Powerful new helicopters are changing mountain rescue in Nepal. But as Ed Douglas explains, the surge in helicopter evacuations is bringing sharp practice, fraud and higher insurance premiums for your next adventure.

With additional reporting in Kathmandu by Richard Bull.

Rescue in the Himalaya is changing. The extraordinary escape of three climbers stricken with frostbite and altitude sickness at almost 7,000m on Annapurna in 2010 is a great example. In the past, they would probably have not survived, yet a powerful Ecureuil B3 helicopter plucked the three men to safety in the nick of time. The Swiss team – pilot Daniel Aufdenblatten and rescuer Richard Lehner from Air Zermatt – were in Nepal to train local helicopter crews in rescue techniques when they got the call. “Until then,” Aufdenblatten said, “helicopter rescues at those altitudes had been regarded as impossible.”

Not so long ago, this kind of rescue in the Himalaya was pure fantasy. Climbers went to the mountains knowing that only they could get themselves off. But it’s in the trekking business that rescue is changing most. Twenty years ago, if you got altitude sickness on the way to Everest Base Camp, then you descended on the back of yak. Now there’s a competitive helicopter industry eager to fl y you straight back to Kathmandu.

Civil aviation has boomed in Nepal since the civil war ended in 2006. Tourism has also boomed, with numbers on the Everest trek pretty much doubling. Some 100,000 trekkers visit Nepal each year and new helicopters have an important role to play in the inevitable rise in trekkers requiring medical evacuation. That’s unquestionably a good thing.

But weak regulation and the chance to tap into insurance premiums have made the rescue business tempting to a new network of middlemen and agents. Charter companies have sprung up, earning commissions as they play different helicopter operators off against each other. Trekking guides and agents are doing the same.

It’s easy to see the attraction. Soon after the Annapurna rescue, David Hamilton – a guide for Jagged Globe with long experience of Nepal – observed: “Imagine you’re a local guide leading a trek of six people for a fairly low-budget outfit. The agent will only be making $500 out of the whole deal. You’ve got someone who’s going a bit slow and it’s a pain waiting for them, you tell them they’ve got altitude sickness, you call in a helicopter and your company gets ten or 15 per cent of what, $10,000? In a couple of years, when the insurance companies start looking at the books, there’s going to be a massive price hike.”

That moment has arrived. Premiums for the BMC’s trekking insurance for Nepal have risen sharply to match those for the United States, from £68.03 for a 17-day policy to £84.56. Andre Graham from the BMC’s underwriters ACE Group suggests they could go higher still: “While it’s fantastic for climbers to have a broader safety net in the event of an emergency, increased costs will result in higher premiums.”

The real question is how much of these increased premiums are funding genuine rescues, and how much is funding dishonest, even criminal, activity? The BMC spoke to a helicopter pilot who fl ies for one of four Nepali companies with the capability to perform high-altitude rescues. Requesting anonymity, the picture he draws of helicopter rescue in Nepal is one of kick-backs, haggling and fierce competition.

“If a client gets sick, then that’s a good thing for the trekking companies,” the pilot said, reiterating what western trek leaders like David Hamilton report. “A client may be paying $1,500 for a trek in the Everest region, but if he gets sick the [trekking] company might make $2,000 or $3,000 out of it from the rescue helicopter.”

Trekkers don’t ordinarily carry the phone number of a local helicopter operator when they go to Everest, so if they get sick they are in the hands of their trekking guide. Thanks to excellent mobile coverage, the trekking guide can phone his boss in Kathmandu, a charter company or even the helicopter companies direct to get the best price – and best commission.

According to the pilot, the charter company or agent tells him: “Such and such a company will do it for $3,000, why don’t you do it for $2,800?” When a price is agreed the charter company contacts the insurance company to request authorisation so there’s no danger of a flight being made without payment.

Not only does the charter company haggle over the price, according to the pilot they also request a fake bill. “If you don’t agree then you don’t get the business. Even if we fl y only two hours, they ask for a bill for five hours. Nowadays they don’t even ask for the bill, they give their own bill.”

The pilot says it’s not the helicopter companies that are cashing in on Nepal’s new rescue business. “The guys who are making the money are the agents right now, without any investment. It’s difficult for helicopter companies in Nepal. We are paying the highest insurance rates in the world: 15% of the value of the helicopter per year.”

Given that an Ecureuil B3 costs around $2.5m, that’s a charge of $375,000 before the airline has sold a ticket – on top of the costs of leasing or buying the aircraft. It’s hardly surprising if helicopter companies feel they are taking most of the risk while those chartering the aircraft are getting the profits.

So what should the insurance companies do to cut down on inflated rescue costs? “There are only certain companies here making rescue flights. You can ask which company made the flight? How many hours did it fl y? Ask for the check log. We write everything down. I can’t fake the check log. If I write ten hours instead of two hours, then the helicopter has to be serviced eight hours earlier.”

The pilot estimated that there are 1,500 tourist emergency flights a year in Nepal, spread between the four companies, the vast majority of which are connected to the trekking business. That’s millions of dollars of commission up for grabs, so it’s hardly surprising that the growth of Nepal’s private helicopter sector has attracted middlemen looking for a slice.

So much for sharp practice, what about outright fraud? Are all those ill people getting a ride home really sick? “I cannot say by looking at their faces,” the pilot says. “Half look quite fit but I cannot decide. I just fly the helicopter – I’m not a doctor. The agents will have called an ambulance, they take them to CIWEC (the reputable and longstanding travel medicine centre near the British embassy) or an international clinic, they go there and get certified as sick.” But, he says, the evacuation of healthy people happens: “A lot.”

There seem to be at least five categories of fraudulent use of insurance policies to profit from helicopter rescues: unnecessary evacuations, fast rides down, overcharging rescues, charging twice for the same rescue and deliberately scheduling ‘rescue’ flights into trekking itineraries. Researching this article, we found direct evidence for all of them.

As crimes go, insurance fraud is something we mostly shrug our shoulders at. Insurers in the UK estimate that whiplash claims add £90 a year to car insurance. Despite the fact that in the last six years there have been 20 per cent fewer road traffic accidents, injury claims from those accidents have risen 60 per cent, a substantial proportion of them fraudulent whiplash claims. So in a poor country like Nepal, it’s not surprising similar scams exist to take advantage of your travel insurance premiums. But trekking and climbing at high altitude are very different contexts from driving in the UK, and the explosion in insurance fraud in Nepal could have worrying consequences – for both your holiday and your health.

Prakash Adhikari is chief executive of the Himalayan Rescue Association (HRA), which runs health posts in Pheriche near Everest and Manang in the Annapurna range. Established in 1973, it offers impartial advice to trekkers and is staffed by western volunteer doctors. The arrival of helicopters has changed the context in which HRA operates from being a valuable aid station to, in the eyes of some trekking guides, an impediment to a big payday – or a nuisance to a western trekker desperate to go home.

“HRA has a simple policy,” Adhikari says, “to stay out of the rescue business. Our responsibility is to save lives. Our job is not to fight with other people over commissions.”

In the autumn season of 2012, HRA saw 650 patients at its Pheriche clinic alone. “With diagnosed high-altitude cerebral oedema or pulmonary oedema we never take a chance,” Adhikari says. HRA authorised 15 evacuations last season, of which 12 were related to these conditions. “Heart problems are the same. For diarrhoea and vomiting, we monitor first. It’s not automatically a helicopter.”

Yet keeping trekkers on the ground is no good for those anxious for a cut from a rescue. Adhikari says he’s heard of trekking guides avoiding the HRA posts with a sick client in case they don’t authorise an evacuation. The consequences of that could be disastrous, especially if the trekker doesn’t have access to any other medical treatment while waiting for a helicopter, which may be delayed in bad weather.

Gobinda Bashyal, a HRA paramedic specialising in altitude sickness, says that western trekkers are also looking for the HRA to do them a favour. “People come in who are obviously tired, unhappy or home sick.” He tells the story of a woman who called at the HRA clinic in Pheriche asking for a helicopter, claiming she could no longer walk. After denying an examination, the woman later called her insurance company using her lodge owner’s mobile phone, pretending to be a doctor authorising a helicopter.

The picture becomes even more confused when the evacuated trekker reaches Kathmandu. A well-regarded doctor working at Kathmandu clinic that sees many evacuated trekkers splits patients arriving by helicopter into three categories: 20 per cent definitely required evacuation (usually because of HAPE or HACE); 60 per cent fell into a range of uncertainty (diagnosing altitude conditions is very difficult once the patient is back in oxygen-rich air); and 20 per cent didn’t require evacuation at all.

The numbers are striking. The doctor, who requested anonymity, reports seeing up to 15 patients evacuated by helicopter every day in the peak season. That means at least three have been fl own unnecessarily at a cost of around $5,000 each. And that’s just one clinic.

“There is a lot of competition these days,” he says. “There’s Norvic and some other big international hospitals coming as well. I think the competition is getting more significant over the last few years. There are agents that push you to go to a certain hospital, the extent of which I couldn’t comment on. But it does exist.”

“I feel sorry for the patients,” the doctor concluded. “If someone comes to you because you feel a little bit lousy and says: “You’ve got to get in the helicopter because you’re going to get a lot worse, then you get in the helicopter.”

If it feels like helicopter rescue has become just one more scam to spoil the enjoyment of your trekking holiday, then rest assured. Use a reputable trekking company, bone up on proper acclimatisation and prepare thoroughly before you go and you won’t fall prey to unscrupulous operators, even if you do have to pay more for your insurance.

But for those looking for a cheap deal who head for the Everest region on a whim, there’s a real danger out there. The danger that both your holiday plans and health could be at risk from an agent out to get rich from western insurance companies.

The scams 1 - Unnecessary Evacuation of someone who would recover. Inexperienced trekkers can be persuaded by lodge owners or trekking guides that they need treatment in Kathmandu, when descent or analgesics would suffice. That treatment can often be hugely profitable: a straightforward check-up following evacuation can cost up to $800 and two or three days in hospital $5,000. At least one helicopter-charter company now has its own medical facility where patients are delivered after being evacuated – a new twist on unscrupulous cab drivers taking you to his ‘brother’s’ hotel. 2 - Overcharging for the rescue. This can work in other ways. Lodge owners calling in a chopper for a stricken guest have been known to ask for goods to be flown in on the incoming flight, and tourists in the area may find themselves being offered a cash-in-hand ride back to Kathmandu. 3 - Charging twice for the same rescue. An organiser in the Manaslu region arranged a helicopter evacuation for two clients – from different countries – suffering from altitude sickness. He learned later that both insurance companies had been billed for the entire $5,000 cost of the charter, totalling $10,000. The profit on the deal would have been around $7,000. 4 - Trekkers or climbers looking for a fast ride down following an expedition. With the right contacts, it’s not difficult to get what looks like bona fide documentation saying that a rescue was medically justified and the insurance company picks up the bill. This isn’t confined to Nepalese trek leaders 5 - Deliberate scheduling of a ‘rescue’ flight in a trekker’s itinerary to save them time. This was offered without prompting to a Dutch group planning a complex itinerary in the Kangchenjunga area. When they decided to include two friends for part of it, they received an email from their agent: “In the beginning they have to pay helicopter cost in Nepal, when they completed there [sic] trekking and arrive in Kathmandu I will make the doctor report saying that we need to rescue the people from Ghunsa because they are ill and the aviation people will too make the certificate saying that we are rescuing these people.” The plan, the agent says, will be ‘a good solution for them,’ and to reassure their prospective clients, the agent goes on to say: ‘I started Nepal tourism business since 1990 most of the time I did the same like this and there was no problem at all till now.’

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