“We were already having the worst time,” her daughter Cat, 34, who is a lawyer, told the BBC. “Mum may not survive this, we just don’t know. And then to have to deal with all this.”

Mrs Rubens was on holiday visiting family in Missouri when she was hit by an SUV in St Louis on 1 November. She sustained severe brain injuries and multiple haemorrhages.

Since then she has been a patient at St Louis University Hospital, where she has undergone five different operations including a cranioplasty where part of her skull was removed. The most recent surgery was on Thursday.

Prior to travelling, her family say, the 73-year-old from Edinburgh took out a travel insurance policy with AXA Partners, which covered medical expenses for up to £15m ($19m).

On Friday the insurance company contacted her two children Cat and Andrew, who are by her bedside, to say they intended to require her repatriation to the Royal Infirmary in Edinburgh this week.

On Saturday, the family sent a letter to AXA Partners outlining the medical advice they had received, not just from her doctors in Missouri but also from NHS specialists to whom they had spoken, as well as the brain injuries charity Headway. All agreed that from a neurological stand-point, she needed several more weeks in the United States.

On Sunday, the family say, they woke up to an email from the insurers saying that “based on all the medical information which has been provided, it has been confirmed that your mother, Jane Rubens, is Fit to Fly via an Air Ambulance, with appropriate medical escorts with immediate effect. We have availability to proceed with the repatriation on 25/11/2024. If you do not accept our decisions and do not want to be repatriated, then we will not provide any cover.”

When Cat Rubens made a call to the insurers later that day she says she was told:

“Getting from St Louis to Edinburgh is a long way,” said Cat. “But they couldn’t provide any details – how many stops would there be, what level of sedation would she receive. Nothing.”

Following the call, one of the doctors in St Louis caring for Mrs Rubens also called AXA Partners. He got no further and was not even given the name of a clinician in Edinburgh he could talk to about his patient.