Medical Tourists in Israel Given Needless Surgery - for Money, Doctors Accuse

A Channel 2 investigative show revealed how operations are sometimes performed on foreign patients for monetary, not health-related considerations. A burgeoning field – and a sad state of affairs.

Nir Kafri

Two senior physicians at Tel Aviv’s Ichilov Hospital are accusing some of their colleagues there of performing unnecessary surgery on foreign tourists who come to Israel for medical care — for large sums of money. The two claim that operations are sometimes performed on terminally ill patients without any medical justification: neither to prolong the patients’ lives nor to improve their quality of life.

In an expose broadcast Monday evening on Channel 2’s investigative program “Fact,” the two doctors expressed their concerns on camera. The allegedly unnecessary surgery is not the only problem with medical tourism, it emerges: Despite the money it generates at hospitals in Israel, treatment of such tourists may also lengthen the wait for Israelis in need of certain medical procedures.

The two doctors’ claims were supported in the TV program by two other physicians who did not appear on camera, as well as by an official with a company that arranges local operations for foreigners. The official acknowledged that at times patients from abroad —“flying bodies,” as he called them – are flown to Israel whose condition does not merit surgery.

The clash that exists at times between monetary considerations and what is in the patient’s best interest is not unknown elsewhere in the country's health-care system, which is constantly operating at a deficit. This has sometimes led to provision of less-than-optimal medical care in an effort to save that system money.

The Channel 2 investigation showed, however, that even when it comes to foreign medical tourism where the motives are very different, since it generates billions of shekels a year – the situation is no less dangerous to the patient. Senior surgeons are apparently performing complicated, dangerous surgery in cases in which there is no medical justification for it, purportedly for the huge sums of money paid in return.

“When you are exposed to major millions, even the most honest person finds it hard to resist the temptation. A person receives 15,000 euros for an operation in a [publicly funded hospital] and uses the department staff to help him. And they see the patient, examine the patient, while he does three or four of these [operations] a week. That’s 60,000 euros a week,” says Dr. Shimon Maimon, a senior invasive neuro-radiology specialist at Ichilov, and one of the two doctors interviewed on "Fact." “How many people do you know who will stand up to this temptation?“

The narrow ethical-medical "corridor" that doctors in the foreign medical tourism sector have to navigate exists in part thanks to the fact that medicine is not always an exact science per se; there is room for interpretation even when it comes to decisions relating to treatment. In addition, by virtue of the large number of tough cases it has to handle, the country's medical profession is treated at times with a measure of lenience, or forgiveness, even when the results are tragic.

'Medicine isn't math'

“After all, what is medicine? Medicine isn’t math. It’s not one-plus-one equals two, and I can always say: ‘Listen folks, it fits into this category, so I am going to operate.' And it will be hard to show that I did something that wasn’t necessary," Maimon explains.

“They take a patient who comes from Russia with a growth on the spinal cord in his neck, who has no prospect of improvement, and it’s clear to everyone that he has no such prospect, but they remove the growth and take money and then the patient’s condition gets even worse. Why? What are the considerations? Where is the medical judgment?

“It might be easier for that doctor to come and tell you: 'The situation got worse in the past week. There was deterioration, as a result of which I decided to operate.’ You can say this to people who don’t live [within] the system, people who don’t understand medicine, but you can’t do it to staff who know the truth. The regular staff and the nurses know the truth.”

Dr. Liana Beni-Adani, a senior physician in the pediatric neurosurgery department at Ichilov’s Dana Children’s Hospital also spoke of the phenomenon on camera.

“There have been children who have arrived with an illness that is clearly life-threatening. The child has major surgery that not only does not help him, but also requires two months of hospitalization and five operations. Ultimately, the writing was on the wall from the beginning: ‘a cancerous growth.’

"In my opinion," Beni-Adani continues, "if it hadn’t involved the payment of money as a private patient, and also the fact that both the surgeon and the hospital get so much money from these patients – in a lot of places around the world, such operations would never be performed, certainly not the scope of this operation.”

Beni-Adani claims that in some of these cases, it could have been determined that there was no point in operating and the patient should be spared unnecessary suffering. “You can take issue with me that on the medical level I am not correct," she says. "As I see it, I am.”

Both Maimon and Beni-Adani, it should be noted, are at odds with the management at Ichilov, each in a different context. Specifically, the poor relations between Maimon and hospital director Prof. Gabriel Barbash and his colleagues has been exposed in recent years even outside the confines of the facility. There have been lawsuits and complaints filed against Maimon with the Health Ministry’s public ombudsman over what Barbash described at the time as Maimon's “problematic personality.”

For her part, Beni-Adani sued the hospital administration after she was not successful in her bid to compete internally for a hospital post.

It’s possible that the poor state of relations these two doctors have with Ichilov's management was a factor in deciding to go public with allegations against that institution, and one may wonder about some aspects of the grave state of affairs they seek to portray. However, as noted, in addition to their assertions, there is other evidence from sources who remain anonymous and who claim that doctors perform surgery on foreign patients only for the money and in circumstances in which there is no medical call for it.

In response, the Ichilov administration stated that it is unfamiliar with the new allegations, which had never been presented to it in the past. “It’s difficult to believe,” the hospital stated, “that in a department functioning at an academic institution with teams of senior physicians, someone, senior as he may be, could carry out an unnecessary procedure on a patient without any oversight from staff and without the subject coming to the attention of quality control [officials] in the administration.

“We are amazed at the staff at ‘Fact,’ which, despite knowing all of the genuine facts, is lending a hand to a distorted and destructive process and harming our dedicated doctors. This is despite the fact that during the course of the past month, the hospital administration met with the staff from the TV program, and presented facts clearly demonstrating that the claims of the two doctors [Maimon and Beni-Adani] are motivated by a desire for personal revenge and by extraneous [personal] interests.

“Dr. Maimon concluded his work at two hospitals following problematic conduct, and by his harmful and derogatory behavior caused all of the catheterization doctors who worked with him to leave; in certain instances, he even refused to care for patients. An outside, independent Health Ministry review committee determined that Dr. Maimon’s conduct was inappropriate and improper on the level of ethics, collegiality [and] contrary to the physician’s oath,” the hospital stated.

Other doctors' concerns

Problematic treatment of foreign patients "has happened more than once,” a doctor from another hospital told “Fact.” Another doctor confirms: “I know of a case of a patient with a highly malignant growth. They invented all kinds of excuses but it was clear to me that the biopsy was unnecessary.”

The TV show also presented the account of a business agent in the medical tourism sector, who blatantly says: “It’s not just at Ichilov. Other hospitals also bring in the ‘flying bodies.’ You know that the person is finished and is being brought here to get another few bucks from him.”

It’s not news that medical tourism is a bonanza for the doctors involved with it and an important revenue source for the hospitals. Over the years, there has been a lot of media coverage about the broad scope of this field, and about its presence at public hospitals. The accounts by physicians in the field as presented on “Fact” expose a serious ethical dilemma when it comes to seeing to the good of the patient.

In June, for example, TheMarker reported how an 85-year-old female cancer patient was transferred from her bed to a chair at a government hospital in the center of the country to free up space for a foreign patient. She was also forced to wait for hours for a CAT scan while foreign tourists got priority.

Foreign medical tourism has flourished rapidly in recent years and Ichilov is one of the three top public hospitals in the country when it comes to revenue generated from patients from abroad.

In December 2013, there was a “Fact” expose showing three senior Ichilov doctors, Zvi Ram, Shlomi Constantini and Yossi Paz, demanding thousands of dollars “under the table” from a representative of a foreign tourism agency, to perform operations on patients from abroad. Following the broadcast the police and the Tax Authority opened an investigation against the three on suspicions of bribery, employee theft and tax violations. If the investigations have amounted to anything, the results have not yet been made public and the three remain on the job. The earlier broadcast also provided a moment of black humor of sorts when it showed a medical team discussing a foreign female patient's case and one of those present quipped: “She should buy a one-way ticket.”