Lessons to Be Learned

I have spent the last three days working on two cases for the U.S. Embassy. Maybe if I document some of the problems involved, it will cause at least one more person to be willing to register with the U.S. Embassy in Panama City, and to set up a personal buddy contact and maybe write a will.

I received a call on Wednesday from the Embassy asking if I could check on a U.S. Citizen that was in the Regional Hospital. The hospital social worker had called the Embassy requesting help because the doctors were saying he was fine and they needed him to leave because the hospital needed the space.

When I saw him he didn’t look well enough to care for himself if he returned to his apartment. I went back yesterday and the doctors again said he was perfectly fine and ready to leave.

I went to meet with the hospital social worker for this case. When I was sitting in the office of the hospital social worker, I called the Embassy so they could talk to her while I was there. She told the Embassy that they needed to release the patient to free up space.

Each time the hospital had wanted him to go, the patient had not wanted to go because he didn’t feel well. The Embassy asked what the hospital’s practice was in cases when the doctors said the patient was fine and the patient felt he needed more care.

The social worker said, if they didn’t leave voluntarily, that the hospital would put them on the street. The Embassy asked if this was the same treatment that would be given to a Panamanian. The answer was yes.

So, it was arranged for an ambulance to take the patient back to his apartment. Yesterday evening I received a call from the apartment landlord asking if I would come and see the patient that had been released.

Lilliam and I got to the apartment about 7:00 PM. When I saw the individual, it was obvious he was having trouble breathing and we called 911 for an ambulance to take him to a hospital other then the Regional Hospital. When the ambulance arrived, he was having more difficulty breathing and his heart stopped while the 911 attendants were there. They administered emergency treatment.

Thirty minutes later, he was pronounced dead. Now here is the part I have problems with. About 9 days ago he was fine. He went to the Olympic pool close to the airport and swam for two hours a day, three days a week, and had the habit of doing this for the last three years. While he was elderly, he could only be described as having exceptional health.

About 7 days ago he was hit by a pickup and taken to the Regional Hospital. In a mere 7 days in he was no longer fine. Of course the accident was the beginning, but broken bones should not be a reason to die. Had he been in one of the private hospitals, I believe he would still be alive. If a person enters the Regional Hospital and has no family there to monitor his/her care, he/she is in high potential risk. It is my opinion that a non-Panamanian has an even higher risk. While this is opinion, I have been to visit 4 prior gringo cases and two left alive. 50% doesn’t built much confidence with me.

I am convinced that had he not been released, he would have died in the hospital do to lack of care. For a medical doctor to have said he was fit to be released is almost criminal. For the hospital to say he leaves of his own volition or he will be put out on the street, should be a warning to anyone that enters and stays for any period of time in that hospital.

Now for you to understand how I spent last night. We called the Police and they came quickly and said we should ask for a doctor from the hospital to issue a reason for death. Obviously the hospital wanted nothing to do with that.

We then asked the police to notify the Fiscalía to come and take the case. I formally asked for an autopsy because I think that will indicate that he should not have been released.

We now started the wait for the Fiscalía. At 2:30 AM, this morning, the police said that nothing would happen until after 8:00 AM. Lilliam and I came home for a couple hours of sleep.

We returned to the apartment at 8 AM this morning and I had Lilliam call the Fiscalía Superior Primero and tell them we were waiting. This time when the officials came, they claimed that they were never notified last night and someone should have come sooner.

At 11:30 AM this morning they had completed all of their paperwork and the body was taken to the morgue for an autopsy. With the David cremation capability being closed, it will have to potentially go to Panama. But again, wishes could be easier exercised, if there was a will.

By the way, I spoke with the deceased’s lawyer this morning and he had also been told by doctors that the individual was fine and the hospital needed the space. The lawyer had told the doctors that he did not appear fine to him.

Now the second case. In the same 6 person room, as the previous patient, was another U.S. citizen. He asked to talk to me. He had had surgery and while he was using the same doctor that had treated him in Hospital Chiriquí, the nursing attention in the Regional hospital was missing. He requested some assistance from the Embassy.

I just spoke to the Embassy and a consul will be here next week to visit the patient and verify that proper care is being given and if the patient wants to move will assist in making that happen. I will tell you that the attention he is now being given seems to have improved. It helps to have someone in your corner. I plan on checking on him Sunday.

Neither of the men have family here and neither were registered with the Embassy. If you are going to live here, you have to understand that this is a third world country. If something happens to your health, you are up a creek without a paddle if you don’t have a buddy and a plan to be executed.

The first died without a will and no family in the states. He personally told me that he had one friend here and thought of him like a son. I know he would want his personal things to go to his friend, but that may not happen.

I plan on going to bed early tonight.

27 thoughts on “Lessons to Be Learned

  1. This post is disturbing on many levels, most of which you have articulated, Don Ray. To all of this I would add that those expats who proudly proclaim that they don’t need medical insurance, that the Panamanian government will take care of them if they are ill or injured, think again. Make health insurance a part of your financial planning.

  2. when you say register with the embassy, do you mean tourists too? I scoured the embassy website and saw no place to register.

  3. Don Ray, you are certainly a giving person to unselfishly spend so much time doing things for and helping others. The expats in David are fortunate to have such a fine person in their community.


  4. Don Ray:
    I am so sorry to hear this tragic story. I believe either he died of a puncture lung o a brain hemorrhage.

  5. The healthcare situation in Chiriqui Province is very precarious and can be dangerous and expensive especially if you are an ex-pat. My wife and I moved back to the U.S. because of the medical issues and complaints that have been posted by ex-pats. Medical costs for ex-pats have increased dramatically over the past two years. What use to cost 2K to 3K surgical procedure is now at least 4 times that amount. All cash…….no tickee….no laundry….attitude.

    I was was diagnosed by one of the major David hospitals that I had a minor groin hernia. They wanted $8,800.00 for the surgical procedure which they said would take 1 to 1.5 hours on an out patient basis. I checked the cost of the procedure in the U.S. and the Pennsylavania Hernia Institute wanted $3,800.00 (no insurance patient) for the same procedure.

    Since my return to the U.S. a few months ago, I had further medical tests including a cat scan, ex-rays and it was discovered I have hip osteoarthritis which is causing the pain in my groin. I simply do not have a groin hernia. If I would have had the operation in that David Hospital it would have been for naught and I would still have my groin pain and out $8800.00 for the surgery. I doubt that the hospital would have acknowledged the mistake.

    In addition, there are places you can actually live cheaper in the U.S. then in Boquete. Where I live, food in most cases is cheaper then Panama except for fish and meat. Plus I can get anything I want when I want it without having to stockpile. No internet, electrical, cable or telephone outages!!! My electricity costs are $.05 a kilowatt instead of $.20 like in Boquete. I enjoyed living in Boquete for 6 years but I am very thankful to be back to the good ole US of A.

  6. Don how right you are! The public health service in David is still Third World and expects a family member or an angel to check-in the patient and monitor treatment, meals, clean up and the safely of personal valuables. David’s private hospitals and clinics are the answer but not all ex pats can afford the insurance. The US State Department should warn potential ex pats.

  7. This is such a sad story. As an RN case manager, I can attest that inappropriate hospital discharges occur in the states as well. Regardless of where they occur, they just plain shouldn’t. If you, a loved one, or someone you are advocating for, doesn’t feel the discharge is appropriate, it might help to appeal to the medical staff instead of a social worker. Either intervene directly with the discharging physician, a covering physician, or go even higher up to the head of the department or the medical chief of staff, if neccessary. If you are unable to to get a response from any of the above, take the patient to the emergency room and insist on another medical evaluation there. What can unfortunately happen is one specialty, such as an orthopedist, discharges the patient after a successful orthopedic recovery. A pulmonary or cardiac condition may have manifested and either not been recognized by or reported to the discharging specialist. As I said, it shouldn’t happen, but it certainly does. More than once in the states I’ve visited a discharged patient and had to intervene in getting him/her urgently re-admitted. It is truly tragic what happened to this poor man. Don is to be commended for getting involved and trying to help.

  8. I agree with several commenters, Don: the expat community in David is indeed lucky to have someone like you. People willing to get involved and help others are relatively rare, but not non-existent, as witness your work and that of your friend, Tom McCormack. Congratulations to you both; there are good guys in David!

    I also want to second Bonnie Williams’ comments. Expats should not delude themselves into thinking that the public health systems are reliable; on occasion they are, but not often, so buying a decent health insurance policy that’s accepted by local (private) doctors and clinics is the way to go…

  9. Don Ray: I want to thank you for your service to this community. I could not do what you do – neither physically or emotionally. You are a special breed of cat my friend. We are indeed lucky to have you around.

  10. Dennis, where do you live in the U.S.? I am getting very tired of the stress of living in Panama. If I could find a reasonable place in the U.S. that wasn’t some place like Detroit or Mississippi, I would seriously take a look at it.

  11. If people move to Panama, they should come with their eyes wide open. That is why I always recommend that people rent for at least 6 months. Some in the dry season and some in the rainy season.

  12. Once again Don, you hit the nail on the head. I love living in Panama BUT for anything major I would fly back to the U.S. and use my Medicare insurance. I think I told you that once that a doctor from a major hospital in Chiriqui advised me to get a stent as I was at high risk for a coronary problem. The next week I flew back to the U.S., seen a specialist and took all kinds of test from 8:45 a.m. until 4:00 p.m. The result: nothing wrong with my heart, stronger than ever. OH, the price tag for the stent, hospital stay, etc…. close to $20,000. My exam in the U.S. cost me around $200. I will say this, the Hospitals and Doctors in Panama City appear to be much better than the local medical profession for anything serious.
    ps: David is lucky to have you as a warden, God bless you.

  13. Don: I went to update my information on website https://travelregistration.state.gov/ibrs/ui/
    to show a trip to the U.S. I will be making next week.
    When I selected the pull down menu to show that i was going to the U.S. the U.S. was not one of the countries listed!!! I was unable to continue as it was a required field. I will e-mail you a print-screen of the Itinerary page so you can see that no U.S. is listed as a destination.

  14. Judy Sacco:

    Send me an email with your email address and I will disclose the place where I live. It is one of the most beautiful places in the U.S. It is a self contained community of 28,000 acres with 15K residents. It has the lowest crime rate in the U.S. and comes complete with 12 lakes (some with nice sandy beaches), nine 18 hole golf courses, great restaurants and a fantastic community center with olympic indoor and outdoor pools, 20 tennis courts, and over 100 miles of walking/jogging trails. It has it’s own police, fire department and ambulance service. It has 6 security entrance gates (two manned 24 hours a day) and is definitely is not a snobby country club environment. It sits at 1000 feet elevation…so for sure it is not Florida. It is not Mississippi. The climate is the most temperate climate in the U.S. except for maybe San Diego. My email is hsvdude9255@yahoo.com


  15. “If people move to Panama, they should come with their eyes wide open. That is why I always recommend that people rent for at least 6 months. Some in the dry season and some in the rainy season.”

    I have lived here for over 6 years and have seen the health care options become more and more difficult to deal with. Over pricing, gringo gouging, and just plain frightening care.

  16. On a more positive note, my sister-in-law received a compound fracture of her lower leg while river rafting. Although her hospital room lacked elegance, she was made comfortable before and after the surgery to insert a pin in her leg. (The pin had to be flown in from Panama City.) When she returned to San Diego, her orthopedic surgeon there looked at her x-rays and said that the surgeon in David did excellent work on her leg.

  17. Dennis, I also would like to find somewhere that is affordable and an alternative to living abroad. I am seriously considering Boquete but the health care issue is of concern. I can take out a tourist’s health insurance for 6 months and then renew it for up to 3 years, or so I have been told. In that case I could be treated at private hospitals, etc. in David without having to pay cash. But if you have a good alternative in the US, I’d like to hear about it. Judith

  18. At Bob’s request.

    “Hospital Chiriqui Doctor Awareness………Went to renew drivers license. 11am for all appointments-30 patients waiting in 500 SF. Blood pressure by attendee is my “normal” 142 over 81. Doc (E. B.) shows at 12:35. I am 4th and see Doc at 2pm. His BP check is 180 over 100. “Not possible” I say. “That’s why it’s called the silent KILLER!!” he says, grins and orders an EKG (where BP check is 140/80–imagine that!), chest X-ray (why?), and the whole battery (again Why?) of blood work, in which they chastise me beause Doc forgot to tell me I had to fast-fortunately I only had non sugar coffe that AM. 1.5 hours and $140 later, I leave to await a letter by Doc that I am healthy and (believe it ot not) Sane!! He (who is the only geriatric Doc one can use for license) forgets in his letter to add I am sane, and I have to wait 3 more days for correction. Yesterday, on last day of renewal, I finally have my license. When it expires in 2 years, I will find another hospital/Doc,or just take cabs! P.S. A new friend I met same day, followed me and had similar BP experience, and then they lost his paper work……..”

  19. Judith:

    Google Hot Springs Village, Arkansas. You will be pleasantly surprised. Look at all the information websites and then email me.

Leave a Reply