US hospitals lose Saudi patients and income

WASHINGTON -- Saudi Arabia has shut down a decade-old program that brought patients to the United States for medical treatment and paid for their care, a move that could translate into millions in lost annual income for Boston-area hospitals.

Saudi diplomats say the growing US delays in granting visas to Saudi citizens, because of stricter rules imposed on visitors from the Middle East after the Sept. 11 attacks, were a major factor in the decision to halt the program in recent weeks. It was funded by a Saudi prince's charity.

Two similar programs associated with the Saudi armed forces and the Ministry of Health will be sharply scaled back but will continue to bring some patients to US hospitals, the diplomats said. The patients travel to US facilities for specialized treatment of such serious ailments as cancer and heart conditions.

The number of Saudis entering the United States for any reason is down sharply since the attacks of Sept. 11, 2001, partly because of the hurdles involved in getting visas but also because many fear being falsely accused of links to terrorism. Since the attacks, US investigators have scrutinized the finances of Saudis as part of international efforts to stem the flow of money bankrolling terrorists.

The number of ''B" visas -- those issued for medical reasons, business, or tourism -- to Saudis plummeted from 56,912 in 2001 to 14,403 in 2002, according to the State Department. Last year, it rose to 22,621, after President Bush met with Crown Prince Abdullah -- who is now king -- at Bush's ranch in Texas and promised to ease the visa restrictions.

In 2001, 459 patients from Saudi Arabia -- out of about 4,000 international patients -- were treated at Boston-area hospitals owned by Partners HealthCare, including Brigham and Women's and Massachusetts General, according to David Jones, executive director of the international program for Partners. Last year, just 163 Saudis -- out of an estimated 3,500 international patients -- were treated at those facilities.

The numbers for both years include patients whose care was paid for by the prince's charity and those run by the government or associated charities, as well as those who covered their own care.

Jones said that instead of coming to the United States for treatment, many Saudis are traveling to Germany, Britain, and India for care. Some are also remaining in the oil-rich kingdom, which provides free health care to all citizens but which -- except for major cities -- offers limited access to state-of-the-art facilities. Since 2001, Saudi Arabia has accelerated plans to improve its health system by attracting more foreign investment and boosting technology.

Boston's medical institutions are scrambling to respond to the loss of patients by joining efforts to launch more hospitals in the Middle East, such as Harvard Medical School's 435-acre medical center being built in Dubai.

''This is one of the many permanent aftermaths [of the attacks]," said Leslie Macharelli, director of international government relations for the Partners network. ''It's never going to be the same."

Unlike most international patients, who hail from developing countries and who struggle to meet the cost of care, patients from Saudi Arabia almost always paid full price for services -- far more than the negotiated rates paid by insurance companies.

It is unclear how much revenue Boston will miss out on from losing some of its highest-paying patients. The medical cases were frequently complex, involving long stays by well-heeled entourages, multiplying the economic boost from hotels and other services.

Nail Al-Jubeir, spokesman for the Saudi Embassy in Washington, estimated that before Sept. 11, the charity program run of Prince Abdul Aziz bin Fahd spent about $15 million per year in the United States on medical bills and living expenses for about 100 to 150 patients, much of which was spent in Boston.

The Ministry of Health program used to spend $60 million per year, he said, but now spends only half that amount. Figures for the armed forces program were not available.

The loss of many of the Saudi patients, who were once seen as an important source of revenue for the hospitals to offset cuts in federal funding, means less money to help cover the costs of Boston's uninsured poor, Macharelli said.

''These international programs were initially seen as a way to offset those losses,"' she said.

Saudi officials say that while the visa restrictions have eased somewhat, bottlenecks remain, in part because visas for Saudis are only being issued at the US Embassy in Riyadh, while consulates in Jeddah and Dhahran have been closed for visa applications for months because of security threats.

''We have many prominent business people who have applied for visas and have been waiting for six, eight months, and when they ask the embassy, the embassy can't answer," said Prince Turki Al-Faisal,the Saudi ambassador in Washington. ''It's not in their hands, in the hands of the Homeland Security, the FBI, [or] the CIA. No one knows where it goes."

The website of the US Embassy in Riyadh says that the wait for tourist, business, and medical visa appointments is six to eight weeks, and that the embassy will expedite consideration of applications in cases of medical emergencies.

The decline in the number of Saudi patients in the United States comes after years of FBI probes of wire transfers from the Saudi Embassy to Saudi citizens in the United States, including some medical patients.

In 2004, the Saudi medical programs received a rash of bad publicity when Newsweek reported that two Saudi men seeking treatment for family members in Boston were suspected of being members of a terrorist sleeper cell. Neither was charged, but one of the men, Hatem Al Dhahri, who came to Boston to seek a cure for his 7-year-old's rare immune deficiency, said the experience of being questioned and cited in the press as a terrorism suspect permanently changed his view of America.

''We've been harmed," Dhahri said in a 2004 interview in the family's apartment, as his son sat in a wheelchair strung with feeding tubes. ''We would like to have our name cleared. It's very important for us, especially that my son is going through difficult times and we as a family are going through difficult times."

For most medical patients, Jubeir said, coming to the United States is no longer an attractive option because of the wait for visas.

''The idea is to provide immediate medical care," he said. ''That is not immediate."