Caymanians dying for their own cardiac cath lab

Dr Frank Pallares,
Cardiologist


Cardiologist Dr Frank Pallares checks
Joni Ebanks’ heart.

Wednesday,  April 27, 2005

There is no doubt that heart disease is the number one killer in the country. But many people could survive and enjoy healthier lives if there was a cardiac catheterisation lab on the Island instead of being sent overseas, according to leading cardiologist, Dr Frank Pallares. 

“This country has the same demographics as the US, the same diabetes, same smokers, same obesity, etc.” said Dr Pallares. “You are more likely to die of heart disease than a stroke, lung cancer, breast cancer and Aids put together. Sudden cardiac arrest claims more lives each year than all of these other diseases combined.”

Dr Pallares is the consulting cardiologist at Chrissie Tomlinson Memorial Hospital, who attends patients here in the Cayman Islands for around ten days each month. His home is here in Cayman but he also works in the United States at a number of leading cardiac centres.

“We have unbelievable technology to keep people healthy and keep them out of the hospital. I was flabbergasted when I found out there was no cardiac cath lab in this country. This is not some third-world country. This is a sophisticated country with a strong financial centre and tourist industry,” said Dr Pallares in an interview with Cayman Net News.

A cardiac cath lab is the standard of care for acute heart attack. With a heart attack the patient needs to be taken to a cardiac cath lab immediately, preferably within three hours.

“Not having a cardiac cath lab for a cardiologist is like a mechanic without a garage,” said Dr Pallares using an example to explain the medical process.

“Let’s say you are a 55 year-old Caymanian attorney. And you wake up in the middle of the night and it feels like you have an elephant sitting on your chest and your wife calls an ambulance and they send you to George Town Hospital. And they find out you are having a heart attack and they call a cardiologist.”

Dr Pallares explained the heart and arteries are like an engine with fuel lines. Over time, the fuel lines get filled with garbage and block the fuel from getting to the heart. Stopping the fuel to the engine is dangerous and it is critical to get the blockage cleared to get the fuel flowing again. He further stated that with a cardiac cath lab, it is a quick and simple procedure most of the time to unblock the arteries. But time is of the essence. 

He explained that to have the best chance of living and prevent heart damage, the patient should ideally be in a cardiac cath lab within three hours from the beginning of symptoms. “With a cardiac cath lab, a cardiologist has the potential to often times open up the fuel line quickly and this restoration of the blood flow can be a life saver. In most cases patients return home in 24 to 48 hours, many times to full activity. 

‘But in reality, in Grand Cayman, the patient is given medication to help clear the blockage. This may or may not unblock the artery, and sometimes can cause severe complications such as a brain haemorrhage,” said Dr Pallares.

“These patients are sent to Miami, and by the time they reach the cath lab in Miami, the damage is most likely already done. Further intervention in an artery that is going to a dead muscle is often times not worth doing. This is assuming that the fuel line in question was not a big one, which in itself can cause death.

“If it doesn’t kill you it causes significant muscle damage to the point that the patient will always be short of breath or suffer from malignant (deadly) electrical problems.

“Sometimes the medication works, sometimes it opens it up a trickle and sometimes the muscle is not completely dead. If it doesn’t work i.e., if the fuel line is not opened then muscle damage occurs, and, if you survive, your heart is probably damaged.”

Dr Pallares explained that in the US, the cardiology departments are the moneymakers for the hospital, because so many people have heart disease and cardiac cath labs are very efficient in treating heart disease. 

Furthermore, a cardiac cath lab is surprisingly affordable if the hospitals are willing to buy refurbished single plane equipment. 

“You can get a top of the line refurbished cardiac cath lab for US$200,000 to $500,000. Or you can get a cath lab for nothing. You can possibly make a deal with an institution in the US whereby they would supply the equipment and the training and the hospital in turn would refer to them the surgical patients.”

Dr Pallares stated that George Town Hospital is the best place for a cardiac cath lab because they have the best infrastructure.

“This Island is ideal for a cardiac cath lab, because anywhere you are in Grand Cayman you are only an hour away from the hospital. You could be in East End and have traffic and still get to the hospital within the hour.

“George Town Hospital already has an Intensive Care Unit and excellent nurses. They just need a little bit of training for cardiac care. And the cost of the catheters and the IVs is minimal.”

Cayman Net News contacted the Health Services Authority (HSA) about plans to bring in a cardiac cath lab. By press time, there was no response from Shirline Henriques, Acting Chief Executive Officer, Dr Courtney Cummings, Medical Director, Stephen Scott, HSA Chairman and the Minister of Health Services, Hon Gilbert McLean.

Furthermore, Cayman Net News has learned that cardiologist Dr Neeraj Prasad wrote to HSA administration over twelve months ago stating that a cardiac cath lab was necessary on 23 April 2004. 

He further outlined three options for how to pay for it including a proposal by Northern Health Care to bear the cost of the equipment and training of the staff at HSA. It is not known if management planned to bring in a cardiac cath lab, but twelve months later, there is still no cardiac cath lab in the country.

Dr Pallares explained that the country could easily attract the best physicians in the world at an affordable cost. 

“This country could be the pearl of the Caribbean. It is a lovely place and doctors who are the top of their specialty, the crème de la crème, would love to retire here and still work a little bit. But they need the basic tools to come here,” explained Dr Pallares.

“You can afford to have your dermatologist, your gynaecologist, even your psychiatrist in Miami, but you cannot afford to have your cardiologist in Miami. You need a cardiologist here who can open up arteries here and for that you need a cardiac cath lab.

“Every major hospital in the US has a cardiac cath lab, because it is the standard of care. 

“Here, people are dying because we don’t have a cardiac cath lab.”

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