A Practical Legal Guide to the Civil, Consumer and Regulatory Liability of Medical Tourism Agencies in Turkey

A foreign patient sees an advertisement on Instagram offering a “complete cosmetic surgery package in Istanbul.”

The patient contacts the company through WhatsApp. The company recommends a surgeon, arranges the hospital, collects payment, organizes the hotel and airport transfer, provides an interpreter and promises that everything will be handled from arrival until recovery.

The operation is unsuccessful.

The hospital then says:

“You are not our direct customer; you came through the agency.”

The agency replies:

“We are only an intermediary. Medical treatment is entirely the hospital’s responsibility.”

Is the agency really free from liability?

Under Turkish law, the answer is not necessarily.

Turkey substantially reorganized its international medical tourism framework through the Regulation on International Health Tourism and Tourist Health, published in the Official Gazette on 26 April 2025. The Regulation expressly governs both healthcare facilities and intermediary organizations and requires intermediary organizations to obtain authorization, satisfy specific service standards, provide transparent information and assume responsibility according to the type of services they provide.

Accordingly, the traditional defence that:

“We only introduced the patient to the hospital”

may not be sufficient where the agency did considerably more than make a simple introduction.

The real legal question is:

What exactly did the intermediary undertake toward the patient, and did its conduct contribute to the patient’s financial or physical loss?

1. What Is a Health Tourism Intermediary Organization?

The 2025 Regulation defines an intermediary organization broadly.

It is an organization operated by an authorized legal entity that provides consultancy to an international health tourist and accompanying persons and organizes services such as:

• healthcare facility arrangements,
• accommodation,
• transportation,
• transfers,
• and other health-tourism-related services.

An intermediary is therefore not merely an advertising company.

It forms part of the regulated international health tourism system.

This distinction is extremely important in compensation disputes.

A company cannot necessarily avoid legal responsibility simply because its commercial title contains words such as:

• tourism,
• consultancy,
• medical travel,
• patient coordination,
• international patient services,
• healthcare consultancy.

Courts will examine the actual function performed, not only the name used by the company.

2. Health Tourism Agencies Must Be Authorized

Under Article 5 of the 2025 Regulation, both healthcare facilities and intermediary organizations must obtain an International Health Tourism Authorization Certificate before conducting regulated international health tourism activities.

Authorization for intermediary organizations is issued through USHAŞ — International Health Services Inc. following the regulatory application and inspection procedure.

This means that a foreign patient should first ask:

Was the company legally authorized to operate as an international health tourism intermediary?

If the answer is no, that fact may become highly relevant in:

• administrative proceedings,
• consumer disputes,
• contractual liability claims,
• misrepresentation claims,
• and potentially other legal proceedings depending on the circumstances.

The authorization status of the intermediary should therefore be checked at the beginning of any medical tourism dispute.

3. The Intermediary Is Not a Hospital — and It Must Say So

A particularly important rule was introduced through the current Regulation on Promotion and Information Activities in Health Services, published on 12 November 2025.

The Regulation expressly states that an international health tourism intermediary may advertise only within the boundaries of intermediary services and must not create the impression that it is itself providing healthcare or operating as a healthcare facility.

Where it promotes healthcare offered through a facility with which it has a protocol, the intermediary must make clear that:

• the medical service is provided by the relevant healthcare facility, and
• the intermediary itself is not a healthcare facility.

This rule has significant consequences in liability cases.

If an agency’s website states:

“We perform the safest rhinoplasty procedures in Istanbul”

rather than:

“We arrange treatment provided by Hospital X and its physicians,”

the wording may become evidence that the agency represented itself as more than a neutral intermediary.

The same applies where the agency controls the entire patient journey under its own brand and keeps the identity of the actual hospital or physician unclear until shortly before treatment.

4. The Starting Point: Liability Depends on the Type of Service Provided

Article 6(3) of the 2025 International Health Tourism Regulation contains one of the most important provisions for patient claims.

It provides that the healthcare facility and intermediary organization are responsible, according to the type of service they provide, for healthcare and intermediary services received by the international health tourist during their stay in Turkey.

The provision further refers to complications and medical malpractice occurring after healthcare services within the responsibility framework.

This does not mean that every intermediary automatically becomes jointly liable for every surgical complication.

Nor does it mean that an agency becomes a doctor merely because it organized the treatment.

Instead, liability requires a factual analysis.

The key issue is:

Was the damage connected to an obligation that the intermediary itself undertook or was legally required to perform?

5. Medical Malpractice and Intermediary Liability Must Be Separated

Assume a surgeon makes a purely technical medical error during surgery.

For example:

• a nerve is negligently damaged,
• the wrong implant is used,
• a surgical instrument causes injury,
• postoperative infection is improperly treated.

The primary medical liability will ordinarily concern:

• the physician,
• the healthcare facility,
• or both,

depending on the legal relationship and the facts.

A genuine intermediary that had no role in medical decision-making does not automatically become responsible merely because it introduced the patient.

However, the analysis changes if the intermediary itself contributed to the harm.

For example:

• it knowingly referred the patient to an unauthorized facility;
• it falsely represented a doctor’s qualifications;
• it concealed material information about the healthcare provider;
• it guaranteed a medical result;
• it altered or inaccurately transmitted medical information;
• it pressured the patient to undergo a procedure despite known contraindications;
• it failed to provide promised post-treatment coordination after a serious complication.

In these situations, the claim against the intermediary is based not simply on the surgeon’s negligence but on the intermediary’s own breach of duty.

6. “We Are Only an Intermediary” Is Not a Complete Defence

Many medical tourism contracts contain clauses such as:

“The company bears no responsibility whatsoever for the treatment, doctor, hospital, complications or results.”

Such wording should never be treated as automatically decisive.

Under Article 112 of the Turkish Code of Obligations, where an obligation is not performed or is improperly performed, the debtor must compensate the resulting loss unless it proves that no fault can be attributed to it.

Accordingly, an intermediary cannot normally escape responsibility for obligations that it personally assumed merely by inserting the word “intermediary” into its contract.

Suppose the company expressly undertook to:

• arrange an English-speaking interpreter,
• provide airport transportation,
• organize postoperative accommodation,
• schedule follow-up appointments,
• arrange emergency communication,
• provide specific accommodation conditions.

If those obligations are improperly performed and damage results, contractual liability may arise independently of any medical malpractice claim.

7. Liability for Employees and Other Persons Used to Perform the Contract

Medical tourism companies rarely provide every service personally.

They may use:

• drivers,
• translators,
• call centres,
• coordinators,
• hotel providers,
• customer-support personnel.

Under Article 116 of the Turkish Code of Obligations, a debtor that entrusts performance of an obligation to auxiliary persons may be liable for damage caused while those persons are performing the contractual obligation.

This can be practically important.

An intermediary should not necessarily be able to say:

“The driver was outsourced, therefore we are not responsible.”

If safe transportation was part of the intermediary’s contractual obligation and the person was being used to perform that obligation, the relationship must be examined under the rules governing auxiliary persons.

8. Transportation and Accommodation Services Are Specifically Regulated

The 2025 Regulation provides that accommodation, transportation and transfer services must be performed through travel agencies authorized under Law No. 1618 on Travel Agencies and the Association of Turkish Travel Agencies, unless the intermediary itself possesses the necessary travel-agency authorization.

This creates a practical compliance duty.

For example, if an intermediary promises postoperative hotel accommodation and transfers but uses an unauthorized operator, the regulatory violation may become relevant when evaluating whether the intermediary properly performed its obligations.

This becomes particularly important after operations where patients have limited mobility and require safe postoperative transportation.

9. The Intermediary Must Provide 24/7 Communication Capacity

Under the 2025 Regulation, an intermediary must maintain infrastructure capable of responding to calls in at least two foreign languages on a 24/7 basis, or contract with a call centre capable of providing that service.

This requirement may become highly relevant in postoperative disputes.

Consider the following situation:

A patient undergoes bariatric surgery and is discharged to a hotel.

At 2 a.m., the patient develops:

• severe abdominal pain,
• fever,
• vomiting,
• bleeding,
• breathing difficulty.

The intermediary previously promised 24-hour assistance but cannot be contacted for twelve hours.

If the delay aggravates the patient’s condition, the question is no longer simply whether the original operation was negligent.

There may also be an independent claim concerning failure of postoperative coordination and communication.

10. Misrepresentation About the Doctor Can Create Liability

One of the strongest potential claims against an intermediary arises where it misrepresents the healthcare professional.

Examples include statements such as:

• “He is the best plastic surgeon in Europe.”
• “He has performed 20,000 successful procedures.”
• “He is a professor,” when he is not.
• “This clinic is internationally accredited,” when it is not.
• “The surgeon personally performs every procedure,” when substantial parts are performed by others.

Such representations may affect the patient’s decision to travel to Turkey and enter into the transaction.

Under the Consumer Protection Law, a service may be defective where it does not possess characteristics promised by the provider or represented in advertisements, websites or announcements and therefore fails to deliver the benefit reasonably expected by the consumer.

Consequently, screenshots of advertising material can become extremely important evidence.

11. Guaranteed Results Are Particularly Dangerous

A health tourism intermediary should be extremely cautious about language such as:

“100% successful hair transplant.”

“Guaranteed perfect smile.”

“No complications.”

“You will definitely lose 40 kilograms.”

“Your nose will look exactly like this simulation.”

Medical treatment inherently involves biological uncertainty.

The current health-services advertising framework prohibits advertising exceeding permissible informational activity and regulates international health tourism promotions separately. Intermediaries must remain within their intermediary role and cannot create the impression that they themselves provide healthcare.

From a civil liability perspective, an absolute guarantee may also become evidence concerning the expectations created when the contract was formed.

12. Before-and-After Photographs Can Become Evidence

A patient may have selected the treatment because the intermediary displayed dramatic before-and-after photographs.

In litigation, important questions may include:

• Was the patient in the photograph real?
• Was the procedure actually performed by the advertised doctor?
• Was the image digitally altered?
• Were different lighting, angles or filters used?
• Did the agency imply that the patient would achieve the same result?

The regulatory rules on advertising and visual content can therefore overlap directly with civil liability.

An advertising violation does not automatically prove malpractice.

But misleading promotional content may help establish that the patient entered the transaction based on inaccurate representations.

13. The Agency Must Disclose Its Own Charges

Article 12 of the 2025 International Health Tourism Regulation requires transparency concerning charges.

The healthcare facility must issue the required invoice or sales receipt together with an itemized breakdown of healthcare services and unit prices.

Separately, the intermediary must provide a detailed breakdown of charges requested for services such as:

• accommodation,
• transportation,
• transfer,
• interpretation,
• consultancy.

This distinction can be extremely important in refund disputes.

A medical tourist who pays EUR 15,000 to a single intermediary bank account should ask:

How much was the hospital fee?

How much was the doctor’s fee?

How much was the intermediary commission?

How much was accommodation?

How much was transportation?

A company should not simply hide every component inside a single unexplained “medical tourism package.”

14. Who Received the Patient’s Money Matters

Payment structure is one of the most useful indicators of the intermediary’s actual commercial role.

If the patient paid:

EUR 8,000 directly to the hospital

and

EUR 500 separately to the intermediary for transfers and translation,

the separation between medical and intermediary services is relatively clear.

Compare this with a situation where the patient pays:

EUR 15,000 entirely to the intermediary, which then privately distributes money between the hospital, surgeon, hotel and itself.

This does not automatically establish liability for the medical treatment.

However, it may strengthen the argument that the patient purchased a single integrated package from the intermediary.

Therefore, lawyers should always obtain:

• bank-transfer records,
• credit-card statements,
• receipts,
• invoices,
• WhatsApp payment instructions.

15. Package Presentation Can Change the Liability Analysis

The way a service is sold may be as important as the written contract.

Suppose an agency advertises:

“All-Inclusive Rhinoplasty Package — €4,900”

including:

• surgery,
• hospital,
• surgeon,
• anesthesia,
• medication,
• seven hotel nights,
• VIP transfers,
• translator,
• postoperative support.

A reasonable patient may perceive the agency as the entity supplying the overall package.

If, after a dispute arises, the agency argues that it was responsible only for airport transportation, the court may compare that defence with:

• the advertisement,
• contractual documents,
• payment flow,
• WhatsApp communications,
• website wording,
• invoices.

The legal relationship is determined by the substance of the transaction, not merely by a disclaimer printed at the end of the contract.

16. Consumer Protection Law May Apply to the Intermediary Relationship

A patient obtaining medical tourism services for personal purposes will generally act outside any commercial or professional activity.

The intermediary, by contrast, acts commercially.

This means that the relationship can potentially constitute a consumer transaction under Law No. 6502 on Consumer Protection, subject also to the applicable-law analysis in international cases.

The Act defines a provider broadly as a person acting commercially or professionally who supplies services or acts on behalf or account of the service supplier.

If the intermediary’s services are defective, the consumer may, depending on the circumstances, seek remedies including:

• performance of the service again,
• reduction of the price,
• termination of the contract,
• refund,
• and compensation under the Turkish Code of Obligations.

Article 15 expressly preserves the right to claim damages in addition to consumer remedies.

17. An Intermediary May Be Liable Even Where the Surgery Was Medically Correct

Not every health tourism dispute involves malpractice.

Imagine that the operation is entirely successful, but:

• the promised five-star hotel is replaced by poor accommodation;
• airport transfer never arrives;
• translation is unavailable;
• the patient pays fees that were supposed to be included;
• the intermediary refuses to provide promised postoperative assistance;
• the patient is charged twice.

The hospital may have committed no medical error whatsoever.

Yet the intermediary may still have breached its own contract.

This distinction is important because the evidentiary burden in such cases may be substantially simpler than proving medical negligence through expert evidence.

18. Can the Intermediary Be Liable for Selecting the Wrong Hospital?

Potentially.

An intermediary markets itself partly on its ability to organize an appropriate healthcare facility.

If the agency knowingly or negligently directs the patient to:

• an unauthorized healthcare facility,
• a facility not authorized for the relevant procedure,
• a physician lacking the represented qualifications,
• an institution with which it had no lawful arrangement,

its own selection and information duties may become central to the claim.

This is particularly strong where the patient did not independently choose the hospital but instead told the intermediary:

“I need a qualified hospital for this procedure; please choose the right one for me.”

The greater the decision-making role assumed by the intermediary, the harder it may be to characterize its function as a neutral introduction.

19. Can an Intermediary Give Medical Advice?

An intermediary is not a healthcare facility.

The 12 November 2025 promotion rules specifically require intermediaries to remain within the boundaries of intermediary activities and prohibit them from presenting themselves as healthcare providers.

This has an important practical consequence.

Statements such as:

“Send me your photos and I will decide which operation you need.”

or:

“You do not need to see a doctor; you are definitely suitable for gastric surgery.”

can create significant legal risk where made by non-medical intermediary personnel.

Administrative coordination and medical diagnosis must not be confused.

The clinical decision must be made by appropriately authorized healthcare professionals.

20. What If the Agency Incorrectly Translates Medical Information?

Interpretation services are expressly recognized among intermediary activities.

This can create an important liability issue.

Suppose a patient tells the interpreter:

“I am allergic to penicillin.”

The interpreter incorrectly tells the medical team:

“The patient has no allergies.”

A drug is administered and serious injury results.

The medical malpractice investigation will naturally examine the healthcare professionals’ own duties.

But the intermediary’s interpretation service may also have causally contributed to the loss.

Similar problems can occur when the intermediary mistranslates:

• informed consent,
• risks,
• medical history,
• medication instructions,
• postoperative warning signs.

Translation in medical tourism is therefore not merely a hospitality service.

It can have direct patient-safety consequences.

21. Postoperative Abandonment Is a Major Risk Area

One of the most common practical complaints from medical tourists is:

“Before payment, they answered every message. After the operation, nobody responded.”

This fact alone does not establish liability.

However, where the intermediary contract included:

• postoperative coordination,
• communication with the doctor,
• arranging control examinations,
• emergency assistance,
• return-transfer organization,

the company must be evaluated according to the obligations actually undertaken.

If failure to provide that service causes additional injury or expense, compensation may be claimed subject to proof of causation.

22. Complications Are Not Automatically Malpractice

Patients should also distinguish a medical complication from negligent treatment.

An undesirable outcome may occur despite proper medical care.

For example:

• infection,
• bleeding,
• scarring,
• asymmetry,
• implant rejection,
• delayed healing

can, depending on the procedure, occur without negligence.

Therefore, neither the hospital nor intermediary automatically owes compensation simply because the result was undesirable.

A medical expert analysis is usually required to determine whether:

• the complication was a recognized risk,
• the patient was properly informed,
• the complication was detected in time,
• appropriate treatment was provided,
• negligent delay increased the damage.

The intermediary’s liability must then be separately connected to its own role.

23. What About Complication Insurance?

The 2025 Regulation requires healthcare facilities to obtain complication insurance for surgical and interventional procedures performed within an operating-room setting in international health tourism.

This requirement is imposed on the healthcare facility.

Patients and their lawyers should therefore investigate:

• whether the required insurance existed,
• which procedure was insured,
• policy coverage,
• exclusions,
• notification requirements.

Insurance may provide an additional recovery route, but it does not necessarily eliminate direct claims against responsible parties.

24. Personal Health Data Creates a Separate Area of Liability

Health tourism intermediaries regularly process highly sensitive information:

• passport copies,
• photographs,
• diagnoses,
• medical reports,
• laboratory results,
• medications,
• surgical histories.

Health information constitutes special-category personal data under Turkish personal-data legislation and requires heightened protection.

An intermediary should therefore carefully determine:

• its lawful basis for processing,
• whether data is transferred to hospitals,
• whether data is transferred abroad,
• retention periods,
• security measures,
• access rights.

The Turkish Personal Data Protection Board has repeatedly emphasized the particularly sensitive character of healthcare information and the need for appropriate technical and organizational safeguards.

An unauthorized disclosure of a patient’s cosmetic surgery or medical condition can therefore create a separate dispute independent of the treatment itself.

25. Using the Patient’s Photographs for Advertising Can Create Additional Liability

A patient may provide photographs for medical evaluation.

That does not automatically mean the intermediary can later post those photographs on:

• Instagram,
• TikTok,
• its website,
• advertisements.

The Data Protection Board has emphasized that health-related images and information used for advertising involve sensitive personal-data issues and that purported consent does not automatically legalize otherwise unlawful processing or advertising practices.

For this reason, consent for:

medical evaluation

should not automatically be interpreted as consent for:

commercial advertising.

26. The Advertising Rules Became Stricter in November 2025

As of 12 November 2025, the current Regulation on Promotion and Information Activities in Health Services expressly covers international health tourism intermediary organizations.

Among other rules, intermediaries must:

• publish their health tourism authorization,
• avoid creating the impression that they are healthcare facilities,
• identify the actual healthcare facility providing the medical service,
• keep their promotional activity within their intermediary role,
• avoid generating demand among persons residing in Turkey through international health-tourism advertising.

These rules are highly relevant in litigation because the intermediary’s website may show what the company represented to the patient before the contract was signed.

27. Administrative Liability Is Separate From Compensation

The 2025 International Health Tourism Regulation provides for regulatory inspection of intermediary organizations.

Violations can result in administrative sanctions, including:

• suspension of authorization,
• and, in specified circumstances, cancellation of the authorization certificate.

Improper record keeping may result in suspension, and repeated violations can lead to cancellation.

However:

administrative liability and civil compensation are different issues.

A regulatory authority may sanction the intermediary while the patient separately pursues compensation.

Likewise, the absence of an administrative sanction does not necessarily prove that the intermediary has no civil liability.

28. Can a Foreign Patient File a Case in Turkey?

Often, yes, but international jurisdiction and applicable law must be analysed carefully.

A health-tourism dispute inherently contains a foreign element because the patient typically resides abroad.

Turkish Private International Law contains specific rules governing:

• applicable law,
• consumer contracts,
• international jurisdiction.

Article 26 of Law No. 5718 contains special conflict-of-laws rules for consumer contracts, while also excluding certain contracts where the service must necessarily be provided outside the consumer’s habitual residence, except package tours.

Consequently, lawyers should not automatically assume that every foreign patient’s dispute is governed by the law of their home country or, conversely, that Turkish law automatically governs every contractual issue.

The particular contract and service package must be examined.

29. Choice-of-Law Clauses Should Be Examined Carefully

An intermediary agreement may state:

“This contract is governed exclusively by Turkish law.”

Another may attempt to apply:

• English law,
• German law,
• Dutch law,
• another jurisdiction.

The validity and effect of such clauses must be examined under Turkish private international law.

Where the relationship falls within Article 26 of Law No. 5718, the consumer’s mandatory minimum protection under the law of the habitual residence may, subject to the statutory conditions and exceptions, remain relevant even where the parties have chosen another law.

International medical tourism contracts therefore require more sophisticated analysis than ordinary domestic healthcare disputes.

30. Consumer Court or Consumer Arbitration Committee?

Where Turkish consumer law and jurisdiction apply, procedural routes may include consumer dispute mechanisms.

For 2026, disputes below TRY 186,000 fall within the monetary jurisdiction threshold announced for Consumer Arbitration Committees.

For claims requiring proceedings before the Consumer Court, mandatory mediation generally applies before litigation, subject to statutory exceptions.

However, international medical tourism cases frequently involve:

• bodily injury,
• moral damages,
• large treatment payments,
• multiple defendants,
• foreign elements.

The correct court and procedural route should therefore be determined after analysing the precise claims against each defendant.

31. Should the Hospital and Agency Be Sued Together?

Sometimes this is the most efficient strategy.

Assume:

• the hospital performed negligent surgery,
• the intermediary made false representations,
• and postoperative assistance was improperly managed.

The patient may have legally distinct claims against different parties.

The hospital may be responsible for the medical treatment.

The intermediary may be responsible for:

• misinformation,
• improper organization,
• contractual breaches,
• translation failures,
• payment irregularities.

Whether liability is joint, several or allocated separately depends on:

• the contractual structure,
• causation,
• individual fault,
• the relationship between the defendants.

A lawsuit should not simply state:

“Everyone involved is responsible.”

The better approach is to identify which defendant breached which duty.

32. Evidence Is Often Hidden in WhatsApp Conversations

Health tourism transactions are unusually dependent on WhatsApp.

Patients may never sign a sophisticated written agreement.

Instead, the entire transaction is established through messages such as:

“The doctor guarantees your result.”

“You don’t need any further tests.”

“Everything is included for €6,000.”

“Our clinic will perform your surgery.”

“If anything goes wrong, we will fix it free of charge.”

These messages can become highly relevant evidence.

Patients should therefore preserve the complete conversation rather than only selected screenshots.

Exported chat histories, attached photographs, voice messages and payment instructions may reveal who actually undertook each obligation.

33. Evidence the Patient Should Collect Immediately

A patient considering a claim should preserve:

• the intermediary agreement,
• hospital contract,
• treatment proposal,
• quotations,
• invoices,
• intermediary fee breakdown,
• bank-transfer receipts,
• credit-card statements,
• WhatsApp messages,
• e-mails,
• voice messages,
• advertisements,
• website screenshots,
• doctor biographies,
• Instagram posts,
• before-and-after images,
• flight and hotel records,
• medical reports,
• consent forms,
• postoperative communications,
• photographs of injuries or unsuccessful results,
• additional treatment invoices.

The patient’s lawyer should also identify the exact Turkish legal entity operating the intermediary business.

The Instagram brand name may not be the defendant’s legal corporate name.

34. Ask Who Signed the Contract With the Hospital

Another critical document is the relationship between the intermediary and healthcare facility.

The current advertising framework specifically contemplates intermediary organizations promoting healthcare provided by facilities with which they have a protocol.

In litigation, it may therefore be important to determine:

• whether a valid protocol existed,
• what services the intermediary undertook,
• who was responsible for patient communication,
• who collected money,
• whether responsibility for complications was addressed,
• who arranged translation,
• who managed complaints.

Even if the patient does not possess this agreement, its production may potentially be sought during proceedings where legally relevant.

35. A Practical Example: Failed Hair Transplant

Consider a British patient who contacts a Turkish medical tourism company after seeing an advertisement.

The agency states:

“Our doctors perform more than 5,000 grafts with guaranteed density.”

The patient pays the entire package price to the agency.

After arriving in Istanbul, the patient learns that the procedure will be performed mainly by technicians rather than the advertised physician.

The result is severe donor-area damage.

Potential claims may involve:

Against the Healthcare Facility

• improper medical treatment,
• inadequate informed consent,
• improper delegation,
• malpractice.

Against the Intermediary

Depending on the evidence:

• false representation concerning the physician,
• misleading guarantee,
• defective intermediary service,
• misrepresentation concerning who would perform the procedure,
• improper package presentation.

The intermediary’s liability would therefore arise from its own conduct, even though the physical medical procedure occurred inside the healthcare facility.

36. Another Example: Cosmetic Surgery Followed by Complication

A patient from Germany undergoes abdominoplasty.

Three days later, she develops fever and severe pain.

The intermediary promised:

“24/7 English postoperative support.”

The patient repeatedly contacts the coordinator.

No response is received for fourteen hours.

The patient is eventually taken to another hospital and diagnosed with a serious infection.

The litigation should distinguish between:

the original medical treatment

and

the delayed response after the complication developed.

Even if the initial surgery was performed according to medical standards, a separate causal inquiry may be necessary regarding whether the intermediary’s failure to provide promised communication and coordination aggravated the injury.

37. What Damages Can Potentially Be Claimed?

Depending on the legal basis and evidence, a patient may seek compensation for items such as:

• refund of intermediary fees,
• refund or reduction of package costs,
• unnecessary accommodation expenses,
• transportation expenses,
• additional hospital costs,
• corrective treatment costs,
• medication,
• additional travel costs,
• loss of earnings,
• other consequential financial losses.

Where bodily integrity has been harmed, claims for pecuniary and non-pecuniary damages may also arise under the applicable liability framework.

Every claimed item must nevertheless be connected to the defendant’s legally relevant conduct.

38. What the Intermediary Cannot Safely Do

From a compliance perspective, an intermediary should avoid operating as if it were the treating clinic.

Particularly risky practices include:

• diagnosing patients through sales personnel,
• guaranteeing medical results,
• concealing the identity of the hospital,
• misrepresenting doctors’ qualifications,
• referring patients to unauthorized facilities,
• collecting unexplained medical payments,
• failing to itemize intermediary charges,
• using patient medical data for unrelated advertising,
• providing misleading before-and-after images,
• failing to provide promised postoperative support.

The legal risk increases when several of these practices appear together.

39. A Practical Liability Test

When evaluating whether an intermediary may be liable, a lawyer should ask seven questions.

1. What did the intermediary promise?

Examine the contract, advertisements and messages.

2. What did the intermediary actually do?

Was it merely an introducer or did it control the entire package?

3. Who selected the hospital and physician?

Was the patient’s decision independent?

4. Who received the money?

Was payment separated between medical and intermediary services?

5. Was any information misleading?

Check credentials, success claims, accreditation and guarantees.

6. Which specific failure caused the loss?

Medical negligence and intermediary negligence must be separated.

7. What would have happened if the intermediary had properly performed its obligations?

This is crucial for establishing causation.

40. Final Assessment: A Medical Tourism Agency Is Not Automatically Protected by the Word “Intermediary”

The modern Turkish health tourism system regulates intermediary organizations as active participants in the international patient journey.

The 26 April 2025 Regulation requires authorization and imposes specific obligations regarding service standards, communication, transportation, records, pricing transparency, complaints and responsibility.

The 12 November 2025 advertising rules go even further by requiring an intermediary to distinguish itself clearly from the healthcare facility and remain within the boundaries of intermediary services.

Therefore, a patient who suffers damage should not accept the statement:

“We are just an agency, so you cannot claim anything from us.”

The correct analysis is more precise.

If the injury was caused exclusively by a surgeon’s medical error, primary responsibility will generally rest in the medical sphere.

But where the intermediary:

• misrepresented the doctor or hospital,
• guaranteed a medical result,
• arranged treatment through an unsuitable or unauthorized provider,
• incorrectly transmitted medical information,
• failed to provide translation,
• failed to perform promised postoperative coordination,
• breached transportation or accommodation duties,
• concealed charges,
• or otherwise improperly performed its own obligations,

the intermediary may face independent civil and consumer liability.

In some cases, claims against the healthcare facility and intermediary may need to be pursued together.

The strongest health-tourism case is therefore not based on the broad allegation:

“The operation failed, so the agency must pay.”

It is built by reconstructing the complete patient journey:

Who advertised the treatment? Who made the promises? Who selected the hospital? Who collected the money? Who provided the information? Who undertook postoperative support? And which failure actually caused the patient’s loss?

Once those questions are answered, the label “intermediary” becomes far less important than the company’s actual role in the transaction.