a requirement. It would be a
good idea to have a place in the room where medical records
could be kept and easily found by caregivers or EMTs, but hotel
staff be instructed that it is not for their eyes.
Recommend to customers that all medications should be kept in
the room safe and the individual using them know how to access
Determine with food services what special diets you can
accommodate low sugar, salt etc., but give the appropriate
disclaimers for that as well as for food allergies.
The courts in Europe, the US and the MENA region have seen few
of these cases, but most judges surveyed indicated that full
disclosure to the consumer is paramount. The more information
provided in plain language, with frequent, specific
acknowledgements, the more likely the judge will shift the risk
to the consumer and away from the hotel. Be aware that one
jurist noted a particular dislike of the lengthy, complex small
print web site disclaimer with the check off box at the end.
The GCC countries are well suited to attract visitors with
medical care needs. The region has been largely unaffected by
the political problems of North Africa and the Levant. The
quality of health care has been vastly improved by the
investments made by the oil rich governments and the thoughtful
joint ventures being done with premier hospitals in the United
States, England and Central Europe.
Countries like Oman have developed turnkey operations for
ambulance services /emergency care with George Washington
Hospital. Nursing, physical therapy and rehabilitative care are
key specialties at area universities and private companies like
Rochester Wellness in the UAE and Oman offer world class
aftercare capabilities. Families from the MENA region are well
known to travel together as a group, and destinations that are
welcoming to all members of the family especially the highly
respected elders will be rewarded with frequent and long stays.
The well financed Gulf region races to meet global medical
standards which will give patients confidence that they will be
safe and well cared for even if their condition worsens or they
have an emergency. Weather plays a role in making the area
attractive. Who wants to be cooped up inside during a cold
dreary winter in England or New England when they can settle in
at a sunny destination resort with golf courses, palm trees,
great food and quality services? Recuperation in a Gulf hotel or
resort may be just what the doctor orders and the industry can
benefit by taking the right legal prescriptions.
May - 2013
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