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What went wrong before and after shooting of U.S. backpacker in Costa Rica?

On Tuesday morning, a month-long Costa Rican travel nightmare ended with the death of 31-year-old U.S. backpacker Steve Flesch. After being robbed and shot in the head by alleged gang members in a dangerous neighborhood in the southern San José suburb of Desamparados, Flesch spent six days unidentified in the hospital, and a month in a coma, fighting for his life. Shaken by the story, members of the travel and expat communities have begun discussing what went wrong for Flesch, and how his situation might have been different.

The Tico Times examines some of the central questions surrounding the events that led to Flesch’s death:

What is the Torremolinos neighborhood of Desamparados, where Flesh was assaulted and shot? How would a tourist wind up there?

Torremolinos is a crime-ridden area in the southern suburbs of San José. How Flesch ended up there is a total mystery. “This is an isolated case,” said Jorge Chávez, the lead investigator on Flesch’s case for the Judicial Investigation Police. Contrary to a rumor published by a local English-language blog, Chávez says he’s never heard of any tourist being lured there by the promise of drugs or sex. “We never find tourists there,” he said. “They would have no reason to go.”

Flesch’s mom believes her son may have simply gotten lost, or taken the wrong bus to get to the dentist.

When Steve Flesch arrived at San Juan de Dios Hospital in San José, unconscious and robbed of his passport, what did the hospital do to try to identify him?

According to San Juan de Dios spokeswoman Andrea de la Cruz, when an unidentified critically injured person arrives at the hospital, the first step is to attempt to save the person’s life. Once the patient is in a stable condition, hospital staff will make calls in an attempt to determine the individual’s identity. If the nationality of the patient is unclear, the hospital contacts the embassies with the highest number of tourists who come to Costa Rica. De la Cruz said this is what was done for Flesch, but she could not say when the hospital first called the embassy.

Why wasn’t he identified?

U.S. Embassy spokeswoman Evelyn Ardón said that San Juan de Dios Hospital never placed a call to the embassy. “The hospital did not identify Mr. Flesch as a U.S. citizen and, therefore, did not inform the embassy of his presence,” she said. Ardón added that consular officers contacted the hospital to inquire about Flesch, but they were not informed that an unidentified 6-foot-3 foreigner – likely a North American – had been there, unconscious, for days.

So who dropped the ball? And whom should you call if a U.S. citizen you know disappears in Costa Rica?

It’s unclear who is to blame for the delay in identifying Flesch, and there were a few factors in play. “We have no higher priority than the safety and security of U.S. citizens overseas,” Ardón said. “When a U.S. citizen is reported missing abroad, our consular officers work with local police and authorities, including medical authorities, to locate the person.”

Although his family was searching for Flesch starting on April 4, the embassy said it did not hear about it until April 7. “Our consular officers immediately began the process of searching for Mr. Flesch after he was reported missing,” Ardón said. Although consular officers made inquiries at local hospitals, the embassy “regrettably” did not locate Mr. Flesch, she said. Instead, it was Flesch’s friends who discovered him at San Juan de Dios.

When Flesch’s parents decided they wanted to airlift him back to the U.S., they were hit up for tens of thousands of dollars in medical bills. How can travelers be sure they are covered for this?

They can’t. While many international insurance plans cover emergency medical transportation between facilities, that doesn’t necessarily include international medical flights. For a patient to be airlifted back to the U.S., underwriters must deem it necessary. “That’s not likely here, because Costa Rica has good medical facilities,” said Zane Beaty of HCC Medical Services, an international health insurance provider.

Flesch’s parents also wanted to transfer him to a private hospital, but the cost would have been high, as he had no health insurance. Will travel health insurance pay for a transport from a public to a private facility?

Four international health insurance providers contacted by The Tico Times reported that their coverage extends to all public and private hospitals in Costa Rica, as well as transportation between the hospitals (if deemed necessary). The companies also pay outstanding medical bills to expedite the release or transfer of a patient. If Flesch had been insured, though, there are no guarantees that his insurance company would have deemed it medically necessary for him to be transferred to a private hospital.

What about risky adventures? Are they covered by travel insurance?

Maybe. Some companies do not cover certain areas of the world or certain activities. Others will cover this kind of travel, but at extra cost. “Bottom line: if you put yourself at risk or you place yourself in the crossfire, then you are unlikely to be covered,” according to travel insurance provider World Nomads.

What happens to Flesch’s body?

Flesch’s body was in the morgue for the time it took to perform an autopsy, part of evidence-gathering in the ongoing criminal cases against three minors and two adults who have been charged with his homicide, according to police. The body was released as of Tuesday, although authorities could not say where it had gone. Don and Sharon Flesch are making arrangements to bring their son’s body back to the U.S.

In an international emergency, getting prompt, accurate information is crucial. But language barriers and confusion often occur. Following are important contacts to keep on hand when traveling to Costa Rica:

United States Embassy in Costa Rica

Telephone: 2519-2000; From the U.S.: 011-506-2519-2000
Location:  In front of Centro Comercial del Oeste Pavas, San José
Address: Calle 98 Vía 104, Pavas, San José, Costa Rica

Public Hospitals in San José

Hospital San Juan de Dios
Telephone: 2547-8000
Location: Paseo Colon, Calle 14, next to the Children’s Hospital

Hospital Calderón Guardia
Telephone: 2212-1000
Location: Calle 15 and 17, Avenida 9-11

Hospital México
Telephone: 2242-6700
Location: Barrio La Uruca in front of the Autopista to the Airport

Hospital Nacional De Ninos (Children’s Hospital)
Telephone: 2523-3600
Location: Paseo Colon, Calle 14, next to Hospital San Juan de Dios

Private Hospitals in San Jose

CIMA Hospital 
Telephone: 2208-1000
Location: Southwestern suburb of Escazú, near Mall Multiplaza off Highway 27 (“la pista nueva”)

Clínica Bíblica Hospital
Telephone: 2522-1000
Location: Calle Central, Avenida 14

Clínica La Católica
Telephone: 2242-6700
Location: Pillar Jiménez, Guadalupe (a suburb northeast of San José)

Hospital Metropolitano
Telephone: 2521-6565
Location: 300 meters south of Hospital San Juan de Dios, Calle 14, Avenida 8

Travel health insurance or international health insurance can be obtained through some existing health insurance providers, private companies specializing in this type of additional insurance, or through some credit card companies. 

Medical evacuation insurance and coverage for extreme sports or situations may not be part of a standard plan, so it’s important to read all the documentation, ask questions, and ensure you feel comfortable with your coverage and its limits.

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