Letter to the Editor, by Patricia Shawcross
SÃO PAULO, BRAZIL – On January 8th this year Brian Shawcross set off on a four day business trip to São Paulo, Brazil. On the 26th of March he returned. A longer meeting than anticipated? NO! He spent over two months in the São Luiz hospital in São Paulo.
The day after arriving Brian tripped and fell in the Hotel bedroom. When he woke next morning he was in a great deal of pain and could not move his arm. His boss thinking maybe it was a minor stroke decided to take him to the hospital to be on the safe side. After four days of intensive tests there was no convincing diagnosis of a stroke so Brian was considered fit to be discharged and the ‘fit to fly’ certificate was issued.
There was a two day delay in getting him repatriated by his insurance and by that time phlebitis had appeared in the site of a catheter in his arm. So he was transferred to another ward in the hospital for the infection to be treated, where he became delirious, reached a dangerously high fever, and was mainly unaware of his surroundings.
Thinking he was coming home Brian’s daughter flew to Brazil to accompany him on his home journey. What she found was an extremely dangerously sick man. After six days of antibiotics, his condition worsened every day. His daughter, watching him ‘dying’ three times’ and being revived, began screaming for a change of antibiotics, as even she could see his condition was worsening day by day.
After continuous consultations with his own doctors in Palma they finally persuaded the doctors in Brazil to change medication. Finally he began to improve but relapsed many times when the antibiotics were changed on an almost daily basis. A dangerous number of TACs had to done, these usually harming the kidneys.
He had brain scans and operations on both knees, where they thought the infection may have settled. There was also talk of removing his pacemaker in case that could also be nest site of the infection. Brian does not remember two whole weeks of his life at this time. With hindsight a good thing.
The private insurance company then dropped the bombshell that they were only going to pay up to 12,000 euros because the hospital was in Brazil not Europe. The family’s answer to this was that as the hospital was to blame for the infection and there was no way they were going to pay the medical bills for treatment needed and given.
This was when the threats and denials from the clinic began in earnest. Denial of course that he could not possibly have caught the infection in the hospital and that he must have brought it in with him. A medical document states that the infection started in the area of the catheter in his arm.
The first threat was to remove him from the hospital and send him to the local hospital. We were told in no uncertain terms by many of the doctors this was NOT an option as the conditions there were very poor. They were treating him and they had to continue until he was well again.
The second threat was that he would not be allowed to leave the clinic until he paid the bill no matter how long they had to keep him there.
The third threat was that even if we agreed to sign a letter of ‘confession of debt’ it had to be signed by a Brazilian citizen, so that they could sue in Brazil. The offer of asking the doorman at the hospital to sign was not taken seriously!!!!
At no time would they tell us the amount of the debt or translate anything in English for us to understand. Finally a business acquaintance in Sao Paulo came to our aid translating Portuguese into English for us. He was then approached to sign the confession of debt which of course he wouldn’t do.
The fourth threat was saying they would cancel any repatriation flight booked by the insurance company, cancel any ambulance and doctors paid by them, and not allow us out of the hospital doors until the debt was paid.
The fifth threat came when they demanded the name, address, phone number and mangers name, of our Spanish bank. They also told us that unless we paid up to the limit on our Credit card we would never leave the clinic. They wanted the actual card sent to their office immediately and demanded to know the limit on it. Three times they sent employees to the room with this demand.
Employees would come to the room and put documents on the table and if nobody would sign they threatened to issue papers to transfer Brian to the local hospital. Papers were always in Portuguese and nobody would give an explanation as to what the documents contained. Naturally Brian refused to sign anything. Some days they would just stand at the door looking at Brian in an intimidating way saying nothing.
Due to work commitments Brian’s daughter had to fly home after more than three weeks there, and his wife came to replace her to be with him. Two ‘windows of time’ where Brian could safely be repatriated came and went because of the refusal of the insurance company to act until the problem of payment to the clinic was settled.
Consequently, Brian developed kidney failure after six weeks of constant antibiotics and various medications. For the first three days of having his kidneys failing nothing was done other than diuretics. As his body ballooned, his weight went from 70 kg to 95 kg.
He could not move his legs feet or hands or even get out of bed, and was in excruciating pain. His wife began to be extremely concerned about the doctor in charge of his case and asked for her to be removed and another doctor to take over.
Within 15 minutes of this new doctor arriving Brian was rushed in to intensive care where he began three weeks of dialysis. The care and concern of this this doctor went far beyond any call of duty. If it wasn’t for him, Brian’s wife was convinced that there would have been very dire consequences from the lack of treatment when the kidney failure first took place.
This doctor argued every day for permission to give Brian his dialysis treatment. His argument being that he didn’t care what the situation was between the patient and the clinic, his concern was the patient’s life. The clinic saying they knew we were not going to pay and were unhappy about any more life-saving dialysis.
After two weeks of constant dialysis the doctor said he could give the last two treatments in such a way that would leave a 36 hour ‘window’ in order to repatriate Brian back to Spain. The insurance once again started to argue that as we had a problem with the clinic and paying the bill, they were not happy to book any flights.
A lawyer reminded them of the law, which made this none of their business, and they were told to get their client out of there on the designated date. The date of repatriation was finalized and the flights booked. Then the Clinic started with the threats again on the day before the flight.
The new demands were that not only had Brian to sign the confession of Debt, they now wanted a Brazilian lawyer to sign with him. Otherwise he could not leave the hospital. Obviously this was not possible, so they then tried to get the flight and accompanying nurse cancelled, also the ambulance booked to carry Brian from hospital to the airport.
This, the insurance refused to do. Finding they could not carry out this threat they then demanded the actual doctor’s bills to be paid, minus the bill for the treatment etc. They had then decided to waive that part of the bill. They informed Brian that doctor’s bill was about R$90,000.
When once again payment was refused they added the two bills together again and said we could just sign the whole bill with an admission/confession of debt. This bill turned out to be around R$300,000. In desperation to get out while Brian was able to fly this was agreed.
On the morning of departure at 10AM our friend went to the office and asked for the confession of debt to be brought to the room to sign. At 3:30 PM the bill was finally brought. It was in Portuguese and they refused us an English copy saying our friend could translate it.
This he did as best as possible. This was when we realized that the debt would also pass on to the children if we did not win the law suit we intended to initiate. A check was made quickly about Brazilian law and found out that the children only had to pay from any inheritance received from us. Easily solved!
Other conditions included total payment in five days and tremendous interest charges. As the time was now past 4PM it was decided to sign the document. So, adding ‘Signed under Extreme duress’ Brian and his wife signed the document and it was taken away to get the director of the clinic to sign.
Then he should issue Brian’s medical reports and hospital discharge. Time went on and not a word or document came back from the office. Finally at almost 6PM our friend went to see what was happening as the ambulance was booked for 7PM to take Brian to the airport.
The next thing to happen was a demand for a Brazilian lawyer to come and countersign with us another copy of the confession of debt, as the other was not acceptable with ‘signed under duress’ added to it. If this demand was not met the police were to be called and we were to be arrested, or kept at the hospital and not allowed to get the flight home.
In Spain working against the clock Brian’s daughter was desperately looking for help. Her husband’s employer had companies in Brazil so had a law firm who worked for him in Sao Paulo.
Literally at the eleventh hour (7:15 PM to be exact) two lawyers came to the clinic and called the police themselves. The ambulance, paid for by the insurance company was refused entrance to the hospital. The guards told the nurse that she would never get her patient out of the hospital. Laughing at her while he said it. Brian and his wife were refuse exit from the intensive care ward.
What exactly occurred between the lawyers and the clinic director is still a little unclear but within five minutes the guards on the clinic doors were told to allow the ambulance in the emergency parking area. The intensive care ward were instructed to open the doors and allow Brian to leave. The discharge papers and medical reports were refused.
Having got Brian onto the ambulance bed, luggage stowed away, the journey to the airport began with lights flashing and sirens blaring in order to meet the nurse accompanying Brian home and to catch the flight home.
The money that this nightmare cost the family for flights, accommodation, meals etc. ran into thousands of euros, but the mental and physical stress and strain on all the family cannot be put into words or monetary terms. Having being refused his medical records, which are legally Brian’s, posed a great problem for his doctors when he arrived at his clinic in Palma.
They literally worked for the first three weeks ‘in the dark’ so to speak. Immediately he arrived he was admitted to intensive care and was put straight onto dialysis while a course of treatment was discussed. They were helped as much as possible by the wonderful doctor who finally took over Brian’s case and eventually helped him to leave his two month nightmare behind him.
The family intend to seek recompense from the clinic for malpractice but for the terrible stress strain and financial burden this whole scenario has caused. So take a lesson from this story. PLEASE check your insurance and check it again before you travel.
Brian finally left hospital after another three weeks and thank God his kidneys slowly but surely are showing signs of improvement and hopefully he will not need dialysis for the rest of his life.