Navy Surgery Referrals Probed : UCSD Group Got 155 Heart Cases

The Navy Hospital in Balboa Park, accused of improperly referring lucrative heart operations to a single group of civilian surgeons, referred 155 open-heart surgery cases to the group at UC San Diego Medical Center during 1984-85, a medical center spokeswoman said Monday.

Pat JaCoby, director of public information, said hospital billing records show that the group led by Dr. Pat O. Daily performed the 155 surgeries referred from the Navy Hospital during the past fiscal year.

JaCoby said half of those patients were covered by the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), the tax-supported health insurance plan that covers military service personnel. She said the other half involved Navy retirees covered by Medicare.

Meanwhile, Dr. James H. Oury, who heads what is described by members of the local medical community as the other most active heart surgery group in San Diego, said his group received only 20 to 30 referrals from the Navy Hospital last year.

Oury, who is also head of cardiac surgery at Scripps Clinic, said he was interviewed three weeks ago by a Navy investigator looking into the referral system. He said she asked him why his group received only “a very small percentage” of the referrals.

The Times reported Sunday that the Naval Investigative Service is looking into allegations that Navy doctors unfairly favored some civilian surgeons in the local Navy cardiac care referral business, valued at more than $6 million last year.

On Monday, a spokesman for the Department of the Navy at the Pentagon confirmed that the investigation is in progress. But Lt. Steve Pietropaoli said the Navy would not discuss who is being questioned or who is suspected of benefiting from the referrals.

Daily, who heads both the cardiothoracic surgery division at UCSD Medical Center and cardiovascular surgery at Sharp Memorial Hospital, could not be reached for comment through repeated calls to his office Monday.

A secretary in Daily’s office, Virginia Jenkins, said he was involved in surgery all day. She said, however, that the Navy had not contacted Daily or anyone in his group. She said, “All we know is what we read in the papers.”

Daily’s group, which performed San Diego’s first heart transplant this month, works at Sharp and UCSD. Oury’s group works at Sharp and Scripps.

Doctors at Mercy and Alvarado hospitals also perform a significant number of surgeries, medical authorities said. However, officials were unable to provide numbers of Navy referrals Monday.

According to a spokeswoman at the civilian health and medical program headquarters in Colorado, heart case referrals to civilian doctors in the San Diego metropolitan area in the fiscal year ending June 30 included $5.8 million worth of vascular disease and cardiology cases and $201,000 worth of chest surgery in general.

Nevertheless, a spokesman at Naval Medical Command Southwest was unable Monday to provide an accurate figure on the number of referrals. He said officials would meet today to try to come up with a figure but might not be able to determine which doctors got the cases.

Navy personnel receive civilian care when military hospitals are either overcrowded or unprepared to perform specialty procedures. The Navy is apparently trying to determine whether Navy doctors steered personnel to certain civilian surgeons, to the exclusion of others.

At UCSD Medical Center, JaCoby said the hospital has no “institutional agreement” covering referrals from the Navy Hospital. However, she noted that the hospitals have a joint teaching program that includes cardiac surgery.

JaCoby said that all of the 155 heart-surgery cases referred from the Navy Hospital were handled by Daily’s group. She said hospital officials knew nothing about the investigation and had not been contacted by the Navy.

A spokesman for Sharp Hospital said it had handled about 50 cardiac surgeries referred by the Navy in the year ending Sept. 30. A spokesman for Mercy estimated “a very small percentage” of the 235 heart surgeries during the first nine months of 1985 were referrals.

Oury said he was surprised to be contacted by an investigator three weeks ago. He said the investigator said the inquiry resulted from “internal questions generated within the Naval hospital.”

“She said she had been through the CHAMPUS documents in reference to the cardiac surgery referral system and asked us why, as one of the large groups here in San Diego, we were not doing a higher percentage of the CHAMPUS cases,” he said.

Oury said he told her, “If that were a problem--in fact if the cases weren’t being spread around in the fashion that CHAMPUS referrals are intended to be--that I’m sure her investigation would reveal that.”

Several heart surgeons Monday described Daily as an unusually able heart surgeon. He has been performing open-heart surgeries for 18 years and was on the team that performed the country’s first heart transplant in 1968 at Stanford University Medical Center.

Several said Daily has been supervising the Navy Hospital’s cardiac surgery program over the past year under a special agreement. However, Lt. Gene Elliot, a Navy medical spokesman, said he was “unable to confirm any official capacity or position held by Dr. Daily.”

Some surgeons suggested it would be appropriate if Daily’s group were getting a disproportionate share of referrals because it is an accomplished group, affiliated with many programs, handling a large portion of all the heart surgery done in the city.