Budget-cutting north health bosses jetted off on 38 trips to North America in four years.
Senior managers at NHS Highland billed taxpayers for tens of thousands of pounds for hotels and flights to Orlando, Boston, Seattle, Toronto and Anchorage in Alaska.
The health chiefs went on the trips – 15 of which were taken last year – to learn about “lean leadership” and “quality improvement”, and to “inspect equipment”.
The North America links have been controversial since the board provoked fury in 2012 by sending directors to Seattle for two one-week periods to learn about saving money at the Virginia Mason Medical Centre.
Now, the full scale of the visits to the US and Canada between 2011 and 2015 and further details of the costs have been revealed in response to a freedom of information request by the Press and Journal.
The disclosure shows that a total of 13 NHS Highland staff went on four separate visits to Seattle over the period, while another 11 went on four visits to Florida.
A further eight bosses went on two visits to Toronto in Canada, four travelled to Anchorage in Alaska and two flew to Boston.
The health board could only provide some of the costs of the journeys “on account of these costs not being easily retrievable as hotels and/or flights were booked through an alternative system”.
But the figures provided totalled £16,659 on flights and £15,697.84 for hotels.
NHS Highland defended the visits last night, insisting it was “essential to learn from others” and vowed to “resist the urge to be insular”.
But the revelations emerged amid ongoing controversies over cutbacks to vital services in the north, including the downgrading of maternity provision in Caithness, which has prompted angry demonstrations in Wick and Inverness.
Nicola Sinclair, secretary of campaign group Caithness Health Action Team, said: “Every profession looks for quality improvement and learning from other countries is very important.
“But when they are cutting frontline services and NHS budgets are under massive strain, they maybe need to think about where they are directing their resources.”
In September, a Press and Journal investigation revealed that NHS Highland had racked up an air travel bill of almost £100,000 in 12 months.
A total of 30 foreign flights were booked by the board between July 2015 and June 2016 – with destinations including Florence, Barcelona, Iceland, Gothenburg, Stockholm, Lisbon, Vienna and Amsterdam.
A subsequent freedom of information request has now revealed details of all North American visits since 2011.
Douglas Ross, Conservative MSP for the Highlands and Islands, said: “The huge number of trips in the last financial year would suggest that while budgets are being squeezed, the health board still think it is appropriate to spend more and more of their resources on foreign trips.
“Given the number of complaints I’ve received about NHS Highland since becoming an MSP, I’m worried that the focus seems to be on expensive globetrotting trips rather than focussing on the care of patients.”
An NHS Highland spokeswoman said: “We want to be at the forefront of providing safer, more sustainable and better quality care.
“We believe it essential to learn from others, whether that be within Highland or across the globe.
“Reaching out to other health providers has been very revealing in terms of what we have learned, but also how most regions are grappling with similar challenges.
“We have already implemented a number of initiatives developed from our partnership working in Seattle, North America, western Europe and across the UK.
“These collaborations have already allowed us to implement more sustainable models of care. More of the same simply won’t deliver the services we need for the future.
“We are determined to look outwards and resist the urge to be insular.
“This means investing in our staff to learn from others either by attending conferences and hosting study tours here in Highland.”