Robert E. Guide,
M.D.
The Heart
Institute for
C.A.R.E.
One Care Circle
Amarillo, TX
79106 - 1825
Dear Bob:
We enclose a copy of our report. to the Society f or Cardiac Angiography and Interventions of our visit to your laboratory on May 7 and 8, 1991. You may use it in any way that seems helpful. We presented it to the Laboratory Survey Committee, and in a summary form to the trustees of the Society. It was approved by each of of these groups.
We
thank you again for the warm welcome given us by
everyone we met
in Amarillo.
Sincerely yours,
DGG/WFW:klf
Enclosure
REPORT OF A CONSULTATION VISIT TO
THE HEART INSTITUTE FOR C.A.R.E.,
DR. ROBERT GULDE’S OFFICE, IN AMARILLO,
TEXAS
MAY 7 AND 8, 1991
This case is carried as a cardiac death in
the
laboratory because it occurred following the angiographic study. On the
other
hand a review of the chart makes it clear this patient died of an
unfortunate
surgical mishap.
In 1988 there were four minor
complications, a
hematoma of the groin and hypertension, a hematoma which resolved at
home, a
third hematoma, and hypotension treated with intravenous and oral
fluids.
This
patient had severe generalized arteriosclerosis
which is a life-threatening complication of coronary arterial disease.
It was
so severe that the usual resuscitation measures could not be carried
out. This
case must be counted as an angiography death. It is the only one which
should
be counted as a death as a result of angiography in the history of the
laboratory.
The other major complications include an episode of
ventricular fibrillation which was reversed with closed chest massage
and
defibrillation. The next had a hematoma with repair of a pseudoaneurysm
two
days later. The next developed dyspnea and hypotension. It was treated
with
steroids, adrenaline, Ringers solution, and elevation of the feet. That
patient
had a meal and then went shopping. The next was a hemorrhage from the
femoral
artery twenty hours after catheterization. This was treated surgically.
Later
there was some minor infection of the operative site which cleared with
appropriate treatment. The next was dissection of the femoral artery
with later
oliguria and hypotension. The pulse in that vessel faded and then
returned. The
last was a hernatoma of the fernoral artery with a pseudoaneurysm
which was
treated surgically.
In 1989 there were four minor complications. One
patient with no history of allergies developed hives and edema
when
given Angiovist. Treatment with Tagamet and Benadryl gave prompt
relief. The
next was a vascular perforation with escape of contrast and no
sequelae. The
third was late suspicion of a pseudoaneurysm with none found, and the
fourth
was orthostatic hypotension with nausea and vomiting treated with
fluids.
In 1990 there were 79 cases with no major
complications and two minor complications. The first was ventricular
tachycardia or fibrillation following a right coronary artery
injection,
successfully treated with cardioversion and the other was a small
hematoma
after the procedure. In 1991 67 studies have been done with no
complications.
The record thus for the past three-plus years
is of
the treatment of 457 cases with one death which was clearly not
attributable to
the procedure and one death which was attributable to the procedure. In
the
three previous years, 1984, 1985, and 1986, 599 patients were treated
without a
death. In fact the only death following a procedure other than the two
already
described was a patient seen in 1974 who was clearly a salvage patient.
The
attempt to save the life of this patient probably had little hope from
the
onset and was unsuccessful. Taking the series from 1984 through 1991
there were
a total of 1056 studies with one death. This works out to approximately
one
death per thousand. This is the same as the mortality in the thousands
of cases
studied in the laboratories of the registry of the Society for Cardiac
Angiography and Interventions. Of the 457 patients studied in 1988,
1989,
At lunch we met nine of Dr. Guide’s
colleagues. (See
Appendix C)
.
They all seemed to be solid citizens established
in the community. From each of them we gathered that there is a
significant
demand for high-quality cardiac catheterization and angiocardiography
in
Amarillo. Patients are referred from the surrounding communities as
well as
Amarillo itself. It is also clear that these physicians from the
community feel
that Dr. GuIde is meeting this demand in an exemplary fashion. Dr.
Phillip
McGraw, a psychologist, is engaged in helping Dr. Guide recruit three
more
professional people at a technical level, as well as a cardiological
partner
whom they expect to have on board in two months.
Additionally, he and Dr. GuIde are going to review the
extensive data bank which has been accumulated by Dr. Guide in relation
to
habits of diet, alcohol, tobacco, associated diseases, and
demographics. They
hope to review some of the traditional ideas in these fields and see
how well
they are borne out by the data. This seems like an ambitious and very
exciting
development. Dr. Guide is clearly not resting on his laurels, but is
planning for the future in an imaginative and
inspiring way. We
were impressed with the excellent patient education and instruction
which is
carried out by the personnel, by the audiovisual material which is
abundantly
available, and by the personal efforts of Dr. Guide himself.
Dr. Guide has recently done coronary
arteriography on
a nationally known radiology consultant who in the course of his
business
visits many laboratories throughout the United States. He is not a
native of
Amarillo, but apparently selected Dr. Guide as the place for his
coronary
arteriography because of his high opinion of the quality of the work.
In summary we find the Heart Institute for
C.A.R.E.,
Dr. Guide’s office, is providing a high quality of general
medical care with
the emphasis on cardiology which is probably not surpassed in any
doctor’s
office in the country. The facilities, the technique, the personnel,
and the
results would be highly commendable in any hospital. In a
doctor’s office they
are clear evidence that it is possible to do this kind of work in an
independent doctor’s office with a high degree of safety and
accuracy and at a
much lower cost than many places. Each of us came to the conclusion
that while
we might not travel to Amarillo for our next coronary arteriograrn, if
we had
to have another coronary arteriogram we would be glad to have it done
by Dr.
Guide in his office.
An essential ingredient is an extraordinary physician with the technical skills, leadership, organizational ability, and humanity
|
represented by Dr. Guide. One reason
that there are not more such laboratories is that persons with his
abilities
are so rare. The patients studied in his laboratory represent not just
easy
cases which could be done well anywhere, but represent diagnostic and
technical
challenges which would test any facility. We have no reservations in
giving
full approval to Dr. Guide for the work in his laboratory. It is one of
the
best laboratories either of us has ever visited. We look forward with
enthusiasm to hearing of the future developments he has in mind.
Respectfully
submitted,
, Appendix B
Cath Lab Staff Listing
May
8,1991
1.
Jim
Fowikes, RT(R), RDMS - Clinical
Consultant & Echo Tech
Address: P.O. Box 9414, Amarillo, Texas 79105
Phone: 806-353-1900
2.
Ernest
Bates, R.N. - ACLS Certified/Instructor - Director of Nurses, Cath Lab
Nurse
Address: Route
1, Box 503, Canyon, Texas 79015
Phone: 806-655-0550
3.
Kenneth
Payton, RMT, TDH-CMRT, HEW-CLT, MRt - Medical Technologist,
Radiology
Technologist
Address: P.O. Box 341, Groom, Texas 79039 Phone: 806-248-7083
4.
Thomas
DiSalvio - B.S. Exercise
Technology - EKG Technician Address: 3610
Lynette,
Amarillo, Texas 79109 Phone:
806-352-8546
5.
Star
Tucker - Nurse Technician
Address:
3707 Catalpa, Amarillo, Texas 79109
Phone:
806-353-1822
,
Appendix C
Physician Listing
Luncheon - May 8,
1991
1.
John Alpar, M.D., P.A. - Fellow of American CoUege of Surgeons -
Ophthalmo!ogist - referring physician - Quality
Assurance Committee member.
Address:
5311 West Ninth Avenue, AmariHo, Texas 79106-4161 Phone:
806-359-3937
2.
Narsyana
PiHai, M.D.
-
FeUow of Associated College of Physicians - Oncologist -
Diplomat American Board of nternal Medicine and
Oncology - referring
physician
- provides
coverage white I am out of town - Chairman, Quality
Assurance
Committee Heart
Institute For CARE.
Address:
1901 Medi Park, Suite 1002, Amarillo, Texas 79106
Phone:
806-353-8011
3.
L.A. White, M.D. - Family Practitioner - referring physician.
Address:
1920 Medi Park, Suite 1, Amarillo, Texas 79106
Phone: •
806-359-3193
4.
Donald Frank, M.D. - Family Practitioner - referring physician. Address: 521 1 West
Ninth Avenue,
Amarillo, Texas 79106
Phone:
806-359-8583
5.
Richard Archer, M.D., P.A. - Diplomat American Board of Internal Medicine -
referring physician.
Address:
1900 Coulter, Suite M, Amarillo, Texas 79106 Phone:
806-353-381 1
6. Mrs. Richard Archer - Dr. Richard Archer’s wife.
Address:
6867 Fulton Drive,Amarillo, Texas 79109 Phone:
806-355-0789
7.
John Easy, MD., PA. - Fellow of American College of Surgeons -
Cardiovascular & Thoracic Surgeon - consulting physician.
Address:
706 North Polk, Amarillo, Texas 79107
Phone:
806-372-2988
8.
Phil McGraw, PhD - Board Certified in
Behavioural Medicine - consultant.
Address: Professional Technologies, nc., 4225 Wingren Road,
Irving, Texas 75062
Phone: 214-717-1477
9.
Bob
Lieman -
patient - Consultant for Heart Institute For C.A.R.E.
Foundation
President of International Platform
Association.
Address:
2937 Westbrook Drive #419A, Fort Wayne, ndiana 46805
Phone: 219-483-2300