Every culture has its own expectations concerning their medical profession. The ancient Chinese paid their physician every day they were healthy in order to be treated for free whenever they were ill. In Mexico, doctors tend to be extremely Hippocratic in their approach – the idea here is that people whose social position has allowed them to learn a great deal now want to help you feel better. But what happens when a patient doesn’t see the improvement he expected?
In the United States, an unhappy patient pays a lot of money to a malpractice attorney and hopes for the best. In Mexico, that sort of patient has more options: he or she can go to the Ministerio Público (the district attorney) to file a criminal complaint for malpractice, go to PROFECO (the federal attorney for the protection of consumers) to file a civil complaint, or ask a medical commission to resolve the problem with expert arbitration. There is no cost involved in any of these options. Additionally, one can hire a private attorney to file the case in civil court, similar to what is done in the U.S. More and more, the medical commissions are becoming the preferred route.
CAME-BC, the Comisión de Arbitraje Médico del Estado de Baja California, is part of the state government and has been around in one form or another for about a decade. Originally it maintained a single office in Mexicali, the state capital. “To do our job, we have to be where the patients are,” says Dr Agustín Escobar, the head of the commission, “so we came to Tijuana in 2008. That’s where most of the medicine is being practiced in this state. Very soon we will be opening offices in Rosarito, Ensenada, and Tecate. We’re also working on a web presence like the one our big brother in Mexico City has.”
CAME-BC’s “big brother” is CONAMED, the Comisión Nacional de Arbitraje Médico, a federal entity that was created in 1996. The federal commission now occupies an entire ten-story building in Mexico City, where it offers training and strategic support to the state-level arbitration commissions throughout the country. The purpose and goals of these commissions are identical: to apply ISO9000–style methodology in improving the quality of medical service as non-confrontationally as possible, in increasing patient satisfaction, and in raising the practitioners’ awareness of their patients’ expectations. The commissions’ approach is to address small problems early in order to prevent them from becoming bigger problems later.
“It is critical for us here in Mexico that we not wind up practicing defensive medicine, like our colleagues in the United States tell us they’re doing. Defensive medicine goes against our culture” says Escobar, who is also a gynecologist in private practice. “We absolutely must maintain open and confidential communication with our patients. We can’t do that in an artificial environment where we’re constantly second-guessing lawyers. That’s far too restrictive. We are human beings trying to help other human beings. To do that we need to be improving our service as much as humanly possible.”
In the relationship between patient and medical practitioner, both have basic rights that need to be respected. In order for patients to understand which of their expectations are considered fundamental, the commissions distribute a ten-point “Patient’s Bill of Rights” based on current law. That document is now being made available in English to our readers as a PDF.
Anyone who feels they have had a problem with any medical practitioner in the state of Baja California is welcome to bring their complaint to CAME-BC. That means complaints with doctors, dentists, pharmacies, laboratories, acupuncturists, homeopaths, you name it. That means complaints that don’t even fall under statutory law. CAME-BC can supply a translator if necessary. There is no charge for this service.
“Our first step is to listen to the complaint,” says Escobar, “and to create a written record of it. From that we’re able to explain to the patient what rights and responsibilities are at issue. This affords the patient a better understanding of their situation. We ask the patient what ought to be done in order for them to be happy with their medical attention. A lot of misunderstandings are cleared up at this point.
“We also look into the credentials of the medical practitioner in question – what sort of medical degree that person has, what professional groups they belong to, what specializations they practice, whether their certifications are up to date. If we encounter a person who is breaking our criminal laws, we pass that information on to the Ministerio Público for prosecution. This is how we weed out people who shouldn’t be giving botox injections, for example, and those who try to practice here after they had been defrocked in their own country.”
The second step, assuming the patient is still unhappy and that the medical practitioner checks out, is to obtain an unbiased expert opinion. All the local medical groups cooperate with CAME-BC in this step. “A woman from the United States came to us recently because she didn’t like the way her butt implant turned out” says Escobar. “She gave us permission to share her clinical file for the purpose of a second opinion. We called the Colegio de Cirujanos Plásticos and they sent us someone who works in that specific field.” Such experts review the particular case and render their findings. Perhaps the attending surgeon might have done something better, perhaps the patient didn’t follow their surgeon’s advice for post-operative recovery; in any event, the case now has an authoritative, unbiased opinion – for free.
Both the patient and the medical practitioner are given a copy of the expert opinion and are asked if they concur. “It’s very rare for our cases to continue beyond this point” says Escobar, “because the second opinion carries a lot of weight. Either the doctor sees a problem to correct or the patient sees the original expectations were unreasonable. If the patient is still unhappy, they have a choice, arbitration or court. The case can continue with us or we will release it to the patient’s designated private attorney. The authoritative opinion becomes part of the official record either way.”
The commission’s third step is reconciliation. Both the doctor and the patient show up at CAME-BC’s office with one of the ombudsmen present. A translator will also be present, if necessary. The ombudsman begins by reviewing the issues and the expert findings with both parties, bringing his own medical and judicial knowledge to bear on the problem. He then asks what each one would like to see as an ideal outcome. From that they all attempt to reach a practicable solution.
Failing a solution at the third step, the last resort is binding arbitration for which the commission in Mexicali sits en banc to review the entire record. They issue their determination as a judicial finding, settling the question definitively.
“We do not have subpoena power,” says Escobar, “we cannot obligate anyone to appear before us. We are a voluntary organization. And yet no medical professional has ever refused our invitation to respond. Once they appear before us, they are obligated by law to accept our judgement. That’s what binding arbitration is all about.”
You can make use of CAME-BC’s services by visiting their office in Tijuana weekdays between 8:00am and 3:00pm. They’re in the Centro Comercial “Las Palmas”, Blvd. Diaz Ordaz 13051, local B2. You can also call them at +52-664-900-7511 during those hours. The office can be contacted by e-mail, available from Reader Service, through their website, and on Facebook.
“More and more,” says Dr Escobar, “people are discovering that our service is better than the traditional approach. Our goal is to improve the quality of medical attention in Baja California, not to be punitive or to cause problems. In the majority of the cases we handle, the patients are simply asking for a little more communication from their doctor or dentist. They get that and they’re happy. Then their doctor or dentist knows how better to treat their next patients. We’re here to help everyone.”
Updated June 2018
In spite of its grandiose promises, or perhaps because of them, CAME-BC in Tijuana has proven itself to be a serious disappointment. We know of two cases at first-hand in which medical tourists came to this governmental agency hoping for redress. In both cases, the medical providers violated the “patient’s rights” promulgated by CAME-BC. And, in both cases, the medical tourists left frustrated after wasting a lot of time and effort.
The office claims to be bilingual and yet all its proceedings are perforce in Spanish. Visitors from the US will have a very hard time communicating with the office if they don’t speak Spanish; getting to the CAME-BC office will also be difficult because it has been relocated a few times and is now in an unmarked office building deep within a proletarian section of the city.
The commissioner told us that patients unhappy about their treatment could receive “specific performance” – the treatment they had contracted for – whether at the hands of the contracting provider or from another at the contracting provider’s expense. The deputy commissioner, on the other hand, began each of the two intake interviews that we followed by telling the plaintiff to be reasonable and to expect no more than half of what had been bargained for “because the nature of arbitration is compromise”.
In both of the cases that we followed, the patients had been cheated through dishonest business practices. One was a clear case of fraud that the Mexican tax authorities ultimately took up for their own purposes … while refusing to help the patient in the slightest. In both cases, the arbitrator excused CAME-BC’s inability to address consumer complaints by claiming a lack of training in that area of the law.
The Tijuana office’s arbitrator, who is also a workers’ compensation doctor in private practice, makes a great show of being unbiased in his handling of each case and yet he lobs softballs at the doctors and then holds the unhappy patients to a higher standard of proof. The doctor’s testimony gets automatic credibility while the patient is presumed to be in error. The arbitrator and the doctor frequently combined forces in attempts to gaslight the plaintiff – but, when called on it, the arbitrator demurs with the excuse that the subject matter, whatever it might be, is beyond his own expertise.
Objectively speaking, CAME-BC functions simply as the government’s first-line defense against unlicensed practitioners and medical malpractice. Its indifference to customer satisfaction was what finally convinced The Real Tijuana’s editors to publish complaints about a few of the local dentists, a decision we’re still not completely comfortable with inasmuch as we were originally constituted to celebrate the good things about our city.
The long and the short of it is that CAME-BC cannot be a substitute for the patient’s own diligence in finding honest, responsible providers – in fact, it even refuses, on grounds of confidentiality, to reveal the names of the providers who have received complaints. The best practices for medical tourists continue to be to vet one’s prospective providers carefully and to hedge one’s bets with medical-tourism insurance, whenever either is possible.
Due diligence means checking your prospective provider’s professional credentials. Not just a once-over of the framed pieces of paper on the doctor’s wall, but confirmation from the state (cédula) and federal (título) authorities that issued the doctor’s licenses. Specialist training also needs to be documented, particularly when it comes to trendy offerings such as stem-cell therapies, alternative medicine, and dental implants, which are being offered by many people who have only the barest minimum of qualifications.
As a hedge against undesirable complications, insurance is better than trusting the government’s oversight. There are very few companies writing medical-tourism policies these days, however, and those appear to be restricted to big-ticket medicine such as bariatric and plastic surgeries. One company might be including oral surgery in their coverage – they seem to be the most innovative of the lot – but our request for clarification has had to be sent up their chain of command and has yet to make it back to us. In any event, no insurance will cover the dishonest commercial practices that we have witnessed.
The International Board of Medicine and Surgery is one potential solution for medical tourists’ dissatisfaction in not getting what one expected to receive. IBMS has five degrees of membership, distinguished by increasing amounts of responsibility toward medical tourists, and the head of IBMS has said repeatedly that he will intervene personally whenever a patient has a problem with the services received from any IBMS member. The drawback here, though, is that very few doctors or dentists in Mexico are members of IBMS at the moment.
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