Childbirth facility is defended

The Health Services Authority’s physician in charge of pediatrics has defended the hospital’s neonatal facility, following the death of premature twins at the Cayman Islands Hospital on 9 November.

The Jamaican twins were born after only 24 weeks of pregnancy and could not be transferred to a Level 3 neonatal intensive care unit for the treatment they required because their mother’s insurance would not pay for it.

Dr. Marilyn McIntyre, who has been a pediatric doctor with the hospital for nearly 30 years, said the neonatal intensive care unit at the Cayman Islands Hospital is a high-end Level 2 NICU (an earlier HSA release had described it as a Level 1 facility), and among the best in the region.

The hospital has come under fire on talk radio for not having a Level 3 facility that can care long-term for babies born before 28 weeks of pregnancy, but Mrs. McIntyre said such criticism are uninformed. She said the cost of recruiting the raft of specialists required to man a Level 3 facility would be astronomical and unviable.

‘People don’t understand that a Level 3 neonatal unit is not commonly in all hospitals – it’s a super-super specialty,’ she said.

‘In the US, UK and Canada, they have one in the major cities but they are certainly not in every hospital. They are staffed by super specialists and we don’t have the volume of work here to keep those people occupied or to maintain their skills.’

HSA figures show that of 540 births at HSA facilities to October this year, 55 babies have been born before 28 weeks of pregnancy and seven have required transport to an overseas facility for treatment. That figure is up on past years. In 2006 only one pre-term baby was sent abroad for treatment from 598 births. In 2005 only two pre-term babies were sent abroad for treatment.

To run a Level 3 NCIU, the hospital would have to recruit ‘all the ‘ologists,’ Mrs. McIntyre said, including a neonatal cardiologist nephrologist, neurologist, gastroenterologist, neonatologist, ophthalmologist, audiologist and a pediatric surgeon.

‘You would also need back-up lab facilities that do everything on micro-methods. You have to have neo-natal support staff that can read the X-rays, ultra sounds and MRI scans.

‘It’s not as simple as it sounds,’ she said.

‘Even if you did get all these specialists, after three months, they wouldn’t have done enough procedures to stay registered in their specialty. So what do you do then? Get a new person every three months?

‘It sounds very nice but really it isn’t very feasible.’

Mrs. McIntyre also dismissed as unfeasible, a suggestion from a radio talk show host that Cayman could fund such a facility by accepting pre-term babies from throughout the Caribbean.

‘There aren’t that many islands around us. If you are talking about the eastern Caribbean, you are not going to get an air-ambulance to carry an immature or very sick baby all the way from Trinidad for instance; they would go to Venezuela.

‘In any event, people on the islands around us probably do not have the $500,000 that it would cost to send these babies over here. If they did, I suspect the people would want to go to the USA rather than here.’

Mrs. McIntyre refused to speculate whether overseas medical treatment could have saved the Jamaican twins, saying she had not been involved in managing the case.

But she said any 24 week birth typically faces ‘a very steep uphill battle’ to survive. Babies born so premature face health complications throughout their lives, she added.

When presented with a possible pre-term birth (defined as less than 28 weeks of pregnancy), the hospital typically attempts to transfer the pregnant mother to a Level 3 facility, Mrs. McIntyre explained. ‘The uterus remains the best transport incubator,’ she noted.

If this is not possible, the hospital can deliver and stabilise the baby while it arranges for a post birth transfer. ‘We then have the problem of getting them overseas in a transport incubator. That’s a far more costly exercise than transporting the mother,’ she explained.

The twins’ deaths have led to renewed calls for government to address the issue of underinsurance through these islands.

Last week, Jamaican Consul Robert Hamaty said the health insurance system in Cayman is failing low income earners, including many Jamaicans.

In the Legislative Assembly Monday, Health Minister Anthony Eden acknowledged that increasing the coverage for catastrophic health problems needs to be considered, but said increased premium costs also had to be taken into account.

He also seemed to suggest that consideration should be given to requiring domestic workers to return to their native country to give birth.

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