It seemed so easy at first, Justine Rodriguez recalled — bariatric surgery for $5,000 and a quick trip over the U.S.-Mexico border. Following the operation in Tijuana, Rodriguez flew back to her home in Idaho, eager to begin shedding pounds.
After a week and a half, she said, surgeons found a grapefruit-sized abscess in her abdomen. Three years later, she owes $1 million in medical bills.
As four Utahns seek treatment after an outbreak of drug-resistant bacterial infections at a Tijuana bariatric clinic, Rodriguez and her doctor at the University of Utah are warning prospective medical tourists to know the risks.
"God spared my life," said Rodriguez, 33, who now lives in Magna. But she has spent weeks in hospitals and almost two years on a feeding tube, suffers from seizures, can't eat most foods, and has to take "about 20 pills a day," she said.
Also high on the list of cruelties: the interminable debt that has followed what was supposed to be a cost-saving option for a procedure that is increasingly seen as the last, best hope for weight loss in patients who have yo-yoed in and out of morbid obesity.
"The broader medical community and insurance community have taken a very long time to recognize [obesity] as an illness," said Anna Ibele, a bariatric surgeon at University of Utah Health. "Insurance [views] bariatric surgery as a cosmetic procedure; they don't really understand the health problems" it can resolve.
When insurance won't cover it, and patients can't afford the $10,000 to $20,000 out-of-pocket cost, they look to cheaper, international options, Ibele said. In Mexico, bariatric surgery usually costs $3,000 to $4,000, she said.
"If you Google 'bariatric surgery,' the ads that come up are these places in Tijuana," Ibele said. "A lot of desperate patients go to Mexico."
"Desperate" was the world Rodriguez used. Her health was deteriorating as her weight reached 387 pounds. She had spent months in weight-loss training and psychiatric reviews preparing for bariatric surgery.
Then her insurance denied the procedure.
"There was this girl I knew, and she lost a lot of weight," Rodriguez recalled. "She said, 'Oh, I went to Mexico and had this surgery done.' After I had gotten a 'no' from my insurance, I got desperate."
Rodriguez found a clinic in Tijuana and flew to San Diego with her mom from her home near Burley, Idaho. After the operation, the doctor said to email him if she had any problems; that was the extent of her follow-up care, Rodriguez said. She didn't even know what symptoms to look for in the event of complications, she said.
"These programs in Tijuana provide these surgeries for a [lower] fee, but the vast majority of the ones I've encountered do not provide follow-up," Ibele said.
In a "sleeve gastrectomy," surgeons put a long staple line along the stomach to limit its capacity. But the line can cut off too much of the stomach, or reshape it in a way that interferes with digestion or doesn't heal properly. The staple line can leak, allowing a person's stomach contents to spill into their abdominal cavity.
That's what Rodriguez said landed her in a hospital with a massive abscess a week and a half after her surgery in Tijuana.
"They did another surgery to try to clear it out, but they couldn't because it was rock-solid, like concrete," she said.
Rodriguez worsened and was taken from an Idaho hospital to the University of Utah’s hospital in Salt Lake City, where she underwent multiple surgeries over several weeks.
One bill alone was almost $500,000, and Rodriguez was no longer uninsured, she said. Even if she had been, insurance often won't cover care for complications from an "elective" surgery that wasn't covered in the first place — and patients who thought they'd be insured are left holding the bag.
"The tragic thing in my mind is, for those patients who are uninsured, the hospital bills are tremendous," Ibele said. "I've had patients where the spouse is taking on a second job, people who cash in on their car or their mortgage" because of life-threatening complications following an uninsured procedure.
Ibele recently presented findings from a dozen cases during the past three years in her practice, where the patients experienced complications after surgeries in Tijuana. It's tough to tell how surgical outcomes in those clinics compare to those in the U.S. because, Ibele said, "we have no idea what the denominator is." That is, U.S. surgeons have no way of knowing of patients for whom all went well. The patient who seeks help may be their doctor's only surgery with complications.
Meanwhile, the surgeons in Tijuana may not learn of their patients' complications. Ibele said that in the 12 patients whose complications she reviewed, she tried calling five of the original surgeons; only one returned her messages.
Rodriguez said she and her mother repeatedly emailed and called her doctor in Mexico as her condition deteriorated, to no avail. He didn't call back for months, Rodriguez said.
"I said, 'I want you to hold yourself accountable because you did this to me,'" Rodriguez said. "He told me I didn't know what I was talking about and then he hung up on me."
The Salt Lake Tribune called the doctor, whom Rodriguez identified as Israel Cabrera. A person in what was described as the clinic's American office said, "We don't even have the doctors' personal phone numbers." A liaison did not return the Tribune's call for for comment.
If doctors aren't available to patients who need follow-up, that speaks to a "systems failure," Ibele said.
"You have to provide channels for patients to have access to you if they have complications, and you have to provide long-term follow-ups. Obesity is a chronic illness; it's not treated with a quick operation," Ibele said.
“It’s a system failure on the part of the medical tourism model. But really, it’s a systems failure of health care in our country.”