28th September 2006: Speech to Heart Niagara Cardiac Rehabilitation Programme Volunteer Physicians by Dr Stafford Dobbin on the 28th anniversary of the programme. Ladies and Gentlemen, Just a few memories: First as a Medical Clerk with Professor Frank Pantridge, (the inventor of the Cardiac Ambulance/Paramedic concept) in his Coronary Care Unit in the Royal Victoria Hospital in Belfast, N. Ireland, 1966: the standard treatment for Acute Myocardial Infarction was 3 weeks of in-hospital bedrest. Coming to Ontario in the early ‘70s – no ERs, no Paramedics – AMIs spent over 2 weeks in hospital. Cardiac Rehabilitation was a major influence in changing that way of thinking. And working at the 1976 Olympic Games, as a Founder Member of the Canadian Academy of Sports Medicine, hearing of Dr Terry Kavanagh’s programme, (started in 1968 at The Toronto Rehabilitation Centre), where post AMI patients were in rehab soon after their event and from which programme a group had run the 1973 Boston Marathon. Going to meet Terry Kavanagh in Toronto and working with him on the protocols for setting up a similar model in the Niagara Peninsula. ; Protocols and standards that were set by the American College of Sports Medicine, with whom I was already a member. Founding Heart Niagara Incorporated, a Community Coronary Care programme, as an extension of the new Department of Emergency Medicine to teach Citizen Cardio-Pulmonary Resuscitation and to teach Advanced Cardiac Life Support to Critical Care staff: physicians, nurses and later, (1979), Paramedics – but also to start primary prevention in schools and provide tertiary prevention/cardiac rehabilitation to survivors of the disease. We got funding for the equipment from four local Lions Clubs and a Wintario Grant plus money to start Heart Niagara itself from the GNGH Foundation through John Carter, CEO of GNGH. The first class: in the old Niagara Falls YMCA on 4th Avenue. September 30th 1978 – ironically the same date 28 years later when we have been told by the Niagara Health System/Brock University group that we are to stop taking referrals. Six patients in that first class on a Wednesday evening – two more the following week and of those 8 first patients seven are still to the fore today – Joanne Allan was the Coordinator and an RN, Susan Martin was the other RN, Robbie Martin and I were the Physicians and Otto Sindelar was the Fitness Director. By 1979 Jackie Robb had taken over as Coordinator and would be beloved by thousands of cardiac patients over the years up to her retirement in 2002. As the ACSM standards required ACLS certified staff – and the only available ACLS at that time in Ontario were Physicians – we approached OHIP with a request that, as the Physicians had to be there anyway, could they bill OHIP for the patients that they saw and donate the money to Heart Niagara to cover on-going costs? The Physician at the head of OHIP felt this was
reasonable and a contract was undertaken with OHIP whereby volunteer Physicians would bill under the name of Niagara Coronary Services and the monthly income would flow directly to Heart Niagara. Under this arrangement Robbie Martin and I were joined by the late Ron Ledray, and by Philip McGarry, Joanna Hill, Kevin Foster, John Palmer, John O’Neill and Ken Armstrong. Azim Velji was the back-up. Later, as they arrived in town: Mike Goodwin, Dan Dargavel, Brian Bassil, Michelle Bertothy, Pat Gibney, Todd Oversholt, Doug Munkley, George Zimakis, Gurpreet Gill and Bob Werhun joined in. This arrangement with OHIP ran until 2004 when someone (? no guesses), lodged a complaint with OHIP that our volunteer Physicians were making a personal profit out of this; after an investigation, Heart Niagara and our volunteers were totally vindicated but the Heart Niagara Board elected to terminate Niagara Coronary Services after the controversy. Back in 1979, the YMCA went bankrupt and Heart Niagara was very instrumental in the City of Niagara Falls refinancing the operation. The Intake Assessments were done at GNGH, with Dr. Jim Harrigan doing a lot of the Stress Testing and Exercise Prescriptions but the activity classes were running Monday, Wednesday, and Friday at the YMCA gym with rarely under 30 patients per class in a fairly small space. A local sports club: the Niagara Falls Badminton, Tennis and Lawn Bowling Club also ran into financial difficulties in 1980 and Heart Niagara moved there as part of a plan to save the facility which included a Federal Grant from Al McBain, the Niagara Falls MP, (and Father of John McBain who made the $1 million donation to build the McBain Community Centre which houses the present YMCA and Heart Niagara Cardiac Rehab). The Badminton Club had floor space for 5 badminton courts and was ideal for activity classes of a large size. In 1982 Dr. Nanette Wenger and her Emory University, Atlanta, group proposed the 5 day AMI Care Map and the 4 phase Cardiac Rehab programme. Dr Jim Harrigan, Sandy Loubier and Susan Leyland from ICU and myself went to Rochester to review her plan and meet her group, (which included a talk by Dr Bill Castelli, the Director of the Framingham Heart Study, and a major supporter of Heart Niagara in the years to come). Sandy Loubier wrote up the Procedures Manuel, (which was also available on Audio and in French and Italian). The AMI Care Map which evolved from this was designed for all Peninsula Hospitals by Dr Kai Chan, Jeff Atherton and Kathy Grant from GNGH ICU, Joanna Mataya, OT and myself. It included automatic referral to Cardiac Rehabilitation from ICU. Phase 1 was in-patient and included an intake assessment by Jackie Robb and Joanna Mataya and incremental daily sessions with nursing, nutrition and physiotherapy. Phase 2 was in GNGH after discharge and was coordinated by a nursing group led initially by Sandy Loubier and later, Dianna Zaniol and then Kathy Grant. A large number of RNs, nutritionists, physiotherapists, occupational therapists, and counselors volunteered for the sessions and the accompanying workshops. All ICU nurses and Medical Floor Charge Nurses were in-serviced in the programme requirements. The In-service extended to St.Catharines General, Hotel Dieu, and Welland General but despite many attempts by Heart Niagara over the years to get in-patient prorammes going in those hospitals, it was not until the evolvement of the Niagara Health System that Don Gibson, a RN(EC) who took over as Programme Coordinator from Jackie Robb, was able
to start Cardiac Rehab satellites in SGH, WGH and in Douglas Memorial in Fort Erie. Those initial attempts at regional expansion included starting a programme at Brock University through the Faculty of Health Sciences with the Dean, Robert Kerr, and Professor Bill Montelpare. Phase 3 was mainly an activity class – with workshops – based on exercise prescriptions and took place at the Badminton Club staffed by volunteer Physicians, RNs, ACSM certified Exercise Specialists and Paramedics. Phase 4 was post graduate and included the option of volunteering back into the programme. As a fun spin-off the Heart Niagara Team were invited to provide Medical Services at a number of mass participation events: rock concerts etc but including the 1980 and 1984 US Olympic Marathon Trials, the 1985 World Masters Games in Toronto and the 1986 World Veterans Games. In 1995 Heart Niagara demonstrated symptoms of burn-out following the effort of teaching all the initial regional CPR and ACLS, (and ATLS), kick-starting the Paramedic programme, initiating the Public Access Defibrillation programme, Workplace Primary Prevention programme and the huge, and unique, Grade 9 Niagara Schools Healthy Heart programme in 1987. The unenviable job of being the new CEO was shouldered by Karen Stearne, Doug Munkley courageously agreed to be President with myself as Medical Director. Largely due to good teamwork and Karen’s personal motivation, fund raising abilities and promotional skills, the organization came through this traumatic period and earned the sobriquet, “the little engine that could”, from Gary Zalot, Manger of the District Health Council. In 1999 the Ontario Ministry of Health put out proposals for funding of Cardiac Rehabilitation programmes. The Niagara Peninsula did not receive funding due to the perception that we are serviced by Hamilton. Ironically, Don Gibson and myself were both invited to sit on the Ontario Critical Care Network committee to participate in the site evaluations of the other 21 programmes. As the Niagara Regional Cardiac Rehabilitation was servicing over 500 referrals at the time it has made us the biggest unfunded Cardiac Rehabilitation programme in Canada. As the funding criteria appeared to require a hospital base the Phase 3 was moved from the Badminton Club to GNGH in 2002. In 2005, the MOH announced funding of $200,000 a year to be directed to the Niagara Peninsula. Heart Niagara has not received anything from this funding so they should all be made available to the NHS/Brock programme and should significantly simplify the start-up of their programmes. In thanking you and all the other volunteers who have enabled thousands of Post AMI and Post Bypass and Angio patients to receive Cardiac Rehabilitation for all those years – in their own area rather than driving biweekly to Hamilton or Toronto – I have to express my condolences to Don Gibson and his staff who have worked so hard to broaden our referral base and initiate satellite programmes. And to Karen Stearne whose amazing abilities and determined focus have enabled us to raise the funds to keep it going through all its recent crises. If requested, we will assist our successors in every way to make the
transition from Heart Niagara based programme to a NHS/Brock programme. We have put too much blood, sweat and tears into Cardiac Rehabilitation down the years not to want it to remain successful. Hopefully the 2005-2006 referral base of almost 600 patients will be soon overtaken by the efforts of our successors in the years to come. As a final word I would hope that none of you who worked on this in past years feels disappointment at its closure. We took the job on in 1978 and ran it for 28 years because there was no-one else in the Niagara health-care system available to do it. Now there is! I feel we did it better than anyone else could have done in our circ*mstances. We didn’t’ whine or complain about lack of resources: we raised our own. Now we can spend that money on other Heart Niagara programmes. There are very few other places in the world where an essential cardiac service which should be available to every Canadian citizen was provided by a group of volunteer physicians, nurses, therapists, nutritionists and paramedics. Even if few others seem willing to acknowledge what you did, you can be very proud of your role in the Heart Niagara Cardiac Rehabilitation programme. And for now “The little engine that could” will continue to shunt down a different set of tracks that lead to the elimination of coronary artery disease altogether through the recruitment and involvement of the only section of our society that does not already have the disease: the adolescents. Thanks again for 28 great years! Stafford
