VA Criticized for High Heart-Surgery Death Rate

A key House subcommittee chairman, castigating the Veterans Administration for high death rates during cardiac surgery at its 172 hospitals nationwide, expressed “outrage and shock” Tuesday that many of the deaths were found to have been “preventable.”

Rep. Ted Weiss (D-N.Y.) cited a recent medical journal article that said 38% of heart operation deaths at VA hospitals from 1981 to 1983 resulted from procedural errors. The article, by Dr. Timothy Takaro, former chairman of the VA’s cardiac surgeons consulting committee, blamed errors of procedure for 45 of 116 deaths during heart operations.

Weiss said those errors included suturing artery grafts incorrectly, keeping patients on heart pumps too long during surgery and even bypassing the wrong arteries.

Half Called Preventable

A 1985 report by the VA’s inspector general, Weiss said, categorized more than half the errors resulting in 134 cardiac surgical deaths in 1983 and 1984 as preventable.

Such findings, Weiss said, should send “shock waves throughout the Veterans Administration,” whose job it is to protect those who “fought and bled for this country.”

Dr. John Gronvall, the VA’s deputy chief medical director, declined to answer subcommittee questions about whether 38% is an acceptable level of preventable error.

‘No Comparable Standard’

“No acceptable or comparable standard for a reasonable minimum” exists in the private sector, he said. But he added that he believes the VA rates are comparable to those in the private sector.

And beyond the question of deaths during heart surgery, he insisted that “the total mortality experience of the VA hospitals is well within an acceptable level.”

Weiss, quoting the inspector general’s report, said that 5% of heart surgery patients at VA hospitals in 1983 and 1984 died during their operations, compared with the 3.1% national average estimated by the National Center for Health Statistics.

‘A Critical Indicator’

But Gronvall said mortality rates alone are not accurate indicators of overall health care quality or a sufficient basis to compare health care facilities. “Raw mortality rate is a critical indicator (of quality care), but it is insufficient in itself” to determine overall quality, Gronvall said.

Gronvall said the VA is working to improve its monitoring of patient care.

He said the VA is aiming to increase quality by closing “as many as one-third” of its 52 cardiac surgical units by 1988. Until now, those units were required to perform at least 100 heart operations each year, but a special VA advisory committee recommended raising that figure to 150 and redistributing patients.

The committee found that units performing fewer than 150 heart operations had higher-than-average mortality rates.