Tag Archives: Hospitals

Another HealthCare Observation

I have another healthcare case, which is providing more experience, that I feel I should share.

This individual came to Panama with no insurance, only social security income, and has developed significant healthcare issues. He was taken to one of the public healthcare facilities and was seen by the resident doctor.

The doctor was very vocal in stating that he did not understand why elder American citizens, with medical problems, are allowed in Panama and why the U.S. Embassy does not provide assistance to them. He ended the conversation saying that he would limit his service, for this patient, to just writing a report on his condition and no more.

He explained that there are no beds in the public hospitals and that a Panamanian needs to wait almost seven days for a bed.

I know this doctor, as he is the doctor that Hogar Santa Catalina took Robert (the stroke victim) for a checkup. In that meeting, he accused all U.S. Citizens of being insolvent and if he needed treatment that he would have to be taken to his private practice in Hospital Chiriqui where he would bet paid his specialist fee.

Needless to say, this doctor was removed from my list of doctors receiving a recommendation by me. His attitude is a discredit to the medical profession and he is a poor representation of Panamanian physicians. He was extremely rude to me when I was was with Robert in his office.

That being said, it should be noted that his sentiments are shared by others. Luckily, they are the minority. I will admit, that while this doctor’s deportment is deplorable, he has some valid points behind his statements.

If this individual goes to the Regional Hospital and has the proscribed CAT scans, x-rays and other tests, he may not have the ability to pay. If that happens, it will put more more burden on the already overburdened Panama system.

Most private hospitals will not admit patients without proof of payment. The public hospitals are crowed and understaffed. Walk-ins to the public hospital will most likely be placed on the same 7 day waiting list mentioned by the doctor.

I had another case where the Regional Hospital asked a U.S. citizen to leave because they said he was in good enough condition and they hospital needed the bed. I received a call from his landlady about 6 hours after his release telling me that he was not doing well. He died about 2 hours after the 911 services arrived. It was obvious that it was an error by the hospital to release the patient.

Bottom line is that if you are moving to Panama, with a problematic medical history or the probability that medical care will be needed, be prepared to pay. I took a physical prior to moving to Panama and found that I needed surgery and didn’t know it. The rumors of cheap health care in Panama is always relative.

I can visit a clinic for a cold or infection or minor office visit. The cost will be $6 for the visit and I have always been treated with respect. However, if I need to see a specialist, the office visit will be from $35 to $80 or so after the jubilado discount. In all of my specialist doctor visits, I have always been treated with resect.

I always advise any person making an exploratory trip, for viewing Panama as a retirement location, to visit the hospitals. You should also visit the Regional Hospital (public) even though you think you would only use a private hospital, because the public hospital is most likely where you will be taken, if you are in a serious accident.

If you do move here, you should immediately determine what doctors you want to use as your primary care physicians. Finding one in an emergency may put you with one doesn’t like foreigners.

S.O.L. In Paradise – Beating A Dead Horse

As I mentioned in the previous S.O.L. post, it will be worth following the thread in Boquete Ning.

Today, Bonnie Williams wrote a comment that I don’t want to get lost in the midst all the other comments on the ongoing thread. While she limited it to ExPats in Boquete, I would expand it to all of Chiriquí.

Here is her comment.

I think we’ve beaten this subject to death. To summarize, I see expats in Boquete having essentially four options for healthcare:

1) Have no insurance in Panama. Go to Hospital Regional for medical emergencies, but be aware that it may be difficult to receive timely attention. And you will be billed upon departure. Non-emergency surgery will be delayed, perhaps forever. Plan to return to the U.S. for any needed medical non-emergency services.

2) Enroll in the Hospital Chiriqui co-pay plan. This will pay for many routine, preventive procedures, but it will pay only part of the cost of hospitalization and/or surgery, and there is a relatively low cap on how much it will pay annually. It pays for no bodily appliances such as stents and pacemakers. This can result in the patient owing a significant amount of money.

3) Buy comprehensive national or international insurance. It is expensive. But it has a high payout limit and, after the chosen deductible, pays most or all medical expenses. There generally is no required deductible for emergency or pre-approved hospitalization or procedures.

4) Self insure and hope that you have enough put aside to cover a catastrophic medical event such as heart surgery, serious automobile accident, etc.
As routine medical care in Panama is relatively inexpensive, most expats can meet those expenses without incurring significant financial difficulty. When considering health insurance needs, it is my opinion that particular attention should be given to catastrophic medical events which, without good insurance, could subject one to no care, poor care, and/or financial ruin.

More Hospital Regional Experience

I thought I would pass on some more recent experience in Hospital Regional. I am assisting a family of an individual that was in Hospital Regional and died.

The funeral home quotation has been provided and and I am enclosing the bill so you can see current costs for cremation. The first charge is transportation charges to take the body to Panama City and return the ashes. You will also see there is a discount for being a jubilado. Continue reading More Hospital Regional Experience

S.O.L. In Paradise Discussion – Continued

The original S.O.L. In Paradise post I wrote provoked Lee Zeltzer to start a discussion on Boquete Ning called “Putting A Healthcare Rumor To Rest”.

I think healthcare is a necessary item to be discussed by foreigners living in Panama and those thinking about or in the process of retiring here. The discussion going on in Boquete Ning is very lively and I think it is worth your following the thread.

I do take issue with the way Lee framed his discussion.

What I take issue with is his saying,

“Don wrote about it, perhaps prematurely and then contacted the US Embassy to obtain verification.”

(“it” referring to Regional Hospital healthcare). That implies, that as an afterthought, I wrote the Embassy, which is not true. I wrote the Embassy prior to writing the post.

I felt that the information I had been given was of significant importance to be presented. I qualified that it might only be related to the fact that heart surgery would not be available in Hospital Regional after July 1.

Lee said that I should have talked to a second doctor before making the post. I have been in Panama since 2002 and know that you can get any number of answers from doctors. I would not trust the answer to this question being told by one, two or more doctors. The only way to get the real answer would be to ask the legal council of the hospital, and the Embassy is the best source to ask the question. Continue reading S.O.L. In Paradise Discussion – Continued

S.O.L. Post Updated

Just a note to let you know I received the U.S. Embassy response from the Regional Hospital.

Here is what the Embassy found out:

Good morning, Mr. Williams,

After several attempts, we finally got contact with the Legal Office at Hospital Regional in Chiriqui few minutes ago.

We asked the attorney there to please clarify if persons without insurance (referring to PNM Social Security Insurance -CSS) could be treated there. The attorney replied that Hospital Regional provides medical services to both the CSS beneficiaries and the non-CSS individuals, in the last case, referring to all individuals in Chiriqui that require medical attention. The attorney emphasized that it is expected that the non-CSS individuals pay their medical bills (–the attorney added that even if the individual does not have funds to pay, the Hospital is willing to accept partial payments until bill is totally paid).

We also asked the lawyer about the Hospital Regional sending or referring non-CSS individuals to Hospital Santo Tomas in Panama City. The lawyer denied this possibility saying that it is not true. Per the lawyer, Hospital Regional’s principles is to provide medical assistance to any person that needs it regardless of that person’s nationality.

Please let us know if you have any other questions regarding to this issue.

Saludos,

S.O.L in Paradise

UPDATED May 15, 2015. The Embassy response is at the end of this post.

I had an interesting call from a physician in David with a growing concern. His concern is related to the large number of immigrants coming to Panama without a plan for health insurance.

I am going to express what I think I understood from the conversation. I have also written the U.S. Embassy and asked if they can verify the official policy for the Regional Hospital.

Let me preface by saying that since my moving here in 2003 and from my experience working on Embassy cases, I have seen many people be transferred to the Regional Hospital after they ran out of funds in the Private Hospitals.

From what I was told, that is going to change. Persons without insurance or proof of payment, will no longer be admitted to the Regional Hospital. People without insurance will only be admitted to the public hospital in Panama City (Santo Tomas).

Getting from David to Panama City may not be possible in many health situations.

I had not heard of Santo Tomas Hospital and asked Lilliam about it. She said it had recently been on the news for not having enough beds to handle the needs or supplies and many surgeries were currently not able to be done. Not a pretty picture.

The price of poker just went up. I have harped many times that a plan for one’s healthcare needs to be in place before moving to Panama. I believe that is truer than ever before.

I hope I can get an official interpretation of the hospital policy from the Embassy, but in the meantime, you have been forewarned. If you don’t heed the warning, you may be S.O.L. in paradise.

As a side note, the information may only relate to coronary care since the doctor that called was a heart surgeon and after July 1, would only work in Hospital Chiriqui. I think he is currently the only certified coronary doctor practicing in Hospital Regional.

However, I thought I had recently heard of another case that was turned away from the Regional Hospital.

I will update this post when I hear back from the Embassy.

Following is the response I received from the U.S. Embassy:

Good morning, Mr. Williams,

After several attempts, we finally got contact with the Legal Office at Hospital Regional in Chiriqui few minutes ago.

We asked the attorney there to please clarify if persons without insurance (referring to PNM Social Security Insurance -CSS) could be treated there.  The attorney replied that Hospital Regional provides medical services to both the CSS beneficiaries and the non-CSS individuals, in the last case, referring to all individuals in Chiriqui that require medical attention.  The attorney emphasized that it is expected that the non-CSS individuals pay their medical bills (–the attorney added that even if the individual does not have funds to pay, the Hospital is willing to accept partial payments until bill is totally paid).

We also asked the lawyer about the Hospital Regional sending or referring non-CSS individuals to Hospital Santo Tomas in Panama City.  The lawyer denied this possibility saying that it is not true.  Per the lawyer, Hospital Regional’s principles is to provide medical assistance to any person that needs it regardless of that person’s nationality.

Please let us know if you have any other questions regarding to this issue.

Saludos,

Panama Living Will Update

This week has provided two more learning experiences. In the past, I have written that if you have a Living Will, it would have to be in Spanish to be valid in Panama. I falsely assumed that your wishes would be taken into consideration in case of a situation where your life was only being maintained by artificial means, provided you had a legally executed document.

This week I have seen that the hospitals in Panama will not honor a legally executed Living Will or Power of Attorney specifying healthcare. These documents would be honored in hospitals in the U.S..

This may be enough to cause pause for some people considering moving to Panama. The understanding gained this week is that the hospitals will maintain life no matter the wishes of the individual or the individual’s family.

It is obviously financially beneficial for the hospital to keep a patient as long as possible, however, I do not know if this is a Panamanian law or if it is just universally observed.

In the past I have been involved with several cases where an individual has had an operation in Hospital Chiriqui and run up a bill of $30+ thousands of dollars. When the patient had run out of money, then the hospital transferred the patient to the Regional Hospital to die, while running up another bill. Continue reading Panama Living Will Update

First & Last Visit to Policlinica David

Back on November 17, we escorted the stroke victim for his scheduled examination at the Policlinica. This had been scheduled by the doctor when he had seen him in the Regional Hospital several months ago.

IMG_0628One of the benefits of the new residence for the stroke victim is that he was able to be transported to and from the Policlinica or other medical facilities by ambulance. While not an easy trip, it was easier than loading him in and getting him out of my car,

He was taken by wheelchair to the ambulance and then moved to the ambulance gurney. At the Policlinica, he was put back in the wheelchair. There is when the ordeal began.

It took over 2 hours to see the doctor, even though the visit was scheduled, the lead caretaker from Hogar Santa Catalina had to stand in many lines because it was his first visit and had no chart. We were finally told that appropriate paperwork wasn’t there and we could not see the doctor. The letter I carry as introduction from the Embassy finally convinced them to make an exception. The charge was only $2.00+. The doctor we saw (who will remain unnamed) was a horrible example of doctor.

He did a very cursory examination and then proceeded to berate U.S. citizens as being indigent and unable to pay their bills at Chiriquí Hospital (where he also offices). Of course I have dealt with several cases, where U.S. citizens have been charged tens of thousands of dollars (one was $40k+) for operations in Chiriquí Hospital and then when their funds ran out, they were moved to the Regional Hospital. Doctors like him can cause many people to become indigent.

Lilliam set him straight on his accusations. Luckily I got experience with this doctor without being a patient.

Needless to say, that is one doctor who will not see the stroke victim again. The lead caretaker didn’t like the doctor either, however, she comes from a belief in really caring for people. On returning to Hogar Santa Catalina, she had another doctor perform a physical and he was scheduled a complete lab workup.

I continue to be impressed with Hogar Santa Catalina. I am convinced that better care is not available for the elderly in Panama.

Great Job Sharon

Great job Sharon. I just got on the Internet and saw a FaceBook post from Sharon Sample, who is handling the US Embassy Warden duties while I am out of the country. Her experience is worth reading. Healthcare, is one item that anyone moving to Panama has to have as a forethought and not an after thought. I have seen many similar cases where a person has been shipped to the Regional hospital after depleting their funds in one of the private hospitals.

Sharon lives in La Barqueta, which means a much more difficult time for her than I have, since I live in David. Here was the synopsis of her week. Her post is as a learning experience for those considering living in Panama.

A tough week turned out to be successful : An ailing American returned home!

Back story – After having the truck repaired we went to the Regional social security hospital to visit an American in need. He had been in the local private hospital for 3 minor surgeries. After spending for here a large chunk of money he transferred to the public hospital to save funds Huge difference – 6 beds to a room v.s. 1 or 2, and no ENGLISH. He speaks no Spanish

He has no family here and was actually here on a medical mission with Floating Doctors building a clinic for an indigenous tribe way out in the jungle when he had an accident of sorts.

Anyhow yours truly as an Embassy Warden with credentials was able to bypass the family only rule and do a welfare check. Mind you he was in the surgical ward and attached to multiple tubes, etc. which would need to be removed and the body closed up. Receiving transfusions to build up his blood and draining fluid from the chest. He wanted to go home! No one would let him…..
If he lived here my method and advice would have been very different. As it was I could see his point that not being absolutely critical he could go back and admit into his home hospital where he does have insurance.
It would take some doing but his doctor friends advised he should be able to make it!
I needed to consult with his doctor and in Spanish. Here the doctors are mandated to put in their time at the public hospital for 1/2 the day, then allowed to spend the other 1/2 in private practice at a private hospital.
Off I go to consult. His doc. did not want to release him until the weekend. The doctors administrative assistant and I had a long chat. There was worry about his lack of funding and ability to travel. Wound care, drainage,oxygen, etc.. I explained that he felt he could travel for a day, he has insurance at home to cover medical there so not to worry and that he would check himself in to his hospital once back stateside.
Should a problem arise en-route he could go to hospital in Panama City….
The doctor agreed he could be released against doctors orders if he insisted and signed a release of liability
He wanted to leave the next day Wednesday. Last night he made it home!
WOOT! So happy for him. Communication is key and the doctor was looking out for his best interest but how can you make a plea? Thank you United States Embassy for allowing me to help this man!