Costa News Spain Breaking News | English News in Spain.
Rod Usher
Angela is still suffering from crippling chronic pain after a knee replacement surgery. Rod Usher, an experienced journalist and her husband, investigates the medical care in southern Spain.
90% of knee replacements are successful. Most recipients are happy after initial pain.
But when things go wrong…
What follows, however, is not a report of medical malpractice, which I first encountered when I was a young journalist covering an inquest following the death of a woman because a surgical sponge had been left in her body in theatre.
This is not a tale about greed, rudeness and lack of transparency. It’s a story of modern times. The players: my wife, Angela, Hospiten, in Estepona, and Asisa, in Málaga.
Angela underwent a total knee replacement in Extremadura nine years ago.
The prosthetic knee was not without problems. The theatre was the next stop (a funny name for a place so grim!).
The knee needed to be replaced. These interventions were two years apart at Clideba/Quirón, in Badajoz.
READ MORE Measles scare in Spain as cases doubled last year – and were virtually zero in 2023
Even worse, the knee had been infected by a staphylococcus variant, either at the first or second surgery.
No one knew how/why. Angela received heavy doses of antibiotics intravenously. However, the bugs quickly formed a film-like coating that prevented antibiotics from touching them.
We moved to Estepona. The second leg had to be removed as well.
Select surgeons in Spain specialize in the treatment of infected extremities. Debridement is a technique that involves removing as much material as possible. You won’t find any gory details here.
We got opinions from a surgeon in Madrid and one in Barcelona. And we also sought one from an expert in Cardiff. The three doctors don’t work for insurers but said Angela should have an a Cono Two.
This is a metal cone that can be used to reinforce the femur and tibiabones after they have been sliced.
We found a doctor at Hospiten Estepona named Dr Fabian Poletti. We found him to be honest when he told us he would need expert advice. He is also well-known in Cardiff. We still trust Dr Poletti who is no longer employed at Hospiten.
Dr. Poletti, an expert in the field, replaced the second knee that was infected with a new one. It happened in Hospiten last January.
Angela’s leg and foot still hurt, but her knee is not infected and she can now bend her leg further than before.
READ MORE Spain on high alert: Two Atlantic fronts will merge and cause chaos in Andalucia
This is a condensed account of almost a decade’s worth of knee injuries.
Another drama begins with the third knee.
Angela is with Asisa, an insurer since 1996. I stopped a few year ago, because my health was better than hers and we were both retired and old. I rely on public services. Yes, it is a huge gamble, especially in Andalucia.
Asisa fully covered the two first knee replacements at Badajoz.
Hospiten had told us, before Dr Poletti cut the cones, that Asisa wouldn’t cover their cost.
Three eminent doctors told us that they may be necessary for someone who has had so many surgeries on the same part of their body.
We paid Hospiten €5,940 for three cones that were ordered.
Dr Poletti needed only one cone on Angela’s tibia. The other two cones were sent back to Waldemar Link with an office in Barcelona, the manufacturer.
Naturally, we asked Hospiten for a refund which we worked out as €3,960 for two unused cones? We also requested a refund of EUR3,960 for two cones that were not used. The following is a list of the most recent and current tax rates. DesglosadaA detailed bill.
Hospiten returned exactly €2,000, and a bill reporting; 1 cono femoral (it was tibial) and 1 Palamix cement.
No matter how many requests I made, Hospiten never provided me with an itemised invoice.
The way to get an answer had to be going to the top, the director, Sñr Gerardo Bravo Chaparro. I delivered him a handwritten letter on April 4, 2009. I received no reply. I sent him an official letter on 4 June. Silence.
As any unpaid worker knows, the question was: Is it worth hiring an attorney? Going to court for €2,000 is, at best, a form of Russian roulette, played very slowly.
The rudeness of Hospiten and their refusal to provide a detailed bill led me, after taking a deep breath, to contact an attorney recommended by our banker.
READ MORE On the marvels of 3D laparoscopic surgery at Quironsalud – and how it helps you in complex operations
The lawyer wrote. The same silence persisted. Finally, he explained certain aspects of Penal Code in Tenerife’s compliance/legal Centre.
After further delay and more letters, he received a reply, presumably drafted by the legal office, from Sñr Bravo. It is almost nine months since Angela’s surgery that his letter was dated.
The letter offers what to me is a limp apology for the ‘inconveniences’, blames Dr Poletti for ‘the confusion’, says Hospiten doesn’t recognise any error in the billing…but will return us another €500.
What it has done now. Why, if everything was clear and accurate? The letter fails to mention that the cone used for Angela’s tibia was actually for her femur. This is a scary error.
Where was this ‘confusion’ caused by Dr Poletti? He answered all our medical questions before and even after the surgery. On our request, the doctor provided us the protocol document that shows the cone was used tibial not femoral. This is confirmed by X-rays.
We found Dr Poletti to be a caring physician. He said that billing is not the surgeons’ business.
Our lawyer asked me for two additional things. Hospiten was to pay for his own expenses, and we were to receive an itemized invoice. They paid half his costs, and… provided a factura desglosada. A real bill
Surprise, surprise, it now totals €3,440, which fits with Hospiten paying us the €500 Sñr Bravo implied was generosity.
As the bill is in front of you, the mystery only intensifies. Instead of just one cone for €1,980 the bill now has three additional items supposedly not covered by Asisa. I tried to get Waldemar, but was unsuccessful in getting them to disclose what they charge hospitals for a cone. I have an idea it’s about €1,500).
The additional items on the bill are: ‘Component femoral y tibial, €574,31; Cemento Palafix, €754; Tapon distal, €131,69.’ Add the €1,980 for the one cone: €3,440.
READ MORE Man dies when a cliff collapses onto his Menorca home, killing him in the bedroom
I make no suggestion Hospiten has done anything illegal, but was this final accounting – so many months later – produced only because I engaged a lawyer?
Here is the part of the medical insurance. Asisa was the one who treated Angela. Why, if all of the costs were covered in the previous two operations, are they not covered now?
How can Hospiten bill us €754 for antibiotic cement? Asisa knows if you do not put cement in a newly-constructed knee, the joint will come out.
Why was the new Hospiten bill missing two other elements?
Writing to Asisa Málaga feels like writing to Sñr Bravo. I wrote the company ten days after January 1st. Before you begin, please read the following: Angela’s procedure, challenging their policy not to cover the cones. Two of Spain’s most renowned surgeons in the field of post-operative knee and hip infection say you need cones. If a world authority in Wales, who helped invent cones, says the same, how can an insurance not cover the costs?
No response one year later to this letter.
If Asisa cared to respond, maybe it would argue that a cone attached on a bone was not part of the prosthetic, even though it is likely to fail without it.
Where is the benefit in doubt? Angela has paid Asisa in full and on time since 1996. Her credit card confirms this.
Look at that total. Asisa could claim that her varied needs during the 30 years have cost more than this total.
But isn’t that how insurance companies work…the healthy people, I mean clients, compensate the provider for the sicker ones?
Have you heard about a medical insurance provider going bankrupt before?
Asisa probably would love to rid my wife of her. We were shocked when the company made a jump of several hundred euros in her premium for 2025 to €4,748.
In December we received advice of the bill Asisa had coming for her for 2026: €6,386. This is a 25% increase per year. The inflation rate is now around 3%. Asisa is also available. co-pago, Meaning, every time Angela attends a medical appointment, she’ll be charged a little extra. The €6,386 alone breaks down to €122 a weekMore than most people spend on food
After finally receiving Sñr Bravo’s letter and dragged-out bill I wrote again to Asisa, about their cover/lack of and the new bill. I suspect that they want Angela opting out as she’s no longer the asset-client she was thirty years ago.
I imagine Sñr Gerardo Bravo has reason to be proud of his hospital’s balance sheet. Asisa is sure to continue its glossy marketing about care.
What I would like to see is the government, particularly in Andalucia stop giving money to private operators, and instead provide funds, staff, and above all efficient management for Spain’s once enviable health system.
Footnote: At the time of writing, Asisa still hasn’t answered why two knee operations were fully covered but the third at Hospiten was not, leaving us to find more than €3,400. My last email to them was back in October.
Someone in Asisa, Madrid (I cannot find out who it was) must have thought that a 25% increase in premiums for this year was too steep. So, Angela’s 2026 bill has been lowered from €6,380 to €5,351, roughly an 11% increase on last year.
Both Hospiten, and Asisa were contacted by The Olive Press for comments.
Hospiten didnt respond to our request in writing, however on the phone would only say: ‘Dr. Polletti no longer works here’. Asisa, on the other hand, did not give us any information despite confirming by email they would send one. After a third email requesting this letter, we were told it would ‘be best’ if we came in person to the head office in Madrid.
Dr. Polletti confirmed that he had left Hospiten and sympathised both with the patient’s husband and with her claim.
He wrote: “I would like to first express my respect both for Angela, my patients, and Rod, her husband.” “Throughout the whole process, Angela and Rod were attentive, thoughtful and cooperative. I still hold them in very high regard.”
“In complex revision surgeries, it’s standard to request as many as two cones in advance due to variable findings intraoperatively; this time only one was needed.
“I had no involvement whatsoever in billing, pricing or financial estimates while working for Hospiten. All of these are exclusively handled by hospital administration. They fall outside the scope of the surgeon.
“Mrs. Usher’s current discomfort reflects the consequences of nearly a decade of accumulated joint damage, not a failure of the surgical procedure – a distinction also acknowledged in the article.”
Rod Usher, an Australian novelist and poet, has lived in Spain for over 30 years. He is the former chief subeditor of Sunday Times London and senior writer for TIME magazine.
Read more Health News at The Olive Press by clicking here.
