Louis Edward Rolle, who died after he was unable to be airlifted from Bimini.
By RASHAD ROLLE
Tribune Senior Reporter
rrolle@tribunemedia.net
FORMER Health Minister Dr Duane Sands said despite high obesity rates in The Bahamas, the country lacks an air ambulance system that can safely evacuate people who weigh as much as 400lb.
He spoke to The Tribune yesterday as the family of Louis Edward Rolle, a 74-year-old man who died on Tuesday in Bimini after a rapid test diagnosed him with COVID-19, demanded an investigation into what happened.
Health officials did not respond to requests for comment yesterday, but Dr Sands said the episode “speaks to the question about how far could you prepare for every eventuality of every patient.”
“As I understand it this patient was not 350lb, but 400lb,” he told The Tribune.
“When you get to that point, you are talking about the operating limit of the aircraft. I believe a safe operating limit for an aircraft like that is about 300lb. There is a limit to how much you could put on that plane and operate it safely.”
“For these King Air planes, if you add a pod, first of all, the pods can only fit people of a certain size. You have to be able to get people physically in the door. If you are beyond a certain girth, you cannot get safely in the plane and the door of the plane is only about 30 inches. You are dealing with serious logistical and physical limitations.
“You can’t get a CAT scan in The Bahamas if you are above 400 lbs. The point is there is a physical limit for equipment and if you go beyond that you will break the equipment. It’s the same with air evacuation. Once you are above a particular size, you can’t access the particular equipment used in The Bahamas.”
Rolle’s death came exactly one year after Kim Johnson-Rolle, another Bimini resident who was not airlifted off the island in time, became the country’s first confirmed COVID-19 death.
Yesterday Denver Stuart, 30, said his uncle spent four nights in a tent outside a Bimini clinic before he died.
“My uncle had to slowly suffocate for days,” he said. “That was worse than being smothered because he was suffocating slowly until he took his last breath. The doctor said he needed to be on the ventilator machine that they don’t have in Bimini. We need an investigation to give us truthful answers on why outer islands are always left out in the dark.”
Dr Sands said the country must grapple with how to handle such episodes and decide whether to get bigger planes or use other resources like boats.
“It may be reasonable to expect that the country could provide emergency airlift services to people regardless of their weight provided that we would be able to pay for it,” he said. “If you now say that The Bahamas is going to provide air evacuation equipment to deal with the morbidly obese patient, then that will have a dramatic increase in cost and who is going to pay for it? Already the people of The Bahamas pay up to $2 million, $2.5 million per year in air transportation costs, 90-plus percent of which is not reimbursed. And if you had an unlimited budget you could say let’s increase that to $3 or $4 million. But the overwhelming majority of people who will need to be transported will fall within the current weight limit. So if you now say you are going to provide services that can manage people who are 400 lbs, then what about the people who are 500 lbs?”
Rolle’s family questioned why Royal Bahamas Defence Force resources were not mobilised to move their relative, but Dr Sands said the Defence Force also lacks the air capacity to move someone of Rolle’s size.
“They don’t have cargo planes,” he said. “And I don’t even know if the pods can handle someone of that size, I think the upper limit is 350 lbs. This tragedy provides an opportunity to once again look at how do we move forward and perhaps when the next aircraft is purchased for air evacuation, a choice may be made to go with planes that have bigger entry doors and which can take a higher patient load but those decisions are not spur of the moment decisions, you have to plan for that and know that the cost for everyone goes up.”
Rolle’s family asked why a ventilator machine was not sent to Bimini along with experts qualified to operate it, but Dr Sands said this would not have been feasible.
“You have to have expertise to safely manage the equipment and they need to have the tools in order to function,” he said. “Let’s say you say you’re going to move an intensive care unit to Bimini. I don’t think that’s either reasonable or practical and perhaps this is where the whole discussion of prevention, of management of non-communicable diseases and the reality that people with non-communicable diseases do very poorly when they get respiratory failure from COVID-19 needs to take place.”
Mr Stuart, a boat captain, said he was denied the chance to take his uncle to New Providence or Grand Bahama by a vessel.
Dr Sands, emphasising he does not know details of the request, said Mr Stuart’s request nonetheless raises complex questions.
“Here we are 188 deaths later and in Bimini again another COVID-related death with real logistical challenges,” he said.
“Modifications were made after the first death, but you’re dealing with a complex evacuation issue. So who is going to be covering the insurance for the people participating in the mission? What happens if the boat sinks? All of that is already dealt with in the existing air ambulance system, but when we talk about a non-certified vessel that now is going to be used for evacuation, if all goes well it’s no big deal, but if it doesn’t go well, fingers point and people say ‘why did you allow it? You know it wasn’t certified, you know they’ve never done it before, why didn’t you stop them?’ We went through this discussion with that first case. Logistically it’s not that simple,” Dr Sands said.
Comments
SP 3 years, 8 months ago
Why the Bahamas with all it's Islands and Cays doesn't have a helicopter remains a mystery!
Emilio26 3 years, 8 months ago
SP I wonder why after all these years the Bahamas doesn't have adequate universal healthcare?
Observer 3 years, 8 months ago
Many years ago, the flying doctor 'project' and the CMO utilized the Grumman Goose aircraft to airlift/service patients from /on family islands where there was no airstrip. The aircraft could takeoff and land on the water. Remember that? How about employing a helicopter for emergency medical evacuation? We must think logically, especially when there is a life/death situation..
tribanon 3 years, 8 months ago
This poor soul wasn't given a fighting chance and instead was forced to die a most agonizingly miserable death over 4 days, literally drowning as the suffocating fluid slowly built-up in his lungs. It's truly sad that our politicians are so very good at wasting our tax dollars and borrowing millions of dollars more for their wastful pet projects while being unwilling to provide for necessary and adequate medical airlift in our nation of islands.
Sands proffers rather lame excuses on behalf of the Minnis-led administration for why nothing was done to try save this man's life. It's as if our public health system did not value Mr. Rolle's life simply because he happened to be a very obese individual. All Bahamians should have great difficulty listening to our politicians and senior public health officials as they now try justify their decision to simply let Mr. Rolle die a horridly frightening and excrutiatingly painful death over 4 days, right up until his final gasp for air.
Mr. Rolle could have been put on a speed boat and brought to Nassau within only a few hours. There were apparently Good Samaritans willing to do just that, but our senior public health officials prevented them from doing so. It's unbelievable and most disheartening to hear Sands ridiculously suggest that none of us should ever take on the role of a life saving Good Samaritan without first ensuring we have adequate insurance coverage. I guess he's the kind of heart doctor that would never perform urgently needed life saving surgery on one of his patients if he knew he had forgotten to prevent the lapsing of his own medical malpractice insurance policy.
Sands and Minnis as medical doctors are quick to remind all of us that too many Bahamians are now obese. But they have failed as legislators, from a public health policy perspective, to pass meaningful legislation to address the problem. There is a direct correlation between the ever growing waist line sizes of Bahamians and the increasing number of unhealthy and highly addictive fast food establishments in our country. The same goes for the increasing number of very unhealthy and relatively low cost food and drink products now found on our grocery store shelves that are well known to be highly processed and addictive.
Our legislators must come to grips with the reality that there are many Bahamians who do not have the mental ability or financial resources necessary to exercise the kind of self-discipline more commonly found among the better educated and more well-off in our society. In the final analysis, it's sad that our politicians are so good at wasting our tax dollars and borrowing millions of dollars more for their wastful pet projects while being unwilling to provide for necessary and adequate medical airlift in a nation of islands.
DDK 3 years, 8 months ago
Too right on all counts.
ThisIsOurs 3 years, 8 months ago
Mostly true. Sands did try. Remember when he spoke of changing bread basket items? He was shot down with keep yuh cornbeef.Then Rupert Roberts spoke up on why he couldnt reduce the price of vegetables and fruits. The truth in this situation is we are too fat. And nothing could help us but our fork and our mouth. It's the truth. And it's hard. But no politician can legislate eating. You can overeat healthy food too.
And I'm not saying they can't do anything. I'm saying they can't do everything for this problem
DonAnthony 3 years, 8 months ago
Lose weight. Practice discipline and you will live. This man almost certainly died because of the cumulative effects of years and years of over consumption. The government did not force food into his mouth, not their fault. It is personal responsibility.
TalRussell 3 years, 8 months ago
@Comrade DonAnthony, genes born with influence every aspect of human physiology, development, and adaptation. Well, Obesity is right up there.
ThisIsOurs 3 years, 8 months ago
true. I never say loss weight as if it's easy. food is a drug and some people are predisposed to storing more fat making it doubly hard. the only time most of us will do it is if the doctor tells us we dying unless....
bcitizen 3 years, 8 months ago
So you know this mans medical history and if he might have had medical disorders that lead to obesity like thyroid problems, medications like steroids and antidepressants, crushing's disease etc?
ThisIsOurs 3 years, 8 months ago
repost: :food is a drug and some people are predisposed to storing more fat making it doubly hard"
everybody can lose weight irrespective of medical challenges. How do I know? Maroon someone on an island for 30 days with only a diet of fish, coconuts and some fresh water supply. They will lose weight. No exercise needed. The challenge is with all the delicious food around us it's hard to say no to such a delicious drug.
bcitizen 3 years, 8 months ago
Next there will be someone who is too tall to fit in the little airplane and their family will offer transport by boat only to be denied and you will suggest they could have had bone reduction surgery to reduce their height.
ThisIsOurs 3 years, 8 months ago
God didn't make Any body fat. Our bodies were made to work and carry muscle and fat that our heart and bones ciuld support. Excusing obesity helps nobody.
bcitizen 3 years, 8 months ago
It is a shame this man died from bureaucracy. The excuses as to why this man could not have been put on a boat and have been to Freeport or Nassau within few hours are disgusting and highlights everything that is wrong with our government and civil servants. It shows their completed inflexibility and/or any ability to think outside of the box. These people do not know what a box is unless it has fried chicken with ketchup and hot sauce in it.
themessenger 3 years, 8 months ago
This man did not die from bureaucracy, he died from complications resulting from poor life choices, obesity, heart disease and hypertension among other things. As mentioned previously, the government cannot protect people from themselves.
bcitizen 3 years, 8 months ago
While if this mans poor life choices resulted in his obesity yes he has some responsibility for the situation he found himself in I agree but, that does not absolve these medical persons from acting in a way that could have maybe saved him. He most likely even with intubation had a long shot. Nevertheless you are assuming allot in you role as god deciding who can live and die based on assumptions. There are many medical reason persons can be obese other than bad habits like cushings disease, thyroid disorders, certain medications like some anti depressant, and a whole host of medical reasons not related to diet. You assume much in your statement.
ThisIsOurs 3 years, 8 months ago
I have obese relatives. I don't want them to die and I dont fat shame them. It's sad that this gentleman died. I'm saying for those that are still here do something there's no need to wait on the govt to build a hospital. This is actually something in our control. It doesnt mean you can't be in a car accident tomorrow. youre just taking care of the things you can see coming. And obesity has a pretty clear path, there's a reason they call it morbid obesity.
xtreme2x 3 years, 8 months ago
IF HE WAS TOO HEAVYFOR AIR AMBULANCE. THEY COULD HAVE SEND A QUALIFY NURSE DOWN THERE TO TREAT PATIENT...SHIT THERE IS MORE THAN ONE WAY OF DOING A THING AND ACHIVING SAME RESULT. HIS LIFE HAD NO VALUE, BUT THEY ARE TRYING TO SAVE LIVES.
ThisIsOurs 3 years, 8 months ago
Not really.
Remember the astronomical death rates in Europe at the start of this pandemic? I had a conversation with someone who explained that only a very small percentage of medical practioners are actually trained to use ventilators. Further even in that trained group there's an even smaller group who actually apply the knowledge correctly. Configure the settings wrong and you could actually kill the patient.
This person postulated that that's exactly what happened. They were throwing every untrained person they could to manage ventilators and in trying to help they probably made things worse... and called it COVID rather than I dont know what I doing with this ventilator.
A few months later a report came out from an independent group of physicians that what this individual had said was most likely the case.
You cant just send a nurse with a ventilator
DonAnthony 3 years, 8 months ago
In most countries if you were put on a ventilator you had a greater than 50% chance of dying. It is not the magic bullet people think it is.
ThisIsOurs 3 years, 8 months ago
the same person told me stay home because if you end up on the ventilator in PMH youre dead. They had horror stories of ventilator mismanagement (not at PMH necessarily but thought the likelihood of getting an untrained person managing you on some obscure night shift was greater)
Emilio26 3 years, 8 months ago
xtreme2z it's sad how bahamians have a crappy healthcare system.
TalRussell 3 years, 8 months ago
Come to the other side COVID, will want a Comrade Leader contest for the realm's premiership for being Herself with a winning outlook and companionate personality that makes everybody sincerely trust their forward-looking optimism.
Well, yes, and I'm wagering on grooming Comrade Sister Gabrielle Turnquest as a serious 2027 contender for the realm's Premiership.
The other side COVID, calls youthful energy, decisiveness, and new bloodlines emerge reshape a different and exciting, realm.
John 3 years, 8 months ago
From it was determined that the patient could not be airlifted or transported to New Providence for critical care, hopefully the patient was offered as much comfort care as possible so as to ease the pain and misery involved in suffering and dying from a severe case of Covid-19. Any life lost is one too many and the country must now re-assess the ability to respond to these unusual type situations. As Dr Sands pointed out, there are many more persons living in The Bahamas with this type weight and they should be made aware of the limitations in transporting them and also in offering some types of treatment. May his soul rest in peace.
tribanon 3 years, 8 months ago
Our corrupt politicians have managed to squander $1.5 billion ($1,500,000,000) on our national airline (Bahamsair) since it was foundeded decades ago, but they can't find a few million dollars a year to provide much needed adequate medical airlift from our family islands. This says a lot about all of politicians and the senior health officials within our public health system.
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