It is not sure what will go where just yet, but what is certain, what is not on the table for discussion with its chief executive officer, Michael DiRienzo, is the creation of a cardiac catheterisation laboratory. Cost and “it’s not a priority” are cited as reasons for ruling out the suggestion to convert the radiology space to a cardiac catheterisation laboratory as proposed by Taree cardiologist, Dr Sesh Narasimhan.

Dr Narasimhan put the idea on the table through the hospital’s clinical services director, Dr Osama Ali, and it forms part of his long-running public and political campaign to try to secure public patient access to cardiac catheterisation laboratory services in the Manning area.

The proposal to use the radiology space in Manning Hospital is in addition to his ongoing call for the NSW Government to negotiate a public-private partnership agreement with Mayo Private Hospital in Taree for public patient access to its cardiac catheterisation laboratory. Currently public patients are directed to John Hunter Hospital in Newcastle or Port Macquarie Base Hospital for cardiac catheterisation services.

Dr Narasimhan’s campaign to try to secure services closer to home spans more than five years, and at one stage the public-private partnership agreement idea did receive in-principle support from former NSW health minister, Jillian Skinner.

However, it has failed to progress despite Dr Narasimhan’s consistent pressure on Mr DiRienzo and NSW Government representative, member for Myall Lakes Stephen Bromhead. The campaign also lost leverage with NSW Health when Port Macquarie Base Hospital opened its new cardiac catheterisation laboratory in 2015 as part of the hospital’s $104 million expansion.

Dr Narasimhan’s campaign caught the eye of NSW Health earlier this year and resulted in an external independent review of cardiology services in the district by Dr Brian Bailey from Royal Prince Alfred Hospital. 

According to Mr DiRienzo, NSW Health’s direction to undertake the review came as “there was a debate out there that there was a bias here and the district didn’t want to do anything in this area”. 

Its terms of reference included the review of the process, quality of care, patient safety, timeliness of patient access, the ability of the Mayo Private Hospital to provide interventional and non-interventional cardiac services and the cost versus benefit of utilising Mayo Private Hospital. It also looked at the ability of the public Port Macquarie Base Hospital cardiac catheterisation laboratory to provide interventional and non-interventional cardiac services.

The resulting report by Dr Bailey saw him conclude that, “in my opinion the NSW hospital facility at Port Macquarie would currently be the preferred alternative to John Hunter Hospital for uninsured patients”.

He identified Mayo Private Hospital as “geographically best suited but currently does not fulfill several CSANZ guidelines for rural catheter facilities, especially in the area of medical governance” and “it depends on the availability of a single cardiologist.”

He also cited the need for “meaningful involvement of at least one additional interventional cardiologist with an appointment at a tertiary hospital and continuing external medical monitoring of the facility’s safety and performance.”

Dr Narasimhan brands Dr Bailey’s review of cardiac services a “sham review” because the terms of reference were created “without any consultation with anyone from Taree”. He contends his decision to lobby for the inclusion of a cardiac catheterisation laboratory as part of the Manning Hospital redevelopment “will also provide a solid base to attract a second cardiologist, which I believe is needed for the region.”

For Mr DiRienzo, the results of the review confirm the district’s position that the preferred pathway for patients in the Manning region is to transfer to either John Hunter Hospital or Port Macquarie Base Hospital, depending on the level of care required.

He now seeks to challenge the “myths” about cardiac services and says “there’s a lot of misinformation in the community” about the need for a cardiac catheterisation laboratory in the Manning area. 

“At the end of the day there is a very good cath lab, and this is probably not something the community of Taree wants to hear - but it’s the reality - at Port Macquarie,” Mr DiRienzo said. “If you need to go under sirens it is about 30 minutes and as a casual drive it’s about 40 minutes.”

However, he stresses that patients in need of urgent care will be transferred to John Hunter Hospital by ambulance.

“You wouldn’t even blink, they must go to John Hunter because they need back-up cardiology cover and the back-up of a level six intensive care unit. The intensive care unit here (Manning Hospital) is not at the level of John Hunter purely because of the role the hospital plays in the district.”

Mr DiRienzo says each patient is assessed when they present at the emergency department and not all require immediate intervention or immediate transfer to John Hunter Hospital. There are options that include access to Port Macquarie Base Hospital.

“Let’s say they’ve come through the emergency department, the physician is not sure what’s really wrong with them but to be safe says, let’s go and do an angiogram or let’s go and do some potential intervention. They will get admitted to the hospital and at the moment, they wait for a transfer to John Hunter Hospital.

“To that group of patients, what we’re are saying is, if you believe there are time delays in going to John Hunter, then why don’t you use the available public cath lab in Port Macquarie?”

Mr DiRienzo challenges the argument that the two-hour travel time from Manning Hospital to John Hunter Hospital in Newcastle is reason alone for the investment of public funds in a Taree-based cardiac catheterisation laboratory.

“So the biggest myth is this issue about distance. In metro Sydney the distance for someone to go in an ambulance to a cath lab, even though it might be 20 or 30 kilometres, it could take up to an hour or an hour-and-a-half in traffic,” Mr DiRienzo said.

“The new models of care and the way that we deliver services … does not have any impact on the quality and clinical outcome if you have a heart attack.”

He cites advancements in tele-health and the ability of emergency department staff to access support from the John Hunter Hospital intensive unit through its critical care cameras, as part of the services mix at Manning Hospital.

“Why are we not reading the research and why are we passionately listening to one passionate clinician but not understanding that there is a complete system that does extremely well?”

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