More than 500,000 Americans traveled abroad for medical procedures last year, and the global medical tourism industry is expected to reach $40 billion per year by 2010. While 10-20 years ago it was primarily limited to cosmetic surgery, today it is becoming more and more common for Americans to fly overseas for vital and complex procedures. From China and India to Singapore and Abu Dhabi, there are major corporate and government investors in the expansion of global medical-related travel.

Medical tourism travel agencies are at the forefront of this budding industry. In addition to serving as liaisons between patients and foreign physicians, they also find hospitals, schedule surgeries, buy airline tickets, reserve hotel rooms, and even plan sightseeing tours for recovering patients. The primary concern for these agencies is to reassure their clients that less expensive medical care does not equate to poor quality. They point to relatively new facilities that maintain high standards of care, but what they typically don't mention is that the victims of botched procedures outside of the country have little or no recourse for seeking reasonable and just compensation.

As the medical tourism industry grows, the potential problems are so significant that the federal government has begun considering the possibility of forming an interagency task force to study the safety issues of going abroad for medical care. Several years ago, the Joint Commission of Accreditation of Healthcare Organizations, the longest standing and largest health care accrediting body in the country, began allowing overseas hospitals to apply for accreditation by meeting the same standards as their American counterparts. A few U.S. health insurers have already instituted pilot programs to study the feasibility of having their plan members travel abroad for expensive procedures. This brings the possibility that employees may soon be offered medical tourism options from their company health plan.

While many of the newer facilities catering to medical tourists have malpractice insurance, ethical codes, supervisory boards and strict compliance codes, very few approach compensation for the victims of negligent care in a manner that is consistent with that of the United States. Patients should first consult with their primary care physician/dentist, lawyer, family members, medical tourism physician/dentist, and insurance provider to discuss all the potential liability and malpractice implications.

These are the important questions that a patient should raise:

• Who will be performing the medical treatment?
• What qualifications, certifications, and experience do they have?
• What are the exact terms and limits of the medical facility's malpractice insurance?
• What internationally recognized standards does the medical facility meet?
• What inspection reports are available for the patient's review?
• What liability will the medical facility assume in the event of errors, accidents, negligence, or malpractice?
• What happens if the treatment is unsuccessful or incomplete?
• How many malpractice suits has the medical facility had in the past?
• What percentage of malpractice suits has the medical facility lost?
• What is the average malpractice payout at this medical facility?

In the event of a botched surgery conducted abroad, the patient should certainly pursue all of the legal remedies that they may have available. However, the most that they could typically expect to receive is a substantial discount or complete waiver of the fee for the procedure. In some rare cases, a nominal settlement from the medical facility may be obtained.

Regardless of the citizenship of the victim of negligent care, the case will be subject to the laws of the particular country in which the procedure was administered. Victims may need to retain a local attorney and extend their medical vacation indefinitely or make several return trips to pursue the matter. In addition, the mishandled procedure may require unforeseen medical attention to resolve, and recouping the costs for the additional treatment will also be difficult.

While they may cost considerably less, medical procedures outside of the United States are not advisable from a legal standpoint. The attorneys of Gamba & Lombana advise those who are considering it or know someone who is to take this important waiver of their legal rights into account when weighing their options.