Essential life-saving cath lab facilities are on the blink at Dunedin Hospital, with a cardiologist saying they are in demand multiple times a day, and the area does not have the recommended amount even when they're running normally. Photo:
A cardiologist says a delay for lifesaving cardiac equipment at Dunedin Hospital could have fatal consequences, and the area's population requires more services, to avoid it happening again.
Dunedin Hospital's cath lab (catheterisation laboratory) is the only unit at the hospital where some procedures vital for treating heart attacks can be carried out, but it's out of action for some of its work while the hospital waits for a replacement part.
Health NZ has already confirmed a patient died in the hospital's cardiac unit while the lab was not at full capacity. The cause of death is not known, and has been referred to the coroner.
The wait without the service has meant some invasive coronary procedures can not be carried out, and an acute patient had to be diverted to Christchurch Hospital.
Cardiologist Gerard Wilkins told Checkpoint that not having full services was a serious problem. The unit provides vital healthcare to a population of about 350,000 people from about Timaru south, and according to recommendations, it should have more than one cath lab.
"Heart attacks are common, they're probably the commonest, most important medical emergency. And the management of a heart attack and near-miss heart attacks is universally through this type of X-ray room," Wilkins said.
Wait time for cardiac equipment could be fatal - doctor
The cardiology team had managed to cobble together a 'go-by' for the components of the system that had failed, he said, but it was less than ideal: "I guess it's slightly knife-edge in the sense of it would be difficult to take on extremely complicated things, emergency situations, people having large heart attacks.
"We're able to do lower risk patients.
"It's certainly anxiety-provoking. Smaller heart attacks and large ones are pretty common in the community - we're not talking about a once a week phenomenon.
"We're talking about patient access to a single room - probably 30 to 50 cases for cardiac-type procedures in that room per week - and we're talking 24 hour cover, day and night for dangerous heart attacks.
"... I don't think it's ideal, what we're trying to do at the moment."
Te Whatu Ora Health NZ southern chief medical officer David Gow said the cath lab had been closed for some procedures since 20 November, due to an equipment issue. Replacement parts were immediately ordered, and the final part was due to arrive this week.
The hospital had taken several measures to mitigate the impact, however elective or diagnostic procedures had been deferred for 10 patients, Gow said in a statement.
Wilkins, who is a cardiologist at Mercy Hospital and associate professor of Medicine at Otago University, said that long term, the solution lay with more labs.
"For a very simple reason, guidelines around the world say that cath labs should be available to patients within 60 to 90 minutes - now that's very difficult to achieve in the South Island of New Zealand ... many of our patients live more than 200km away," he said.
"We are the greatest users of helicopter retrieval, but if we don't have a room that works, we've got a problem."
Airlifting patients to Christchurch while facilities are not available in Dunedin adds more time to the delay before they get potentially lifesaving treatment.
A second cath lab was needed both for this sized area, and because having it would provide the redundancy that could safeguard their services.
"All of the other cardiac units that serve similar sized areas have two or three or more of these rooms, because the works that's done in these rooms is steadily rising over the last 30 or more years," Wilkins said.
"Equipment will break down no matter where it is, including in hospitals. Our problem for the region that we serve - the lower half of the South Island - is that we only have one of these rooms, and therefore a delay that goes on for some time, makes patient care vulnerable."
Dunedin currently only has one cath lab. (File photo of a cath lab overseas). Photo: Supplied/ Echa24161 - CC BY SA 4.0
Wilkins said the company overseeing the gear was doing a good job, but occasionally something unforeseen could crop up: "and that has happened serially with this repair job. I think at the moment, we're still a day or two away from a repair".
The answer lies with the promised - but currently being re-thought and downgraded - new Dunedin Hospital build, which would have include at least one more cath lab, he said.
"At the time that this hospital building was designed, in the mid-70s ... no one had even done a balloon angioplasty or a stent in the days of design. So it's not surprising that this hospital doesn't have those structures - but obviously delays in getting suitable rooms as a backup, is part of the issue.
"[The] new hospital build plans ... all contained two rooms, or even an ability to go to three in the more recent one ... and there lies the solution."