So is ‘get on that plane no matter what’ sufficient advice for dealing with a hostile repatriation?
Dear Aunt Madison
I recently was sent to Malta to repatriate an elderly female patient who was recovering from a fractured hip for which she had undergone a hemi-arthroplasty at a private clinic. She was known to suffer from osteoporosis and her mobility was limited, especially as she was finding it difficult to manage crutches. She was travelling with her husband, also elderly.
I had been forewarned that she was reluctant to return to the UK as she had a holiday home in Malta and wished to continue her rehabilitation there with her husband to assist. Her main argument was that she wanted to remain somewhere sunny and warm rather than to return to the cold weather back home.
The assistance company was insisting that she return home and I was sent out to complete the task of persuading her to comply with their wishes. However, when I met the patient her attitude was hostile and she refused to return to the UK.
I discussed this with the assistance company and their response was to instruct me to “’get on that plane no matter what or her insurance will not cover her.”
I continued discussing the situation with the patient, explaining the risks of remaining in her apartment with her poor mobility in that she could easily topple over and fall, and sustain further injury. I also explained that the insurers had identified this risk and could foresee a high possibility of further claims being made.
She simply would not take this on board and told me she would complain at the highest level that she was being forced to return against her will and that no one had explained anything before. She still refused to be repatriated and I had no choice but to leave her in Malta.
On return I was reprimanded for not being able to persuade her to return to the UK and told that, because of this, the money paid for her return tickets had been lost. What should I have done differently?
Aunt Madison replies:
Sorry to hear that the assistance company was not supportive to you. It is clear that they sent you out before they had properly satisfied themselves that this patient would return home with you and you were left to pick up the pieces.
The assistance company should have ensured that this patient was fully informed of the risks of remaining in Malta – the risks concerning her own safety and well-being as well as the risk of having her insurance cover withdrawn should she choose to remain there against the advice of the assistance company.
Assuming this patient was capable of making autonomous decisions, she had the right to choose not to comply with the recommendations of the insurance company and remain in Malta at her own risk, providing all concerned were satisfied that she had been fully informed of the risks involved.
It is always worth checking – before you are sent out – what conversation has been had with the patient regarding the risk to them should they refuse to be repatriated as recommended. That way an evaluation of this patient’s understanding of her situation/risk could have been clarified. This should have been done by the assistance company concerned.
It may have helped if you had involved the treating doctor in the discussions with the patient.
I hope you kept a clear written record of your discussions with the patient, including your explanation of risks, your recommendations and her final decision – plus the time and date, and both your and the patient’s signature, preferably a witness’s as well – so all this could be kept on record. The patient should also have been given a copy.
The assistance company should have sent you a disclaimer form for this purpose. You should have also insisted that a senior person from the assistance company had spoken directly to the patient and discussed the implications of her decision, both medically as well as from the insurance standpoint.