Doctors and other health-care advocates describe an increasingly dire situation for cardiology in Nanaimo, one that’s worsened since last year when a Nanaimo doctor recommended people have their heart attacks in Victoria for the best care.
Almost 400 seats were filled at the Nanoose Place Community Centre on Thursday, Oct. 16, as the Fair Care Alliance updated the community on the past year’s advocacy for a hospital tower and cardiac cath lab, what has changed, and what has gotten worse.
“We wanted to update the public on what has been going on for the past year, we wanted the public to know Fair Care has not gone away,” said Donna Hais, alliance chairperson, speaking with the News Bulletin after the meeting. “We wanted the public to know we have been fighting behind the scenes all this time and the conversation, the desperateness of it has just grown.”
Three cardiologists currently work in Nanaimo, Hais explained, and of those only one is a hospital-based cardiologist, a drop from two a year ago. Meanwhile, Victoria’s team has grown to 26, the majority in-hospital.
Vancouver Island’s population north of the Malahat is 490,000, compared to Victoria’s 460,000.
The reason that there is a struggle to retain cardiologists, advocates say, is the lack of a cardiac cath lab and as a result, the inability to treat patients with a modern standard of care. Due to the lack of a cath lab, doctors have no choice but to treat heart attacks with thrombolytics, also known as clot-busting drugs, rather than an angioplasty, a procedure to open the clotted blood vessel. Thrombolytics don’t always work, and side effects can include lethal brain bleeds.
The reason why the patient can’t simply be transported to Victoria to undergo the procedure was explained by Dr. David Forrest, head of infectious disease and critical care at NRGH, who stated that minutes mean heart muscle.
“You’ve got only minutes to open up that blood vessel, 90 minutes, you have to be able to access that procedure,” he said. “It’s only if you have it locally you can benefit from it. It doesn’t matter how many cath labs there are in Victoria, without a cath lab here it won’t be accessible.”
Forrest spoke to the crowd, recounting stories of individuals in the community who died or suffered major injuries without timely access to a cardiac cath lab.
The first was a 68-year-old man with a history of heart disease who presented to the hospital in May with chest pain. Doctors came to the conclusion it was due to low blood flow, a stress test confirmed their suspicions, and an urgent enneagram was ordered to investigate it further.
The provincial standard for catheterization access times for emergent is within hours, for urgent inpatient is 24-48 hours and a maximum of five days, for urgent outpatient is within two weeks and for elective outpatient is within six weeks.
“Three months after this patient had been referred for an urgent inpatient catheterization he was in the parking lot at Walmart when he suffered a cardiac arrest.”
Fortunately, emergency doctors were able to resuscitate him and have him taken immediately to Victoria.
“Twenty-four to 48 hours is the wait time. He waited three days. He got down to the cath lab there, they identified he had multi-vessel disease, he needed bypass surgery. He waited in the ward there for a few days. He had more chest pain, he had another cardiac arrest. He died.”
Another patient, a 62-year-old woman, was more fortunate. She went to the hospital with a heart attack at around 11:30 p.m. After receiving thrombolytics, the heart attack was not resolved and she was sent to Victoria.
“She got into the cath lab at four in the morning. Four and a half hours after she presented with the heart attack and the cardiologist noted she was no longer having chest pain. Why? Because dead muscle doesn’t cause pain. She had completed her heart attack.”
While she lived and was able to get surgery, she had a reduction in heart function due to the delay.
The most recent incident happened earlier this week and Forrest said it made him particularly angry. A 63-year-old Nanaimo patient with no history of heart disease was also put on thrombolytics, with no effect.
“Next thing you know his blood pressure was falling rapidly. He was put on medications to try to support his blood pressure, they tried to resuscitate him. He got worse. His heart stopped. We spent 40 minutes trying to resuscitate that patient. He died. He died because he did not have access to heart catheterization here in Nanaimo.”
According to the doctors and advocates there has been push-back from cardiologists in Victoria – the current hub of cardiology on the Island.
Forrest alleged that one cardiologist in Victoria told him, “you chose to live in Nanaimo,” when discussing the lack of cardiac care in the area. Barney Ellis-Perry, Nanaimo and District Hospital Foundation CEO, told the News Bulletin that a cardiologist from Victoria told him,”You don’t need a cath lab, you need better patient transportation.”
Forrest said arguments against a cardiac catheterization lab in Nanaimo have included the notion that there aren’t enough cardiologists at NRGH to maintain an active cath lab, though advocates argue they need a cath lab to attract cardiologists.
The hospital foundation recently commissioned a study on the cost to build a cardiac cath lab in Nanaimo.
“We’ve had donors come forward, we’ve had over $3 million committed to a cath lab,” Ellis-Perry said. “There is no campaign, I can’t run a cath lab campaign because we don’t have a commitment [from the province]. Once we have that commitment we can raise the money to really expedite the project and do something really powerful for our community alongside the regional hospital district’s commitment.”
The Nanaimo Regional Hospital District board has previously told the province it is willing to pay for a business plan and concept plan to expedite the project once approved.
