Children’s Hospital sues Saudi prince over $3.5m bill for child’s care

A statue at Boston Children's Hospital's rooftop garden.Jessica Rinaldi/Globe Staff/File/Globe Staff

Boston Children’s Hospital has sued a member of the Saudi royal family for $3.5 million, alleging that he broke a promise to pay for the care of a very sick child from his home country.

The lawsuit, filed Tuesday in US District Court in Boston, outlined the repeated entreaties the hospital said it made — including dozens of e-mails and letters over many months — to obtain payment from Prince Abdelilah bin Abdelaziz bin Abdulrahman Al Faisal Al Saud for the child’s treatment with an expensive new drug.

The 2-year-old, who is identified in court documents as “Jane Doe,’’ has been a patient at the hospital since November 2017. She has a rare genetic disease, type 1 spinal muscular atrophy, that causes severe weakness and breathing problems.

The medicine used to treat the condition, Spinraza, is not available in Saudi Arabia, the lawsuit said. The drug can cost $750,000 per patient in the first year alone.

The prince sent an initial $750,000 for the child’s care, the hospital said, but refused to pay anything more, despite repeated assurances from his representatives and the child’s parents that he would do so. The price tag quickly mounted. Children’s said the prince now owes $3.5 million — a tab that is growing daily.

Court documents did not list a lawyer for the prince. Contacted by the Globe, an official at the Embassy of Saudi Arabia in Washington, D.C., said he would look into the allegations but did not immediately respond with a comment.

Children’s declined to comment on the suit.

Along with the prince, the hospital is suing Dr. Hamdy Dawoud, an Egyptian citizen who is the prince’s doctor and representative. Dawoud and staff at Brigham and Women’s Hospital in Boston, where the prince and his brother have received medical care, encouraged Children’s Hospital to admit the child for treatment, the lawsuit said.

The lawsuit shines a light on the popularity of elite Boston teaching hospitals among Middle Eastern royalty, and other international patients with resources to pay out-of-pocket prices.

Children’s treats 2,000 patients annually from overseas, according to its website. It has made a special effort to attract families from Saudi Arabia and other Middle Eastern countries, and the number of international patients is rising — 37 percent in the past four years.

A 2016 analysis predicted that the hospital’s number of international patients would more than double in the decade leading up to 2022. That projected increase was a key reason hospital officials said they needed to undertake a $1 billion expansion project, which is now underway.

The prince learned about the child’s condition through media reports in Saudi Arabia, contacted the patient’s family, and offered to pay for care in the United States, said the lawsuit, filed by the hospital’s attorneys at Ropes & Gray.

Dawoud e-mailed Carol Saul, then manager of international programs at Children’s, on Nov. 13, 2017, to say the prince would pay for the girl’s treatment.

Brigham staff, including Ramy Ibrahim, an international patient coordinator at the time, and Dr. Phillip Camp, a thoracic surgeon, encouraged Children’s to accept the patient, the lawsuit said. Camp, who has since left the Brigham, described himself as the “Prince’s surgeon and family friend,” and told Saul that he helps coordinate the prince’s care. Camp stated that the prince “is entirely serious about paying the cost personally, and has the means,” according to the suit.

But in an interview Wednesday, Camp said he did not encourage Children’s to accept the patient and only discussed the finances after the child was already being treated at the hospital. He said Dawoud initially contacted him for advice when the family was trying to arrange the girl’s transfer to Children’s and he tried to be helpful because he knew him.

For example, the family wanted to drive their infant from the airport in New York City to Boston, but Camp recommended an ambulance, he said.

Brigham spokeswoman Erin McDonough said that “any assurances regarding the Prince’s commitment or capacity to fund the treatment were not made on behalf’’ of the Brigham.

Later that November, Dawoud attempted to wire a $750,000 payment to Children’s but there was a problem with the transfer and instead Ibrahim handed Children’s staff a check, the hospital said in the suit.

The sick child was admitted on Nov. 27, 2017, and that was the last money Children’s said it saw from the prince — even though he has visited the child at the hospital since.

During the following winter and spring, Children’s officials tried to contact Dawoud and the prince numerous times but every time they thought they’d made progress toward receiving payment it would slip away. At one point, the hospital tried to reach Dawoud though the US Embassy in Cairo.

Dawoud replied in May 2018 that the prince planned to visit Boston in the summer and would discuss the financial details of the case then. “Everything will be fine,’’ Dawoud wrote in a WhatsApp message.

After a meeting with Dawoud and Camp from the Brigham in July, Children’s said it developed an itemized bill for the child’s care, but when staff tried to give it to Dawoud and the prince, they had already left Boston. Dawoud said he was having technical problems with his e-mail, so Children’s staff sent him 54 separate e-mails containing various sections of the bill, the lawsuit said.

In another attempt to contact the prince, hospital Chief Executive Sandra Fenwick wrote to the patient’s parents on Dec. 14, 2018, and asked them to forward a letter to him. The letter asked the prince to meet with Fenwick the next time that he visited Boston to discuss the “immediate and long-term care plan for [the patient] who came to us under your sponsorship.”

That meeting apparently never materialized and the lawsuit followed.

As of Tuesday, the patient continued to receive inpatient care at Children’s, even though acute inpatient care is no longer necessary, doctors believe. They discussed transferring the patient to Franciscan Children’s Hospital in Boston for rehabilitation.

“Although a transfer or discharge to assisted home care is warranted, it is highly unlikely that a rehabilitation facility or home care company will accept this patient without assurance of payment,’’ the lawsuit said.

Children’s “has continued to care for this patient at great expense and burden to [the hospital],’’ court documents read. Children’s “seeks immediate payment of all unpaid bills with interest to allow it to continue serving Jane Doe and the other patients in its care.’’