Sunday, Feb 18, 2018
These days, finding excellent and cutting-edge cardiovascular care in Northwest Georgia isn’t hard, but that wasn’t always the case. More than three decades ago, a group of Harbin Clinic doctors realized the need for heart care in the area and began working toward bringing the programs to our community.
“We were watching how percutaneous coronary intervention was spreading worldwide, and we wanted to be involved in it,” Retired Harbin Clinic Cardiologist Dr. Frank Stegall says. “At the time, you had to have an open-heart surgery program to do it.”
The words percutaneous coronary intervention don’t flow off the tongue, but most people have heard the more common name for it – coronary angioplasty. It is a non-surgical procedure that improves blood flow to the heart.
A Need for Care
With the incidence of obesity and heart problems growing in Northwest Georgia, Harbin Clinic teamed with Redmond Regional Medical Center to start an open-heart surgery program in 1981.
At the time, most open-heart surgery programs were located in big cities like Atlanta, Birmingham and Chattanooga.
“It was really unheard of for a town the size of Rome to have an open heart program,” Stegall says.
“If you lived in Northwest Georgia and you needed a heart operation you had to go to Emory or St. Josephs Hospital (both located in Atlanta),” Harbin Clinic Vascular Surgeon Dr. John Kirkland says.
The process of opening the program proved to have many obstacles and speed bumps. Harbin and Redmond needed to secure a certificate of need from the State Health Planning Board.
The Certificate of Need programs were established across the nation for three main purposes. Those purposes were to measure and define need, to control costs and to guarantee access to healthcare services.
Harbin Clinic and Redmond felt the need for interventional heart care was growing in Northwest Georgia and wanted to be able to provide the vital service to the local population so they wouldn’t have to travel to Atlanta but could stay closer to home.
After a couple of attempts, Dr. Kirkland was appointed to the state board and was able to present evidence showing a growing need for services and an underserved population in Northwest Georgia.
We already had a successful diagnostic cardiac catheterization lab at Redmond started by Dr. Raymond Young and Dr. Scott MacLeod.
The statistics helped Harbin Clinic and Redmond gain momentum, and it was only a matter of time before they would secure the certificate of need. But they faced a big obstacle— they needed someone with experience to help them start and oversee the program.
Finding the Right Leader
Dr. Kirkland happened to know someone who fit the bill.
“I had gotten to know Dr. John Kirkland during training. He was three or four years ahead of me at the University of Michigan,” Dr. Daniel Goldfaden says. “When I was finishing my cardiac surgery training, he was interested in me coming to Georgia. I told John I would come for a visit, but that I was going to go into an academic practice.”
Dr. Goldfaden visited Rome and helped put together information about the equipment, personnel and other vital pieces an open-heart surgery program needed so they could start working towards opening the program.
However, Dr. Goldfaden let them know one key element about his help.
“I told them this is not for me. I was fresh out of training, and I didn’t want to start my own program,” he says. “I wasn’t interested. I really came down here as a favor to Dr. Kirkland.”
Harbin and Redmond didn’t get the certificate at the time but did secure it more than a year later.
“When their certificate of need came through, they called me back and asked if I was interested,” Dr. Goldfaden says. “I told them I was reasonably happy in Chicago but a bit disillusioned with the academic career. They invited me back. This time, I brought my wife and she loved Rome.”
His wife’s love of the town helped, but something else impressed Dr. Goldfaden as well.
“I was very surprised a town the size of Rome could support a medical practice like Harbin Clinic with the quality and number of medical specialists in a variety of fields,” Dr. Goldfaden says. “More than anything, that is what overcame my concerns about moving to a small town in the south. And now I wouldn’t have it any other way.”
Once Dr. Goldfaden arrived, everything began happening quickly.
“Starting the program was fairly seamless. We brought the surgical team from Redmond to Chicago and we spent about a week with observing various procedures,” Dr. Goldfaden says.
A Successful Start
After the team went through several dry runs, it was time to begin performing surgeries.
“In October 1986, we performed the first open-heart procedure in Northwest Georgia at Redmond. The Rome News-Tribune and Channel 11 from Atlanta each found out about it and made a big deal reporting it,” Dr. Stegall says. “They even asked to put a television camera in the operating room, but we told them that wasn’t allowed.”
After screening a number of candidates, the first patient, Gertrude Garland, was selected and underwent the procedure on October 22, 1986.
“We took her to the operating room and everything went smooth as silk until we came off the heart lung machine. She had some bleeding from her aorta that required more stitches. We had to put her back on the heart-lung machine,” Dr. Goldfaden says. “Dr. Kirkland assisted me on the case and after a few minutes we got it fixed, and she did fine. As a matter of fact, for several years we had reunions for the heart program and she was at almost every one wearing a t-shirt which said she was the first patient.”
The program exploded after the success of their first patient. Dr. Golfaden anticipated about 100 cases in the first year. Roughly six months after performing the first procedure, the team finished its 100th surgery.
“I was very surprised at how fast it grew. I think we did something like 180 to 200 the first year. I was about as busy as I wanted to be,” Dr. Goldfaden says.
With the high volume of patients, it wasn’t long before Harbin Clinic began bringing in more cardiologists along with additional cardiac and vascular surgeons.
“We went forward and we started recruiting other cardiologists including Dr. Michael Ware, Dr. Hector Picon and Dr. Hunter Myers among others,” Dr. Stegall says. “At one time, we ranked No. 2 in volume of coronary interventions in the state behind St. Josephs.”
But open-heart surgery was just the tip of the iceberg for cardiac and vascular care in Northwest Georgia.
The Program Takes Off
“We started out with just coronary bypass. The second year we started doing adult valve replacements,” Dr. Goldfaden says. “Over the years we have added a lot of other procedures, and we pretty much do a full spectrum of adult cardiac surgeries.”
The location of the program couldn’t have been better as the prevalence of heart disease is high in Northwest Georgia and the surrounding area.
“If you look at cardiovascular disease, there is a belt in Texas, Alabama and Georgia. It’s pork, French fries, hamburgers and cigarettes. The statistics show we serve an area of approximately 450,000 people. A good portion of that population is an older demographic that doesn’t want to go to Atlanta or Chattanooga,” Dr. Stegall says. “Geographically, it’s easier for a lot of those people to come to Rome.”
“We had people hand us demographics studies that predicted the number of heart and vascular cases we would have in our area would double and by the early 1990s. We saw that was true,” Dr. Kirkland says.
While the incidence of heart disease and heart cases did rise as projected, the doctors also point to another key statistic showing how big a role the program has played in helping heart patients in Northwest Georgia.
The mortality rate for heart attack patients has steadily declined, since the heart program began. Dr. Stegall says one of the most beneficial parts of the heart program has been the way Harbin and Redmond have changed treatment for heart attack victims.
“In the old days, we put heart attack patients in the hospital and observed them,” he says. “Now, we go in and open up the artery with a stent.”
And the process has been streamlined, as technology has allowed the treatment process to begin when the heart attack patient is picked up by EMTs.
“The mortality rate of acute heart attacks has been halved due to the rapid restoration of coronary blood flow in a cardiac catheterization lab. Our program involves a lot of people and starts with the EMT’s. They perform an EKG on site when they pick up the patient and transmit those readings to the emergency room,” Dr. Stegall says. “This allows them to get the patient into the cath lab as quick as possible, so the cardiologists can open the artery. The standard of quality across the country is that this process be within 90 minutes from the time the patient enters the emergency ward. Our current time at Redmond is 50 minutes.”
Stegall notes the service is available 24 hours a day seven days a week.
“This has resulted in a dramatic mortality reduction in the treatment of acute heart attacks,” he says. “To be able to reduce mortality by 50 percent is almost unheard of in medicine. A lot of work has gone into this by everyone involved. It has taken lots of effort and coordination, but the end results are worth it.”
And as the technology has improved, the doctors have stayed on the cutting-edge of it in order to help their patient. That technology came to Northwest Georgia through Redmond’s EMS.
Cutting-edge Heart Care
“We’ve done valve replacements, complicated aortic dissections, thoracic aneurysms, cardiac assist devices,” Dr. Goldfaden says. “We’ve also done minimally invasive procedures for valve replacement and coronary bypass.”
In 1995, the doctors teamed to build the Harbin Clinic Heart Center and Vascular Center to allow them to offer all of their services under one roof.
Harbin Clinic’s Vascular Surgery program has also enjoyed enormous success in Northwest Georgia.
Dr. Leeon Rhodes established the Vascular Surgery practice in 1975. Dr. Kirkland joined the team in 1978 and Dr. Michael Rogers came on board in 1981. The practice now includes Dr. Jon Molnar, Dr. Trent Prault and Dr. David Wilson with Dr. Frank Stegall Jr. joining the group in 2017.
“We started the vascular lab in about 1980 with one tech, one secretary and one Doppler machine. If we wanted to record the waveforms, we had to borrow an EKG machine from another doctor,” Dr. Kirkland says. “We now have one of the largest vascular ultrasound labs in the country with 13 registered vascular technologists, and we perform about 16,000 studies a year.”
“We opened the Harbin Clinic Vein Center in 2005 and it is still the only accredited AAAASF (American Association for Accreditation of Ambulatory Surgery Facilities) vein center in Georgia,” Dr. Kirkland says.
“You hear people talking about hybrid operating rooms now and Redmond and Harbin actually opened one of the first hybrid room in the United States in 1998. A hybrid room is room where you have an operating room and you also have an angiography suite,” Dr. Kirkland says
Hybrid operating rooms allow doctors to combine the techniques of interventional cardiology, radiology and those of cardiac and vascular surgery to help maximize benefits of the procedures while minimizing the invasiveness.
Vascular surgeons from around the country visited the hybrid room at Redmond to study its operation and design.
The doctors and the technology allowed Harbin and Redmond to add more techniques and life saving and prolonging procedures, including the first iliac angioplasty with a Palmaz-Schatz stent in 1992 and the first endograft aortic aneurysm repair in 1999.
Looking to the Future
With an eye towards the future, the men who helped start it all say Harbin Clinic is poised to continue bringing great cardiac care to Northwest Georgia.
The doctors point to the TAVR (transcatheter aortic valve replacement) procedure being spearheaded by Dr. Christopher Merritt, Dr. Charles Jackson and Dr. Cyrus Parsa as yet another milestone in cardiac care. They also acknowledge the work of Dr. Billy Chacko as the first vascular medicine specialist in Georgia and the pediatric cardiology program, which takes care of the smallest patients.
“We have some great surgeons groups here,” Dr. Kirkland says. “We are fortunate enough to have Dr. Chacko as the first vascular medicine specialist in the state as well.”
“Looking ahead, I see great things for the cardiology and vascular programs. The TAVR program has gotten off to a great start and Dr. Girard has done amazing work helping build our non-cardiac thoracic surgery practice,” Dr. Goldfaden says.
And as the programs expand and citizens of Northwest Georgia continue to rely on Harbin Clinic’s long list of top-notch services, the doctors who have been helping serve the population of Rome and surrounding counties for decades, get a smile on their faces when they think of the impact of the programs they created.
“I don’t think there is any doubt that we couldn’t have found anyone better to start the heart surgery program than Dr. Goldfaden,” Dr. Kirkland says.
“Dr. Goldfaden has been a steady source of leadership,” Dr. Kirkland says. “At the time, cardiac surgeons were kind of the kingpins. They had big egos and he doesn’t.”
When asked to look back on his years at Harbin Clinic, Dr. Goldfaden pauses and scratches his head as a big smile spreads across his face.
“I’m proud of what we’ve done. I don’t think it’s anything heroic, but it’s been a solid practice, and we’ve provided a good service to this community over the years,” he says. “Things are changing so much in medicine. I’m getting close to the age that I want to slow down.”
Dr. Goldfaden does mention the word retire as he talks but quickly adds a caveat.
“I think the program has a good, solid base and will be here for a long time,” he says. “We have lots of younger doctors who are all doing great work.”
It’s a sentiment that Dr. Stegall, who retired in the summer of 2015, echoes.
“The young group of cardiologists and surgeons we have here are world-class,” he says. “ We are very lucky, because they could have chosen to go anywhere. They chose to come to Rome.”
With a history of innovative, cutting-edge heart and vascular care, the citizens of Northwest Georgia can breathe easier knowing Harbin Clinic is ready to help keep their hearts, arteries and veins healthy and pumping for years to come.