Heart Care Scrutinized at 3 L.A. Hospitals

Signaling that the government is investigating whether unnecessary heart surgeries were performed at Tenet hospitals in the Los Angeles area, federal prosecutors have requested documents related to coronary procedures and billing practices at three medical centers in the region.

Tenet Healthcare Corp. said Friday that it would hand over the documents, including arrangements with cardiologists who practice at Daniel Freeman Memorial Hospital in Inglewood, USC University Hospital in Los Angeles and Centinela Hospital Medical Center, also in Inglewood and home of the Tommy Lasorda Heart Institute.

The three hospitals are among the larger and more profitable of Tenet’s 40 medical centers in California. State records show that these facilities have had a substantial increase in cardiac services in recent years.

Officials at the U.S. attorney’s office in Los Angeles, which is seeking the documents, declined to comment. Sources familiar with the investigation said prosecutors were focusing on whether heart patients received unnecessary treatments and whether Tenet hospitals improperly recruited physicians.

The request for documents dating to 1998 was made Thursday afternoon -- exactly one year after federal agents raided a Tenet hospital in Redding and accused two cardiac doctors there of needlessly performing bypass operations and other procedures on patients. In August, Tenet agreed to pay $54 million and institute certain changes to settle those allegations, without admitting guilt. The two doctors have not been charged with any crime.

Tenet spokesman Steven Campanini said Friday that “we don’t know the scope of what they are looking for.” But he vigorously denied any suggestion that this was anything like the Redding case.

“It is inappropriate for anyone to speculate that this information request for documents is in any way similar to Redding Medical Center,” Campanini said. “There is no subpoena, there was no raid. This is a letter requesting information.”

Analysts said it was apparent that federal prosecutors were widening their investigation of the nation’s second-largest hospital chain and that it could lead to a worsening of troubles and more legal exposure for the company.

Over the last year, Santa Barbara-based Tenet has been pummeled by multiple probes and lawsuits over its business practices, including its Medicare billing, treatment of uninsured patients and recruitment of physicians.

“This is potentially opening a Pandora’s box -- people in Southern California worried that they may have had some unnecessary heart surgeries,” said Andreas J. Dirnagl, an analyst with Harris Nesbitt Gerard. “You had such a high profile case in Redding, and with this, people, whether rightly or wrongly, could start questioning heart procedures at all Tenet facilities.”

Separately, Blue Cross of California, one of the state’s largest health insurers, said Friday that it had data suggesting that doctors at Tenet’s hospitals in Redding and Modesto performed a high percentage of unnecessary coronary bypass operations on Blue Cross members.

Dr. Woodrow Myers, chief medical officer for Blue Cross of California, said a review by independent cardiologists of 52 bypass operations at those hospitals had concluded that 85% of the surgeries at Redding had been unnecessary and that 59% at Tenet’s Doctors Medical Center in Modesto had been unwarranted.

As a result, Myers said, Blue Cross this week stopped authorizing elective bypass operations at those two hospitals.

Steve Newman, chief executive of Tenet’s California operations, said in a statement Friday that Blue Cross first raised these concerns Wednesday.

“They made serious allegations based upon a very small sample of cases,” he said, noting that Tenet had proposed further patient safeguards while it reviewed those cases.

In recent years, Tenet has been building its cardiac programs at a number of its hospitals as part of a strategy to provide acute-care services to aging baby boomers. The programs have helped the company increase profitability, but its troubles at Redding have intensified scrutiny of many of its practices.

On Friday, the Senate Finance Committee threatened Tenet with a subpoena if the company did not provide certain information the panel had requested as part of its investigation of the firm.

In a draft letter obtained by The Times, Sen. Charles E. Grassley (R-Iowa), chairman of the committee, chided Tenet for withholding information related to a consultant’s report on the cardiology program at Redding Medical Center.

The committee in September sought a wide range of materials from Tenet, including the findings of an independent consultant, Mercer Human Resource Consulting, that had been retained to review Redding’s cardiology program.

The three Los Angeles area hospitals for which documents were sought did not have the kind of unusually heavy volume of cardiac procedures as at Redding. Still, their heart practices have been growing.

The number of cardiac operations at USC University Hospital, which is near the much larger L.A. County/USC Medical Center, more than doubled, to 442, between 1999 and 2001, according to the latest available data from the Office of Statewide Health Planning and Development.

Tenet said its USC hospital had a total of 24 cardiologists, 14 of whom were USC faculty members. The company said that in 2002 the hospital had performed 150 bypass operations.

Tenet said Centinela had a 30-bed heart facility with 33 cardiologists associated with it. Tenet bought the 370-bed hospital in 1997 and committed to building a major cardiology program, pumping $14 million into the Tommy Lasorda Heart Institute and hiring Dr. Robert Chesne, the former chief of Daniel Freeman’s cardiology program.

Lasorda, the former Dodger manager, was treated at Centinela and in 1999 lent his name and support to the new state-of-the-art heart clinic. Centinela representatives did not return phone calls Friday, and neither did Lasorda’s assistant.

Tenet said there were 145 coronary bypass operations at the Lasorda Heart center in the 12 months ended September. The company said it couldn’t provide figures for previous periods. According to the latest state data, the number of bypass and other cardiac surgeries at Centinela jumped from 75 in 1999 to 179 in 2001, and total catheterization services more than tripled during that period to 1,809.

Times staff writer Don Lee contributed to this report.