Critical Condition

Botani had made marketing trips to the Middle East for foreign patients.
Monica Fuentes

In early 2001, Kareem Botani was overseas spreading the gospel of the Memorial Hermann Healthcare System to medical staffs in the Persian Gulf. As the manager of Memorial Hermann's international affairs department, Botani was marketing his employer's reputation to foreigners seeking quality care that they couldn't find in their home countries.

Like other hospitals in the Texas Medical Center, Memorial Hermann banked heavily on the business generated from international patients. It treated about 450 international patients annually at that time, and could count on full compensation for the services. Unlike many domestic patients with Medicaid or private insurance that might not cover their full bills, these foreigners carried the best kind of currency to cover tabs: hard cash or guaranteed payments from their home governments.

Coupled with the medical services was a solid support network of TLC. The royal treatment extended a red carpet across the Atlantic to make patients and their entourages feel special from the moment their planes landed. Botani, a registered nurse, also describes himself as a concierge -- and that demanded the bulk of his time.

However, that marketing trip to the Middle East in 2001 would be the last for Botani. Similarly, the travel to Houston would be the last for many international patients at the Medical Center.

Lost medical business looms as a hidden cost to Houston of the post-9/11 homeland security measures -- a price likely to be exacerbated by the fallout from the raging Iraqi war. International patients, a valuable mainstay of the Medical Center's economy, are down by an estimated 5,000 annually.

While medical officials are hesitant to reveal the monetary losses, they can be expected to add up to more than $50 million in direct revenue to hospitals and indirect revenue from industries providing support services for travelers to the Medical Center.

The reasons behind the lapse in international patients are basic: Post-9/11 security restrictions put visas in a vice. Now, Operation Iraqi Freedom is tightening the grip.

The tightening of U.S. visa regulations has effectively barred many from entering the country for medical care. In these tense times, others simply choose to get treatment outside the United States.

When Botani made his business trip two years ago, visas for medical patients were so routine they could usually be secured in a matter of hours. After 9/11, the Department of State's increased background checks for visas delayed waiting time by months in some cases. Fewer people even applied for visas.

Like other hospitals with a heavy international clientele, the number of Memorial Hermann's international patients has dropped 23 percent since 9/11, according to spokesperson David Mendel.

Now the Iraqi war has fueled tensions even more. With the new and improved Desert Storm under way, some hospital officials say recovering their Arab clientele is as likely as a Congress-funded French film festival.

Ruthy Khawaja, director of international services at The Methodist Hospital, is frank about the war's effect on the already dwindling Arab patient population:

"I expect it to go much worse this year," she says.

Prior to 9/11, the hospital treated about 5,000 patients from 80 countries -- primarily Latin America and the Middle East. Since the terrorism in New York City and Washington, D.C., Methodist has lost about 500 of those foreigners. But while the Latin American numbers are now bouncing back, Operation Iraqi Freedom is keeping potential patients away. Methodist's Middle Eastern patients decreased by 46 percent between 2001 and 2002.

Bed counts belie a bigger proportional loss in revenues. Foreign patients don't fly in for help with a bout of the flu. Most are arriving because there are no specialists in their native lands to perform substantial procedures such as cancer treatment, organ transplants and heart surgery. Bills for a transplant alone can run into the hundreds of thousands of dollars.

Although only 6 percent of the M.D. Anderson Cancer Center's patients are foreign, they constitute about 10 to 12 percent of the total revenue, according to international program director Wendeline Jongenburger.

Before 9/11, about one-third of the hospital's international patients came from the Middle East. Now it's down to about 15 percent, she says.

Jongenburger expects the overall number of international patients to return to pre-9/11 levels, but she doesn't see the Arab market bouncing back.

"We'll potentially develop other markets in other countries," she says.

Although hospital officials did not provide the Houston Press with real dollar amounts, even a conservative estimate of $5,000 in charges per patient would mean a direct loss of $25 million from having the estimated 5,000 fewer patients at the Medical Center. And that doesn't count repeat visits.

Aleya Sourour of the Egyptian consulate's office handles all Egyptian visitors coming to Houston for medical treatment. Before 9/11, that meant about 120 patients a year, most of whom sought care at M.D. Anderson or the Texas Heart Institute. But last year, she handled only eight. So far this year, she's had two.

"They keep on applying, and being delayed, or asked for more papers, or [for] statements from their doctors here," Sourour says. "And some of them, you know, they just need to be treated right away."

Even though some applicants are accepted, they can't get visas to bring family members with them for support, Sourour says. They wind up seeking treatment in Europe, or at Cleveland Regional Medical Center's new branch in Egypt, she says.

"They prefer to come here. But if it's difficult, they find another solution," she says.

Stuart Patt, a state department spokesperson in D.C., disputes the complaints about the visa process. Since 9/11, the state department has reduced visa delays and now processes about 90 percent of the applications within three weeks, he says.

The department issued 7.5 million visas out of ten million applications processed in the fiscal year ending September 30, 2001, Patt says. But only 7.9 million applied the following year, with the department granting 5.7 million visas -- a 24 percent decrease in visas issued.

Houston is hardly alone with its financial woes. Other U.S. premium medical institutions such as the Mayo Clinic also report hefty drops in Arab clientele, according to Andy Icken, executive vice president of the Texas Medical Center.

Icken met with officials from the Mayo Clinic and other complexes last October to develop a plan to alleviate the grip on visas. They came up with a proposal for a "health care visa," which Icken and others are pushing through Congress and the Bush administration. He says the new visa, which he hopes will be approved this summer, would help expedite the application process.

But Memorial Hermann's Botani says it's the quality of U.S. medical care that ultimately will get the numbers back up. He's just not sure when.

"That's related to many…political issues," he says. "I do believe that the U.S. provides the best medicine in the world…and that will keep people coming back."

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