In Mexico, public hospitals do not accept medical insurance, so if a foreign patient is admitted to any public hospital, the patient is obliged to pay out of pocket for the medical services needed.
Public hospitals also do not release any information to medical insurance companies or third-party payers; they are obliged by law to release medical information only to the patient or direct family member who is physically there through a daily verbal report, and in cases where a final report is needed, a very brief clinical summary is given to the family, which can take a long time after discharge to be issued, delaying the refund process between the patient and his/her private insurance – if it applies. Therefore, compiling clinical information in a timely manner with the public hospital’s assistance is extremely complicated.
One of the biggest challenges we face, especially in small cities such as Playa del Carmen (estimated population: 300,000), with a second-level public hospital, is the limited access to technology, medical specialties and subspecialties, access to highspecialty medications, medical supplies and some procedures.
In November last year, during the first year of Covid-19 pandemic, Logimedex received a request to intervene in the case of a 53-yearold male from Switzerland who had been hospitalised hours before at an intensive care unit (ICU) in a public hospital in Playa del Carmen, Mexico, with suspected Covid-19 pneumonia and septic shock. In addition to language barriers, our assistance was requested due to difficulties the insurer found in accessing clinical information.
Our initial plan was to move the patient to a private hospital in our network, but a transfer wasn’t possible due to the patient’s condition – he had signs of haemodynamic instability, and the ICU doctor didn’t consider it appropriate – so keeping him in the public hospital was the best option. Our case management team found a way to obtain permission to review the patient’s clinical evolution, noting that in addition to the known pneumonia and septic shock, there were signs of kidney failure and anaemia, but due to the unavailability of a nephrologist and haemodialysis equipment in the area, neither had been addressed. The next step was to send a field agent on site who could personally approach clinical staff, social workers and the medical subdirector, and ask for special permission to complement their care with private medical staff at our cost and co-ordination. Permission was granted 24 hours later.
Interoperability between private and public health parties
It is important to note that the public health system does not normally allow external medical professionals to work in public hospitals as staff have to follow certain government protocols. The permissions we managed with the hospital administration were granted without violating this law. After permission was granted, we brought an external haemodialysis machine to the Covid ward where the patient was being treated, and we provided a private nephrologist who coordinated all the sessions. Through the treating doctors, our field agent and nephrologist, we compiled clinical information and a list of medications and supplies necessary for adequate care of the patient. These were acquired despite their rarity in Cancun and were sent the same day to the public hospital; photographic evidence of this was obtained. Road to clinical recovery On the 17th day of the patient’s stay in the respiratory care unit, the patient was under sedation and VMI, with a diagnosis of AKIN 3 acute kidney injury being treated with haemodialysis, remitted septic shock, community-acquired pneumonia CURB65 (SARS-COV-2 PCR test came back negative), mild SIRA, rhabdomyolysis, anaemia and pressure ulcers. On his 23rd day in hospital, the patient suffered hypovolemic shock, upper gastrointestinal bleeding, AKIN 3 acute kidney injury, anaemia, pneumonia CURB65 with four points remitted, and pressure ulcers. The prognosis was that the patient had a high risk of fatal complications and mortality. Due to the upper gastrointestinal tract bleeding, and the unavailability of the service in the hospital, our team arranged a therapeutic endoscopy with a private specialist, which identified a duodenal ulcer that was promptly treated. After the therapeutic endoscopy was performed, the hypovolemic shock and bleeding were solved, and the patient’s condition improved tremendously, and the patient’s discharge for repatriation under controlled conditions was moved forward.
Transfer to Switzerland
After more than 30 days in an ICU, the patient was repatriated to Switzerland by air ambulance with a specialist onboard, with mechanical ventilation on AC mode, and upon arrival was admitted to hospital in his hometown.
The patient continued his hospital treatment and was discharged successfully to continue his recovery at home with physical and neurological therapy. Almost one year after the event, the patient is still attending his therapy with some improvements.