The questions are just as relevant to solo travelers. Woodman tells of a Vietnam veteran who had a hip replaced, developed complications on his return, and found his doctors here unwilling to help. "There's a lot more burden on the consumer to have a successful medical journey," says Woodman.
Doing the sort of advance research that makes this possible can be arduous. You might or might not get answers if you ask about a hospital's mortality rates or a surgeon's credentials and how many heart valves he has replaced, for example. "Getting data out of some of these places is like pulling teeth," says Woodman—and even if you do, the answers are not necessarily trustworthy. Not that stateside hospitals cheerfully volunteer such information. But they are being monitored by the federal and state agencies and professional and trade organizations that collect such data. "Our system is subject to extreme scrutiny, for better and for worse," says Karev. Overseas, he says, similar monitoring is largely absent. That is especially true in developing countries such as India and Thailand, which offer the least-expensive options.
So far, however, no reports of patterns of botched operations, rampant infections, or other warning signs have surfaced. In March of last year, the Singapore National Eye Center suspended laser eye surgery after 17 patients developed an inflammation, but it was the first interruption of the kind at the center. A few weeks later, surgery resumed. Overall, medical standards in Singapore, where prices are somewhat less attractive but English is universal, are very high, especially at western-oriented hospitals such as Mount Elizabeth and Gleneagles.
One precaution Americans can easily take is to choose a hospital accredited by the Joint Commission International, the global arm of the Joint Commission, which makes sure U.S. hospitals meet specific standards. In early March, as Barnum was recuperating from his two hip surgeries and faced his final procedure, Wockhardt's facility in Bangalore was recovering from a grueling JCI accreditation survey. (Accreditation was awarded in mid-April.) The hospital is immaculate but makes no attempt to look fancy; it's a Wal-Mart next to the soaring atrium and opulence that make Bangkok's Bumrungrad Hospital especially popular with medical travelers.
Accreditation does not ensure good care, but it does offer important evidence of safety; Karen Timmons, president and CEO of the JCI, says going to an accredited hospital is "essentially a risk-reduction activity." Physicians must be adequately credentialed and their patient data examined at least once a year to pick up a spike in deaths or complications, for example, or longer hospital stays. And as a patient moves through the hospital, a formal system must track him to avoid treatment mix-ups. A transfer from the or to intensive care at Wockhardt, for example, is documented with a written transfer statement and verbal confirmation by a physician and compiled into an ongoing summary. Computerized tracking, with supermarket-type bar codes that can be scanned from patient wristbands and stickers on their records, is coming soon.
JCI standards also call for various means of minimizing infections, including collection and review of infection statistics and any necessary corrections. At Wockhardt, water used in surgery and laboratories is filtered and regularly tested. Western patients always get bottled drinking water ("for comfort," says Arshanapalai Malathi, head of medical services). Dispensers of disinfectant alcohol gel at the foot of each bed for hand cleaning are hard to miss.
A safe blood supply cannot be assumed—especially in a developing nation. "When we started watching the development of medical tourism," says Karen Lipton, CEO of the AABB, the association that represents American blood banks, "we asked ourselves, 'Where is the blood coming from? How well do they screen donors? Who's making the judgment about the safety of these products?' " Patients can and should ask a hospital representative these questions, but there is no way to verify the answers. On the other hand, says Lipton, the hospitals "don't want to do anything bad—the last thing they want is for people to go back home and have problems."