Heart surgeons get state report card

By: BRADLEY J. FIKES - Staff Writer | Thursday, July 12, 2007 10:34 PM PDT ∞

In their first public grading by the state, California heart surgeons have been rated in a report on how their patients survived coronary bypass operations.

Though not without its flaws, the report measures Tri-City Medical Center's Dr. Thomas A. d'Amato as North County's best bypass surgeon with a 2.57 percent mortality rate in 75 surgeries, and Escondido cardiologist Jeffrey M. Rosenburg as its worst. Rosenburg, however, no longer performs the procedure.

D'Amato was recruited to work at Tri-City in 2002, but took a one-year leave of absence in 2005 and resigned from the medical staff on July 27, 2006. Tri-City is suing d'Amato for more than $600,000 in outstanding loan payments, interest and legal fees for allegedly breaking a deal the hospital made with him to bring him to town.

He has since joined the staff at Thomas Jefferson Medical College in Philadelphia. He could not be reached earlier this week.

The report is not as simple to understand as a letter grade on a report card. Some doctors see sicker patients than others. Doctors have been known to refuse sick patients to get a higher score in similar reports.

Issued on Thursday by the California Office of Statewide Health Planning and Development, the 143-page document contains information from 2003 to 2004. The report is intended for use by the public as well as health professionals.

The report is "not very consumer-friendly," conceded Joseph Parker, director of the agency that prepared the report, the Healthcare Outcomes Center. However, Parker said, the report still gives patients information on doctors' success rates that can help them make an informed decision.

Rosenburg takes issue with the report for classifying him as one of 12 surgeons with mortality rates significantly above average. He operated on 12 patients, three of whom died.

The report doesn't fully take into account the condition of some of his patients, said Rosenburg.

"Most of the time, I was getting patients who were very high-risk," he said.

For example, he said, he operated on one seriously ill woman at her insistence, despite a high risk.

"Nobody really wanted to do anything, and she finally just said she couldn't live that way and wanted to do anything, no matter what the risks were," Rosenburg said. "Another one was a person who had a very large (heart attack), pre-op. ... She required a tracheostomy, however, and was on a ventilator on the hospital for two months. The third one, I just remember was a very high-risk patient who had been at Tri-City and was discharged there, then ended back over here. We took her to surgery and she expired also."

Parker said the report is adjusted for the risk of surgery. The report is available online at: http://tinyurl.com/ypjvxe.

Rosenburg's 12 operations is a relatively low number; many of the surgeons performed hundreds of operations during that two-year period. That low number makes mortality results less statistically significant, said Opal Reinbold, chief quality officer at Palomar Medical Center, where Rosenburg practices.

Medical studies usually find that doctors who frequently do operations of any sort get better results than those who rarely perform such procedures.

Previous reports, which had only looked at hospital performance, had scored Palomar as one of the worst-performing hospitals in the state. This report listed no San Diego County hospitals among the best or the worst.

Readers of the report need to keep in mind that the numbers are three to four years old, and to consider the risk-adjusted mortality rate as opposed to the raw data, said Ehtisham Mahmud, a cardiologist at UC San Diego Medical Center.

"If somebody's operating on a number of high-risk patients, and their mortality rates are higher, you'd expect it to be higher," said Mahmud, director of the cardiovascular catheterization laboratory and interventional cardiology.

Some doctors, anxious about their statistics, have refused to operate on high-risk patients, Mahmud said. The result is that some high-risk patients who might benefit from surgery can't find a doctor willing to perform it, he said.

That happened in New York state when it began ranking mortality rates for cardiothoracic (heart and chest) surgery, Mahmud said.

"The first year it went into place, the mortality actually went down," he said. "Somebody went to look into it, and those high-risk patients were then going from New York to Ohio to the Cleveland Clinic, and their mortality actually went up."

And since the numbers are a few years old, they may not reflect the current state of expertise, Mahmud said. For example, less experienced surgeons have higher death rates among their patients. But with a few years' practice, they could be much more successful ---- something that wouldn't be evident today with numbers gathered years ago.

Reinbold said more current medical information is available at two Web sites: CalHospitalCompare.org (http://www.calhospitalcompare.org) and Hospital Compare (http://www.hospitalcompare.hhs.gov/).

Even with those cautions, Mahmud said, the report is helpful.

"If someone's risk-adjusted rate is much higher than most surgeons in the state, and someone's is significantly lower, those are important points. The people who are lower are clearly cream of the crop ---- and the people who are higher, despite risk adjustment, than most people in the state, you want to think long and hard about letting (one of them) operate on you."

-- Contact staff writer Bradley J. Fikes at (760) 739-6641 or bfikes@nctimes.com.

Highest and lowest risk-adjusted death rates for coronary bypass surgery at North County hospitals, 2003-2004:

Highest:

Jeffrey M. Rosenburg, 28.43 percent, 12 patients, Palomar Medical Center

Lowest:

Thomas A. D'Amato, 2.57 percent, 75 patients, Tri-City Medical Center

First name only. Comments including last names, contact addresses, e-mail addresses or phone numbers will be deleted. Attempts to misrepresent your identity or impersonate any person will not be approved. All comments are screened before they appear online, so please keep them brief. Comments reflect the views of those commenting and not necessarily those of the North County Times or its staff writers. Click here to view additional comment policies.