Hard times for a case manager

Tyrol Air Ambulance (TAA) reports on a tricky medical case in South Africa

TAA’s Medical Assistance centre received a request from an insurance company to confirm the transport recommendation of a patient’s family doctor and organise his transport back home to Luxembourg. After the case was opened, two short medical statements were forwarded to TAA. It was immediately identified that the medical statements did not include any informa- tion about the patient’s current medical status, although they did provide TAA staff with some general information to begin their work

Patient: 86 years old, suffering from a range of various diseases

Accompanying person: 84-year-old spouse, herself suffering from a collarbone fracture

Located: Johannesburg, South Africa

Transport recommendations Te medical statements issued by the client’s family doctor recommended a return flight in business class for the couple from South Africa to their home destination in Europe. According to the statement, the patient’s spouse was capable of taking care of her husband during the flight. Tis point regarding the transport recommendation had already raised concerns with the insurance company, and these concerns were shared by TAA’s assessment doctors. No current medical information concerning the patient’s status had yet been received, meaning that the transport decision of the family doctor was not fully comprehensible, and could not be

supported without more information. TAA’s Medical Assistance centre therefore contacted the couple’s son to find out more details. At the same time, TAA’s assessment doctor made efforts to contact the family doctor.

Long journey to information TAA’s case manager was informed by the patient’s son that his father had suffered two strokes as recently as five years ago, and as a result he had restricted use of the left side of his body. TAA also learned that the father was able to move, but only with the help of a walking frame. Furthermore, the son informed TAA that the father’s health status had worsened, leading to the recommendation of the designated family doctor in South Africa to fly him home. To the best of the son’s knowledge, his mother was in good general health despite a collarbone fracture from a fall she suffered some weeks previously. TAA’s assessment doctor received the same information once contact was made with the family doctor in South Africa, but a completely new situation then arose as it became clear that the doctor had no medical examination results available for the patient, and indeed had never met nor examined the patient himself in person. According to the forwarded medical statement, the patient suffered from an impairment of the left side of his body and a chronic cardiovascular illness. Apart from these factors, the statement described the patient as being in a good general state of health. Te statement also concluded that the patient’s spouse (84 years old) would be able to take care of her husband during the flight back home. In summary, they would be able to manage the trip by themselves.

26 | International Travel & Health Insurance Journal

TAA’s assessment doctor declined to declare the patient fit-to-fly without first having access to up-to-date medical information. Te recommendation was instead that TAA’s Medical Assistance centre should first transfer the patient to a local hospital nearby to obtain the latest and most accurate information about his medical status. Admittance to the hospital would be organised by the South African family doctor on site. Te patient’s son was subsequently informed by TAA of this initial admittance requirement in order to continue with further steps to repatriate his father. TAA’s additional request to the son for direct contact with the patient was declined. It took three days for the son to contact TAA with a response, informing us that his father had since been for a medical check, without showing any new results. For that reason, he requested that TAA immediately make all necessary arrangements for his father’s return flight. Te son also said that his father was very eager to fly home and that due to the delay and the gruelling hospital examinations, his health status had significantly worsened in the interim. In addition, the son assured TAA that the South African family doctor would forward the medical update shortly, to allow TAA to move forward with the transport. Te family doctor would also sign the MEDIF for the commercial airline. Tis form was forwarded by TAA to the family doctor without delay. Te next day, TAA finally received the medical update from the family doctor, together with an incomplete MEDIF. Again, TAA’s assessment doctor became suspicious as significant information was missing from the documents. He tried unsuccessfully to contact the family doctor on site. Two days later, TAA received an email from the family doctor with

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