Hair transplant dispute - what options are there to resolve it?

[NikosHair]

46 minutes ago, Snowman123 said:

I sense that the refusal to proceed ( and the policy of needing to be below an HbA1c of 6.0 is ) is not medically sound anyway.

That sounds like a rabbit hole. As long they set out in their T&C's the reasons for declining surgery then it's their decision. Of course, the terms need to be reasonable and defensible in court but good luck proving otherwise.

[Snowman123]

1 hour ago, NikosHair said:

You said the UK referral company advised you before committing ie. paying money, getting on planes.

Yes, they did. 

 

1 hour ago, NikosHair said:

1. Again, did you engage with the clinic performing the surgery before paid any money?

No, all direct communication was via the UK agent. However, I did communicate indirectly and asked them for the range of HbA1c acceptability.  At that point I hadn’t read their policy of 6.0 until the dispute started and I investigated further. 
 

Section 49 of the Consumer Rights Act 2015 requires the contracted party’s service to be carried out with reasonable skill and care. This holds any work done to the standard of a competent professional. 
 

Which Legal advise that the problems described show that they have failed in their legal obligations and therefore a claim against breach of contract is valid. 
 

What I now want to focus on is the clinical basis for refusing the procedure, since this is the basis for ramping up the separate claim for the loss of opportunity. 
 

The UK company say that the surgical guidance and thresholds of HbA1c of diabetes at 6.5 cited by Diabetes UK, do not apply since the threshold in Turkey is different.  Well they market on a UK domain/website to a UK audience and contract in the UK.

Diabetes UK have asked me to establish the clinical basis as they say the actions of the UK company are prejudicial to those diagnosed with Diabetes. 
 

Does anyone know the clinical basis for handling persons with controlled diabetes 2?

 

[HappyMan2021]

curious why diabetes disqualifies you from a hair transplant in the first place?

[NikosHair]

1 hour ago, Snowman123 said:

No, all direct communication was via the UK agent. However, I did communicate indirectly and asked them for the range of HbA1c acceptability.  At that point I hadn’t read their policy of 6.0 until the dispute started and I investigated further. 

1. So the UK referral company informed before you put any money down there was a risk that the procedure may not go ahead if you had an adverse test.
2. Naturally you wanted to know before putting money down, booking flights etc, if your HbA1c level would jeopardize having your procedure. So you checked the clinics acceptable levels. Have you got it in writing their response?
3. Why did you commit and pay money if (2) confirmed you weren't eligible? or did they say your levels were acceptable?

[Snowman123]

2 minutes ago, NikosHair said:

• So the UK referral company informed before you put any money down there was a risk that the procedure may not go ahead if you had an adverse test.
• Naturally you wanted to know before putting money down, booking flights etc, if your HbA1c level would jeopardize having your procedure. So you checked the clinics acceptable levels. Have you got it in writing their response?
• Why did you commit and pay money if (2) confirmed you weren't eligible? or did they say your levels were acceptable?

 

1. Yes

2. Yes, but they refused to answer asking me to have the test in the Istanbul hospital clinic.   They had a policy and did not communicate it. The UK referral company has the policy published on their website, but didn't cite it in communication with me.  I do have it in writing on WhatsApp and screenshots of the web article on the policy ( seen later by me ), just in case the information goes missing.

3. Per 2, I had no reason to believe without the information that i would be refused the procedure.   There would have been no point to travel, and be encouraged to travel if they had alerted me to their policy. There were no adverse findings from the test. My diabetes is under control with tablets

I'm trying to get clinical inputs on the acceptable HbA1c levels. Diabetes UK have said 6.5 is by the definition of  Diabetes 2, and that surgical guidance permits sub 8.0 as acceptable.

I've started a thread on Diabetes UK to see if i can get any inputs of a clinical nature, since the clinic and UK referrer have shut down answering my questions on this.

I sense that their policy is without scientific medical basis - but i could be wrong - can anyone help?

[NikosHair]

1 hour ago, HappyMan2021 said:

curious why diabetes disqualifies you from a hair transplant in the first place?

Diabetes can be the cause of hair loss. Recovery can be affected. Higher risk of infection. Blood sugar monitoring to avoid complications during a long surgery.

Ultimately, it's a cosmetic procedure and the clinic reserves the right of refusal. In the eyes of a clinic it is better to turn away a patient that may have complication/poor outcome than to proceed and risk the consequences.

We have seen it before where an ethical doctor refuses to proceed because they find out someone is a poor candidate. Some doctors insist on face-to-face consultations to allow for an examination and concerns discussed.

[Snowman123]

24 minutes ago, NikosHair said:

Diabetes can be the cause of hair loss. Recovery can be affected. Higher risk of infection. Blood sugar monitoring to avoid complications during a long surgery.

Ultimately, it's a cosmetic procedure and the clinic reserves the right of refusal. In the eyes of a clinic it is better to turn away a patient that may have complication/poor outcome than to proceed and risk the consequences.

We have seen it before where an ethical doctor refuses to proceed because they find out someone is a poor candidate. Some doctors insist on face-to-face consultations to allow for an examination and concerns discussed.

How do they determine the acceptable levels.   I get what you are saying, in general terms, but is there a clinical basis.

I'm lost, but have come across this article

Quote

Evaluation in Diabetics

A preoperative assessment should be done with support from a diabetologist/endocrinologist. It should occur sufficiently in advance of the planned surgery to ensure optimization of glycemic control as per the recommendation of the treating physician for the particular patient, before the date of the proposed surgery. People with diabetes should have their most recent HbA1c test results analyzed. HbA1c testing should be offered to people with diabetes having surgery if they have not been tested in the past three months. With appropriate guidance, patients with diabetes should be allowed to retain control and possession of, and continue to self-administer, their medication. The aim is to avoid hypoglycemia or hyperglycemia during the period of fasting and the time during and after the procedure, until the patient is eating and drinking normally.

Routine HbA1c testing before surgery to people without diagnosed diabetes is not essential.

Level of Evidence: 4

Grades of Recommendation: D

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611706/

To keep this thread OT I need to focus on the legal and professional basis surrounding the loss of opportunity which stems from a universally acceptable professional clinical standard.   Is there such a standard in HT / diabetes that members are aware of.

 

Edited December 10, 2022 by Snowman123

[NikosHair]

6 minutes ago, Snowman123 said:

2. Yes, but they refused to answer asking me to have the test in the Istanbul hospital clinic. 

That was your cue to reject them. You provided your HbA1c levels and they refused to confirm acceptability.

Did you try google? "<name of clinic> diabetes", what comes up?

Turkey is awash with hair transplant clinics, why take the risk with a clinic that refuses to answer your question(s)?

I know you're fired but the idea that legally a clinic is forced to carry out a cosmetic procedure is fanciful. 

 

[NikosHair]

6 minutes ago, Snowman123 said:

How do they determine the acceptable levels

They set their own levels according to their ability and what they are comfortable with.

We have lots of examples on the forum where someone is declined by one doctor and accepted by another.

I'm sure there are plenty of clinics that will carry out a hair transplant for you.

Accept that you had a chance to bail out before parting with your cash but you chose to proceed regardless - that's on you.

[Snowman123]

3 minutes ago, NikosHair said:

That was your cue to reject them. You provided your HbA1c levels and they refused to confirm acceptability.

My argument  is that they had a policy and they refused to communicate it.  Which Legal say that's culpable and exposed to a breach of the cited Act's referenced above.

5 minutes ago, NikosHair said:

Did you try google? "<name of clinic> diabetes", what comes up?

I did and they have an article that publishes their guidelines of 6.0 - only saw it later when i had reason to investigate it.   If I'd known, I would never have travelled.  I don't want to name the UK referrer at this stage, but will do if/when the solicitor approves it as it will have an impact on the referrers reputation - my hope is that they will see sense and settle.

 

9 minutes ago, NikosHair said:

I know you're fired but the idea that legally a clinic is forced to carry out a cosmetic procedure is fanciful. 

 

Yes I agree to a point, but according to the legal advice I'm receiving "repeat performance" is a remedy. So if they don't want to do it, they may have to pay another to do it.  That's written into the law - so it can be forced on them as a breach of a Court determination is a criminal offence - so I'm told.

[Snowman123]

14 minutes ago, NikosHair said:

They set their own levels according to their ability and what they are comfortable with.

So there is no universally accepted standard for procedure or qualification?   That's a worry.

 

16 minutes ago, NikosHair said:

Accept that you had a chance to bail out before parting with your cash but you chose to proceed regardless - that's on you.

Not really :

Quote

Section 49 of The Consumer Rights Act 2015 requires you to carry out your service with reasonable
skill and care. This holds any work done to the standard of a competent professional.
The problems described show that you have failed in your legal obligations. I therefore have a
claim against you for breach of contract.

Quote

Additionally, under Regulation 5 of The Consumer Protection from Unfair Trading Regulations 2008 it is a banned practice and criminal offence to mislead a consumer. Under the regulation if a consumer is provided false or misleading information and based on that information the consumer makes a transactional decision they would not have taken otherwise, that consumer has been misled.

 

Regulation 9 states a trader is guilty of an offence if it engages in a commercial practice which is a misleading action under Regulation 5 otherwise than by reason of the commercial practice satisfying the condition in Regulation 5(3)(b).

 

Under The Consumer Protection from Unfair Trading Regulations 2008 these practices are a banned practice and criminal offence, and an offence that Trading Standards has the powers to investigate the company and prosecute for. Furthermore, it can lead to significant financial penalties for the company. 

We'll see what their response is - they have 14 days to reply to the formal notice sent from the legal team. 

 

[NikosHair]

51 minutes ago, Snowman123 said:

My argument  is that they had a policy and they refused to communicate it.

Exactly - thats why you should have bailed out.

This may be of interest to you:

[Snowman123]

29 minutes ago, NikosHair said:

Exactly - thats why you should have bailed out.

This may be of interest to you:

Gold. Does it look like a genuine review to you?   

[Snowman123]

13 hours ago, NikosHair said:

Diabetes can be the cause of hair loss. Recovery can be affected. Higher risk of infection. Blood sugar monitoring to avoid complications during a long surgery.

Ultimately, it's a cosmetic procedure and the clinic reserves the right of refusal. In the eyes of a clinic it is better to turn away a patient that may have complication/poor outcome than to proceed and risk the consequences.

We have seen it before where an ethical doctor refuses to proceed because they find out someone is a poor candidate. Some doctors insist on face-to-face consultations to allow for an examination and concerns discussed.

Certainly, I accepted that and told the surgeon who refused me that I respected their view, even though I am still questioning it. 

There just seems to be no standardised approach and there seems to be a lot of discretion surrounding medical objectivity v subjectivity.   That said, this clinic had a policy, as i stated of not performing over a very low hba1c result of 6.0

I guess I'm coming to the conclusion that the "loss of opportunity" is based on the probable fact that if I had known their threshold of refusal, I could have gone elsewhere to plenty of other clinics.

I've opened a thread on https://forum.diabetes.org.uk/boards/threads/hair-transplant-safety-with-diabetes-hba1c-test.103707/  at Diabetes.org.uk to see if it can provide any further perspective

Edited December 10, 2022 by Snowman123

[NikosHair]

2 hours ago, Snowman123 said:

Certainly, I accepted that and told the surgeon who refused me that I respected their view, even though I am still questioning it.

That was the correct and measured response. What's in it for the clinic to turn people away? It would have been easy for them to proceed against their medical judgement and collect the $$$$. One of the biggest criticisms with HT's in Turkey is clinics taking money from unsuitable candidates. You might have been one of the people on here complaining about a poor outcome / 'botched' HT.

How many doctors have you consulted? Have you had your scalp examined in person? You need to eliminate the possibility that quite aside from the diabetes, did the doctors see something else that may lead to a poor outcome? eg. poor donor. 

Use the resources on the Diabetes to find out how people kicked a horrible disease into remission and got off the pills. You made some poor choices using a referral site and not bailing out when you didn't get answers to your questions. You didn't do your due diligence examining the clinics websites for the answers you were looking for (until it was too late). The legal route while an interesting exercise (I'm all for expanding knowledge) is also futile.

[Al - Moderator]

16 hours ago, Snowman123 said:

Yes I agree to a point, but according to the legal advice I'm receiving "repeat performance" is a remedy. So if they don't want to do it, they may have to pay another to do it.  That's written into the law - so it can be forced on them as a breach of a Court determination is a criminal offence - so I'm told.

 

I'm not in the UK, so I don't know UK law, however the "repeat performance" forcing them to pay to have it done somewhere else seems to me that it can only be applied if they actually performed the surgery and it didn't work (i.e. repeat performance). If they didn't "perform" the surgery in the first place how can they be made to pay you to have it done somewhere else? That would mean potentially any Dr who ever turned someone down would have to pay for that persons surgery somewhere else. That obviously is not going to be the case.

 

[HappyMan2021]

3 hours ago, NikosHair said:

That was the correct and measured response. What's in it for the clinic to turn people away? It would have been easy for them to proceed against their medical judgement and collect the $$$$. One of the biggest criticisms with HT's in Turkey is clinics taking money from unsuitable candidates. You might have been one of the people on here complaining about a poor outcome / 'botched' HT.

How many doctors have you consulted? Have you had your scalp examined in person? You need to eliminate the possibility that quite aside from the diabetes, did the doctors see something else that may lead to a poor outcome? eg. poor donor. 

Use the resources on the Diabetes to find out how people kicked a horrible disease into remission and got off the pills. You made some poor choices using a referral site and not bailing out when you didn't get answers to your questions. You didn't do your due diligence examining the clinics websites for the answers you were looking for (until it was too late). The legal route while an interesting exercise (I'm all for expanding knowledge) is also futile.

I agree with this comment here OP. Consider the 1k pounds lost to be an expensive lesson, and this whole situation to be a blessing in disguise. 

You likely would have been botched in Turkey and your situation literally would have been 20x worse than losing this referall fee.

Feel free to keep exploring the legal route, it is interesting, but im just not sure any lawyer or judge is going to see you as a tragic victim. 

Consider its near impossible as it is for actual patients who spend 10k and are botched to recoup their losses. Considering you weren't even botched, and no one stole money from you, this was a voluntary transaction, i have to say i think i court of law will be much less sympathetic to your case than us on this forum. 

Not to mention the stress and emotional cost of going the legal route, it very well may be worth more than the actual expenses incurred 

Edited December 10, 2022 by HappyMan2021

[Snowman123]

8 hours ago, NikosHair said:

That was the correct and measured response. What's in it for the clinic to turn people away? It would have been easy for them to proceed against their medical judgement and collect the $$$$. One of the biggest criticisms with HT's in Turkey is clinics taking money from unsuitable candidates. You might have been one of the people on here complaining about a poor outcome / 'botched' HT.

Well that's their fixed policy view in their guidelines.  Maybe there are other factors. Maybe their medical indemnity insurance doesn't permit any discretion for risk over a low hba1c, regardless of their professional opinion - who knows.

8 hours ago, NikosHair said:

How many doctors have you consulted? Have you had your scalp examined in person? You need to eliminate the possibility that quite aside from the diabetes, did the doctors see something else that may lead to a poor outcome? eg. poor donor. 

Zero doctors consulted and no scalp examinations.   Just photos and medical history.   But that's how it's done for the majority of candidates going to Turkey - Y/N?

8 hours ago, NikosHair said:

You didn't do your due diligence examining the clinics websites for the answers you were looking for (until it was too late).

It's always better in hindsight, I guess and at the end of the day folks are travelling to Turkey in large numbers. I doubt if they would be as wised up as those on these forums, plus it's an unregulated industry ( isn't that a concern for many having cosmetic surgery).

My research comprised of 

a) 4 successful hair transplants ( friends sons in their late 20's, early 30's ) through this specific referral company, that i saw and heard from first hand - they were satisfied 

b)   NHS guidance per https://www.nhs.uk/conditions/cosmetic-procedures/hair-transplant/  - no mention of diabetes being high risk

Quote

What could go wrong

A hair transplant is generally a safe procedure, but as with any type of operation there's always a small risk of:

• bleeding
• infection
• an allergic reaction to the anaesthetic

Your surgeon should be able to treat these problems quickly.

There's also a small risk the transplant will not take and the hair falls out, or a noticable scar may form.

c)  (i) Australian government medical authorities https://www.healthdirect.gov.au/hair-transplant ( Where I reside 50% of the time over the year and i consider reliable ) - no mention of diabetes being high risk  (ii) https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hair-transplant-surgery

Quote

Complications of hair transplant surgery

All surgery carries some degree of risk. Some of the possible complications of hair transplant surgery include:

risks of general anaesthesia, including allergic reaction, which may (rarely) be fatal

surgical risks such as bleeding or infection

scars that may be severe, raised, reddened and itchy

nerve damage, including permanent loss of sensation

death of the skin grafts

tissue death along the wound

further surgery to treat complications.

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. Speak to your surgeon for more information.

No mention of diabetes

d) US .gov medical sites covering risk including https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8719980/

Quote

Hair transplant surgery per se has low risk, is relatively safe, and has minimum incidence of complications. However, it is a well-accepted fact that no medical science procedure exists without any potential risk of complications. The complication may be a single complaint in the form of pain, itching, dissatisfaction related to the procedure's outcome, or surgical complication in the form of infection, wound dehiscence or skin necrosis.

d) friends also going for HT, using this referral company, who we compared notes between us with

e) numerous independent videos demonstrating the before and after process, such as Swedish hair transplant journey

f) professional inputs from the UK referral company consulting with the clinic, approving my visit on known medical history (albeit if the hba1c guidelines were made known to me I would not have gone + this could have been done in the UK** ) - trusted these guys and have several friends still going with them

** I was also short on time as I had to return overseas within a 4 week window

Quote

Section 49 of The Consumer Rights Act 2015 requires you to carry out your service with reasonable
skill and care. This holds any work done to the standard of a competent professional.
The problems described above show that you have failed in your legal obligations. I therefore have a
claim against you for breach of contract.

At the end of the day one has to put themselves at the mercy of professional inputs, none that cite controlled diabetes as a risk.  What could go wrong in a controlled environment with anti biotics and a stable medical history?  

Clearly, all  cosmetic procedures have an aesthetic and medical risk.

8 hours ago, NikosHair said:

You need to eliminate the possibility that quite aside from the diabetes, did the doctors see something else that may lead to a poor outcome? eg. poor donor. 

They confirmed on consultation at the clinic that the donor area could support 3,000 grafts. Only the risk of infection was communicated.

 

8 hours ago, NikosHair said:

The legal route while an interesting exercise (I'm all for expanding knowledge) is also futile.

I guess this is subjective.  To me it's not, I'd like my money back and be compensated according to the law. I'm not comfortable with the error by the referral company and them being rewarded with my money, and folks in the same position as me researching a recourse, or planning, can have better knowledge. Who knows, the referral company may lift their game and provide a better benchmark for service in the future.  Which Legal Service  is in the thick of consumer matters, generally at the lower level of $$ complaints and in the position to refer the complaint to media and consumer affairs for deeper investigation.  If people just roll over and give up where would we be ?  I don't therefore don't think it's futile for myself or others.

It's time consuming, I agree. The more it goes on, the more motivated I am to see it sorted.

7 hours ago, BeHappy said:

That would mean potentially any Dr who ever turned someone down would have to pay for that persons surgery somewhere else. That obviously is not going to be the case.

Not really. That's not the point of the legal advice if you take a closer look.

Medical culpability on a general scale is complex these days, which is why professional indemnity is so expensive and disputes take a long time.   Luckily, I'm not talking about culpability as a result of the surgical and aesthetic view.    One risk I do see is the inability to ensure medical cover for negligence in a Turkish hospital.

Are there insurances that can cover this - I didn't see any, and I'm doubtful they would pay up easily anyway. Private health funds maybe ? 1 don't know.

5 hours ago, HappyMan2021 said:

i have to say i think i court of law will be much less sympathetic to your case than us on this forum.

I'm not so sure. In law you have to strengthen your case and sometimes through the investigation process more facts and avenues come to light.  At the end of the day it's a commercial decision and nothing in law is certain, so it comes down to the value of what you're doing v's doing nothing. 

From a strategic point of view, the UK referrer has to weigh up the balance to. All they have to do is consider the argument and commercial risks against themselves and fight or settle. But the more they fight, the higher the risks are for them in terms of costs to reputation. The $$'s are minimal for them, looking at their company balance sheet.

Getting the emotion out of it, is important to keep a clear focus IMO.

It's OT, but Is there a checklist of things to be aware of that members can rely on when selecting a clinic service ?

Edited December 11, 2022 by Snowman123

[Snowman123]

21 hours ago, NikosHair said:

This may be of interest to you:

I noticed ( if it's genuine - and i believe it is ) that this guy is Diabetes 1 (not 2 as per me). According to the Diabetes UK.org thread i opened, he can quite possibly have an HbA1c below 6.0.

[NikosHair]

On 12/6/2022 at 10:29 PM, Snowman123 said:

£400 (teeth whitening)

You're claiming for the teeth whitening.

Why couldn't you have got that done while you were in Turkey?

[Melvin- Admin]

6 hours ago, HappyMan2021 said:

I agree with this comment here OP. Consider the 1k pounds lost to be an expensive lesson, and this whole situation to be a blessing in disguise. 

You likely would have been botched in Turkey and your situation literally would have been 20x worse than losing this referall fee.

Feel free to keep exploring the legal route, it is interesting, but im just not sure any lawyer or judge is going to see you as a tragic victim. 

Consider its near impossible as it is for actual patients who spend 10k and are botched to recoup their losses. Considering you weren't even botched, and no one stole money from you, this was a voluntary transaction, i have to say i think i court of law will be much less sympathetic to your case than us on this forum. 

Not to mention the stress and emotional cost of going the legal route, it very well may be worth more than the actual expenses incurred 

I’ve seen cases of real botched hair transplants, that never got anywhere through litigation. This already looks to be a grey area of medical tourism. I agree, an expensive lesson. OP if you had put this much energy into researching hair transplants to begin with, you wouldn’t be in this situation. Hindsight is always 20/20, but take it as a lesson. 
 

[NikosHair]

5 minutes ago, Melvin- Moderator said:

OP if you had put this much energy into researching hair transplants to begin with, you wouldn’t be in this situation.

We live in a blame culture. It far easier to point the finger at others than take responsibility for your own actions. Some people never learn but I'm optimistic for the OP.

OP spends some time looking at the resources provided by this website.

Hair Loss Learning Center | Coalition of Independent Hair Restoration Physicians

[Snowman123]

10 hours ago, NikosHair said:

You're claiming for the teeth whitening.

Why couldn't you have got that done while you were in Turkey?

I'm not sure how the chargeback will work in lieu of consequential losses permitted with offsets under the credit card scheme for consumer protection. I'll wait for the response from the hair transplant referrer and also the Bank, then get advice from the solicitors as to how the claim is structured and funds are best secured and recovered. 

Usually in disputes monies are withheld where possible, pending settlement or legal outcome determinations.  That's what the referrer tried to do on their side with the cash they held and I will do, if advised.

It was done as part of the overall package.

 

Edited December 11, 2022 by Snowman123

[NikosHair]

3 hours ago, Snowman123 said:

It was done as part of the overall package.

Lots of words that have nothing to do with the question. Of course we're just casual spectators but if you want to mount a legal claim you need to be clear with your answers.

So, again.

Did you get your teeth whitened in Turkey or not?

If not, why not? 

[Snowman123]

4 hours ago, NikosHair said:

So, again.

Did you get your teeth whitened in Turkey or not?

If not, why not? 

 

7 hours ago, Snowman123 said:

It was done as part of the overall package.

Yes it was done

4 hours ago, NikosHair said:

Lots of words that have nothing to do with the question. Of course we're just casual spectators but if you want to mount a legal claim you need to be clear with your answers.

This is the context regarding the offset:

7 hours ago, Snowman123 said:

I'm not sure how the chargeback will work in lieu of consequential losses permitted with offsets under the credit card scheme for consumer protection. I'll wait for the response from the hair transplant referrer and also the Bank, then get advice from the solicitors as to how the claim is structured and funds are best secured and recovered. 

I hope that clarifies things.