— Raj Gopaldas MD FACS ,
Cardiovascular and Thoracic Surgeon
“No matter how thin the pancake is, there’s always two sides to it.” I am a cardiothoracic surgeon at HaysMed and have been practicing here for more than a year. I was on family vacation for a couple of weeks and recently returned only to note the buzz and media attention surrounding HaysMed. Eventually I read the articles and didn’t think much of it until I noticed that several patients decided to seek care for their heart conditions elsewhere. Therefore, I felt compelled to write this letter to you.
To provide some background, I have been practicing cardiothoracic surgery for almost 15 years. Last summer, I was asked to provide temporary coverage for cardiothoracic surgery services (heart and lung surgery ) at the DeBakey Heart Institute in HaysMed.
At that time, I lived in Michigan and the travel to Hays was certainly neither easy nor fun. Given the location of Hays in a rural part of Kansas, I had some reservations about the place.
But when I showed up here, I realized that I was wrong and maybe negatively prejudiced. When I performed my first heart surgery here, I was rather pleasantly surprised with the caliber of the open heart surgery team, the ICU nurses, the cardiac catheterization lab team and the Cardiac Anesthesiologists - Drs. Pham and Kreisler.
I was puzzled because I didn’t expect that a hospital located almost in the middle of nowhere would have a great team with a positive attitude and sincere dedication. But clearly, something was lacking – a consistent heart surgeon. But why?
So here is a little perspective for the community at large to understand. There are currently about 300 job openings in hospitals across the country for a full-time heart surgeon. There are only about 20 to 30 heart surgeons graduating in the country that maybe competent and confident to perform heart surgeries independently.
Almost every hospital in a major city is looking for a heart surgeon today. The average age of the cardiac surgeon in the United States is about 60 years old, and there are approximately 60 to 70 of them retiring every year.
This has resulted in a dire shortage of heart surgeons and, therefore, plenty of opportunities for practicing heart surgeons to pick a job anywhere they like. For hospitals located in rural communities such as Hays, it’s an even bigger struggle because many families, including mine, would not want to move to small communities but rather seek the conveniences that the bigger cities have to offer.
Furthermore, let me share my first hand experience at one of my previous jobs as a full-time heart surgeon.
At one of my prior employments elsewhere, I experienced on a first-hand basis an utter lack of competence, responsibility and accountability in the realm of heart surgery - Yes, in the United States - which is NOT a third world country.
My two associates at that time were trained at Mayo Clinic, and we were a complement of three highly trained heart surgeons. We had to on a day-to-day basis endure inexperienced ICU nurses, hospital-wide inefficiencies, grossly incompetent scrub technicians in the operating room, lack of any cardiac surgery PA to assist us, and above all we had to perform the majority of heart surgeries without a qualified cardiac anesthesiologist - something which is NOT THE STANDARD OF CARE in this millennium.
Between dealing with nurses connecting cardiac catheters backwards, nurses providing anesthesia for majority of the heart surgery procedure with almost no anesthesiologist supervision, administration pressuring us to do high risk and minimally invasive surgeries and heart surgery patients complaining that the ICU was like a frat house at the wee hours of the night ( I can go on and on) - we had enough!
And so I parted ways with a hospital system that was purportedly financially strong. Despite lucrative contracts, my two colleague surgeons departed as well in a short span of time, leaving the hospital with almost no permanent heart surgeons, leading the hospital to almost shut down all the cardiac surgeries
Why? Because - no surgeon or physician would or should practice in an environment that jeopardizes the safety and well being of the patient.
And then I come to HaysMed - and lo and behold, I notice that during the entire heart surgery - the cardiac anesthesiologist physicians are performing all the anesthesia duties and watching over these patients like a hawk, there are two highly seasoned circulating nurses in the operating room on every surgery and two scrub techs on every case, a cardiac surgery PA assisting on most of the surgeries and a perfusionist trained from the renowned Texas Heart Institute who runs the heart-lung machine.
Furthermore, the patients are co-managed in the ICU by two highly experienced pulmonary critical care physicians, Drs. Tangel and Biring, along with an entire team of hospitalists. Thus, I learned, “Never judge a book by its cover.”
As time went on, I realized that the DeBakey Heart Institute had even more to offer - the cath lab nurses were like a band of brothers/sisters, the ICU nurses were quite competent and dedicated despite some of them being only two years out from graduation, the clinic staff and nurses ran logistics like a well-oiled machine and the cardiology nurse practitioners were quite skilled and diligent.
The vetting process that this hospital has before allowing any ICU to take care of our cardiac surgery patients is rather stringent and thorough, which is clearly reflected in the way they care for our very sick patients.
Above all, the cardiologists are highly compassionate and competent. Between Drs. Crawley, Gleed, Wagle - I don’t know if I can pick one over the other. The three interventional cardiologists - Drs. Janif, Sedhadri and Okuhara are technically superb.
Dr. Seshadri built the TAVR program here and many of our rural patients have benefitted tremendously from this procedure. Dr. Crawley has been a strong leader for the specialty, and Dr. Janif was a doyen in the field for this community.
It became evident that the Debakey Heart Institute was in need of a consistent heart surgeon, and, above all, the community at large needed it. Many patients had to travel hundreds of miles to seek open heart surgery due to the lack of a consistent heart surgeon.
I could see the staff in the operating rooms and ICU longing to have a strong heart surgery program. And so I was faced with this difficult decision - how do I commit more to this place?
Given our previous negative experience at a hospital in a midsize town, my family was clearly unwilling to move to any small city. But there had to be a way and a door opened when Dr. Roberto Cervera decided to be the other surgeon to partner with me and HaysMed in the winter of last year.
Dr. Cervera and I trained together at Texas Heart Institute/Baylor College of Medicine in Houston almost 15 years ago. We decided to split the time at Hays between us so that the hospital would have a full complement of heart and lung surgery services 24/7 at any point in time. This would also allow us to alternate our time with our families.
Through 2024, our program has advanced significantly. The collaboration between cardiology, vascular surgery and cardiac surgery has been at its best. Dr. Seshadri and I performed the first transcatheter implantation of the mitral valve here.
Drs. Cervera and Seshadri performed the first detour procedure - a minimally invasive procedure for rerouting blood. We also started the minimally invasive heart valve program here and have recently performed in our community the first mitral valve surgery through keyhole incisions without cracking the patients breast bone unlike conventional open heart surgery.
Dr. Gleed has performed numerous minimally invasive watchman procedures and ablations for atrial fibrillation. The DeBakey Heart Institute has been firing on all cylinders.
I can say confidently that the patients have been receiving utmost care for their heart conditions from our physicians, practitioners and staff with compassion, empathy and dedication. And then when I see the news article and the opinions on social media that seemingly portrays our hospital in different light, I am rather disappointed.
We live in a world where everyone is entitled to an opinion that is promulgated by the power of social media.
Sure - anyone can have an opinion. Einstein had an opinion, so did President Reagan, so did President Lincoln, so do our next door neighbors. Even an inmate in prison has an opinion.
The question is: can I trust that opinion ? Is that opinion just speculative or it based on facts or is it complimented with foundational knowledge? Let us not forget that in the previous century, the opinions of a handful of prejudiced people with extreme ideologies led to two world wars and the deaths of millions of innocent humans. Opinions have consequences.
This is why I am compelled to write this letter to you. I had come to notice that patients who need cardiac care are now canceling their appointments/ procedures and seeking care elsewhere. Now they will be traveling a couple of hundred miles to other hospitals. In circumstances where these heart patients need urgent care, this could be rather detrimental and unsafe to their health.
They will be seeking care from physicians they have never met before and there will be a break in the continuity of their care - something that has been known to be detrimental to better clinical outcomes.
The Debakey Heart Institute has been delivering the best care for its patients all throughout, and it is rather unfair that these patients are now going to suffer and be collateral damage of what I perceive to be a “social media lynching” of one of the best community hospitals I have worked at. Why do these patients have to face the consequences and suffer?
I’m not contesting the opinions of a urologist or a dermatologist or whoever it might be. It is not my place and I certainly am not privy to what had happened - so I am not in a position to judge or opine.
Every hospital has its challenges and difficulties, which have been aggravated since COVID. But I feel it is important for the community at large to understand that these generalized opinions have nothing to do with the DeBakey Heart Institute at HaysMed in any form.
I have worked at a few hospitals in my career, and I have covered emergency cardiac surgery services at other hospitals in Kansas, Colorado, Michigan, and Minnesota. I could pen volumes about how some of these places shouldn’t be even performing heart surgery in the United States.
Furthermore, I would like to caution that the opinion of a physician who has not been in practice every day for several months or that of a physician whose area of practice is primarily restricted to outpatients simply cannot be extrapolated in general terms- it would be rather preposterous to correlate this with the performance of high-level inpatient services.
When a patient undergoes heart surgery or a cardiology procedure, their care in the hospital is resource intensive. Majority of patients undergoing these procedures at the DeBakey Heart Institute have done well given their risks and comorbidities.
For example, when I perform a heart surgery, there is a battalion of people involved in the care of the patient ranging from the cardiac anesthesiologist, the cardiologist, the hospitalist, the pulmonologist and critical care physicians, the circulating nurses in the operating room, the Perfusionist, Scrub Techs, the ICU nurses, the lab technicians, the respiratory therapist, the physical therapist and the social workers.
All these people have put their blood, sweat and soul every day in taking care of these very sick patients who undergo heart surgery and cardiac procedures.
Our former patients will speak to the level of care they have received at our facility here in Hays, Kansas. Clearly these staff at the hospital didn’t come from thin air - someone hired them here and who is that “someone?"
I feel that it is a disservice to these highly dedicated staff and physicians when an opinion rendered by a physician who doesn’t even witness or use these intensive services at the hospital on a day-to-day basis goes viral on social media and negatively impacts the community as well as the staff that serves the community.
This has real consequences. If patients choose not to seek their cardiac care here, our procedural volumes will decrease - which means more physicians would leave and consequently staff will leave as well.
Reimbursements to hospitals are dictated by insurance companies who for the most part do not differentiate between competent and incompetent care - all get paid the same.
The community deserves a good hospital, and HaysMed is a good hospital. Is it perfect ? - maybe it is or may be it is not, but no hospital I have worked at is perfect by any stretch of the imagination! But compared to few of the other hospitals I have worked it, HaysMed is staffed with sincere, competent and compassionate people and delivers good clinical services. These staff take pride in their work to serve this community - they certainly deserve credit and appreciation.
On a closing note - while many have harnessed the power of social media and press to express opinions and concerns whether it is right or wrong or true or untrue - I would like to use this opportunity to ask the community at large to help us.
We are constantly faced with shortage of blood and especially blood products such as platelets, which some of the sick patients are in dire need of.
Sometimes, we have to cancel procedures due to the lack of these blood products in our region. Donating blood helps us tremendously- but more importantly you are helping a fellow citizen.
So if you can find a nearby blood bank or a hospital and donate blood, it would be for a noble cause. Let us live with integrity, compassion and empathy.
Life is precious, time is valuable!