Moral hazard

The sad conclusion to the case of British grandmother Sheila Hollinghurst has left me conflicted.

Mrs. Hollinghurst developed a brain aneurysm during a cruise to Bermuda, requiring specialist neurological care that the Island was unable to provide. However, as she did not have medical insurance, no US hospital would treat her and the British government refused to pay for an emergency airlift back to the UK. It was left to an anonymous local benefactor to pay the $89,000 to fly her home. Nevertheless, she died on Saturday.

Mrs. Hollinghurst's daughter, Amanda Turner, is blaming the British government for her mother's death. "The British government has murdered my mum because they would not pay to get her home," she said.

However, had the British government paid for Mrs. Hollinghurst's flight home it might have encouraged other Britons to travel abroad without insurance cover. It would have sent the message that should you become ill, you can rely on the Government to bail you out, creating what in insurance terms is known as a "moral hazard". While the Government would presumably try to recover any such costs from the uninsured persons, what if they could not afford to pay?

On the other hand, it's sickening to think that Mrs. Hollinghurst's death might have been averted had the $89,000 been forthcoming sooner. It's also possible that Mrs. Hollinghurst may have been unaware of the need for insurance when travelling abroad, since the UK's national health service (NHS) provides healthcare that is free at the point of use.

Mrs. Hollinghurst's case demonstrates the fundamental problem with medical insurance: should those who cannot afford it be denied treatment and possibly allowed to die? I'm all for personal responsibility, but isn't that just a little too Darwinian?

Comments

[Nicolette on 01.11.05 at 18:23]

Bermuda's no stranger to moral hazard when it comes to health insurance:

http://www.theroyalgazette.com/apps/pbcs.dll/article?AID=/20030519/NEWS/105190002

as previously reported in the Gazette....

[loki on 01.11.05 at 18:27]

A very tough issue to discuss and an awfully tragic conclusion. Had I been Ms. Hollinghurst, I know that I would have wanted the British Government to step in. Trying to be as objective as possible, though, I can totally understand the position taken by the British Government and, ultimately, I think that the Government's policy is probably correct.

[SmokingGun on 01.11.05 at 18:56]

"Mrs. Hollinghurst developed a brain aneurysm during a cruise to Bermuda, requiring specialist neurological care that the Island was unable to provide."

1: A rapid attack.
2: At Sea.
3: Where the closest hospital just happens to be on one of the wealthiest countries on earth yet has no proper capabilities to handle the victims needs.

This wasn't a long term illness that could be expected to have some consequences during travel. For the few times that this happens in the vicinity of Bermuda I think our own Government should have a policy to fly the patient to care as rapidly as possible. At our expense if absolutely necessary.

The kind person who stepped forward and paid the bill is a truly caring person.

I'm deeply sorry to the Hollinghurst family for our country failing them.

[Full Fullish on 01.11.05 at 19:27]

Ahhh yes the almighty dollar is worth more than a person....truely a sad period of time we live in....What ever happened to the days where insurance wasn't needed, when you brought someting it wasn't intangeble?

[Rev. Goat on 01.11.05 at 19:28]

The British Government should have flown her back and worried about money afterwards. Had she survived they could have worked something out so there would be a deterent for others that travel without insurance.

But what really disgusts me is the the way the British labour party seems all to ready to hand money out to immigrants left right and center.

[Tim Taylor on 01.11.05 at 20:20]

I totally agree with Smoking Gun on this one. Our Government has access to millions of our personal dallars. The U.S. has access to billions. So do the Brits. If that money is not collected by these Governments to help and succour helpless citizens, what the hell are we giving it to them for? Surely, between them, they could have got this lady into an East coast hospital and underwritten the cost, and claimed it back later. They do it all the time with Student Loans.

May God bless the unknown businessman who paid to fly Mrs. Hollinghurst home. He personally did what two world powers and one of the richest places on the planet should have done immediately.

My heart goes out to her daughter and family. The same thing killed my Dad eighteen years ago, only it took its own sweet time doing it and the doctors were helpless to do anything about it.

Not too long ago, the Yanks and the Brits would have sent a fleet to rescue any citizen who fell into the wrong hands. Now, it seems, they'd be quite happy to watch them die because they're not rich enough to have insurance. Or don't know that they should.

[loki on 01.11.05 at 21:17]

"Not too long ago, the Yanks and the Brits would have sent a fleet to rescue any citizen who fell into the wrong hands. Now, it seems, they'd be quite happy to watch them die because they're not rich enough to have insurance. Or don't know that they should."

Sorry, I can't agree with you on this one. The British Government or, indeed, any government, cannot be responsible for its citizens who fall ill on vacation without health insurance. I have had my own relatives fall ill on vacation in Bermuda and, whilst they accrued some $30,000.00 in medical expenses, they recognized that they needed travek insurances and took out the same whilst they were in the UK before they left as part of their travel package. I do believe that if the British government started to 'pick up the tab' for people falling ill overseas, this would lead to a rash of abuses, much as it has in relation to British citizens seeking medical treatment in other EU nations. This is not to minimize the tragedy of Ms. Hollinghurst's death, but there are wider considerations for the British government.

[SmokingGun on 01.11.05 at 22:18]

Loki. With all due respect. This is a case of certain death if something isn't done immediately. If a heap of doctors all stand up and say they can't do anything and that's it then what you are saying is humanity has no place on earth.

Governments print money every day. Life's not something one can order up at will.

What I can't understand is why it cost $89,000 to fly her home.

[Rev. Goat on 01.11.05 at 22:36]

That was someones LIFE, loki what if it was your nearest and dearests LIFE. Like Tim said, do the right thing and get it dealt with later, put a lean on their house or something but the womans LIFE could have been saved.

Funny though how the UK gov will give immigrants houses(worth a lot more than 89K).

[Amin Swan on 01.11.05 at 22:44]

Phil,

Do you have contact info. for the family? I would like to send a condolence card....This story brought tears to my eyes - so so sad.

Atlanta, GA

[Phil on 01.11.05 at 23:04]

Sorry Amin, I'm afraid I don't have any contact information.

[SmokingGun on 01.11.05 at 23:28]

Amin, this is the web site for Hope Hospital in Manchester where Mrs. Hollinghurst was taken to.

www.srht.nhs.uk

I am sure if you contacted them they would be happy to get the card to the family for you. Very considerate of you.

[US nurse at Hopkins on 02.11.05 at 00:33]

I'm stunned that the US didn't allow this woman to come to the states without insurance. We treat everyone...insured and uninsured. Of course, that's why our health care system is in a crisis. I see immigrants and US citizens who are "self pay" day in and day out. I'm sure that there is more to this story than people know. She could have shown symptoms of irreversible brain damage, shown that she would not have been able to breathe on her own...no one will ever know without examining her medical record. It's nice to be a Monday morning quarterback, but welcome to the world of US medicine...God rest Mrs. Hollinghurst and may peace be with her family.

[Amin Swan on 02.11.05 at 01:08]

Thanks Smk Gun, if I find something, I'll post it....

[Anon on 02.11.05 at 07:23]

Loki,

I agree with you (albeit with a heavy heart). I have just returned to the UK and am sickened by the status of the NHS (great idea but oh how they have screwed it up!). Situations like the one being suggested here would only serve to weaken the NHS system.
When you go to your "High Street" travel agent, they all but force insurance on you - for that matter with just about any significant purchase you are pressured to buy some form of insurance.
I truly feel for the victim and her family and applaud the kind soul who assisted them. However the UK government cannot be expected to pick up the tab for someone who can clearly afford a vacation and thus the few extra pounds for insurance while less fortunate people at home are waiting months (no exaggeration here) for the most basic medical care.

As Rev Goat says it is life that we are discussing here, but one must look at the whole picture before condemning the Govt. approach. Housing for immigrants is just another of the UK governments farces, but cannot be used to strengthen or weaken the argument at hand.

Being a tourist destination, could/should the Bermuda government create a fund (with proceeds from their departure/airport/cruise
taxes)to handle such eventualities? They haev a similar set up in the form of the Motor Insurance Fund (MIF). We obviously can't leave a person here to die, but are we responsible for their transport? I dont know the answer to that one.

[hotspur on 02.11.05 at 07:35]

A very sad experience for the family but you have to detach yourself emotionally to discuss this issue.

People travel today like never before. If Governments started setting a precedent by airlifting sick people around at the tax payers cost it would very quickly get out of control.

Imaging if the new school wasn’t finished year after year or the roads weren’t getting fixed (as an example) and the reason was that Government was spending hundreds of thousand of dollars a year airlifting people to the US who had no insurance… fairly soon people would be attacking the policy. Here’s another thought: Imagine if the head of Nazi organization was on the Island in a similar situation – what would the response be then? Would we still feel morally obliged to help this person out as well? It’s Pandora’s Box.

A very sad and emotive issue but the answer is to educate travelers about the necessity of appropriate insurance. This sounds callous and my heart sincerely goes out to the family but what, realistically, would you do if you were running the country’s finances?

[Full Fullish on 02.11.05 at 07:43]

Anon - I like your idea of funds being in place for travelers in the country, for eventualities such as this. Of course with the current system of give and take that will also bring up a whole problem of legalities, ownership of the problem, and compensation I fear.

I just feal that the current status quo is inadequate at the end of the day $$ should not be more imporant than someone's life....

[Curried Goat on 02.11.05 at 08:07]

A very sorry state of affairs. I have great sympathy for the family.

If a Bermudian on holiday falls ill in the UK the NHS would do whatever is required and ask questions later.

With regard to the attitude towards travel insurance in the UK, obviously, it is a good idea, and should be mandatory in my opinion. However, since there are reciprocal agreements between all European countries and most Commonwealth countries many people in the UK do not see insurance as essential. Canada would have accepted Mrs. Hollinghurst, as Bermuda did, but would have had the ability to help her out.

If a Bermudian were to fall ill in the same way, what would happen? They would be airlifted to the US asap. The bill for treatment would be sent to the Government and dealt with in arrears. The same should have applied in Mrs. Hollingshurst's case. I myself have had to be treated in hospital in Bermuda as a visitor several years ago. They did not ask me for money up front. I paid by credit card after I was treated (I then claimed it back off my insurance, well most of it, they would not honour the whole claim!). Whether it required a second mortgage or Government intervention there is no excuse for the bermuda government not allowing Mrs. Hollinghurst immediate treatment.

[Bermudian in Limeyland on 02.11.05 at 09:24]

The cost to Mrs. Hollingsworth of travel insurance which would have fully covered medical fees including air lifting her to either the US or back to England is very small. Annual travel insurance in the UK with substantial overseas medical coverage runs at less than £100 and a single trip policy is approximately £30. Blaming the government of either country does not make economic sense as it would set a precedent that would eliminate people purchasing travel insurance altogether. While this incident was deeply unfortunate it does hi-light a growing trend amongst people to refuse to accept personal liability for their own decisions and actions and look to the goverments of the world to hold their hand through life.

[jake on 02.11.05 at 09:46]

Medical care costs money, and expensive care lots of it.

Insurance only works when people pay the premiums. The healthy pay for the sick and if people who do not pay, seek to benefit from the pool of funds allocated by those who do, they will soon overwhelm them.

I would argue that with Governments it is different. We all pay into the Government system, and there is not really an opt in to it. I would encourage us to look at the way in which an emergency medical fund could be set up for those who travel to our country without insurance. We could allocate funds, or mandate our own form of travel insurance, which premiums we could subsidize. Why?

I would say because we are a service industry, and this is an additional service that our customers obviously need. Would this have played out better if the news article had read "Bermuda saves British Mum"? How much would that have been worth to us as a tourist nation? $89,000? I would argue yes.

To me it looks like an opportunity to craft another value added item to the list of reasons why Bermuda is a good option.

I would love it if our country got into the habit of finding ways of adding value to our guests. Perhaps then we could change the negative and creeping anger which has entered our national mindset toward IB and Tourists both.

You know, the old 'hand that feeds you' thing.

[SmokingGun on 02.11.05 at 10:00]

To travel without risk is impossible. However there are riskier ways and places to travel to. To an individual a hiking trek through Nepal is somewhat riskier than a cruise to Bermuda. We all know about risk.

My sincere feeling is that if a person is stricken with a rapid illness or injury that happened within or near our jurisdiction and it is determined that they need to be airlifted off island, Bermuda should step up and take care of the matter. We have excellent Doctors and Nurses and for such a small population we have quite adequate facilities, however we cannot handle some extreme cases. If we were a poorer nation similar to some of the islands in the Carribbean then that would be different.

Threre is truth in the fact that people must be made aware of the different levels of risk when they travel and should purchase protection accordingly. Maybe the UK should pass law for people who travel to either prove they have coverage or purchase it accordingly. However I still maintain if they should end up on our shores and the Doctors state emphatically that this person needs evacuation immediately then we should also have a policy to handle that no questions asked.

Heck, all Government has to do is walk down Front Street and purchase a policy from any of our Re-Insurance domiciles.

Now someone please let me know. Why $89,000 for a plane ticket?

[Nicolette on 02.11.05 at 10:01]

Quite frankly, if you want insurance - buy it. One of the main reasons the US had a liability crisis, Lloyd's had to put pre 1992 U/W years into run-off (Equitas) and Bermuda has been a direct receipient by providing excess capacity is because of primarily judges and other unilateral decision makers forcing insurers/reinsurers to pay for losses they never received a premium for. This is political posturing and exactly what the AG of Mississippi is trying to do now with uncovered flood losses from Katrina. What's reprehensible is that the flood exclusion language isn't merely approved by the Mississippi Department of Insurance, it is required by it. When my father died - no insurance picked up his air ambulance freight - we did and we didn't go public blaming countries and governments for not keeping him alive and we had a few justifiable gripes but that's personal and will stay that way.

[Yet Another Limey on 02.11.05 at 10:16]

Smoking Gun, '$89,000 for the emergency flight with a full ICU medical team on board'

http://www.theroyalgazette.com/apps/pbcs.dll/article?AID=/20051028/NEWS/110280131

[SmokingGun on 02.11.05 at 10:30]

YAL, Thanks. I do realize the good old middle aged BA flight attendant might have abeen a bit out of her league on this one but I do question the cost. I've just spent the better part of this year watching a young child's hospital bills hit $750,000 only to be slashed in half when the Insurance Company decided to cough up.

[Uncle Elvis on 02.11.05 at 11:11]

"Would this have played out better if the news article had read "Bermuda saves British Mum"? "
-jake-

EXACTLY!

Strictly from a PR perspective, we should have done something. It wouldn't have set a precedent here, I don't think, it would have just been the right thing to do.

I understand the problem with the British Government not doing it. I can see both sides of it. I can see where it WOULD set a precedent there and would probably open the door for abuses.

I CAN'T see why WE couldn't have done something. A small community like ours is way less open to the kind of abuses of the system a large country like the UK or US are, as it's probably a lot harder to slip something under the radar, y'know? Everyone is in everyone else's business.

Couldn't someone set up a charity for something like this? $89,000 is a tonne of cash for an individual, but for a community, it's not, really.

How would someone go about that? Anyone?

[Curried Goat on 02.11.05 at 11:40]

You are right but what if she had died in Bermuda? She would probably have had to be post mortemed, a investigation would almost certainly have followed, and then repatriation. Most of this would have been at Bermuda's expense. What about the medical costs for the time she was in KEMH? Who paid for that? Had she been sent back earlier, how many days KEMH cost would have been saved, let alone the "Bermuda Saves...." qudos.

I agree the Government should but a policy for this sort of event, even though it is rare. Maybe they could use it to their advantage. As I said in my earlier post, any Bermudian can go to the UK and get free heathcare. It basically says so in you pasport.

[davecrem on 02.11.05 at 18:36]

Ruptured brain aneursm has an incidence of 6-10 in 100 000. Once it happens even despite the best surgical care death still occurs in over 30% while less then 50% make a full functional recovery. We live in a culture where everyone wants to blame someone else so what does this family spout - "the government killed my grandmother". I'm sure the Iraqui's have great sympathy for you. The sort of statement you'd expect from the uneducated - well who else goes on a cruise ship? She was unlucky but as we doctors like to say - shit happens. Brain injury of such an extent requires prompt treatment to get the pressure building up in her head down as soon as possible. It happened on a cruise ship, took her time to reach the tinpot bermuda NHS and even if the government (who we complain when its a nanny state but now want it to be) did fly her over the likelihood is she wouldn't have made it but we have no way of knowing yet we seem to assume she would have miraculously survived. Jesus, take some responsibility. You chose not to pay for it, and limey its got nothing to do with not being able to afford it, she chose not too, so take the consequences. I'm sick of our culture where if things go wrong its someoneelse's fault. As doctors we are not miracle workers, people die all the time and you just have to accept it and grieve in the way you feel best. Chances are she would have died so I'm sure you'd rather she hadn't gone to the states where they'd do lots of fancy (but futile) things to drum up a nice bill!. Just out of interest what do bermudians do if they need neurological surgery?

[Bill Cook on 02.11.05 at 18:43]

davecrem,

Pray that you are not their doctor or surgeon would be my guess.

[Rev. Goat on 02.11.05 at 18:56]

Nice one Bill!

Davecrem you are pretty cold aren't you.

[SmokingGun on 02.11.05 at 19:09]

Bill now you're Cookin'! Very funny and quick to boot. ;)

With all due respect Daaaave. If you really are a Doctor, wouldn't you be the first to say: "Hey! If this lady has a 50% chance of survival and seeing that we have no qualified docs nor facilities around to give us the real low down let's get her out on the first available flight!. Because you see time is ticking and I swore some kind of oath way back when and I don't give a rats arse as to what you insurance types care."

[Andrew on 02.11.05 at 19:18]

My heart goes out to the family, but I felt they were wrong by claiming that the British Government murdered the poor lady. People have a responsibility to care for themselves. a $30 policy, most certainly offered by the travel agent, probably would have helped.

I have travelled with people who have opted out of travel insurance to save a few bucks. I thought they were mad. If you can afford the cruise, surely you can afford the insurance.

The kind soul who put up the cash to get her home is an angel.

[Tim Taylor on 02.11.05 at 19:23]

Okay, now I agree with both Smoking Gun AND Jake. This is getting scary.
Having read all the various opinions, I am now prepared to cross out both the U.S. and the U.K. as care-givers.
They are both so hidebound with regulations, they can't and won't adapt quickly to a unique situation.

We can.

Is there a single family on this rock that wouldn't put themselves out to help a person in distress?

No.

We,as a community, are like a huge, inbred, feudin', catfighting family - but give us a reason to help out or stand together for a worthy cause and, by God, just watch us go.

This attitude should be reflected by those who govern us. If you want to be really cynical about it, it's WORTH a couple of hundred thousand dollars for the good ink in the international press.

Perhaps we should be humbled by this tragic story and grasp the opportunity to commit ourselves to show the world the hospitality we are justly famous for.

Perhaps I am a little oversensitive to this, as I lost my Father the same way, so forgive me if I ask Davecrem if he (or she) would be so detatched and clinical if we were discussing a close family member of thiers?

[loki on 02.11.05 at 19:33]

"We,as a community, are like a huge, inbred, feudin', catfighting family - but give us a reason to help out or stand together for a worthy cause and, by God, just watch us go.

This attitude should be reflected by those who govern us. If you want to be really cynical about it, it's WORTH a couple of hundred thousand dollars for the good ink in the international press."

Agreed, but it's a large leap from a country such as Bermuda acting charitably (which is a good thing) to the creation of a RIGHT to be flown home at UK taxpayers' expense, which is clearly what many are implying. The death of this lady is tragic, but governments have to make cost/reward judgments in terms of policy every day. Harsh, but a fact of life. As much as many - myself included - would have liked to have seen this poor woman flown home in a timely manner, there are enormous public policy reasons as to why the UK government's policy is sound in the grand scheme of things. The UK government has enough problems with the NHS without expecting it to cough up huge sums of money because people choose not to purchase a thirty quid travel insurance policy. Like I said, if I was this poor woman's family, I would probably be screaming blue murder as well, but stepping back and trying to look at the big picture objectively, I can see why the UK Government's policy is the way it is.

[Andrew on 02.11.05 at 19:33]

I agree with Tim. If I invited guests to my home and they found themselves in a position requiring help (can't think of an example right now), as their host I would feel an obligation to help out and worry about the costs later.

...and I would probably feel good doing it.

...like if they had too much to drink and needed cab fare. I'd reach in my pocket and worry about payback at a later date, if at all. I have to think that the ratio of cab fare to my income is probably close to the ratio of an $89,000 flight to UK to BDA government's resources.

[tilti on 02.11.05 at 19:44]

For fear of being called cold I agree with Davecrem in that are emotional attachement to the image or an orderly English mother cloud rational judgement. All the talk of "this is a human life we're talking about here" begs the question why exactly are we so attached to the life of this particular women?
There are roughly 2 types of medical care in the world: the North American one and what the rest of the world goes by. The former operates with privileged people receiving extremely expensive care for any and all disease/affliction (regardless of possible success) at the expense less fortunate people. A quick look at the US reveals that while it has the most advanced hospitals in the world (by far)it has one of the highest levels of child mortality rates and people dying of the flu of any developed country. The other system of healthcare doesn't spend massive amounts on the health of a single individual, but has generally higher standards of health for the entire population.
$89,000 is a lot of money no matter how you cut it to spend on one woman who has a slim chance of survival - AND could afford the luxury of travel but scimps on insurance. There are a large number of Asian and Indian workers in Bermuda, primarily in the service industry, who could use $89,000 to provide medical treatment to ALL of their families put together - and they need the money and don't have it.
There are 6 Billion people in the world and the situation is grim. Why is there an attachement to one person who has large financial needs and could afford her own coverage, but not to millions whose life could be saved for a couple of dollars each? I'd like to think that it is because the former is clear and present, but I don't know if that is the case.

[Rev. Goat on 02.11.05 at 19:56]

Sounds to me like you resent that Mrs Hollinghurst was on a cruise.

[Rev. Goat on 02.11.05 at 19:57]

Hey whatever! 11 mil on a cricket tour is much better spent NOT!

[SmokingGun on 02.11.05 at 19:58]

Loki- I think the gist of this thread has turned more to Bermuda's failure as opposed to the UK's policy for it's people when travelling. There is a definite need for people to be far more aware of the possible ramifications of their own decisions or lack of a decision. As in this case it was something that the individual or those close to her should have paid more attention to. Insurance whilst travelling is extremely important even if you just break a leg or arm. It really is a stretch to blame the UK if there is no policy on the books stating they would or wouldn't fly a person home. In fact it would have to be on the books in order for it to even happen in a timely manner. As we all know getting the attention of the right decision maker is next to impossible unless there is a clear path of authority.

In this case though things are different. Bermuda has the monetary resources to evacuate a person who cannot be treated properly on island. It's a qaundry that we will always have the possibility of facing. It does not make sense to have a full neurological staff and facility in Bermuda as we do not have enough cases to warrant it. This is true about a lot of specialists. We send our people away for such extreme needs. Thus we should factor in that a visitor might very well need help as well.

It's ironic because I was just having a discussion a few weeks ago about setting up a charity that might handle similar situations for Bermudians and now this has happened I think visitors should be included as well. It would obviously be a case by case scenario but this type of thing would more than qualify. I think I shall research a little more.

[hotspur on 02.11.05 at 20:00]

Tim, whilst I understand your point I think you’re treading a dangerous path.

In addition to the comments I made above if Bermuda tried to cash in on this “value add” it would attract many who are unable to get travel insurance due to their medical history. They would feel quite happy coming here knowing that they would be well taken care of if anything bad happened.

It’s a nice gesture but trying to set yourself up as the Mother Teresa of the world would be a financial disaster.

[hotspur on 02.11.05 at 20:06]

Nice one, tilti. Nice one.

[Rincewind on 02.11.05 at 20:13]

I am very curious as to what would have led to a total cost of $89,000 for the trip, does anyone know?

[davecrem on 02.11.05 at 20:19]

As a doctor working in UK if a tourist pitches up in A+E then of course we would do everything to help this person and give the best medical care. For all the knockers of the NHS we are one of the few countries who do this. Once someone is stabilised, payment can become an issue (it has to be, we can't look after our own effectively let alone free-loaders and its not heartless to use such a term but realistic) and now there are people in every hospital who work to assess certain patients rights for treatment. But this only becomes an issue once they are STABLE. A bleed in the brain is an emergency and if we at my hospital are referred a child over the phone to ask if we can accept this patient, that hospital is responsible to send the patient too us ASAP and we don't go and pick them up as they takes longer at the risk of death. Time is the essence, like it was in this case. This woman never regained consciousness and the right thing, the only thing that would save her is if she was immediately transported to the NEAREST hospital to deal with her medical condition. Therefore my point is, if you are going to blame someone else other then nature and herself, you blame the Bermudian healthcare system. Simple fact. My point is expecting the governemt to sort it out. Not a common policy, would take too long to sort out, hey she's dying and needs urgent attention. Bermudans take a look at your healthcare system and don't condemn me for being a shite doctor. You don't know me at all and I don't condemn any of you as being bad at your profession. My original point is that people have to take responsibility for their actions, and don't pass the buck. In this case if you are, then that buck sits squarely in your grass court munching away on a few blades! It seems you offer stroke rehab anyway?

http://www.bermudahospitals.bm/services/kemh/stroke-rehab.html

Seems fuck all use if you can't keep them alive initially. Maybe if you'd have done you could have "re-learned" her to buy insurance next time

[Rincewind on 02.11.05 at 20:26]

I 've heard the stroke rehab isn't worth a whole lot and worth even less when your insurance won't pay for it because you have reached a certain age.

[SmokingGun on 02.11.05 at 20:42]

Dr. Dave, no-ones called you a "shite" doctor but I have to admit your bed-side manner is a little off putting. Never-the-less let me tell you a little story about the NHS.

Many moons ago, actaully not that long, I took a trip to Egypt to see the Nile. Needless to say I came down with Pharoah's Revenge and spent 4 days losing close to twenty pounds. I arrived back in London at midnight with a very sore throat. I was checked into Charing Cross Hospital with a bad case of strep. After a few hours and a shot of pennicilin I was told I could go home. I asked the staff how I should pay. Would they take a credit card? The response was "No, they don't take credit cards because it was too expensive to set up and manage so they just treat people and deal with the NHS".

I had two brainstorms that night:

1: Write some software to handle the billing systems simply and effectively and charge a fee.

2: Set up a travel company that guaranteed you'd lose weight or your money back.

[loki on 02.11.05 at 20:55]

Not to turn this into a Bermuda medical care system v NHS debate, but each has it's strengths and weaknesses:

1. NHS: good for emergency treatment due to the wide availability of treatment options/piss poor for 'non-emergency' treatment (whatever that means, I guess). People dying on waiting lists for heart bypass operations ain't my idea of a great healthcare system. Similarly, my father in law had to wait six years for a knee replacement operation.

2. Bermuda: not so good for dire emergencies, requiring specialist treatment not available on the island - you will get your treatment, but if you need neurosurgery within 12 hours, you're shit out of luck. Non-emergency treatment: fab, in my experience. Need an MRI? No problem. Knee replacement? We'll see you in four weeks, sir. Heart valve acting up? Not a problem.

On balance, I have got more faith in the Bermuda healthcare system, to be honest. I'm not knocking the doctors and nurses in the UK, by any means, but the NHS has become a victim of its unwieldy rules and regulations and its sheer size (EU issues don't help. either.)

[SmokingGun on 02.11.05 at 21:15]

Well put Loki. Both systems have their up-sides and both have their limitations. Get a blood test at a top rated hospital in Boston and you'll have your results back before you said ouch. Bermuda, three days if you know the Technician. Why? Boston has fifty people doing lab work 24 hours a day whilst we only have three working 5 days a week. I'm making numbers up but you get my point. We have what we have so we therefore need to be creative and do what we can with whatever resources are available.

There's a very good up-side to the fact that we don't have nightly emergency room visits for gunshot wounds, stabbings, over-doses, assaults, vehicle accidents etc.

[Raptor on 02.11.05 at 21:36]

"I am very curious as to what would have led to a total cost of $89,000 for the trip, does anyone know?" Posted by Rincewind on 02.11.05 at 20:13

It's a private plane with medical staff, lots of medical equipment, and I believe they said two stops between Bermuda and the UK.

[loki on 02.11.05 at 21:50]

"two stops between Bermuda and the UK."

Eh? The first land between here and the UK would be Ireland, and I doubt they'd be stopping there. It's probably because they need a long-range aircraft, such as a Gulfstream V, to get from here to the UK, as well as the emergency equipment, staff, etc.

[automatic on 02.11.05 at 22:19]

They did indeed make two stops, in Montreal and Iceland, before landing in England. The reason given was to pick up essential medical supplies and to change over the medical staff.

That makes sense, this lady needed constant care from a team of doctors and nurses, and it was a 10 hour flight, the staff would have needed to change over to give her the best care.

Seems odd at first glance that they went west to Montreal, before heading over the Atlantic, but maybe they needed extra eqipment they could only get in Canada? And knowing that they had to stop in Iceland they will have gone North first to reduce the distance across the Atlantic.

The Medivac people are experts, we are not. I'm sure they simply came up with the best plan of getting her to England as quickly and with as much chance of success as possible, whatever the cost.

I don't think it does anyone any favours to try second guessing them on the cost, they did the best they could.

[jbhvt on 02.11.05 at 22:29]

I'm curious-why did they not send her to Canada in the first place after the US wouldn't accept her because of the lack of insurance? It's closer than the UK and they have a similar national health care system don't they?