“I’ve gotta get out of this place, if it’s the last thing I ever do.”

Jack and Jill were travelling in Cambodia in January 2016. Jack fell down stairs at their hotel and severely injured his knee. Jack was rushed to the local hospital and was assessed by surgeons who said he needed to have urgent knee surgery.

Jill contacted the couple’s travel insurer to seek approval for the surgery. The travel insurer said that the Cambodian hospital was not equipped to do the surgery and that Jack and Jill would need to be flown to Bangkok.

Later, the travel insurer approved surgery and Jack was taken through for the procedure.

 

Jill’s concerns

Jill was concerned about the surgery taking place because she said the Cambodian hospital was very unhygienic. In addition, after Jack was out of surgery, the nursing staff were not keeping Jack mobilised, and Jill was concerned he may develop blood clots. Jill wanted to fly home to New Zealand with Jack the next day. The Cambodian surgeon said that Jack could fly the next day, in business class, if he gave Jack a blood thinning injection.

However, the travel insurer’s medical team said it was not safe for Jack to travel back to New Zealand the next day. Jill then spoke with a nurse from the insurer, who upon discovering Jack was not being mobilised post-surgery, advised Jill to get Jack mobilised.

Jill was then contacted by another person from the insurer who said they could travel home to New Zealand the next day. However, the next day the insurer’s medical team changed their mind and said Jack could not fly because he could not be placed on flights where his leg would be fully elevated for the full journey.

 

Jack develops a pulmonary embolism

The next day Jack and Jill flew home to New Zealand. Jack seemed well, However, about 7 hours after arriving in New Zealand, Jack became breathless and they rushed to the hospital emergency room. It transpired Jack had developed a pulmonary embolism which was life threatening and he was admitted to hospital.

Surgeons reviewed Jack’s knee and it appeared the surgery in Cambodia had failed to re-attach Jack’s patellar. The New Zealand surgeons wanted to take Jack back into surgery but because of the blood clots and the medication he was on, he had to wait at least another 3 months. In that time, Jack’s knee deteriorated, severely affecting his mobility and the ability for his knee to ever return to normal.

 

The complaint

Jack and Jill considered the insurer was responsible for Jack losing mobility in his knee. They said the insurer should never have permitted the surgery to occur in Cambodia, and should have immediately evacuated them to Bangkok or New Zealand.

Jack and Jill wanted their insurer to pay them $30,000 to resolve their complaint. This was $10,000 for distress and emotional harm caused by hospitalisation in Cambodia, and from the development of the pulmonary embolism. Jack and Jill also sought $20,000 for the ongoing physical harm Jack was suffering.

When the insurer declined to pay compensation, Jack and Jill complained to FSCL.

 

Our review

We reviewed the insurer’s file on the complaint, including around 50 telephone calls.

It transpired that although the insurer originally had concerns about the Cambodian hospital conducting a full open surgery, the Cambodian surgeon had talked to the insurer’s doctor and the Cambodian surgeon had confirmed he would not conduct an open surgery, but would see whether he could perform a ‘closed reduction’ (a type of manipulation). However, the Cambodian surgeon then conducted the full open surgery.

We sought another travel insurer’s view about whether it would have approved a closed reduction in the circumstances in the particular Cambodian hospital, and it advised it would have. This meant it was ultimately the Cambodian surgeon’s (alleged) negligence in conducting full open surgery which caused Jack’s issues.

We also considered whether Jack should have been evacuated to Bangkok after the insurer discovered that the full open surgery had occurred in order to receive better post-operative care. However, as Jack was given medical clearance to fly home to New Zealand, we thought it was reasonable for the insurer to rely on this advice.

We also said the $30,000 in damages Jack and Jill sought were for consequential losses which FSCL cannot award compensation for.

 

The insurer’s service

We noted there were shortcomings in the insurer’s service in that it seemed Jill was unable to get through to the insurer’s medical and claims staff within reasonable timeframes. We also said the insurer had originally given the impression Jack and Jill would be flying home the next day and their already significant stress was increased when they were unable to fly home until several days after this.

Lastly, we thought the insurer’s staff members taking over new shifts could have been briefed better on Jack and Jill’s situation so they were fully up to date with what was happening.

 

Outcome

We said the insurer should pay Jack and Jill $1,000 for the inconvenience it had caused them. Jack and Jill did not accept this. We then assisted the parties to negotiate an agreement whereby the insurer would pay Jack and Jill $2,500.

Jack and Jill accepted that amount and the complaint was resolved.

 

Key insight for consumers

The standard of medical care in many countries is poor compared to what one would expect in New Zealand. If you travel in such countries you run the risk of receiving sub-standard and risky care. Although your travel insurer will assist you as best it can, it cannot be responsible for the (alleged) negligence of a foreign doctor.