22 California Facilities Had Higher Than Expected Figures : U.S. Releases Hospital Death Rate Data

The U.S. Department of Health and Human Services Wednesday released the names of hospitals throughout the country with unusually high or low death rates for Medicare patients. The unprecedented disclosure of previously confidential information found that 22 California hospitals had death rates above the expected figures, including 14 in Southern California.

The controversial report contains lists that include not only abnormal overall mortality rates but also unusual death rates for nine specific medical conditions and surgical procedures, such as heart bypass surgery, pneumonia, prostate surgery and pacemaker implants.

The report was praised by consumer groups, who said such information should lead to improved health care, but was denounced by the hospital industry as potentially misleading.

Federal government officials and academic health care researchers also said that such data, while suggestive, are far from conclusive.

Some hospitals may in fact provide good care even though they have an unusually high mortality rate. They may, for instance, only treat sicker patients. Others may have ended up in this group by chance. By the same token, a lower-than-expected mortality rate does not necessarily mean a hospital’s quality of care is good. Such a hospital may, for instance, treat more patients who are less seriously ill.

“We strongly caution the general public against drawing any conclusions from these statistics alone,” said Dr. Henry Desmarais, acting administrator of the federal Health Care Financing Administration (HCFA), which released the report in Washington on Wednesday.

The lists are not intended to allow a comparison of one hospital to another, but rather a comparison of a hospital’s own predicted performance against its actual experience, the agency said.

In overall death rates, 22 hospitals in California and 142 elsewhere had significantly more deaths than predicted. Fewer than average deaths were found in 127 institutions, including three in California--Grossmont District Hospital just outside San Diego, Mills Memorial in San Mateo and St. Helena in Deer Park.

More important than the overall death rates, however, are the lists of deaths from the nine specific conditions, which could point to potential--and more specific--problems, particularly at hospitals which perform relatively few of these procedures.

For example, of the 36 hospitals around the nation with high death rates from coronary artery bypass surgery, the 24 hospitals that did fewer than 100 such surgeries annually had a death rate of more than 14%, compared to predicted rates of about 5%.

“Many of the death rates are so high that they are unlikely to be explained by differences in the (condition of) patients,” said Dr. Sydney Wolfe, head of the Public Citizens Health Research Group and a leading advocate of health care information disclosure.

“The health care system is one of the major causes of preventable death in this country,” he said. “We are now figuring out where this is happening.”

Some hospitals had death rates of more than 10% for gall bladder surgery, while their predicted death rates were usually under 3%.

The “raw computer printouts” were designed to help the federally financed Peer Review Organizations in each state that oversee the Medicare program to target problems for further analysis.

The printouts were made public after their existence was disclosed by the New York Times on March 2 and the Health Care Financing Administration, barraged by requests, concluded it had no other choice under the federal Freedom of Information Act.

They are based on statistical analyses of the case records of millions of Medicare patients treated in 1984 at acute-care hospitals throughout the country.

The major problem with these statistics is their inability to distinguish differences in death rates caused by quality problems from differences that result from sicker patients, according to Dr. Mark R. Chassin of the Rand Corp in Santa Monica, who is directing a federally funded study of this precise problem.

Another problem is errors in coding the Medicare billing data. If a hospital, for example, failed to record a patient’s death on the data form, its death rate would seem lower than it actually was.

The lists also do not reflect deaths or the number of admissions for the two-thirds of the nation’s hospital patients who are not covered by Medicare, the program for the elderly and disabled.

“The release is premature and inappropriate,” said Jo Ellen H. Ross, executive director of California Medical Review Inc., the San Francisco-based watchdog group for the Medicare program in the state.

The data were characterized as “untested and isolated” by D. Duane Dauner, the president of the California Hospital Assn. Publishing the data “constitutes a disservice to the hospitals and the public,” he added.

Medical experts played down the importance of the variations in overall death rates. “This may be useful, but it needs to be pursued much more to know what it means,” said the Health Research Group’s Wolfe.

Nevertheless, while cautioning that inferences about individual hospitals may be erroneous, experts pointed to a number of ways in which the lists of death rates could be helpful to consumers and the medical community.

For example, the death rate for some medical illnesses is much higher than for many surgeries. “This difference is generally not appreciated,” Rand Corp’s Chassin said. “If there is a quality problem, this is likely to be a more significant problem.”

The lists show that predicted death rates for illnesses such as heart attacks, heart failure and pneumonia tended to be much higher than those for many of the surgical procedures. These death rates were about 10% for pneumonia and heart failure and about 20% for heart attacks.

Physicians also have known that for many surgeries, the death rate declines when the surgeon performs ample procedures to remain highly skilled.

The lists show, for example, that 57% of the 179 hospitals with high death rates from heart pacemaker insertions performed less than 10 pacemaker surgeries on Medicare patients in 1984. Many hospitals with high death rates for knee and hip surgery, gall bladder surgery and prostate surgery had fewer than 50 Medicare surgeries a year.

Wolfe predicted that publicizing the names of such institutions would speed the process of improving quality where problems exist.

“This is a hard list for consumers to make anything out of,” said Barbara Herzog, director of the Health Care Campaign for the American Assn. of Retired Persons in Washington. She called for the federal government and the peer review organizations to prepare “consumer friendly” explanatory materials.

Consumer groups on Wednesday nevertheless maintained that the lists would be used responsibly and that it was better to err on the side of providing too much information than too little. MORTALITY RATES IN CALIFORNIA HOSPITALS Amid cautions about using these figures to judge the quality of hospitals, the federal Health Care Financing Administration identified 269 hospitals across the nation whose 1984 Medicare patients died at unusually high or low rates. Hospitals treating very sick patients, for example, may well show “above average” mortality rates. These Southern California hospitals are ranked by percentage of patient deaths:

Total Patient 1984 Deaths Hospital Community Patients By % Barlow Hospital Los Angeles 131 18.3% S. Bernardino County Med. Center San Bernardino 913 11.1% Valley Medical Center of Fresno Fresno 2401 9.5% Riverside General Hospital Riverside 1293 9.3% Granada Hills Community Hospital Granada Hills 2236 8.3% Downey Community Hospital Downey 2990 8.2% City of Hope Nat’l Medical Center Duarte 1439 8.1% Greater Bakersfield Memorial Hosp. Bakersfield 2305 8.1% Redlands Community Hospital Redlands 3339 7.7% Palomar Memorial Hospital Escondido 5096 7.3% St. Francis Medical Center Lynwood 4827 7.3% Long Beach Community Hospital Long Beach 3439 6.9% Pomona Valley Community Hospital Pomona 4579 6.8% Mercy Hospital & Medical Center San Diego 7070 5.7% Tri-City Hospital Oceanside 5946 6.5% Grossmont District Hospital La Mesa 6261 2.9%

Predicted Deaths Hospital By % Barlow Hospital 4.0% S. Bernardino County Med. Center 6.7% Valley Medical Center of Fresno 7.2% Riverside General Hospital 6.3% Granada Hills Community Hospital 5.3% Downey Community Hospital 6.0% City of Hope Nat’l Medical Center 5.4% Greater Bakersfield Memorial Hosp. 4.9% Redlands Community Hospital 6.1% Palomar Memorial Hospital 5.3% St. Francis Medical Center 5.7% Long Beach Community Hospital 5.1% Pomona Valley Community Hospital 5.2% Mercy Hospital & Medical Center 4.5% Tri-City Hospital 4.6% Grossmont District Hospital 4.8%

The agency released information on patient deaths within these diagnostic categories:

CONGESTIVE HEART FAILURE

Total Patient 1984 Deaths Hospital Community Patients By % West Side District Hospital Taft 32 28.1% Santa Ana Hosp. Medical Center Santa Ana 26 26.9% Long Beach Community Hospital Long Beach 42 21.4% Sierra Hospital Fresno 42 21.4% Charter Suburban Hospital Paramount 77 19.4% Garfield Medical Center Monterey Park 109 16.5% Hemet Valley Hospital Dist. Hemet 317 15.7% Grossmont District Hospital La Mesa 330 2.7%

Predicted Deaths Hospital By % West Side District Hospital 9.7% Santa Ana Hosp. Medical Center 9.1% Long Beach Community Hospital 9.5% Sierra Hospital 9.6% Charter Suburban Hospital 8.9% Garfield Medical Center 8.7% Hemet Valley Hospital Dist. 10.1% Grossmont District Hospital 10.1%

HEART ATTACKS

Total Patient 1984 Deaths Hospital Community Patients By % Corona Community Hospital Corona 34 50.0% St. Mary Medical Center Long Beach 105 33.3% Methodist Hospital of So. Calif. Arcadia 149 31.5% Cedars-Sinai Medical Center Los Angeles 406 15.2% Tri-City Hospital Oceanside 239 14.2% Kaiser Foundation Hospital Los Angeles 161 13.0% Midway Hospital Medical Center Los Angeles 94 12.8% St. John’s Hospital & Health Center Santa Monica 112 12.5% Kaiser Foundation Hospital Panorama City 252 11.9% Kaiser Foundation Hospital W. Los Angeles 123 10.6% Grossmont District Hospital La Mesa 201 7.4% Fountain Valley Comm. Hospital Fountain Valley 75 6.7% Century City Hospital Los Angeles 41 0.0%

Predicted Deaths Hospital By % Corona Community Hospital 22.2% St. Mary Medical Center 21.3% Methodist Hospital of So. Calif. 21.5% Cedars-Sinai Medical Center 22.8% Tri-City Hospital 21.6% Kaiser Foundation Hospital 21.5% Midway Hospital Medical Center 23.7% St. John’s Hospital & Health Center 23.2% Kaiser Foundation Hospital 20.5% Kaiser Foundation Hospital 21.7% Grossmont District Hospital 21.4% Fountain Valley Comm. Hospital 20.7% Century City Hospital 23.3%

PNEUMONIA

Total Patient 1984 Deaths Hospital Community Patients By % Barlow Hospital Los Angeles 3 100.0% City View Hospital Los Angeles 4 50.0% LA County Harbor-UCLA Torrance 29 37.9% Daniel Freeman Marina Hospital Marina del Rey 23 30.4% Kaiser Foundation Hospital Oakland 83 26.5% San Bernardino County Med. Center San Bernardino 52 25.0% Riverside General Hospital Riverside 73 24.7% Victor Valley Community Hospital Victorville 35 22.9% Panorama Community Hospital Panorama City 64 21.9% Medical Center of Garden Grove Garden Grove 82 20.7% San Joaquin Community Hospital Bakersfield 83 20.5% Downey Community Hospital Downey 70 20.0% Greater Bakersfield Mem. Hospital Bakersfield 125 20.0% Glendale Adventist Medical Center Glendale 178 19.7% Eisenhower Medical Center Rancho Mirage 82 19.5% Valley Community Hospital West Covina 62 19.4% Kaiser Foundation Hospital Panorama City 75 18.7% Torrance Memorial Hospital Torrance 125 18.4% Kaiser Foundation Hospital Fontana 149 17.5% Pomona Valley Community Hospital Pomona 106 17.0% Granada Hills Community Hospital Granada Hills 67 10.4%

Predicted Deaths Hospital By % Barlow Hospital 12.0% City View Hospital 10.0% LA County Harbor-UCLA 98.8% Daniel Freeman Marina Hospital 11.0% Kaiser Foundation Hospital 12.8% San Bernardino County Med. Center 10.8% Riverside General Hospital 10.4% Victor Valley Community Hospital 8.7% Panorama Community Hospital 11.0% Medical Center of Garden Grove 11.0% San Joaquin Community Hospital 8.6% Downey Community Hospital 10.1% Greater Bakersfield Mem. Hospital 10.7% Glendale Adventist Medical Center 10.3% Eisenhower Medical Center 9.3% Valley Community Hospital 9.3% Kaiser Foundation Hospital 9.0% Torrance Memorial Hospital 10.6% Kaiser Foundation Hospital 9.7% Pomona Valley Community Hospital 9.3% Granada Hills Community Hospital 8.8%

HEART PACEMAKER IMPLANTS

Total Patient Predicted 1984 Deaths Deaths Hospital Community Patients By % By % Lincoln Hospital Los Angeles 1 100.0% 3.1% Calexico Hospital Calexico 3 33.3% 3.0% Santa Marta Hospital Los Angeles 7 28.5% 2.6% Santa Paula Memorial Hospital Santa Paula 4 25.0% 2.5% Burbank Community Hospital Burbank 15 20.0% 2.9% Doctors Hospital of Lakewood Lakewood 14 14.2% 2.7% Valley Presbyterian Hospital Van Nuys 26 11.5% 2.7% UCLA Medical Center Los Angeles 29 10.3% 3.0%

KNEE AND HIP SURGERY

Total Patient 1984 Deaths Hospital Community Patients By % Crenshaw Center Hospital Los Angeles 1 100.0% Los Angeles Community Hospital Los Angeles 1 100.0% Mission Hospital Huntington Park 1 100.0% Port Hueneme Adventist Hospital Port Hueneme 5 40.0% Valley Community Hospital Santa Maria 8 37.5% Santa Clara Valley Medical Center San Jose 12 33.3% Dominguez Valley Hospital Compton 7 28.5% Burbank Community Hospital Burbank 17 11.7% Hillside Hospital San Diego 19 10.5% Greater Bakersfield Mem. Hospital Bakersfield 100 1.6%

Predicted Deaths Hospital By % Crenshaw Center Hospital 4.8% Los Angeles Community Hospital 5.1% Mission Hospital 4.5% Port Hueneme Adventist Hospital 3.5% Valley Community Hospital 3.2% Santa Clara Valley Medical Center 2.0% Dominguez Valley Hospital 3.9% Burbank Community Hospital 3.3% Hillside Hospital 2.8% Greater Bakersfield Mem. Hospital 3.3%

GALL BLADDER SURGERY

Total Patient 1984 Deaths Hospital Community Patients By % Riverside General Hospital Riverside 3 33.3% Harbor View Medical Center San Diego 5 20.0% S. Bernardino County Med. Center San Bernardino 11 18.1% Pacifica Community Hospital Huntington Beach 12 16.6% Santa Ana Hospital Santa Ana 6 16.6% West Hollywood Hospital Hollywood 6 16.6% Temple Community Hospital Los Angeles 13 15.3% Mission Valley Medical Center Lake Elsinore 15 13.3% Mission Hospital Huntington Park 8 12.5% Torrance Memorial Hospital Torrance 46 10.8% San Antonio Community Hospital Upland 45 8.8%

Predicted Deaths Hospital By % Riverside General Hospital 1.8% Harbor View Medical Center 3.1% S. Bernardino County Med. Center 2.6% Pacifica Community Hospital 2.2% Santa Ana Hospital 2.5% West Hollywood Hospital 3.0% Temple Community Hospital 3.1% Mission Valley Medical Center 2.6% Mission Hospital 1.8 Torrance Memorial Hospital 1.9% San Antonio Community Hospital 2.0

GASTROINTESTINAL BLEEDING

Total Patient 1984 Deaths Hospital Community Patients By % Ojai Valley Community Hospital Ojai 7 42.8% Kingsburg General Hospital Kingsburg 3 33.3% Simi Valley Community Hospital Simi Valley 8 25.0% City of Hope Nat’l Medical Center Duarte 13 23.0% Western Medical Center Anaheim 9 22.2% UC Irvine Medical Center Orange 22 18.1% Children’s Hosp. of San Francisco San Francisco 49 16.3% Victor Valley Community Hospital Victorville 25 16.0% Hi-Desert Medical Center Joshua Tree 27 14.8% Greater Bakersfield Mem. Hospital Bakersfield 43 13.9% Doctors Hospital of Lakewood Lakewood 36 13.8% Valley Medical Center of Fresno Fresno 45 13.3% Glendale Adventist Medical Center Glendale 79 12.6% Redlands Community Hospital Redlands 69 11.5%

Predicted Deaths Hospital By % Ojai Valley Community Hospital 4.8% Kingsburg General Hospital 5.1% Simi Valley Community Hospital 5.3% City of Hope Nat’l Medical Center 4.2% Western Medical Center 5.7% UC Irvine Medical Center 4.6% Children’s Hosp. of San Francisco 5.7% Victor Valley Community Hospital 5.2% Hi-Desert Medical Center 5.2% Greater Bakersfield Mem. Hospital 5.1% Doctors Hospital of Lakewood 5.1% Valley Medical Center of Fresno 5.6% Glendale Adventist Medical Center 5.2% Redlands Community Hospital 5.3%

CORONARY ARTERY BYPASS SURGERY

Total Patient Predicted 1984 Deaths Deaths Hospital Community Patients By % By % Garfield Medical Center Monterey Park 47 17.0% 5.7% St. Vincent Medical Center Los Angeles 365 1.9% 5.5%

PROSTATE SURGERY

Total Patient 1984 Deaths Hospital Community Patients By % Serra Memorial Health Center Sun Valley 2 50.0% Crenshaw Center Hospital Los Angeles 8 12.5% West Side District Hospital Taft 8 12.5% Ventura County Medical Center Ventura 9 11.1% Valley Park Medical Center Canoga Park 10 10.0% Greater El Monte Comm. Hospital El Monte 12 8.3% French Hospital of Los Angeles Los Angeles 13 7.6% La Habra Community Hospital La Habra 13 7.6% Clairemont Community Hospital San Diego 15 6.6% Costa Mesa Med. Center Costa Mesa 18 5.5% Community Hospital of Glendale Gardena 19 5.2% Tustin Community Hospital Tustin 20 5.0% Circle City Hospital Corona 22 4.5% Marian Medical Center Santa Maria 22 4.5% Kaiser Foundation Hospital Anaheim 54 3.7% Verdugo Hills Hospital Glendale 60 3.3% St. Francis Medical Center Lynwood 97 3.0% Doctors Hospital of Lakewood Lakewood 75 2.6%

Predicted Deaths Hospital By % Serra Memorial Health Center 0.6% Crenshaw Center Hospital 1.1% West Side District Hospital 0.3% Ventura County Medical Center 0.3% Valley Park Medical Center 0.5% Greater El Monte Comm. Hospital 0.5% French Hospital of Los Angeles 0.7% La Habra Community Hospital 0.2% Clairemont Community Hospital 0.6% Costa Mesa Med. Center 0.4% Community Hospital of Glendale 0.4% Tustin Community Hospital 0.5% Circle City Hospital 0.5% Marian Medical Center 0.6% Kaiser Foundation Hospital 0.2% Verdugo Hills Hospital 0.5% St. Francis Medical Center 0.6% Doctors Hospital of Lakewood 0.4%