Khan to Cut Heart Care Unit

The job of Prof Giovanni Teodori—the lead cardiac surgeon who performed triple bypass surgery on Dr Gregory Bissessar, husband of Prime Minister Kamla Persad-Bissessar, and cardiac surgery on former justice minister MP Herbert Volney and Chaguanas mayor Orlando Nagessar—is now hanging in the balance, as plans are afoot to scrap Caribbean Heart Care Medcorp’s (CHCM) contract with the Government by September.

Teodori, an Italian, is one of 21 doctors and technicians at CHCM whose contracts may not be renewed by the Health Ministry. Bissessar’s three-hour surgery was done by Teodori, CHCM’s chief heart surgeon, along with Dr Natasha Rahaman-Ganga and Dr Anand Rampersad at St Clair Medical Centre in June 2011.

On Thursday, Health Minister Dr Fuad Khan said he was moving to clamp down on private hospitals that have been milking the State of millions yearly. Established in 1993, CHCM performs 20 cardiovascular surgeries monthly at the Eric Williams Medical Sciences Complex (EWMSC) and St Clair Medical Centre, which the ministry pays for. Each cardiovascular surgery costs the State US$10,000, Khan said.

When a surgery is performed at EWMSC, Khan said, the hospital provides anaesthetists, materials, operating theatre, bed, clinic and office spaces, as well as nurses and ICU facilities. Khan plans to send out tenders for Indian and Venezuelan companies “expressing an interest at a lower cost.”

He said a Sai Baba group from India was interested in coming to Trinidad to perform the surgeries at EWMSC for far less. “If I could get the Sai Baba people to come and do it for free and I supply the raw materials, that would be even better. I am trying to reorganise cardiac surgeries into a public programme.” One doctor from San Fernando, Khan said, had also offered to do “volume surgery” for one price.

Khan: Ministry a slush fund
Khan said he had asked CHCM, which has a proven track record—zero per cent mortality rate for 2012—for an overall price on all surgeries and not a per case price.

“The ministry is paying for everybody in this country that has heart surgery for free. So we have now become a slush fund for cardiac surgery in the country. People think I have something against them. I am just trying to make a public service that will be more efficient, as it is, with doctors who work as salary workers. I many not renew their (CHCM) contract.”

So what will happen to CHCM’s team?
They can be absorbed into the public hospital as consultant surgeons or salary workers, who would have to work under the ministry’s terms and conditions, Khan said. “I think I am doing the right thing.” Khan agreed that doctors and nurses’ salaries were too low and they should be offered a better pay packages.

Khan said he was in the process of establishing cardiac centres at San Fernando, Port-of-Spain and EWMSC. In December, CHCM was identified by Khan as having received millions of dollars in payments for medical services. Between 2009 and 2010, Khan said, the Eastern Regional Authority outsourced $6.4 million in services to CHCM. The NCRHA also pumped some $73 million to CHCM for cardiovascular services and intensive care treatment.

Rampersad: A noose around our necks
 On Tuesday, managing director of CHCM Dr Kamal Rampersad and Teodori said they had heard that CHCM’s contract would not be renewed. “It’s confusing. It is difficult to work with a noose around your neck,” said Rampersad. Admitting that the ministry had asked them to review its cost per patient, Rampersad said CHCM’s price was the cheapest in the world.

“Cardiac surgery is expensive business...especially with raw materials. We also have to pay for the use of the private hospital and doctors. What we pay doctors here is really a joke to what doctors receive abroad.” Both doctors said if CHCM’s contract was not renewed, they would have to go job hunting globally.

Teodori said, however, “We will cross that bridge when the time comes.” Teodori admitted that they could increase the number of surgeries they did, but the EWMSC lacked capacity, especially the ICU. “Caribbean Heart Care is not limited...it’s the hospital,” said Teodori. Rampersad interjected: “We need to bring the hospital up to international standards and accommodate more patients.”

Teodori said the last thing he wanted to do was return home, since he likes working in Trinidad. Rampersad said patients now have to wait six months for surgery instead of four weeks, due to the long list seeking heart care.