Peconic Bay Medical Center will open its interim cardiac catheterization lab in one week, bringing life-saving cardiac techniques to Riverhead and the North Fork for the first time.
The hospital gave members of the media a tour of the new facility this morning, which included a demonstration of a catheterization procedure by Dr. Stanley Katz, a pioneering interventional cardiologist tasked by Northwell Health with establishing an advanced cardiac program at the Riverhead hospital. The demonstration centered on simulation with Northwell Health’s Center for Learning & Innovation, featuring a lifelike mannequin and interactive audio.
The scenario: “Michael,” a 48-year-old Nassau County resident who had been visiting the North Fork to pick pumpkins with his family. He was stricken in a pumpkin field and EMTs, who did an EKG on the spot, determined he was having a heart attack due to a blockage and notified Peconic Bay of the situation. The hospital called in an interventional cardiology team — Katz, cardiovascular technologist Christine Brooks and RNs Mary Danowski and Gerard Halfpenny — which was waiting for the patient in the ER. They whisked “Michael” up to the cath lab for the procedure.
Katz inserted the flexible, hollow rubber tube into the patient’s artery through an incision at his groin. The catheter is used to inject a dye so that any blockages can be seen on images created by an x-ray machine. It is also used to insert a stent in the blocked artery, to keep it open.
In the simulation, “Michael” — who is conversing with the doctor, complaining of chest pain and talking about how nervous he is — experiences a ventricular fibrillation, a life-threatening disruption of the normal heart rhythm that requires immediate treatment with a defibrillator.
“This has to happen in under 20 or 30 seconds,” Katz explained afterwards. “That means, first you have to recognize it, then you have to get the defibrillator and use it.”
The cath lab is equipped with two defibrillators within arms reach. Halfpenny swiftly pulled one to the table and placed the paddles on the patient’s chest, administering a dose of electric current to the heart.
“Michael,” who was briefly unconscious, came to, groaning, and asked what happened.
“Did I pass out?” the simulator machine inquired.
“Yes, everything is fine,” Katz responded reassuringly. He finished his work, clearing the blockage and inserting the stent.
“We’re all done. Everything came out fine.”
Katz has been at the forefront of interventional cardiology for more than three decades — he was among the first in the nation to perform angioplasty on patients who were having heart attacks in the early 1980s and he began using stents to open coronary arteries even before they were approved for that use by the FDA in 1994. He was the head of Northwell Health’s cardiology program and a professor of cardiology at Hofstra University School of Medicine before moving to the East End to establish an interventional cardiology program at Peconic Bay
The new cath lab will be open for patient treatment on Monday, Oct. 16.
After the conclusion of the simulation, Katz sat at the control panel in the adjoining room, where the lab is visible through a large plate-glass window. He brought up video images of an actual catheterization procedure, done on a North Fork patient of his who was scheduled to have the procedure done next week. But he began experiencing symptoms and an earlier intervention was required. Katz showed the audience of reporters, photographers and videographers how he opened up the man’s 99-percent blocked main artery. The patient had to travel west to have the procedure.
When someone is having a heart attack, intervention to clear a blockage is supposed to take place within 120 minutes of first contact with EMTs or within 90 minutes of coming through the emergency room doors, according to cardiology practice guidelines.
Every 30-minute delay in commencement of PCI increases the risk of mortality, the American College of Cardiology says.
“Time is life,” Riverhead Volunteer Ambulance Corps Chief Rod Richardson said. “Having something like this right in our community — currently we have to travel upwards of 30 to 40 minutes — best case — just to get to Stony Brook,” he said. “So we’re losing half an hour-plus on transport — and that’s without traffic.”
Richardson said the opening of the cath lab in Riverhead is “phenomenal.”
“It’s nothing short of a life-saver having this here. It’s great for the whole North Fork,” Richardson said. “Andy Mitchell did a great job,” he said, referring to PBMC president and CEO Andrew Mitchell, who was dogged in his pursuit of an interventional cardiac facility at Peconic Bay Medical Center.
The ambulance chief noted that every transport to Stony Brook takes one of RVAC’s rigs out of district — and out of service — for 90 minutes to two-and-a-half hours. “We’re a very busy town. The call volume just keeps going up,” he said. Taking one of the corps’ five ambulances out of service for that length of time makes it more likely the organization will have to call for mutual aid from other ambulance companies. The domino effect stretches everyone’s resources to the max.
“It’s going to be great having this here,” Richardson said.
The ride to Stony Brook feels even longer when you’re the cardiac patient being transported.
Steve Schreiber, 60, of Flanders had his first heart attack at age 46. His second heart attack, which he calls “the kicker,” came in December 2014.
“I almost died in the ambulance,” Schreiber recalled.
Greg Conrad, of Riverhead said as he was being transported to Stony Brook with his first of three heart attacks, “I thought to myself, this has to be the longest bus ride of your life.”
The retired court officer, now 62, said he had three friends, all Riverhead Town residents and all about the same age, who had heart attacks around the same time. Two of them didn’t make it. The third survived but died of a subsequent heart attack last year.
“I’m the last man standing,” he said. “I don’t know why. I often wonder why.”
His two other heart attacks were treated at St. Francis — an even longer ride than Stony Brook. The ambulance brought him to Peconic Bay, which stabilized him and transported him to St. Francis where he had catheterizations and stent implants.
“It’s great that this is right here now,” Conrad said. “It’s a home run. God bless Andy Mitchell for fighting the fight.”
Katz said the state health department license requires the hospital to perform at least 200 procedures a year.
“Based on the experiences we’ve had at other hospitals, we expect it will grow to at least 600 a year over the next couple of years,” Katz said.
Of that number, 10 to 15 percent will require bypasses, he said. Thirty-five to 45 percent will require stents. “The rest are treated with medicine,” Katz said.
Only about 10 percent of the total number each year are expected to be patients brought into the ER in the midst of heart attacks, he said. The rest come into the office with symptoms or are referred for the catheterization due to risk factors, such as smoking or family history.
Peconic Bay has begun construction on a $60 million, three-story critical care tower with a rooftop helipad. The expanded emergency department on the ground floor will have greater capacity to handle trauma cases; the hospital was certified as a trauma center in March. The new facility will also cut back on ambulance trips to Stony Brook, PBMC’s Mitchell noted. The second floor will house an electronic intensive care unit dedicated to cardiac patient care. On the third floor will be two cardiac catheterization suites, an electrophysiology suite, recovery rooms and space in which cardiac surgery facilities may be built in the future, Mitchell said.
The electronic intensive care unit, or EICU, is monitored remotely 24/7 by a staff of physicians and nurses who are focused exclusively on the patients in the EICU, said Susan Somerville, vice president of clinical transformation at PBMC. Somerville, a Southold resident, and a trained ICU nurse, said the monitoring is invaluable in ICU patient care.
Katz said while the cardiac care center is very exciting, he can already see the impact on the hospital in general. “Every part of the hospital has to elevate their game,” he said.
“I believe that once we’re up and running, within a short period of time, it starts to make PBMC a much more attractive landing zone for physicians who are highly specialized that are working in Nassau County,” Katz said.
“The East End of Long Island is beautiful, as you all know,” Katz said. “They all come here and vacation here. What could be better than to actually live here and work here year round? I think you’re going to see a huge upheaval the next coupe of years and this will become a major medical center with highly specialized physicians and nurses in more than just cardiology,” he said.
The hospital is offering the community tours of the new facility on Thursday, Oct. 12, from 1 to 2 p.m. and 7 to 8 p.m.
RiverheadLOCAL photos by Denise Civiletti