A patient’s inability to access cardiac surgery at University Hospital of the West Indies (UHWI) goes beyond being unable to afford treatment, according to consultant cardiothoracic surgeon Dr Sunil Stephenson, who pointed out that there are several factors that influence the hospital’s ability to facilitate the procedure.

Dr Stephenson, who works at UHWI, reached out to the Jamaica Observer recently after online readers took local doctors to task while responding to a story about a six-year-old girl who needed heart surgery, but had to go outside of Jamaica to get it.

Little Cassie Drummond’s parents were unable to pay to have a critical heart surgery done and reached out to the public, through the

Observer, for help. Through the newspaper’s global reach, the six-year-old got an opportunity to have the procedure done in the Cayman Islands at no cost to her family.

“Wow. It took a doctor from Cayman to come to this man’s rescue. Do we have doctors in Jamaica who could perform the surgery? Do doctors in Jamaica perform this kind of humanitarian assistance or do we always have to depend on persons from abroad?” one online reader commented while thanking the doctors for helping Cassie.

Another reader said: “It’s all about the $$$$. No humanity. No love. Don’t care for our less fortunate ones… It’s all about the $$$$$.”

While other readers attempted to defend local doctors by highlighting that it is not a lack of expertise, but really an issue of limited resources, one reader pointed to the tough realities doctors would face if they were to decide who should benefit from free surgeries.

“Do we have doctors in Jamaica who could perform the surgery? Very good question, do we? And if we do, would they have performed free of cost? I guess we have so many heart patients, how would they decide? The ones who asked or are publicised? Ticklish situation, I suppose,” the reader commented.

However, Dr Stephenson and Dr Joseph Blidgen, who is also a consultant cardiothoracic surgeon, have decided to set the record straight by shedding light on cardiac surgeries in Jamaica.

“This University Hospital is the only hospital in Jamaica that you can get adult cardiac surgery,” Dr Stephenson pointed out, adding that cardiac procedures for children are done at Bustamante Hospital for Children.

He said that, unlike at Bustamante Hospital, UHWI is not free and patients are expected to pay.

And the patient’s bill could run them between $850,000 and $1 million for the average open heart surgery.

Manager operating theatres and intensive care units, at UHWI Barbara Garcia told Your Health Your Wealth that the price tag includes the cost of surgical consumables, which could run about US$3,000, and hospital fees. She explained that the procedure does not fall under free health care and that the things used during surgery are for one-time use.

“…All of these things are imported, and the hospital, they have to buy it, so they have to recover the costs,” Garcia noted.

She explained that, while there are patients who can afford the consumables and others who have insurance, the hospital has been “very creative” in trying to assist those patients who cannot afford to pay by seeking funding through the Ministry of Health, facilitating payment plans, and providing different payment mechanisms to facilitate family members who want to assist their loved ones.

Stephanie Shaw Smith, director communications and public relations at the Ministry of Health, told Your Health Your Wealth that on average, the ministry receives between 30 and 40 requests from cardiac patients yearly. Just last year, it received 41 requests and assisted 21 patients at a cost of $13,055,397.77.

She said the ministry tries to assist as many cardiac patients as possible through the National Health Fund’s Compassionate Fund, “once all required paperwork is submitted”.

But the cardiothoracic programme at UHWI is “very robust”, according to Garcia.

“We certainly don’t lack for patients,” she shared.

Garcia explained that the ministry, through the Compassionate Assistance Fund, covers up to 50 per cent of hospital fees. She said once the bulk of the expenses are covered, which would include surgical consumables, since these have to be bought by the hospital, UHWI gets creative so patients can have their cardiac surgeries done.

“So whenever a patient is referred and they say that they are waiting long and they say that they have to go overseas, it is not because we are not trying to do the patient’s surgery, it is just that in the whole scheme of a lot of the limitations that we have, some of the times surgery for the patient is delayed for various reason,” Dr Stephenson added.

Some of these limitations, as highlighted by both Drs Stephenson and Blidgen, are the reality of competing with other specialties, such as obstetrics, general surgery and orthopaedics, for bed space inside the hospital’s Intensive Care Unit (ICU), as well as the lack of intensive care nurses and, in some cases, availability of blood.

They pointed out that while emergency cases are done everyday, elective surgeries are only done on Mondays and Thursdays.

“Once you come in as an emergency, you are done, but we sort of stratify the cases,” Dr Blidgen explained. “If you are an elective, you basically go on the list (and we do) one to two cases per day, but usually it depends on the ICU space.”

Added Dr Stephenson: “The thing is, all our patients need to go to ICU afterwards, so if we don’t have the ICU space, then we can’t go ahead with the surgery.

“And, at this hospital, all the other specialities in the hospital use the same ICU. Now, we only have eight beds, so when we have other medical emergencies or surgical emergencies that need ICU space, we have to admit them, which will cut back on the amount of space you have for an elective cardiac case,” he continued.

The manager for operating theatres and ICUs explained further: “Resources are limited, that’s just a factor. We have seven operating theatres… normally we have 16 ICU beds, but at this time one of the units is closed, so we have eight.”

She explained that surgeries have to be pushed back by a month, and another month, because trauma cases, like gunshot victims and those with stab wounds, get precedence at all times.

“Another thing, too, is that ICU nurses are very short, so even sometimes if we have say a physical space, you might not have a nurse to nurse the patient, because every month you have quite a few critical care nurses who leave,” Dr Stephenson said. “Right now, we have quite a few nurses who have left in the last couple of months, a whole lot, so that is another issue that restricts the ICU.”

However, Dr Blidgen was quick to point out that the issues affecting cardiac patients are not unique to Jamaica.

In the meantime, the doctors are calling on corporate Jamaica to assist cardiac patients, especially the cohort who still cannot afford to have surgeries done despite being given financial assistance.

Dr Stephenson told Your Health Your Wealth that, up to recently, though not static, there were 20 patients at UHWI awaiting financial assistance to have cardiac surgeries done.

“One of the things that might be able to help is perhaps to have a fund for these people… a fund specifically for them, or if one of the charity organisations can collaborate with us and decide that they will help a few of the patients,” he suggested.

“If we can have a foundation or fund to fund some of these patients, even if they decide to help five or so patients per year to fund the supplies and half of the fees, I think that would help them,” the consultant cardiothoracic surgeon appealed.

For his part, Dr Blidgen said a partnership with corporate Jamaica is necessary because, despite the fact that some of the surgical consumables are subsidised by overseas companies, it is still very expensive to the majority of Jamaicans.

Dr Stephenson pointed out that what is charged for cardiac surgeries at UHWI is cheap when compared to elsewhere that patients have to pay for service, but admitted that patients must first pay for the surgical consumables before doctors can get the go-ahead to do cardiac surgeries.

He reiterated that the limitations are why only 200 cardiac cases are done per year, because if the UHWI were operating everyday and didn’t have ICU limitations, and had all the resources necessary, patients wouldn’t have to wait long for surgeries.