It was a typical week and Erica Pontes put through 18 referrals for Bermuda patients to have their hearts checked overseas.

On average she said three or four new patients are referred to cardiologist Dr. John Doherty each day. He is one of only two heart specialists on the Island and the only one operating a private practice.

“Everyone in Bermuda that has to be referred to a cardiologist, gets referred here,” said Dr. Doherty’s medical administrator Erica Pontes. Not all those who are referred will require treatment or surgery. All those who do are directed overseas.

“The hospital (King Edward VII Memorial Hospital) does not have facilities for cardiac angioplasty,” said Mrs. Pontes. This is the standard test to determine exactly what the problem is in most cardiac cases.

“We don’t make decisions on bypass surgery here,” she said.

At the office patients are given a stress test. This is a physical exercise tolerance test. Depending on the results patients may also have to have an echocardiogram ECHO or ultra sound but many times these tests are not sufficient to diagnose the problem. In these cases patients are referred overseas.

Mrs. Pontes handles all the paper work involved in the transfer. She liaises with the patients here and the overseas hospital. She said the office works with the patient and will deal with whatever hospital they choose. The majority of patients go to the Lahey Clinic in Boston, or Johns Hopkins in Baltimore. The office has what Mrs. Pontes describes as “open communications” between these two facilities and she said doctors there are so familiar and at ease working with her office that when necessary patients can be seen as quickly as the next day.

“Panicky patients sometimes ask if we get paid for sending them to these hospitals. This is a ridiculous question and of course the answer is no,” she said.

“We also work with Mass General, Brigham and Women’s Hospital and the Cleveland Clinic,” she said. “But many hospitals overseas are reluctant to take overseas patients because of insurance.”

Where a facility is concerned that it will not be paid for services rendered or that it will have undue difficulty in trying to collect those funds, liaison can be strained and difficult.

Both the Lahey Clinic and Johns Hopkins have a good working relationship with Bermuda and health insurers here. They are also excellent medical facilities. Mrs. Pontes said those are the reasons that Dr. Doherty’s patients are encouraged to have their testing carried out at Lahey and Johns Hopkins. It can be less stressful.

Patients who are referred abroad for tests are given an information packet which describes the medical facility, the test which will be carried out, and gives details on where to go and who to see at the hospital. It also includes other practical information like which hotels are in the area, their addresses and telephone numbers, area restaurants and churches. Mrs. Pontes, has a very pleasant and accommodating personality. She said many of the patients are scared and anxious.

“Once a patient knows they have a heart problem they want to know exactly what the problem is right away,” she explained.

“They are anxious to have the testing done.” She tries to put them at ease, explains the testing that will be carried out and puts them in touch with a hospital representative who takes charge of their case. She handles all the necessary paperwork from Bermuda including insurance forms, the medical referral forms, any test results including ultrasound images.

“Once we send the information out it networks to where it needs to be,’ she explained.

“Our patients don’t need to take any of their files with them.”

Mrs. Pontes also puts patients in touch with a representative from the overseas hospital.

The representatives add another layer of ease to the patient’s journey. Typically they contact locals while they are still in Bermuda and explain things like travel arrangements. Reps at both Lahey and Johns Hopkins even arrange to have patients picked up at the airport and taken to their hotel and from the hotel to their facilities.

While emergency cases can be seen as quickly as the next day, in general patients who are referred overseas get appointments about a week to a week and a half away. “It really depends how ill they are,” said Mrs. Pontes.

And the overseas hospitals are usually also sensitive to the amount of time their international patients have to be there. This means that quick test results and the ability to act quickly on those findings is the aim of these facilities. So locals having to go up usually do not find that they are waiting weeks for test results and then months for a surgery date, if surgery is needed. Mrs. Pontes said that most patients have major medical, which covers both the testing and, if needed, surgery, usually airfare and hotel accommodation as well. The Hospital Insurance Plan (HIP) does not provide full coverage. Patients she sees who only have HIP are directed to the Lady Cubitt Compassionate Association (LCCA) for assistance.