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For this the premise, a local medical fraternity’s respect for the sanctity of life, reflects that country’s conformity to democratic principles.
However, before such an elaboration, an explanatory review will be undertaken of the heart, a fist size muscular organ that pumps blood around the body. For intriguing it’s, despite being the source of blood, the heart itself is dependent on blood, channelled by small diameter coronary arteries. But being small diameter, the obstructive atherosclerotic process remains a perennial threat, that can cause further narrowing. In fact, this process which has its genesis in childhood, maybe accelerated in adulthood, with underlying risk factors, eg uncontrolled diabetes. Such that, in critical narrowing, heart muscles become starved of oxygenated blood, leading to that colloquially known as a heart attack or medically as Acute Coronary Syndrome(ACS).
Testing for ACS
To that end, establishing an ACS diagnosis requires medical testing, which consistent with all things medical, carries risk. Nevertheless, cognisant of these risks, doctors weigh them against the benefits, to determine the optimal test in establishing a diagnosis.
Thus, an illustration of risk is required, utilising the routinely employed heart tracing (ECG), that provides critical information, via sticky body labels, hence risk-free. In contrast, of high-risk is the Percutaneous Coronary Angiogram (PCA) that assesses narrowing of the coronary arteries. For this entails a large needle inserted into an artery of the wrist, serving as a conduit to the heart for a catheter, dye or stent(PCI).
But cognisant of the risks, doctors mitigate by firstly establishing the probability, that the patient’s symptoms represent ACS. Thereafter, the calculated probability, which reflects benefits, is balanced against the risks, to determine the optimal test. Such that, patients with high-probabilities of ACS, doctors are justified undertaking the high-risk, but gold-standard PCA. Whereas, for low-probability patients, PCA isn’t justified, since it exposes the patients to serious harm, but with minimal benefits. In fact, for such low-probability patients, low-risk tests thereunder, are recommended;
Exercise Tolerance Test
Coronary Artery Calcium scoring
Pharmacological Stress Testing
Nuclear stress Scan
Where the aforementioned are underpinned by recommendations from the major Cardiology Societies;
European Society of Cardiology
British Cardiology Society
Canadian Cardiology Society
American Cardiology Association
America Society of Interventional Cardiology.
Recommendations that state PCA is potentially fatal, hence should be of last resort, except in emergencies. Where
low-risk tests should be the preferred option, in the vast majority of cases.
Thus, we revisit a Stabroeknews(2015) article, caption, “Guyana-born doctor who ordered unnecessary heart surgery, risky tests jailed in US for 20 years.”
“A Guyana-born, US cardiologist who ordered patients to undergo unnecessary open heart surgery and carried out risky tests and procedures in order to tap fraudulent payments from Medicare and private insurers has been sentenced to 20 years in a US federal prison.”
“The doctor may have put lives at risk and threatened people’s health while making more than US$7m from manipulating patients’ “sacred trust”, US federal investigators found.”
“The report said that some patients were injected repeatedly with radioactive material for heart tests which they didn’t need…the report said that federal investigators found that Dr Harry Persaud inserted cardiac stents in patients who didn’t need them and sent patients for bypass operations performed via open heart surgery, so he could undertake follow-up tests and bill for them, investigators found.”
The Caribbean Heart Institute (CHI) was established through a Public Private Partnership, between the Governments of Guyana and Canadian. And through this, tax-payers were guarantee subsidised cardiology interventions, while the Canadians, hassle-free CHI access.
But the practices at CHI is far removed from these guarantees, as a matter of fact, comparable to Dr. Harry Persaud’s crimes. For Dr. Mahendra Carpen, based on the Toronto and Massachusetts Medical Registers, isn’t an Interventional Cardiologist, as he claims. Thus, this concern was raised in 2018, supported by patients alleged exploitations and unnecessary cardiac interventions. Thereafter, former President Donald Ramotar expressed similar concerns, of thereunder snippets;
“The following is based on many complaints made to the author”
“The first and most widespread of these is the money hungry attitude of many persons and institutions providing medical services to the public. It appears to some that the pursuit of huge fees is more important that curing the sick.”
“Some of those that manage the Public-Private Partnership facilities are more interested in money than the patients. Stories abound about how people are treated. I heard of the ordeal of a wife whose husband was on the operating table opened up. He had to pay a few million dollars before the operation[PCI] was done. While he was being operated on, I am told that they went to the wife who was sitting outside and told her that they found another problem[narrowed coronary artery] and enquired whether she would pay to get it attended to then or should they close up the patient. The poor woman scrambled around to raise the funds.”
“Unfortunately, I understand that many groups [Canadians] that provided voluntary services are experiencing great problems in having access to these facilities, which were purchased with taxpayers’ money, that has resulted in some of them abandoning their humanitarian work in Guyana.”
But the democracy they speak of, extends beyond the ballot boxes, inclusive of right to life etc. Therefore,
of valued Americans lives, Dr. Persaud languishes in prison. But in PPP
Guyana, Dr. Carpen who isn’t an Interventional Cardiologist, continues to undertake risky procedures, without the mandatory cardiothoracic backup.
However, with the Medical Council remains unbothered, private citizens like Ramotar and myself are inundated with complaints of alleged exploitation at CHI. Where two such cases involved patients, who hadn’t a heart attack, yet Dr. Carpen allegedly requested US$10,000 for PCI. But one sought a third opinion in America, whence assurance was of a healthy heart, thus saving him a potentially fatal procedure.
Then a patient, suspected to have had a heart attack, forced to await treatment, as the relatives struggled for days to accrue the US$10,000 fee. Thereafter, it was alleged, Dr. Carpen with bulging pockets undertook an unnecessary PCI, knowing the heart muscles were long dead. For it’s medically established, denied of blood, the heart muscles are dead within an hour. Consequently, the patient died, and it was further alleged, Dr. Carpen with images in hand, extricated himself from responsibility, in defending his ‘perfect’ PCI.
Thus Mark’s Take- The right to life under PPP is nonexistent, therefore most certainly the CHI concerns, articulated by Ramotar and myself, will be swept under the rug. But this is assured, unless these concerns are addressed, this column shall not rest.