Experienced travelers generally agree that tourists -- especially the elderly -- should take copies of pertinent medical records with them on vacation. You can, of course, buy U.S. insurance to cover hospitalization in foreign countries. And a credit card can usually serve as ready cash in a medical emergency. But there is no insurance policy now available in this country which would have prevented the near-tragedy in French Polynesia that Dr. DeVore has called a "horror show."
WHILE ARRANGEMENTS were being made in the United States, the Consulate in Suva, Fiji, called me in Tahiti to confirm my father's illness since there was no Consulate in French Polynesia. The next morning the Consulate called again but was unable to speak with me and therefore spoke with my father and told him, "Before you can be taken home it will cost $10,400, which has to be paid in full." What an appropriate remark to make to a man recovering from the acute phase of a heart attack!
On Sept. 21, my family in the United States informed me by phone that final arrangements for a medical evacuation had been made, with the understanding that we would have to pay $10,400 prior to departure of the military med-evac airplane from Australia and that a letter must first be obtained from the attending physician stating the evacation was necessary and indicating that a commercial airliner could not provide a similar service. Another requirement was that the airlift had to be in the "national interest"! My father's company, Wyle Electronics, offered to pay the $10,400, since it was not covered by insurance, and Dr. Auger transcribed the letter stating that transport by airplane with oxygen, cardiac monitoring equipment, a stretcher and a physician were mandatory for his safe return home.
As I was about to send the letter to the Consulate in Suva, Fiji, in the late afternoon of the 21st, a second call from my mother in the United States informed us that, according to the Department of Defense, the evacuation had been indefinitely postponed because of a two-to-three-week delay due to the need to arrange diplomatic clearance with the French government in order for a military plane to land in Tahiti. Therefore I did not send the letter to the Consulate in Fiji. That evening the Consulate called to inform me of the requirements for med-evac transport, which had been scheduled for Sept. 21. I informed them that they were six hours behind in their communication and that the trip had been postponed because of a diplomatic clearance problem. Mrs. Stillman of the Consulate's office did not believe me and called the State Department in Washington, which confirmed the latest action of the Department of Defense.
We were now back to square one. I did nothing over the weekend. I could tell that the many phone calls from the United States, the Consulate in Fiji, and the changes in evacation plans were beginning to wear on my father. He was not sleeping at night and was becoming quite depressed over the difficulty with what appeared to be a simple matter.
On Saturday, Sept. 22, my mother was given the home phone of the lieutenant colonel who had blocked the evacuation because of diplomatic clearance problems. She informed him that she had spoken with the French Embassy which told her that it would require only two-three days for clearance. When confronted with this the colonel said, "Well, I guess it could be done if we really needed to." On Monday, Sept. 24, The Defense Department and the State Department received phone calls from Bill Simpson of the White House, wanting to know why the evacuation plans were not completed.
The Defense Department proceeded to blame the State Department because it did not have the letter from Dr. Auger. The State Department blamed me because the letter had not been sent. I had not sent it because the evacuation had been cancelled after I had obtained the letter. A copy of the letter was then sent to the Consulate in Fiji to transmit to the State Department with a copy to the brother-in-law of the Secretary of the Air Force who lived in San Lorenzo, Calif., near our home. Copies were sent in French with a translation in English.
Meanwhile, Dr. Auger was contacted by a military physician in Honolulu, who informed him that the evacuation plane would be routed from Australia to Tahiti-Honolulu-San Francisco and would take two days. It would fly at 10,000 feet (a propeller-driven plane), was not as well pressurized as the commercial airliners and would stop in Honolulu for the night. On Sept. 26 Dr. Auger received an urgent telegram from the Consulate in Fiji requesting his recommendation.
He stated that a two-day run from Tahiti-Honolulu-San Francisco was unacceptable because it would greatly fatigue and endanger the health of my father. He suggested that a direct flight from tahiti to San Francisco would be the most appropriate. If this was not possible, then a commercial flight from Tahiti to Los Angeles with a private plane from Los Angeles to our home in Hayward, Calif., would be the second best alternative. This, however, posed a certain risk because monitoring and defibrillating equipment would not be available on a commercial airliner.
When the possibility of a direct flight to San Francisco was pursued with the Defense Department, we were told it would cost us $72,000 paid in full before the plane would evacuate my father. When my mother asked a Defense Department official what would happen if people did not have $72,000 or even $10,400, for the medical evacuation, she was told, "Then they would die."
The only alternative was to fly my father home on a commercial airliner on a stretcher. These arrangements were made for Sept. 29. No monitor or defibrillator was available. I accompanied him home with intravenous solution, morphine, anti-arrhythmic agents, lasix and other medications. The price for the tickets was equivalent to four first-class tickets (a cost of over $5,000) because the stretcher occupied 12 economy seats. The plane was a 747 and turned out to be packed because one of the competing airliners scheduled to return the passengers to the United States had had an engine explode over the Pacific on the flight from Los Angeles to Tahiti two days before.
My brother Steve was on that plane to bring the money to pay the hospital, hotel and telephone bills, and to assist me through Customs on the return flight to the United States. Because the plane almost crashed, and he could not catch a flight which would arrive in time to have the money changed to pay the bills, he returned to San Francisco.
I left the hospital in Papeete after promising to send the money for the hospital bill by a bank check. I paid the other bills by credit card, with my father signing blank forms in the hospital and having the amounts filled in for him later. The hospital bill was only $1,800, the hotel was $3,000, car rental $1,000, phone calls $4,000, plane tickets $5,500, and the private jet used to transport my father from Los Angeles to Hayward, Calif., cost $2,00, for a total of more than $17,000.
On the flight home, passengers would walk by the stretcher, which was enclosed with a curtain, and ask, "What's behind there?" Three people, wanting to sit in the three empty seats which had been blocked off in front of the stretcher, asked if oxygen was being used because they wanted to smoke. I tactfully told them just where they could sit!
Upon arrival in Los Angeles, my father was removed from the plane by ambulance and transported to a waiting jet. The Immigration officers were helpful, but Customs was of no assistance. A second brother, Jim, helped me through Customs, a process which took two hours because the airlines lost our luggage. We finally left L.A. and in 40 minutes landed in Hayward, where an ambulance was waiting to take my father to our local hospital. He remained hospitalized for more than 10 days. During this time further observation and tests were done. He will soon be scheduled for cardiac catheterization so that his disease can be better defined.
As I returned to my own responsibilities at Yale-New Haven Hospital, I reflected on the many problems we encountered. My father was fortunate; his son spoke French and happened to be a physician. His wife had some prior experience in dealing with the U.S. government and knew when she was getting the run-around.
I wondered about the thousands of Americans who travel abroad each year to the far corners of the earth and those unlucky ones who become ill, and who do not have the family or financial resources which would permit their safe return to the United State in those cases where medical facilities are inferior. As I inquired further, I learned that in Europe travelers can now purchase insurance which will provide for immediate air evacuation from any place in the world with whatever is necessary: physicians, nurses, equipment, etc.
Dr. Auger's comment to me as we left was that a country as great as the United States certainly should have a better and more efficient means of aiding its citizens who become ill abroad.