For several years there has been an ongoing debate surrounding the issue of a steady cardiology service here on the Cayman Islands. This topic has also brought to light a number of related concerns including the need for a Cardiac Catheterisation Laboratory and an air ambulance service for the Islands.


Haphazard history of Cardiologists

Since around 2003, the country has witnessed the sometimes abrupt exit of several cardiologists. In 2003 it was Dr Neeraj Prasad; in 2005 Dr Stefan Ott; in 2006 it was Dr Peter Schultz and most recently; it has been Dr Frank Pallares who had previously worked at the Chrissie Tomlinson Memorial Hospital (CTMH) for almost two years, seeing patients twice every month.

According to Dr Pallares, he has stopped seeing patients at CTMH because the hospital refused to spend US$2800 to repair basic equipment required to diagnose patients. Without the ability to diagnose them, Dr Pallares said he could see no point in continuing to see patients.

In a letter recently written to Cayman Net News, Dr Pallares expressed his regret for not being able to see patients on Island anymore but said this was a decision that could have been easily avoided if the hospital had simply repaired the necessary equipment.

“Cardiologists that are hospital-based need basic equipment to work with. Without basic equipment, I could not diagnose. Without the ability to diagnose I was unable to advise or initiate a treatment,” he said.


Implications of not having a steady Cardiologist or Catheterisation lab

Heart disease is regarded as the leading killer in the western world. According to Dr Pallares’ letter, “The great majority of Cayman Islanders, both men and women, will die of heart disease, not cancer or aids or the bends.”

This fact is said to cause many heart patients and their families to suffer serious heartache when they consider the incessant turmoil that the cardiology fraternity has experienced in recent years.

This lack of a consistent cardiology service highlights several serious health and financial implications for patients. Health officials constantly emphasise the fact that heart patients desperately need constant cardiology attention to remain at their best.

“The Cayman Islands need not one, but at the very least, two full-time cardiologists,” wrote Dr Pallares.

He said patients have explained that they have had to start over with a new doctor, on many occasions every three months, or even to have a new cardiologist for several months at a time.

Health officials have argued that this is definitely not ideal for a patient with chronic heart disease. Not only is there a serious risk to the lives of these patients but there are also incredible heightened healthcare costs as well.

One heart patient explained that he had to pay in excess of US$104,000 to travel abroad to have a procedure done simply because there was not a catheterisation lab on Island—this procedure was one that could have been easily performed by a cardiologist surgeon on Island if the relevant services were available.

This therefore raises concern for those unfortunate Caymanians who cannot afford to travel abroad for help.

A cardiac catheterisation lab is necessary for diagnostic testing, which would be essential for early detection and is needed for invasive cardiology procedures.

Such a facility is regarded as one of the most essential aspects of cardiac care.


Minister of Health and Cardiologist face-off

However, regardless of the fact that cardiologists, health officials and heart patients alike have argued for the necessity of a catheterisation lab, Minister of Health Hon Anthony Eden has recently said that patients are not in danger because of an absence of such a service. Furthermore the Health Minister said that there is not enough demand to render a cath lab a necessity for the Cayman Islands.

Mr Eden also said that heart patients in Cayman have nothing to worry about and rebuffed reports that patients in need of cardiac and heart services had to travel overseas because they were not available on Island.

Although the Minister admitted that there did exist a need for a catheterisation lab on Island, he said that patients had not suffered as a result.

These claims have however been refuted by cardiologist Dr Pallares, who argued that the Health Minister has been grossly misinformed.

In response to Mr Eden’s claims Dr Pallares said, “I have, on multiple occasions been frustrated with a young patient, suffering from a heart attack—knowing full well that I could fix him in minutes if we had a cath lab.

“Knowing full well that without an emergency air ambulance that could fly this patient to a cath lab, he would either die or at least suffer muscle damage that would forever follow him with either (heart) pump failure and/or electrical heart problems,” wrote Dr Pallares.

The Minister also argued that to safely operate a cath lab, there was need for a cardiovascular facility in the event of any complication occurring as a result of any invasive procedures done.

He further stated that there are other specialised services provided by the government-run HSA, which are not as invasive as a cath lab and could provide doctors with same diagnostic information.

Again, Dr Pallares, who is a member of the Heart Rhythm Society and an interventional cardiologist, has contested the Health Minister’s arguments.

“There is no non-invasive cardiology that gives you the information that a cath lab does,” said Dr Pallares.

“Implanting a pace-maker is not a sophisticated cardiac procedure. You do not need a cardiologist or a cath lab to implant pacers. The cardiologist explained that in many countries this procedure is performed by surgeons using a simple X-ray equipment.

He however further explained that some of the latest ICDs (intra cardiac defibrillators) and some of the biventricular units and selective-site pacing, will need a cardiologist well versed in pace-maker technology, which Grand Cayman at present does not possess.

“The Health Minister should really be talking to the patients who have survived a major heart attack and now have permanent heart damage,” said Dr Pallares.

“Many of these patients, if they had gotten to a cardiac cath lab in under 90 minutes (an easy task in Grand Cayman), would more than likely be spending their retirement years playing golf, gardening or teaching their grandchildren to fish instead of sitting in a rocking chair, watching their legs swell and having a hard time catching their breath.”

athaliah@caymannetnews.com