Long Beach VA Cardiac Surgery Unit Fights Closing

The Veterans Administration said Monday that it intends to close cardiac surgery units at four hospitals, including the Long Beach VA, because the hospitals have performed too few heart operations and too many patients are dying.

But the director of the Long Beach hospital said that the problems that prompted the closings are being solved and that the decision will be appealed to VA headquarters in Washington.

“We were surprised and disappointed,” said Dean Stordahl, the hospital’s director, who was informed of the decision Friday. “We plan to demonstrate that we can meet the criteria (to keep the heart surgery unit open).”

There will be no immediate effect on the Long Beach VA’s heart surgery team, which expects to perform about 125 operation this year, he said. Stordahl said he expects that the phase-out may take one to two years.

The VA headquarters will announce a timetable in February for the closing at Long Beach and the Brooklyn VA. Heart surgery has already been halted at VA hospitals in East Orange, N.J., and Washington.

The closings were called for by the department of medicine and surgery at the VA’s central office. The decision followed internal audits of excessive deaths related to heart surgery and a recommendation by an outside advisory panel that each heart surgery unit perform at least 150 procedures each year.

Numerous studies have shown a direct relationship between the number of cardiac operations performed at a hospital and the percentage of the patients who die. In 1985, the average mortality rate at the VA’s 51 heart surgery units was about 5%.

The open-heart surgery unit at the Long Beach VA was closely scrutinized because its mortality rate was 18.2% during a six-month period that ended in April 1985, according to a report by the VA’s inspector general. It was the highest mortality rate for any hospital in a nationwide study that was made public last August.

Stordahl said the high mortality rate is “significantly misleading” because the statistics applied only to a period when facilities were being renovated and only 33 open-heart surgeries were performed.

In comparison, he said, the mortality rate was 4.7% for the 107 open-heart cases performed at the Long Beach VA since Jan. 15, 1986, when the program once again became fully operational.

By 1988, Stordahl predicted, the Long Beach VA could perform 150 heart surgeries a year.

Typically, over the last four to five years, between 140 and 145 annual cardiac surgeries have been done at the Long Beach VA, according to Dr. Edward Stemmer, the hospital’s chief surgeon.

The closing of the Long Beach facility would place increased demands on the Wadsworth VA Hospital in West Los Angeles and the San Diego VA, the two other VA hospitals in Southern California that have open-heart surgery units. The Loma Linda VA and the Sepulveda VA perform heart catheterizations but lack cardiac surgery units.

According to the VA’s inspector general, 7.1% of the 183 heart patients operated on at Wadsworth VA died during the six months ending in April, 1985. At the San Diego VA, the death rate was 4% for the 175 heart operations performed during the same period.

Last August, VA officials said they eventually expected to close about one-third of their 51 heart surgery departments.