Closing a Chapter and Lessons Learned

I am sad to report that the last gringo I was assisting in the Regional Hospital passed away on Sunday. It is my hope that discussing his passing may keep someone else from the same ending.

About 18 months ago he was in the U.S. and wanted to get a colonoscopy at the veteran’s hospital. He was told that he could be scheduled in three weeks. He made the decision he couldn’t wait three weeks and would have it done in Panama.

Upon having the colonoscopy in Panama he was advised that surgery was necessary. I don’t know if he asked all the questions he should have or if he was led to believe that it was a simple surgery and there was no risk.

How ever the conversation went, he made the decision to have it done in Panama. If he had bought an airplane ticket to the U.S., he could have had the operation for no cost at a VA hospital.

Instead he started the journey to his end with a simple surgery in Panama. The surgery turned into four surgeries. I was told that He spent in the neighborhood of $26,000, maybe more, and when he said he couldn’t afford more he was quickly transferred from Hospital Chiriqui to the Regional Hospital. He was in the Regional Hospital over a month and a half. His time there was inexpensive as far as medical expenses, but he did not walk out of the hospital and you can weigh that expense.

I saw him several times. He went from being alert and complaining one day to struggling to breath the following day. A Panamanian lady staying with a family member saw him having problems and notified the nurse and he was placed on oxygen. I was at the hospital early that morning so I could catch his doctor on his morning round.

I couldn’t believe the change I found that morning. I had been in contact with his family in the U.S. and I contacted them and told how his condition had changed. My recommendation was if possible to immediately come to Panama.

The good news is that when the family member came, he brought his will and a power of attorney to make decisions in critical care situations. That is the only good thing I can share about this story.

I would be willing to bet, if he knew he was going to spend the amount he spent and a month a half in the Regional Hospital, that he would have flown back to the U.S.

Now I can’t say for sure that he was seen as a $ or not. I have repeatedly been told that many doctors in Panama are eager to operate on a person that is perceived to have money. On multiple occasions, the doctors have been associated with the private hospitals in David. When the money runs out, it is easy to just transfer the patient to the Regional hospital.

So that is your caution for the day. If you are going to move and live in Panama, have health insurance so you are not forced to move to the cheapest alternative. Understand the risks of your operation well. Get a second opinion. Consider if it would be wiser to return to the U.S. if that is an option.

Now let me move on to the experiences that we went through assisting with dealing with the death of the patient. As I said earlier, the patient’s family member was here, prior to the patients death and had all of the necessary documents to make decisions for the patient’s care, to claim the body, as well as the patient’s last will and testament. I can’t tell you how much easier things are in situations such as this, when you are prepared. Are you prepared?

Nothing could be done on Sunday because the office in the hospital, that was safeguarding the patient’s personal items was not manned. One of the items being held was the passport of the patient and that was needed to fill out all future documents.

Once we had the passport, we had to leave the hospital to get copies made of the passport. They could not make them in the hospital. We had to walk to the entrance to the hospital, on the InterAmerican Highway, where there was a kiosk that could make copies. Realize that everyone we are dealing with requires you to communicate in Spanish.

In the hospital, to get all the information, we walked the stairs to the fifth floor, second floor, emergency area, where you pay the bill, multiple times. Often you get to one area only to find that you need a document from another area before you can proceed.

The body cannot be claimed if the account is not paid. Payment must be in cash as credit cards are not accepted. In this case, the bill was over $5,000, which most people don’t carry on them. Have you considered how difficult it is for a foreigner to get money from a foreign bank to pay a hospital?

With the hospital paid, now you can proceed to finding a funeral home to process the body. In this case, the decision was to have the body cremated. We visited two funeral homes and the best choice was Asociacion Funeraria Del Retiro.

The funeral home required paperwork from the hospital and a signed authorization to have the body claimed and sent for cremation.

Since the cremation facility in David closed last year, the body must be sent to Panama City for processing. A consideration, in today’s environment, is what happens if the road is blocked due to protests. This funeral home has its own morgue and can hold the body if that were to happen before transport. The price for cremation, when David had its own capability, was around $700. The cost with the funeral home was less than $1,500.

We now had to go back to the hospital and verify that the body being picked up by the funeral home was the correct body. The processing time, assuming the roads to Panama City are not blocked, is about a day for the ashes to be returned.

We now went back to the second floor of the hospital, which was holding the patient’s luggage. We couldn’t pick it up earlier because the jefe ( boss) for that station was not there. When we returned, the jefe was still not there and we were told to return tomorrow.

We told them they had to do better than that as the family member would not be in Panama to get it tomorrow and we had to have it now. After another 30 minute wait, the luggage was brought out. Nothing is easy in this process.

Now for another change to a previous process. In the past when you received to paperwork, you were given a document that stated the time of death and cause of death. This time, when the bill was paid at the hospital, a fingerprint was taken of the payer and we were told the final paperwork would be available in 30 days.

In the past, you took the this paperwork to the Tribunal Electoral and they provided a Panama death certificate. With the Panama death certificate and the the paperwork that identifies the cause of death, the U.S. Embassy in Panama City makes up 10 copies of a U.S. death certificate and sends it to the appropriate person.

The Embassy was surprised to learn do the new 30 day process. Realize that processes change rapidly and by the time you read this it may be different again. In this case the Embassy said they could provide a document that could be used on a temporary basis until the final information was provided by Panama.

Obviously this is not the end for the family that was left behind following the death. Any death is difficult to deal with, but dealing with death in a foreign country, where you don’t understand the language and the processes are ill conceived and poorly executed, make it much more difficult.

This is why I keep harping on having your life in order if you plan on moving to Panama. Have a will. Have a plan if something happens. Know who is going to assist in taking care of your belongings. Know what your medical needs are and what your plan is in the event of the unforeseen.

One last thing I will pass on. When a U.S. citizen dies in a Panama, the U.S. Embassy sends out some general information to whoever is going to be responsible for the deceased.

This was the current information that was went out.

It is unfortunate at this sad time that we must immediately call your attention to the urgent need for making necessary arrangements.  Panama law requires disposition of remains cremation or burial within one month after death unless the remains are to be shipped outside the country.

The total cost for preparation and air shipment to the United States is approximately $4,500 from Panama City.  This includes a metal casket meeting international regulations.  The cost for preparation and burial in Panama City, Panama is approximately $1,500.

The cost for cremation and disposition of ashes in Panama City, Panama is approximately $800.  The cost for preparation, cremation and air shipment of ashes to the U.S. is approximately $2,500.  This includes a plastic urn.

Please note that the above cited costs are only estimates.  We should point out that preparation and air shipment are carried out in accordance with the laws of and the facilities available in Panama.  In some cases, the services fall short of those expected in the United States.  We recommend that you ask your hometown funeral director to determine the advisability of viewing the remains.

The local authorities also require that the next of kin submits evidence of relationship with the deceased to retrieve the remains.  You need to submit proof of your relationship to your [deceased’s] (birth certificates, etc.) to the appropriate Panamanian authorities and the local funeral home.

To facilitate the transfer of funds to the U.S. Embassy, the Department of State provides a means whereby you may wire money to the Department in Washington, DC.  Upon receipt of the funds, the State Department will authorize the U.S. Embassy to use the money for the preparation and disposition of your [deceased’s] remains according to your instructions.  Please note that the Department charges a $30.00 processing fee for the transfer of funds.  You may forward the funds by Western Union telegraphic money order to the Office of Overseas Citizens Services, Department of State, Washington, DC  20520.  Please include in the money order the full name of the deceased, your instructions as to the disposition of the remains, and instructions that the funds should be transmitted to the U.S. Embassy in Panama City, Panama.  See Sending Money To U.S. Citizens Overseas flyer on the Department of State Bureau of Consular Affairs Internet page.  Please include Special Instructions:  “Department of State, OCS for Benefit of Disposition of Remains of [name of deceased], U.S. Embassy Panama, Panama” and include your name, address and telephone number.  Please note that the transfer of bank wires through Bank of America may take several days (as opposed to several hours through Western Union).  Bank of America charges a fee for processing the bank wire.

After all bills for costs incurred in the preparation and shipment of the remains have been received and paid, you will be sent an itemized accounting of final costs.  Any balance left will be refunded to you by the Department of State.

To ensure that your wishes are carried out, your written instructions are required as soon as possible.  We ask that you e-mail your instructions to the Embassy at Panama-ACS@state.gov .  Your instructions should give the full name of the deceased, your name and address and phone numbers and email address where you can be reached.  If shipment of remains to the United States is desired, please include the name, address and full telephone number of the U.S. Funeral Home you have selected to handle the arrangements.

You will also need to execute a notarized Power of Attorney giving someone in Panama or the U.S. Embassy the authority to represent you before the Panamanian authorities and to retrieve [the deceased’s] remains and personal belongings.  If you choose to use the Embassy, you should send this notarized authorization by fax to (011) (507) 207-7278 as soon as possible.  After faxing the document to us, the original notarized document should be sent to the Secretary of State for the Apostille Stamp and then sent to U.S. Embassy Panama, Consular Section/ACS, Unit 0945, DPO AA 34002.

Again, we extend on behalf of the United States Government our sincere condolences to you and your family in your time of bereavement.

American Citizens Services Unit
Unidad de Asistencia a Ciudadanos Estadounidenses
Consular Section / Sección Consular
U.S. Embassy Panama / Embajada de los Estados Unidos de América en Panamá
e-mail: Panama-ACS@state.gov  Tel: (507) 207-7000 / 207-7030
http://panama.usembassy.gov    Fax: (507) 207-7303

They also sent out a list of funeral homes in Panama City. I am not including that because it isn’t of much help in Chiriquí.

That is the close of this post. I hope it motivates all retirees moving to Panama to be better prepared. If you don’t like the process and think things are poorly handled here, reconsider your move.

13 thoughts on “Closing a Chapter and Lessons Learned

  1. Please clarify something. You must bury or cremate the body within 30 days, but it takes 30 days to get the death certificate and the other paperwork? How is that supposed to work?

  2. Hi Judy. Obviously, the Embassy’s document wasn’t written recently. It may or may not need to be changed. I am sure the Embassy wrote that document based on information it received from Panama. If indeed Panama is changing their process, then I would expect that Panama would change their requirements manaña. As you learn when you move to Panama, manaña does not mean tomorrow. It means no today.

  3. Don Ray,
    Could you give directions to Asociacion Funeraria del Retiro — always good to keep in the file I have on “What To Do” in such an instance, both for easy reference for my husband and I and also for our daughter who would come here from another country. As far as power of attorney and Will go, I am assuming that the family member brought the will and Power of Attorney from the US or did the deceased have a Panamanian Will and Power of Attorney drawn up and sent to the family member? Always good to get clarification on these things from “the expert”.
    Thanks, You do such a great job for the expats of David and for keeping us all informed.
    Marion

  4. I don’t understand the following sentence from your post: “The Embassy was surprised to learn do the new 30 day process.” Please explain.

  5. Marion. The best directions I can give is to say that the funeral home is on the same block as The Tambu restaurant, but in the corner of the other one way street. The will and POA were bothe U.S. documents, but if there was a need to have them in Spanish, I am sure the Embassy could assist with a legal translation.

    Bonnie, when I sent the documents I received to the Embassy and told the, that I was told that the final document might be in 30 days, I got a surprised reaction. I don’t know any other way to express it.

  6. Don: It’s unbelievable the amount of time and work you put into being a Warden. You are supposed to be retired enjoying your sunset years and yet, here you are, doing a full time job and not getting paid for it. Oh! it doesn’t appear to be a fun job at all. A letter acknowledging your service from the Embassy hardly expresses the help you provide to your fellow citizens and government. God Bless you Don, you are one of a kind.
    Patrick

  7. What is the nature of the “temporary document” the family receives from the embassy? What is the document exactly?

  8. From what I was told, it will say something to the effect that the cause of death is pending, but can still be used to close accounts etc.

  9. A little detail to consider..

    On the hospital or doctor’s death certificate the parents names and their places of birth of the deceased are required to be filled in on the document. If I recall right also the birth date and birthplace of the deceased. You use the hospital document to secure the official death certificate made by the government at Tribunal Electoral. The embassy will need both death certificates.

  10. While the Hospital took all of that information, it was not on the typed paperwork that was given out as well as the cause of death. The payee had to put his index finger print on the information and that was when the hospital said the final form would be ready in 30 days. The payee did not have his birth certificate, but they still took all other information. The lack of the cause of death on the paperwork is why the U.S. Embassy cannot issue the final Death Certificate.

  11. So basically what you are saying is that the hospital will jack the body until the bills are paid?

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