State launches campaign to combat backroom medical clinics

By Tovin Lapan

Thursday, April 12, 2012 | 2 a.m.

A year after the tragic death of a Las Vegas woman who sought plastic surgery in the backroom of a tile store, a recently created statewide task force has launched a public awareness campaign and hotline for reporting people practicing medicine without a license.

On April 9, 2011, Elena Caro, 42, went to see Colombian nationals Ruben Dario Matallana-Galvas and Carmen Olfidia Torres-Sanchez for a buttocks lift on the recommendation of her beauty salon.

One of Caro’s three children dropped her off at a tile shop on East Charleston Boulevard. After the fraudulent surgeons bungled the operation, they left Caro by the roadside and scurried to the airport to flee the country, Metro Police reported at the time. Caro died that night in the hospital.

The case garnered widespread media attention and raised awareness of what is a common problem of people using unlicensed medical practitioners. In February, a state task force including several agencies and the UNR Latino Research Center was formed to address unlicensed medical care. In particular, the task force is focusing on Hispanics and other communities seen as vulnerable because of language barriers, cultural differences and lack of knowledge of the U.S. health care system. On Monday, a year and a day after Caro’s death, the public awareness campaign and hotline were announced.

Caro died from an allergic reaction to the anesthesia the two dubious doctors injected into her. Metro Police apprehended the two Colombians before they boarded a plane. Yet, officials say many more cases are never reported or the perpetrators are successful in escaping arrest.

“Since 2009, we have found four documented cases in Nevada,” said Drew Bradley, outreach coordinator for the Latino Research Center. “It’s not a whole lot in three to four years, but ever since we started looking at the problem, we’ve realized it’s a nationwide issue. You can’t tell from the numbers how significant it really is. A lot of people assume that if someone says they are a doctor and they wear a white coat, they are telling the truth. Another obstacle is people don’t think they can afford legitimate care.”

Bradley said since she started working on the issue, she had heard many anecdotes from people who have gone to see underground, unlicensed doctors and dentists.

“If everything goes well and you pay $75 instead of $500 to get a tooth pulled, that will never be reported,” she said. “Also, if we are talking about immigrants, they may have a fear of getting involved with law enforcement.”

In 2009, authorities closed a Las Vegas botanica ­— a neighborhood shop that Hispanics frequent in search of powders, herbs and other remedies for common ailments — after a woman began bleeding profusely during gynecological surgery in a backroom and needed to be taken to a hospital. Authorities found a log listing patients and dozens of prescription medications in the room, but the clandestine clinic did not come to light until there was an emergency.

Caro’s children are suing both the tile shop and the beauty salon for their involvement in the failed plastic surgery.

“It appears as though they were performing far more serious procedures than the typical people engaged in this type of activity,” said Michaela Tramel, an attorney representing Caro’s daughter, Janet Villalobos. “In this case it was within the Latino community, but it happens with other communities, too. It happens with pharmaceuticals, self-help remedies and natural remedies.”

The task force, which is funded through a grant from the Nevada Attorney General’s Office, has had two of its three planned meetings and is including law enforcement, health care professionals, pharmacists, school nurses, community organizations and academics in their deliberations.

Frankie Sue Del Papa, former Nevada attorney general, is leading the task force and is responsible for coalescing all of the ideas, reports and initiatives into an action plan due this summer. Some of the possible recommendations, such as an oversight board that monitors unlicensed activity or changes in the law to make penalties stiffer, would have to be taken up in the 2013 legislative session.

“Realizing that we face a huge budget crisis, we want to make sure that the innovations that we offer don’t cost a lot of money,” Del Papa said.

Some in the Hispanic and health care communities say public awareness and increased enforcement will only go so far, and real progress will come from making health care more accessible and affordable. According to data from the Kaiser Family Foundation, 21 percent of the Nevada population is uninsured compared with 16 percent of the nation as a whole. In Nevada, 33 percent of Hispanics under age 65 lack health coverage, compared with 28 percent for blacks and 18 percent for whites.

“Even for people with insurance, just getting an appointment can be difficult,” said Annette Raveneau, communications director for Know Your Care, an advocacy group for the Affordable Health Care Act. “So if you are in pain and a friend says, ‘I know someone who can check that out for you for cheap,’ that may sound pretty good. I think the problem in the Hispanic community stems from a mix of culture and lack of knowledge. A lot of people don’t know that there are some clinics that may be of service, that help people without insurance. But those services are also limited, there is not enough capacity and they have limited budgets.”

Raveneau said Nevada had some of the strictest laws in the country regarding eligibility for Medicaid, a program that could help low-income residents avoid fraudulent medical services.

Bradley agreed the recession and cost of care are factors in why people choose fraudulent medical providers. She also pointed to the need for diversity among the state’s doctors.

“There is a big issue with the language barrier,” Bradley said. “People are uncomfortable in settings they don’t understand. If they only speak Spanish, maybe they are using a brother or friend as a translator. Going to the doctor can be scary, and it’s more scary when you don’t understand what’s going on. Patients want to see someone who is familiar with their culture and speaks their language. In Nevada, there are not too many Hispanic doctors, especially plastic surgeons.”