Wednesday, January 01, 2020

The Risks of Attending an Offshore Medical School: Students at Offshore Medical Schools Killed or Injured by Gas Explosions

US and Canadian medical education has a peculiar gray zone.  A substantial proportion of US and at least some Canadian doctors have received their medical degrees from offshore medical schools.  These are medical schools located in other countries, mainly the Caribbean, that exist only to train students for North American practice.  They are often owned by for-profit US or Canadian based companies, have little accountability to their host countries' governments, or to the US or Canada, and have generally flown under the radar despite being an important component of North American medical eduction..

Many questions have been raised by the quality of training received by students at such offshore schools.  We have recently discovered new risks to offshore medical students, in particular, that of dangerous living conditions.  We were alerted to two cases since 2018.


Gas Explosion Injured Two Medical University of the Americas (MUA) Students, Both Fatally, on Nevis in 2018

As reported by WINN FM on November 15, 2018

At around 8:00 pm on October 3, an explosion rocked the medical university and sent two American students to the hospital with severe burns across their bodies. The two students were subsequently flown to the United States for treatment.

On Wednesday (Nov 14) Acting Commissioner of Police, Hilroy Brandy disclosed that a faulty knob on the stove caused the explosion. He said one of the injured females was the actual occupant of the apartment and a female friend had come over to study. One of them lit a cigarette which ignited the gas.

That explosion eventually proved fatal to one medical student, as reported again by WINN FM on November 21, 2018:

One of the students who sustained major burns in an explosion and fire on Nevis in October has succumbed to her injuries.

28-year-old Nada Magdy Khalil of East Brunswick, New Jersey was one of two female students of the Medical University of the Americas (MUA) in Nevis inside the apartment when it exploded on Oct 3.

WINN FM confirmed that Khalil died on Sunday, November 18 in Florida where she had been receiving treatment.

The other student was very severely injured

The other victim is 31-year-old Gayane Borisovna Balasanyan from San Francisco; she is still hospitalized in Miami, Florida with burns across 90% of her body.
According to her GoFundMe page, Ms Balasanyan died in January, 2019.


There is no other publicly available  information on this explosion. Importantly, there has never been a public response from MUA, or its owners:

Since the explosion, the medical university has not issued a statement on the matter.

Gas Explosion Severely Injured Two Saba University School of Medicine (SUSOM) Students in 2019

There was an unnervingly similar case one year later, as reported by Saba News on October 15, 2019:

Saba’s emergency services were rushed to a dormitory building on Thais Hill Road in The Bottom around 7:30am Saturday, for a gas explosion that left one man severely burned.

A loud crack was heard throughout The Bottom that morning and a large plume of white smoke was seen coming out of the building and drifting into the sky. Several village residents also reported feeling the explosion’s aftershocks, which prompted them to call the Caribbean Netherlands Police Force KPCN and the Saba Fire Department.

Police, firefighters and the Ambulance Department were then dispatched to the building.

The dormitory is a privately-owned building that mainly houses students of Saba University School of Medicine (SUSOM).

Again, two students were injured:

One student was severely burned in the incident and was taken to A.M. Edwards Medical Center for treatment. He was later flown to Miami, Florida, for further medical attention.

A second victim was treated for smoke inhalation and was admitted at A.M. Edwards Medical Center for observation. She was released several hours later.

There is a GoFundMe page which is apparently for the student most seriously burned in this explosion.  It was created 3 days after the explosion, but I could find no other followup information on the explosion or the student.  Again, I could find no public response from SUSOM.

Who Should be Accountable?

These cases have been uncannily anechoic.  While the students injured were from the US, their fate has received no coverage in the US media.  Nor have the cases received recognition in the US health care literature, particularly the medical education literature.

The silence from the medical schools involved is quite unsettling.  That immediately leads to an obvious question.  Just who at these schools might be responsible for their students' physical safety?  Who currently runs and is accountable for both Caribbean schools is not glaringly obvious.

The website for the Medical University of the Americas lists an Executive Dean, but no President or CEO, or Board of Directors.  Its Wikipedia page states:

Medical University of the Americas (MUA) is a for-profit medical school in Saint James Windward Parish, Saint Kitts and Nevis.

Buried in the MUA 2018 catalog, however, is this statement:

Medical University of the Americas is a foreign profit corporation owned by R3 Education Inc. which is registered with the Florida Department of State, Division of Corporations to do business in Florida as Medical University of the Americas.

Saba University School of Medicine has a President, Dr Joseph Chu, according to its website. Its Wikipedia page does not state whether it is non-profit or for-profit.  However, like that  of MUA, the SUSOM 2018 catalog states

Saba University School of Medicine is a foreign profit corporation owned by R3 Education Inc.  which is registered with the Florida Department of State, Division of Corporations to do business in Florida as Saba University School of Medicine.

R3 Education Inc turns out to have a remarkable history, which we  discussed back in 2013.   To summarize what we found then...

The couple who founded two Caribbean medical schools which catered almost entirely to US and Canadian students ran into significant legal trouble.  Founder David Leon Fredrick and his wife, Dr Patricia Lynn Hough were indicted for tax evasion for failing to report income from the two medical schools they allegedly owned, and later sold.

The schools were Saba University School of Medicine, on Saba, and the Medical University of the Americas, on Nevis.  The initial legal proceedings revealed that while Saba University School of Medicine was apparently first set up by a non-profit foundation (or NGO) run by the couple, somehow it became for-profit owned by Mr Fredrick and Dr Hough, and Saba and the Medical University of the Americas were subsequently sold to a private equity group, Equinox Capital.  R3 Education Inc, owned by Equinox Capital, appears to have been given responsibility for running the schools, along with St Matthew University.

Before jury selection started, Mr Fredrick disappeared.  Dr Hough was eventually convicted of defrauding the US Internal Revenue Service, and income tax evasion, after trial testimony to the effect that the couple concealed money in a Swiss bank, got $36 million from the sale of the schools, and bought an airplane, two houses, and a condominium.

Left mysterious at that time were Mr Fredrick's whereabouts, where the money that the couple received from the sale of the medical schools went, and how a school that began as a non-profit organization run by the couple became a for-profit corporation owned by them.  The case should have lead to some concerns about the leadership and governance of the off-shore medical schools that now train increasing numbers of would be US and Canadian physicians.

In 2014 we provided something of an update. Mr Fredrick and Ms Hough made more than $35 million from the sale of the schools.  Ms Hough eventually went to prison.  Mr Fredrick's whereabouts remained unknown.  My internet searching in 2019 failed to produce any new information about him.


Now in 2019 we do not know much more about who is really accountable for MUA and SUSOM.  According to the Bloomberg corporate information website,

R3 Education Inc. operates as a holding company that acquires and manages for-profit educational institutions such as Saba University School of Medicine, the Medical University of the Americas, and St. Matthew's University. The company was incorporated in 2007 and is based in Devens, Massachusetts.

According to his LinkedIn Profile, the CEO and Chairman of R3 Education is Steven Rodger, of Greenwich, CT. For 23 years he has also been Managing Partner, Equinox Capital.

The Equinox Capital website make it clear that it still owns three Caribbean medical schools:

Saba University: Since its founding in 1993, more than 1,500 physicians have earned their M.D. at Saba University (www.saba.edu). Saba University School of Medicine has been accredited by the Accreditation Commission on Colleges of Medicine (ACCM) and its program has received approvals from licensing boards in New York, California and Florida. The campus is on Saba, which is located very near St. Maarten.

Medical University of the Americas: Since its founding 1998, Medical University of the Americas (www.mua.edu) has awarded approximately 500 M.D.’s. The MUA program is accredited by the Accreditation Commission on Colleges of Medicine (ACCM) and its program has received approvals from the licensing board in New York. MUA is located on Nevis, near St. Kitts.

St. Matthew’s University (www.stmatthews.edu) offers both a medical and a veterinary program. Since 1997, almost 1,500 students have obtained their M.D. and D.V.M. degrees from St. Matthews. The program is accredited by the Accreditation Commission on Colleges of Medicine (ACCM). St. Matthews is located in the Cayman Islands.

Who are the leaders of MUA and SUSOM who are accountable for what happens to their students, including their physical safety?  What allegiance do they owe their for-profit, private equity owners?  Who is responsible for the governance of the schools?  What responsibility does the private equity firm that owns the schools bear? All these questions remain unanswered.

The Perils of Offshore Medical Schools

US and Canadian medical students are promised a lot on the flashy websites (eg for MUA and SUSOM) for offshore medical schools. They may depend more on their medical schools for basics like housing than would students at American and Canadian schools. Yet they end up in physical environments with which they may be unfamiliar, and which may expose them to unexpected perils.

We should not forget that the US invasion of Grenada in 1983 was rationalized by the physical risks to US medical students at St George's University School of Medicine. The school was then a private for-profit owned by its founder Dr Charles R Modica and partners (but now partially owned by a private equity firm, Atlas Partners, per their news release.)   As the New York Times reported at the time, some students

told of bullets crashing through their dormitory rooms, of fears of being taken hostage, of a week of campus confinement under the Government's 'shoot to kill' curfew, of soldiers pointing guns at them

In particular,

Many of the students said that supplies of food and water began running low Tuesday after a weeklong curfew had been imposed by Grenada's military leaders following the slaying of Prime Minister Maurice Bishop on Oct. 19. Under the terms of the curfew, people on the street were to be shot on sight, the students said.

'I saw soldiers with guns during the curfew,' said Miss Nelson, 'and while none of them ever threatened me, several of my friends told me guns had been aimed at them, and they were terrified.'


[US Department of Defense image, Grenada invasion, 1983, via WikiMedia]


In the 21st century, the risks may be of gas explosions in accommodations more basic. and risky than students may have expected.    Yet who is ultimately accountable for disclosing and mitigating the risks?  In the case of MUA and SUSOM I cannot tell.

For would-be medical students trying to cope with the vagaries of medical school admissions in the US and Canada, the apparently easier accessibility of off-shore medical schools may be attractive.  Yet such accessibility may come with costs, and risks.  Until more is known about the risks, caveat emptor.


While Eckhert wrote in 2010(1) that the increasing presence of offshore medical graduates in the US "obligates U.S. medicine to take a closer look at these educational programs," no such scrutiny has occurred since then.  While offshore medical schools account for the training of an increasing proportion of US (and presumably Canadian) physicians, we know next to nothing about their leadership and governance.  This seems to be just another part of the decreasing accountability of the leadership of US health care, and the increasing opacity of the governance and stewardship of US health care organizations.  True US health care reform would make leadership transparent and accountable.

 Reference

1.  Eckhert NL.  Private schools of the Caribbean: outsourcing medical education.  Acad Med 2010; 85: 622-630.  Link here.




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