Medical malpractice overseas: The legal uncertainty surrounding medical tourism

Law and Contemporary Problems

Volumn 70, Issue 2, 2007, Pages 211-232

  Mirrer Singer, Philip ^a  

^a DUKE UNIVERSITY   (United States)

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EID: 35048893757     PISSN: 00239186     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (155)

1. One hundred fifty thousand foreigners visited India for medical procedures in 2003, and a health-care specialist with the Confederation of Indian Industry predicted that the business would grow at a rate of fifteen percent per year. John Lancaster, Surgeries, Side Trips for "Medical Tourists": Affordable Care at India's Private Hospitals Draws Growing Number of Foreigners, WASH. POST, Oct. 21, 2004, at A01.
2. The Apollo Hospital in Chennai, India and the Bumrungrad Hospital in Thailand are two such examples. See, e.g., 60 Minutes Story: Vacation, Adventure, and Surgery? (CBS Broadcast, Apr. 24, 2005), available at www.cbsnews.com/stories/2005/04/21/60minutes/ main689998.shtml.
3. Patients at Bumrungrad Hospital in Thailand pay about one-eighth of what they would pay in the United States. 60 Minutes Story, supra note 2.
4. See Randeep Ramesh, This UK Patient Avoided Waiting Lists and Flew to India for a Heart Bypass. Is Health Tourism the Future? THE GUARDIAN (London), Feb. 1, 2005, at Guardian Home Pages 3 (citing a joint report by McKinsey and the Confederation of Indian Industry).
5. See, e.g., Med Journeys, http://www.medjourneys.com (last visited May 27, 2007);
6. PlanetHospital, http://www.PlanetHospital.com (last visited Apr. 10, 2007).
7. See Ramesh, supra note 4.
8. India Profile, Medical Insurance and Legal Aspects, http://www.indiaprofile.com/medical-tourism/ medical-insurance-and-legal-aspects.html (last visited Apr. 10, 2007).
9. See, e.g., Grove v. Maheswaran, 498 S.E.2d 485, 508 (W. Va. 1997) (holding that there were insufficient contacts between the nonresident third party defendants - physicians and a hospital to support West Virginia's exercise of personal jurisdiction over them);
10. Biggs v. Robert Thomas, O.D., Inc., 893 P.2d. 545, 548 (Or. Ct. App. 1995), rev. den., 901 P.2d 246 (Or. 1995) (holding that the defendant, a California optometrist who practiced only in California, did not purposefully direct his activities at the residents of Oregon and therefore the court lacked jurisdiction over the defendant).
11. Wright v. Yackley, 459 F.2d 287, 290 (9th Cir. 1972) (finding that "there is no systematic or continuing effort on the part of the doctor to provide services which are to be felt in the forum state" when the physician practiced elsewhere).
12. See, e.g., N.Y. C.P.L.R. 302 (a)(1) and (a)(3)(i) (2001 & Supp. 2007).
13. E.g., Mosier v. Kinley, 702 A.2d 803,808 (N.H. 1997).
14. 687 N.E.2d 1293, 1295-96 (N.Y. 1997).
15. 655 F. Supp. 1418, 1419 (W.D. Pa. 1987).
16. 223 A.D.2d 777, 778 (N.Y. App. Div. 1996).
17. See also Ingraham, where the New York Court of Appeals declined to decide whether a contract like that in McLenithan - a "referral/fee arrangement creating mutual obligations" - would suffice as "interstate business activity" for purposes of long-arm jurisdiction.
18. Wright v. Yackley, 459 F.2d 287, 289 (9th Cir. 1972).
19. See, e.g., Torres v. State, 894 P.2d 386, 390 (N.M. 1995).
20. See, e.g., Wright, 459 F.2d at 289-90 (holding that refilling a prescription for a resident of the forum state is insufficient to establish personal jurisdiction);
21. see also Kennedy v. Ziesmann, 526 F. Supp. 1328, 1330-31 (E.D. Ky. 1981) (holding that "incidental phone calls" to a patient in the forum state are insufficient to establish personal jurisdiction).
22. 459 F.2d at 289-90.
23. Id. at 290-91.
24. Id. at 291.
25. MedRetreat, http://www.MedRetreat.com (follow "About MedRetreat[:] Getting to know us" hyperlink to view slide presentation) (last visited Apr. 10, 2007).
26. MedRetreat Press Release, Nov. 18, 2005, available at http://www.medretreat.com/templates/UserFiles/Documents/ Press%20Releases/MedRetreatPressRelease20051118.pdf.
27. Id.
28. See MedRetreat, Why MedRetreat, http://www.medretreat.com/ medical_tourism/why_medretreat.html (last visited May 27, 2007).
29. U.S.C.A. § 1332(c)(1) (2006).
30. See, e.g., Darling v. Charleston Cmty. Mem. Hosp., 211 N.E.2d253,258 (III. 1965).
31. For examples of cases on both sides of the issue of whether MCOs can be held liable for corporate negligence, see Clark C. Havighurst, Making Health Plans Accountable For the Quality of Care, 31 GA. L. REV. 587, 609 n.58 (1997). Among other cases, Havighurst cites Elsesser v. Hospital of Philadelphia College of Osteopathic Medicine, 802 F. Supp. 1286, 1291 (E.D. Pa. 1992) (recognizing corporate negligence as a theory of liability);
32. Harrell v. Total Health Care, Inc., 781 S.W.2d 58, 60 (Mo. 1989) (relying on a state statute to reject the theory of liability);
33. and McClellan v. HMO of Pennsylvania, 604 A.2d 1053, 1056 n.6 (Pa. Super. Ct. 1992) (finding it unnecessary to decide the case on the issue).
34. See infra Part III.
35. Edmonds v. Chamberlain Mem. Hosp., 629 S.W.2d 28,29-30 (Tenn. Ct. App. 1981).
36. Id.
37. Id. at 30.
38. See Havighurst, supra note 27, at 604 ("[A] hospital is accountable for such a physician's performance only if it was, or should have been, aware of a specific problem - much as, in many jurisdictions, a dog owner is entitled to one free bite.").
39. Catherine Butler, Note and Comment, Preferred Provider Organization Liability for Physician Malpractice, 11 AM. J.L. & MED. 345, 361 (1985).
40. Id.
41. MedRetreat, for example, states that all MedRetreat partner facilities are "private institutions that either meet or exceed the high standards of quality care, technological innovation and accreditation that American medicine is known for." MedRetreat, Hospitals, http://www.medretreat.com/procedures/hospitals.html (last visited Apr. 10, 2007).
42. E.g., Foflygen v. Zemel, 615 A.2d 1345, 1353 (Pa. Super. Ct. 1992) ("[U]nder normal circumstances, only the physician who performed the operation on the patient has the duty of obtaining the patient's informed consent.").
43. Eg., Salis v. United States, 522 F. Supp. 989, 1005 (M.D. Pa. 1981) (recognizing a cause of action in lack of informed consent when the injured plaintiff was not warned of all the dangers of an angiogram);
44. Wagner v. Georgetown Univ. Med. Ctr., 768 A.2d 546, 560-61 (D.C. 2001) (finding error in granting the defendant's motion in limine in part, because a reasonable jury could conclude that the plaintiff's physician had overestimated the odds of surgical success and therefore the plaintiff did not give her informed consent).
45. 800 A.2d 73,82,86 (N.J. 2002);
46. see also Johnson v. Kokemoor, 545 N.W.2d 495,504 (Wis. 1996) ("We reject the defendant's proposed bright line rule that it is error as a matter of law to admit evidence in an informed consent case that the physician failed to inform the patient regarding the physician's experience with the surgery or treatment at issue.").
47. Id. at 83, 86. Interestingly, the Howard court did not permit an action for fraud. For a critique on this point see Vincent R. Johnson and Shawn M. Lovorn, Misrepresentations by Lawyers About Credentials or Experience, 57 OKLA. L. REV. 529, 569-70 (2004).
48. Howard, 800 A.2d at 84.
49. Id.
50. Id.
51. Id. at 76.
52. See MedRetreat, Physicians, http://www.medretreat.com/procedures/ physicians.html (last visited Mar. 1, 2007).
53. Tellingly, MedRetreat has since changed the statement that its partner facility physicians are trained according to the "same" standards and practices that exist in the U.S. with the less contentious statement that its partner facility physicians are trained according to international standards and practices that are "comparable" to those existing in the U.S. See MedRetreat, Physicians, http://www.medretreat.com/procedures/physicians.html (last visited Apr. 10, 2007).
54. See Havighurst, supra note 27, at 596.
55. See, e.g., Sloan v. Metro. Health Council, Inc., 516 N.E.2d 1104, 1109 (Ind. Ct. App. 1987).
56. Mejia v. Cmty. Hosp., 99 Cal. App. 4th Supp. 1448, 1456-57 (Cal. Ct. App. 2002).
57. See, e.g., Gilbert v. Sycamore Mun. Hosp., 622 N.E.2d 788, 796 (Ill. 1993) (holding that a hospital holds itself out as a provider of care if it fails to inform the patient otherwise).
58. See, e.g., James by James v. Ingalls Mem'l Hosp., 701 N.E.2d 207, 211 (Ill. 1998).
59. McGill v. Newark Surgery Ctr., 756 N.E.2d 762, 773 (Ohio C.P. 2001)
60. (quoting Clark v. Southview Hosp. & Family Health Ctr., 628 N.E.2d 46, 53 (Ohio 1994)).
61. See, e.g., Paraperin v. Trinity Mem. Hosp., 423 N.W.2d 848, 849 (Wis. 1988).
62. Id.
63. See, e.g., Boyd v. Albert Einstein Med. Ctr., 547 A.2d 1229, 1229, 1232 (Pa. Super. Ct. 1988).
64. Id. at 1235 (denying summary judgment to HMO by finding "an issue of material fact as to whether the participating physicians were the ostensible agents of HMO.").
65. See Havighurst, supra note 27, at 608.
66. Id.
67. Espalin v. Children's Med. Ctr., 27 S.W.3d 675, 684-85 (Tex. Ct. App. 2000).
68. Id. (finding no error in granting summary judgment where the waiver stated that the physicians were not employees of the hospital).
69. See MedRetreat, supra note 21.
70. MedRetreat, Medical Tourism Agreement, http://www.medretreat.com/ templates[UserFiles/Documents/ Medical%20Tourism%20Agreement%20-%20Jane%20Doe(1).pdf (last visited Apr. 16, 2007).
71. See Mediescapes India, http://www.mediescapes.com/ Legal_Issues_and_Risks.html (last visited Apr. 10, 2007).
72. See Espalin, 27 S.W.3d at 684-85 (although the discussion concerning waivers in Espalin was confined to the hospital context, courts will likely find that medical-tourism firms can similarly waive risks, especially since firms have even less control over doctors).
73. See infra text at note 89.
74. Koster v. Lumbermens Mutual Casualty Co., 330 U.S. 518, 524 (1947).
75. Stangvik v. Shiley Inc., 54 Cal.3d 744, 755-56 (Cal. 1991) ("[T]he presumption of convenience to a defendant which follows from its residence in California remains in effect...."). However, the convenience of a state of incorporation or principal place of business is not always dispositive.
76. See Ussery v. Kaiser Found. Health Plan, 647 A.2d 778, 781-82 (D.C. 1994) (holding that a Maryland plaintiff could not sue her health plan in the District of Columbia for malpractice that occurred in Maryland even though the defendant was incorporated in the District).
77. See, e.g., Gundlach v. Lind, 820 N.E.2d 1, 5, 6 (Ill. Ct. App. 2004) (holding that the circuit court abused its discretion in denying defendant's motion to transfer venue when neither the plaintiffs nor the defendants resided in the county where the plaintiff brought suit and the acts giving rise to the litigation were also located outside the forum county).
78. See, e.g., Stangvik, 54 Cal.3d at 751.
79. Id.
80. 751 F. Supp. 122, 126, 128 (S.D. Tex. 1990).
81. Id. at 126.
82. Id.
83. Id.
84. Id.
85. Gulf Oil Corp. v. Gilbert, 330 U.S. 501, 509 (1947).
86. Gibbon v. Am. Univ., 1983 U.S. Dist. LEXIS 13401, *1 (S.D.N.Y. 1983).
87. Id. at *7.
88. Id. at *9.
89. Id. at *9 n.6
90. (quoting Judge Friendly in Conte v. Flota Mercante Del Esatado, 277 F.2d 664, 667 (2d Cir. 1960)).
91. Jeha v. Arabian Am. Oil Co., 751 F. Supp. 122, 128 (S.D. Tex. 1990).
92. Gibbon, 1983 U.S. Dist. LEXIS at *10.
93. Jeha, 751 F. Supp. at 125.
94. Id.
95. Piper Aircraft Co. v. Reyno, 454 U.S. 235, 254 (1981).
96. See, e.g., Banco Mercantil, S.A. v. Arencibia, 927 F. Supp. 565, 567-68 (D.P.R. 1995).
97. Id.
98. (quoting Chesley v. Union Carbide Corp., 927 F.2d 60, 66 (2d Cir. 1991)).
99. Bhatnagar v. Surrendra Overseas Ltd., 52 F.3d 1220, 1227-28 (3d Cir. 1995).
100. Id. at 1228.
101. 454 U.S. at 249-55.
102. Id. at 252 n.19.
103. Id. at 254.
104. 186 F. Supp. 2d 279, 298-99 (E.D.N.Y. 2002).
105. Id. at 298.
106. Id.
107. 208 F. Supp. 2d 74, 91-92 (D. Mass. 2002).
108. Id. at 92. The court was also persuaded to find that Belgium was an inadequate forum because Belgium lacks a class-action mechanism.
109. Id. at 91.
110. See supra text at note 65.
111. See supra text at note 66.
112. See Jeha v. Arabian Am. Oil Co., 751 F. Supp. 122, 126 (S.D. Tex. 1990).
113. Id.
114. See Gulf Oil Corp. v. Gilbert, 330 U.S. 501, 509 (1947).
115. Id.
116. E.g., Gibbon v. Am. Univ., 1983 U.S. Dist. LEXIS 13401, *10 (S.D.N.Y. 1983).
117. E.g., In re Lernout and Hauspie Secs. Litig., 208 F. Supp. 2d. 74, 91-92 (D. Mass. 2002).
118. Bhatnagar v. Surrendra Overseas Ltd., 52 F.3d 1220, 1227-28 (3d Cir. 1995).
119. Banco Mercantil, S.A. v. Arencibia, 927 F. Supp. 565, 567-68 (D.P.R. 1995).
120. RESTATEMENT (SECOND) OF CONFLICTS OF LAWS § 145 (1971).
121. Id.
122. See Shirley A. Wiegand, Fifty Conflict of Laws "Restatements": Merging Judicial Discretion and Legislative Endorsement, 65 LA. L. REV. 1, 39-40 (2004)
123. (quoting Symeon C. Symeonides, Choice of Law in the American Courts in 2003: Seventeenth Annual Survey, 52 AM. J. COMP. L. 9, 33 (2004)).
124. Chadwick v. Arabian Am. Oil Co., 656 F. Supp. 857, 858 (D. Del. 1987).
125. Id. at 860.
126. Id. at 860-61.
127. 789 F.2d 236 (3d Cir. 1986).
128. Id. at 239.
129. Id.
130. Id. at 241.
131. Id. at 242.
132. Id.
133. Id. at 243.
134. See id. at 241.
135. See RESTATEMENT (SECOND) OF CONFLICTS OF LAWS, supra note 107.
136. See Chadwick v. Arabian Am. Oil Co., 656 F. Supp. 857, 858 (D. Del. 1987).
137. See 60 Minutes Story, supra note 2 (explaining that many medical tourists receive treatments not covered under their insurance or not FDA approved).
138. For the parallel argument in the MCO context see Havighurst, supra note 27, at 618 (arguing MCOs are "in a position to make quality a desideratum in selecting specialists").
139. See, e.g., MedRetreat Press Release, supra note 22.
140. See supra text at Part II.A.
141. In India, for example, the delays in judicial proceedings are notorious. See supra text at note 87.
142. See Clark C. Havighurst, Vicarious Liability: Relocating Responsibility for the Quality of Medical Care, 26 AM. J.L. & MED. 7, 23 (2000).
143. See Havighurst, supra note 27, at 591-95.
144. Id. at 594-95.
145. See, e.g., MedRetreat, Why MedRetreat, supra note 24.
146. MedRetreat, for example, has only been in existence since 2003. MedRetreat, supra note 21.
147. See discussion supra, Part II.B.1.
148. See, e.g., Jeffrey O'Connell & James F. Neale, HMO's, Cost Containment, and Early Offers: New Malpractice Threats and a Proposed Reform, 14 J. CONTEMP. HEALTH L. & POL'Y 287, 296-98 (1998).
149. Id. at 294.
150. See supra Part II.
151. O'Connell & Neale, supra note 134, at 294.
152. See, e.g., Havighurst, supra note 128, at 18-19.
153. Id. at 18.
154. Id.
155. M. Dinesh Varma, Insured in U.S., Treated in India, THE HINDU, Feb. 8, 2006, available at http://www.hindu.com/2006/02/08/stories/2006020817240300.htm.