The dark side of cosmetic surgery in Thailand
When British woman Joy Williams went into the SP Clinic in Bangkok last October, she must have believed she was about to undergo a straightforward cosmetic operation, at a very reasonable price, and at a modern facility which has been widely used, and often praised, by other patients from overseas.
But her wounds became infected, and she died under anaesthetic as the clinic tried to correct what had gone wrong.
Her doctor, Sompob Sansiri, has been charged with recklessly causing her death, and the SP Clinic closed down. It turned out he was not licensed to carry out surgery.
Ms Williams was one of thousands of foreigners who come to Thailand every year for cosmetic surgery.
There are good reasons for this. The prices are typically a third of what they cost in Europe or the US, the medical facilities are often first-class, and Thai doctors have developed specialist expertise in some cosmetic procedures.
"Many factors have made us a hub for cosmetic surgery," says Dr Apirag Chuangsuwanich, president of the Thai Society of Plastic and Reconstructive Surgeons.
"The quality of the service, the fact that we have good hospitals with international accreditation, and the cost in Thailand is very competitive."
Most patients leave Thailand very happy with the results of their surgery. But what happens when something goes wrong?
In 2010 Helena Grace, who lives in Bangkok, decided to alter the shape of her nose.
"I admit, I saw the advertisement in one of Bangkok's best-known hospitals," she says. "It guaranteed satisfaction."
Armed with her own illustration of how she wanted her nose to look, she went into the hospital for a consultation. To her surprise, she found herself undergoing surgery just four hours later.
"When I woke up I knew immediately that something was wrong," she recalls.
She alerted her doctor, who assured her that everything was fine and that she should wait a few days for her nose to heal.
But the final shape was very different from what she had been promised. Helena also found that she could no longer breathe easily through one nostril.
She consulted other cosmetic surgeons, even travelling to the US for a second opinion. They told her the rhinoplasty operation had been botched; it would take another, very expensive operation to fix it, and even then the results could not be guaranteed.
But the hospital where she had the operation refused to pay for corrective surgery. It just offered her a refund of what she had paid for the first procedure.
Helena has spent the past four years fighting for compensation in the Thai Civil Court. By her count she has attended approximately 50 hearings. This week, the judge rejected her complaint, citing a lack of evidence of negligence as well as damage.
It is rare for hospitals in Thailand to be successfully sued for medical malpractice, and even rarer for the courts to award significant damages. That helps explain why doctors there pay much less for insurance than in Europe or the US, which in turn explains why medical costs are much lower.
James Goldberg found this out when his son Joshua died suddenly in February 2006 after seeking treatment for a leg injury at Bumrungrad, the hospital that has been most successful in marketing itself as a medical tourism facility.
Mr Goldberg obtained the hospital charts, and had forensic pathologists in the US examine them. He believes his son was killed by being given far too many different drugs.
The hospital has denied any negligence, and retains a high international reputation. But Mr Goldberg claims his concerns were never properly investigated by the Thai police.
"No attorney in Thailand will take up a case on contingency," he says. "If you want to take a personal legal action in Thailand you have to pay the lawyers up front, with very little chance of winning."
He says the police have little medical expertise, so they rely on the Thai Medical Council for advice on whether or not to prosecute - but the council is made up of representatives of the medical industry, with arguably little incentive to expose wrongdoing by their colleagues.
He also complains that the international certification Thai hospitals receive, in particular from the US Joint Commission International (JCI), means little, as the JCI does not involve itself in allegations of malpractice, but simply charges the hospitals hefty fees for a thrice-yearly inspection.
The lack of regulation in Thailand has been harshly exposed by the case of Joy Williams.
Dr Sansiri was released on bail after being charged, and continues to practise at another clinic.
When the BBC asked the Medical Council of Thailand why he was not at least suspended, it told us it would have to await the outcome of the investigation - which could take years.
So should would-be patients steer clear of Thailand?
No, argues Rachel Goldie from Makeover Thailand. She helps arrange treatment here for overseas clients and says Thailand still has excellent medical facilities and outstanding doctors.
But she warns patients that they must do their homework, to be sure of the quality they are being promised.
"You need to find out that your surgeon is certified to be doing what he is doing. And if you don't have that information then you certainly should not go ahead with it."
Surgery, she says, should take place only in a fully equipped hospital or a clinic that has the qualified staff and equipment to cope with an emergency.