The message was dire as local doctors and municipal politicians gathered in Nanaimo for the official launch of the Fair Care Alliance’s campaign calling for a catheterization lab and a new patient tower at Nanaimo Regional General Hospital.
At a press conference Wednesday, May 29, at a private medical clinic, doctors spoke to the extent of how badly equipped NRGH is for care, and how this is resulting in fully preventable deaths every year as well as skilled cardiologists choosing to leave the community.
Dr. Niels Schwarz is a consultant in internal medicine with a specialization in heart health, and was medical lead at NRGH in 2006-07 and 2009-10.
“If you’re living in this area, central Island or north Island, the best time to have a heart attack is actually if you’re visiting Victoria,” he warned. “That’s when you get the standard of care, that’s when you’re going to go to the cath lab. Otherwise you’re like everybody else, you’re going to get inferior treatment.”
Since 2003, he said, the standard for treating a heart attack is a percutaneous coronary intervention, which uses minimally invasive procedures to open up blood flow to the heart. In practice, the patient goes directly to a catheterization lab to identify a blocked artery. Once the artery is found, it can be pumped using a balloon angioplasty then stents can be surgically placed.
The less effective treatment is thrombolytics, also known as clot buster – and it’s the only treatment Nanaimo hospital is equipped to provide. The strong blood thinner isn’t always effective, said Schwarz, and can have lethal side effects including brain hemorrhaging. In addition, patients will still likely need stents.
“Why do patients in Victoria then get exclusive access to PCI while the majority of us on the Island receive the less effective and riskier clot buster that was first developed in the 1970s?” he asked.
The doctor didn’t have specific data, but estimated that at least 12 patients per year at NRGH die from heart attack-related causes that would be preventable with access to modern medical technology.
“So we’re talking about three deaths per hundred cases and we have around 500 … major heart attacks a year, not all of them are in central Island, some of them on north Island,” he said. “We can extrapolate to several bleeds, five to six inter-cerebral bleeds, at least 12 to 20 cases of serious heart failure with the long-term outcome still being death, but we don’t have good data for many years out.”
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Dr. Jodie Turner experienced the hospital’s shortcomings first-hand both through her time working at NRGH as an emergency physician, and also as a patient needing life-saving care elsewhere. While having a medical emergency during a trip in rural southern Thailand, Turner caught a look at the heart attack flow sheet. It showed that the remote hospital was equipped to provide the very treatment that NRGH isn’t.
“[They] have access to a simple procedure available for patients in that community, but not ours, that would save their life and change their outcome,” Turner said.
She told a story from one of her shifts a few years ago when a patient came in suffering from a heart attack.
“Next to me was a cardiologist who trained in Cleveland Clinic in the U.S., one of the best cardiac facilities in North America, and he helped me with a difficult decision to give that patient a clot buster, the only medication that we had even though we knew it came with risks, and I did my best to explain this to the family. I carried on with my shift, and later on my colleague… he informed me this patient was dying because they bled in the brain. Which never should have happened,” she said. “I realized, as a physician who had gone into health care to help people and families, I had been the one to give the order for that medication that ended up killing him.”
According to the Fair Care Alliance, Island Health is currently conducting a third feasibility study into a second catheterization lab on the Island, with no timeline committed.
For the campaign, residents are being encouraged to get involved by signing an online petition at http://weneedhealthcare.ca or sharing their own health-care stories. The alliance has also started a public awareness campaign including billboard advertisements and commercials.
Ian Thorpe, chairperson of the Nanaimo Regional Hospital District, attended the press conference and offered support to the professionals and reiterated a commitment to raise the local government’s share of the capital costs for a cath lab and patient tower through hospital taxes.
