The Ministry of Health is officially investigating a German spine surgeon after his visit to New Zealand this year - but Kiwis remain keen to sign up to his operations costing nearly $80,000.
Dr Thomas Beirstedt dined in Auckland in early February with a group of New Zealand patients he previously performed disc replacement surgery on in Düsseldorf, Germany.
However, despite his European company Spine Connection being directly warned by the Ministry of Health not to treat or diagnose patients while in the country, new evidence suggests he did.
Ministry of Health chief legal advisor Phil Knipe said they were concerned about a meeting Dr Beirstedt had with around 10 prospective Kiwi patients in Auckland on Waitangi Day.
"The Ministry of Health is concerned that despite the advice we provided to Spine Connection ahead of their visit to New Zealand, they and Dr Bierstedt may have acted in breach of the Health Practitioners Competence Assurance Act 2003 (the Act)," Knipe said.
"If health practitioners are visiting New Zealand and carrying out consultations, then they should be registered with the relevant registration authority and hold a current practicing certificate otherwise they are likely to be in breach of the Act and liable for prosecution."
Aucklander Alan Weaver attended the Waitangi Day Spine Connection meeting, and is now planning to head to Düsseldorf in order to have a $78,000 spine operation.
Weaver had a private meeting with Dr Bierstedt in Auckland and on February 18 was sent a "Diagnosis" and "Proposed Treatment Plan" document for a spinal fusion and disc replacement operation.
"There were about 10 people there and, one by one, we went in and saw the surgeons, and they went over our cases, and said 'this is what we'd do'," Weaver said of the meeting.
"Then they said if you want to go ahead with this we need more recent MRI scans and we can make a booking - which I've got no trouble with. If the health department wants to try and stop me from going overseas, good luck."
Weaver said he "immediately" wanted to sign up for the Spine Connection meeting because of debilitating back pain after a serious work accident in mid 2017.
Spine Connection told the Weekend Herald they have not received any "formal writing or notice" from the Ministry of Health advising they have breached the Health Practitioners Competence Assurance Act 2003.
"At no stage of the event was medical treatment provided to any New Zealand resident, nor did they receive any report or individualised document pertaining to medical advice or any future treatment," Spine Connection director of patient services Jake Lemon said in a statement.
"We suspect a formal complaint was made to the Ministry of Health by a local surgeon who has a vested interest in dissuading New Zealand patients from travelling overseas for spine surgery.
"We are aware of two Auckland-based spine surgeons who have repeatedly warned their former and prospective patients against travelling overseas for spine surgery, citing a great deal of inaccurate information."
But after reviewing details of Spine Connection's Auckland meetings, Melbourne orthopedic surgeon John Cunningham said Dr Bierstedt has "clearly seen the patients and taken on the role of medical practitioner".
And Auckland spine surgeon Peter Robertson saw the original advertisement for the Waitangi Day meeting on the Spine Connection website and said the mere fact it required a fee to attend constituted "the practice of medicine".
"The concern we would express is it's called medical tourism - people go away for operations they perceive they can get a better operation, or a better cost. In general it's not associated with a lot of follow up," Robertson said.
"There's been positive feedback from patients, that's fine. But things go wrong occasionally and I can't imagine they'll be flooding back to Germany for Dr Bierstedt to look after. It's unlikely ACC will cover them, it's unlikely an insurance company will cover them and they end up a burden to the New Zealand system."
Auckland orthopedic surgeon Anthony Field said if Kiwi patients were being told by overseas surgeons they were getting something "better than what they can get in New Zealand then they were being misled a little bit".
"I suspect there won't be many patients who shell out $80,000 to fly across the world thinking they're going to get a better operation, who then say 'damn, I wasted my money'. There's going to be a certain bias," Field said.
Robertson insisted "the stuff that works" in terms of spinal surgery is "available in New Zealand".