A bariatric surgeon has warned of the dangers of travelling overseas for weight loss surgery after two separate inquests were heard in Cork on Thursday following the deaths of two Irish women who had undergone such procedures.
Dr Colm O’Boyle, who works at the Bons Secours Hospital in Cork, was speaking at the inquests into the death in 2021 of 46-year-old Estelita Hamelin from Fermoy, Co Cork and the passing the following year of 53-year-old Pamela Canty from the Commons Road on the northside of Cork city.
Both women had gastric operations in Turkey.
Dr O’Boyle told the City Coroner’s Court that weight loss surgery abroad is often carried out based on the ability of a person to fund the procedure rather than how appropriate it is for their particular circumstances.
Accountability
He suggested that there is often little accountability when operations go badly wrong.
Dr O’Boyle, who has carried out over a thousand gastric bypasses, said that most “medical tourism” is based in non-English speaking countries and is encouraged by attractive low tariffs and shortened waiting times for surgery.
“The selection process for surgery appears to be based on ability to pay rather than medical appropriateness, despite many patients being vulnerable psychologically and/or having complex medical co-morbidities.
“The emphasis is on the surgical procedure and often very little advice or care is given regarding the appropriate pre-operative selection and work-up and the post-operative follow-up.
There appears to be little in the way of clinical governance, evidence of surgical or bariatric team accreditation or evidence of outcomes in these institutions. Furthermore, there appears to be very little accountability when things go wrong.”
He said patients are often offered financial rewards to promote the institution. Dr O’Boyle said some patients are persuaded to have another major procedure in addition to bariatric surgery under the same anaesthetic.
“There is no evidence of multidisciplinary team discussion (of bariatric surgical intervention) or referral to a psychologist or dietician, which would be standard practice in all reputable centres internationally.
Pre-op
Pre-operative work-up in foreign hospitals was performed on the day before or the day of surgery with only basic blood tests performed.
Patients met the surgeon for the first time on the day of surgery.
"Patients (for obvious financial considerations) return home very early during the post-operative period at a time when it is contra-indicated to fly due to the increased risk of DVT (deep venous thrombosis and PE (pulmonary embolism), which are further increased for patients undergoing major surgery, especially if they are overweight or obese. For this reason, it is recommended not to fly for at least a month following major surgery.”
He also indicated that he was aware of several deaths in recent years of Irish people who had gone abroad for weight-loss surgery.
Meanwhile, the inquest into the death of Ms Hamelin heard that she travelled to Turkey for liposuction after the beautician who dyed her eyebrows recommended the surgery to her.
Turkey
Her daughter Hazel Gervacio told the inquest that her mother went to a hospital in Istanbul to have liposuction and a tummy tuck.
Hazel accompanied her mother on the trip. She said that she and her mother were collected from the hospital and driven to the hospital where blood was taken. She said that the following morning her mother was given a file of documents.
“They were pushing her to sign those (documents) which she did without reading them.
The doctor put marks on her body where the surgery was to have been done. I was told she would be in the hospital for a few nights. I went to the hotel to get mum’s clothes and that was the last time I saw her alive, as when I returned she had gone into surgery.”
Several hours passed and eventually, Hazel was informed that Estelita, who is originally from the Philippines, had sustained massive blood loss during surgery and was in the hospital intensive care unit.
Hazel recalled that she became so desperate to see her mother that she ended up showing a picture of her to a member of the cleaning staff. The cleaner went in search of information.
Hazel was later informed that her mother was in a critical condition and was having seizures. Unfortunately, she still wasn’t allowed to see her mother. The following day, she was told her mother had passed away. The surgeon who carried out the procedure said that Estelita may well have had an underlying medical issue.
Refund
Hazel told Coroner Philip Comyn that the hospital offered her a refund for the money paid for the surgery. They also said they would pay for the expatriation of the body and subsequent cremation.
Mr Comyn noted that as Coroner he experienced enormous difficulty in obtaining medical information from the hospital. He made representations to the Turkish Embassy and the Department of Foreign Affairs about the problems he experienced in receiving information from the hospital.
An open verdict was recorded. Mr Comyn said he believed that it was a case of medical misinformation, but he didn’t have enough information to bring in such a verdict.
Dr Margaret Bolster, Assistant State Pathologist, said that the cause of death was haemorrhage and shock arising out of liposuction surgery.
The other case heard was that of the mother of one Pamela Canty, who was due to have a gastric sleeve operation in a Turkish hospital on October 17th 2022.
However, because she had a hernia they said that this was not possible and they offered her a bariatric bypass procedure. When she agreed they also removed the hernia the same day.
Pamela was discharged from the hospital the following day.
She became very ill in her hotel. Her husband Finbarr, who previously had a weight loss operation, said that the hospital were of no assistance to his wife following surgery.
Medical misadventure
The couple travelled back home to Ireland on October 21st, 2022. Ms Canty subsequently collapsed. She was rushed to the Mercy University Hospital where she passed away on October 23rd, 2022. She died from septic shock and her death was ruled a medical misadventure.
Dr Bolster, who carried out a postmortem on Ms Canty, said that she died from septic shock because of improper healing following surgery. Pamela also had inflammation of the thoracic cavity.
Mr Comyn offered his sympathies to the relatives of both women. He warned members of the public who are interested in having surgery abroad that “care may vary from hospital to hospital and country to country.”
“People need to be aware of the risks involved when they go abroad for this type of surgery. I am concerned that people should know the nature of the risks involved and discuss it here with the relevant medical personnel.”
By Olivia Kelleher
