Dr Fragen in the operating room

Medical Tourism


If you had any doubts that undocumented aliens are sapping our resources and utilizing out tax dollars let me relate a story. As you may or may not know I’m a surgeon. I still take ER Call at our [local hospital][1] and this story occurred over the recent holiday weekend.
A woman came to the ER with signs and symptoms of a small bowel obstruction. She was brought by her daughter-in-law, who lives locally. She is from Mexico, a Mexican national. Her story starts about the end of last summer when she fell ill and was hospitalized in Mexico. While there she was found to have a large pelvic tumor causing obstruction of both her colon and her right ureter. At operation both of these were bypassed. She and her family were told she had an unresectable colon cancer. She apparently underwent a weeks worth of chemotherapy with little result. OK, enough history.
While here she had a bowel obstruction. CT scan showed a large, amorphous mass in the pelvis; but curiously no real suggestion of liver mets. In other words, something not acting like a colon cancer. I took her to the operating room as her bowel obstruction didn’t improve. At operation I found cancer everywhere, except the liver. I’ll save the suspense. This was acting much more like metastatic ovarian cancer than colon cancer. Pathology proved me right.
Here’s where parts of the story get interesting. Ovarian cancer is *very* responsive to chemotherapy. In fact, many tumors that could be considered incurable do *amazingly* well. End of the medical part of the story. The family checked her out of the hospital *against medical advice* to take her home to be with her family in her death.
This post isn’t about the tragedy of her seeming *misdiagnosis* in Mexico, or her family’s decision not to have me consult an oncologist to potentially treat her.
This patient was likely driven across the border by her family and came promptly to the hospital. In the few days she was in our country her family had gotten her qualified for *emergency* Medical, California’s Medicaid system. How is it that an *tourist* is able to qualify for paid State medical care. Does anyone really think that this patient’s medical bills — hospital bills, lab bills, radiology bills, consultant bills, and oh yeah my bills, will ever get paid? I don’t know — they might. But from past experience, I’m not betting on it.
BTW, if don’t start thinking that this is an isolated incident. I’ve got lots of other stories, this one just happened to be the most recent.