Hospital Data Misleading, Officials Say

Hospital officials in Orange County warned the public against making decisions based on a federal report released Wednesday that names hospitals with unusually high and low death rates among Medicare patients.

Nine hospitals in Orange County had unusually high mortality rates among Medicare patients who underwent certain common surgeries or treatments, according to the information released by the federal Health Care Financing Administration. One local hospital was listed as having a lower-than-expected mortality rate among its Medicare patients treated for heart attacks.

Hospital spokesmen said the figures can be misleading because they were sometimes calculated on the basis of a small number of patients. Also, they said, the statistics do not reflect patients’ ages, the severity of their illnesses when they were admitted, complications they may have suffered and other variables.

“I think it’s a scare tactic for the public that will lead to misinformed decisions on health care. . . . These generalized statements are headline grabbers,” said Michael Servais, executive director of Pacifica Community Hospital in Huntington Beach, one of the hospitals the report listed as having an unusually high death rate.

Richard Butler, executive director of the Orange County Health Planning Council, an independent agency that monitors the health care industry, said that although he had not seen the report, he would caution the public not to make snap decisions based on it.

“You have to keep in mind who’s treating the sicker patients, the older patients. . . . And the Medicare patient is usually the sicker patient,” Butler said.

According to the report, Santa Ana Hospital Medical Center had a 26.9% mortality rate among 26 patients treated for congestive heart failure, compared to an expected rate of 9.2%. It also had a 16.6% death rate among six patients who underwent gall bladder surgery, compared to an average rate of 2.1%.

A spokeswoman for Santa Ana Hospital Medical Center, who refused to give her name, said she would not comment on the figures because she had not seen the report.

Servais said Pacifica’s statistics--a 16.6% mortality rate among 12 patients who underwent gall bladder surgery, compared with an expected rate of 2.2%--can be explained partly by demographics.

Higher Mortality Rate

“This hospital treats a large population of older clientele. There’s a significant number of convalescent hospitals around here, and we treat an older and generally less healthy clientele. There’s a higher mortality rate when you deal with that type of grouping,” he said.

Servais said the lack of other information--age, complications, whether surgery was the primary or secondary reason for hospitalization, and “dozens of other factors”--render the data worthless. “I don’t think you can draw any conclusions based on this,” he said. “I don’t think they (the statistics) give the patient any grounds for saying this or that hospital is better or worse.”

Fountain Valley Regional Hospital got the best rating in the report--a 6.6% death rate from heart attacks, compared to an expected rate of 28.8%, among 75 Medicare patients. Hospital officials there had not seen the report but they indicated that such data must be evaluated carefully.

“There’re not enough background data to know what’s going on,” said Bob Hanna, director of administrative services. “You don’t know the condition they (the patients in the study) are in. Some are high-risk when they walk in the door.”

For example, Barlow Hospital in Los Angeles led California’s total mortality rate list. However, it admits mostly terminally ill patients suffering from emphysema, lung cancer, chronic bronchitis and other respiratory diseases.

Report Based on Billings

According to Dr. Hans E. Einstein, medical director at Barlow Hospital, three-fourths of its admissions represent patients on mechanical ventilators who have been referred there by other hospitals. Barlow specializes in treating such patients.

The Health Care Finance Administration compiled the information from hospital billing data and not from the findings of federally mandated review committees in each state whose job is to check the quality of care, according to Leon Starr, financial vice president of Hospital Council of Southern California.

“The quality of care will be determined when there has been a review of the medical records rather than the billing information,” Starr said.

On the other hand, some hospitals may look unusually good when their mortality data for a specific diagnosis, such as heart attack, is considered.

For example, the record for Century City Hospital in Los Angeles shows that there were no deaths among the 41 Medicare patients treated for heart attack in 1984, although the federal agency had predicted that a death rate of 23.3% could be expected.

The hospital, it turns out, accepts only elective heart patients, according to Joel Bergenfeld, its executive director. Century City does not accept acute heart attack patients.

Also, open-heart surgery is not performed there. “So the very sick (heart attack patients) go to Cedars-Sinai Medical Center or UCLA Hospital . . . ,” Bergenfeld said.

Conclusions Questioned

At UCI Medical Center in Orange, Assistant Director Larry Stahl said he had no figures for 1984, the year of the federal data, but that other statistics from the hospital cast doubt on the report’s validity.

According to the federal report, 18.2% of 22 Medicare patients in 1984 treated for gastrointestinal bleeding at UCI Medical Center died, compared to an expected mortality rate of 4.7%.

Stahl said that for the first quarter of 1985, the medical center had 21 patients with diseases and disorders of the digestive system, a category that would include gastrointestinal bleeding. According to statistics from the state Medicare office, UCI Medical Center had a 4.7% death rate, compared to a state average of 5.4%, he said. In the second quarter, UCI Medical Center had 21 patients in that category and no deaths, and the state average for that period was 4.8%, he said.

“I’m questioning their figures,” Stahl said of the federal report. “We are well below the statewide death rate for the category of diseases and disorders of the digestive system.”

At Western Medical Center-Anaheim, 22.2% of eight Medicare patients treated for gastrointestinal bleeding died, compared to the average rate of 5.8%, according to the federal report.

“With eight patients, you’re skewed . . . ,” said hospital administrator Carolyn Gillespie. “It’s a very difficult thing. If you have five patients and one dies, that’s a 20% mortality rate. How do I know--maybe the average age of the patients is 95.”

Furthermore, she said, gastrointestinal bleeding can be caused by a wide variety of ailments such as ulcer, a ruptured aneurysm or surgery.

Times medical writer Harry Nelson contributed to this report.