Veterans Battle VA Proposal to Close Cardiac Unit in L.B.

Times Staff Writer

As a World War II veteran, Melvin Abramovitz fought for his country. As a heart attack victim five years ago, he struggled for his life. Now, he is fighting for the Long Beach Veterans Administration Hospital cardiac surgery unit.

Abramovitz, 65, is part of a troop of local veteran groups mobilizing to save the unit, which has come under fire from the VA and is scheduled to shut down in September.

"It just doesn't make any sense," Abramovitz, of the Disabled American Veterans Lakewood chapter, said of the decision to close the unit he credits with saving his life.

Michael Gureckas, president of the Long Beach-based Paralyzed Veterans of America California chapter, expressed similar frustration and said his group wants to pressure the Veterans Administration to change its position. If the unit closes down as proposed, he said, the end result "is that you're going to have guys dying while waiting in line for cardiac surgery."

VA spokesman Larry Caird called such a statement "an irresponsible claim." Caird said the veterans are fighting a losing battle because the VA already has "closely scrutinized" its decision to close the unit. "It's pretty much a closed case," he said.

Highest Mortality Rate

The unit at the Long Beach facility had the highest mortality rate for open-heart surgery during a six-month period that ended in April, 1985, according to a study released last year. The Long Beach unit is one of five in the country the VA has decided to phase out based upon the number of surgeries they perform and their mortality rate, Caird said.

Last year, a special panel of outside physicians, at the request of the VA, investigated the system's 51 heart-surgery units during the same six-month period in the VA's 172 hospitals. The panel found that many of the units had been performing so few operations that mortality rates were above normal in some cases.

The panel recommended that no unit should perform fewer than 150 open-heart procedures a year.

The correlation between the number of operations performed each year and the number of patients who die is the result of what medical authorities call the "practice effect." Doctors who perform open-heart surgery infrequently are not as skillful, on average, as those who do it all the time, studies have shown.

But doctors at the Long Beach facility dispute the report, which showed Long Beach had an 18.2 % mortality rate. Dr. Edward Stemmer, the hospital's chief surgeon, said last year that the rate appeared excessive because there were 33 open-heart surgeries performed during the six-month period studied and six of the patients died.

"When you take six months out of a 19-year history, you get a distorted idea of the overall program," Stemmer said at the time, adding that the high percentage didn't "mean a thing except that a small number of patients" were operated on during that time.

Dr. Robert Detrano, chief of the heart station, said this week that more recent statistics paint a more positive picture of the unit, and also indicate that having local cardiac patients travel to other VA hospitals for surgery raises the mortality rate.

Temporary Closure

Between April 7, 1985, and Jan. 15, 1986, the unit was closed temporarily at the request of the VA's central office because of the 18.2 % mortality rate shown in the study and because of construction at the unit, Detrano said. Detrano noted that during that period, patients sent to other hospitals for heart operations had a 10% mortality rate. Of the 50 patients, five died, Detrano said.

When the Long Beach unit reopened, 51 patients were operated on between Jan. 15 and Sept. 7, and two died, Detrano said.

Comparing the number of deaths during the period when veterans were sent outside the city to the period when they were treated at Long Beach, Detrano said, the numbers mean that the patients stand a better chance for survival if they are operated on locally.

Detrano also said statistics have improved in the last couple of years compared to the period studied for the report released last year. Between Jan. 15, 1986, and Jan. 15, 1987, the unit had 108 heart operations and six deaths--a 5.5 % mortality rate, Detrano said.

A report published last year in a surgical journal stated that the comparable rate for VA hospitals nationwide ranged between 5% and 8%.

To Detrano, the figures mean the hospital's cardiac surgery unit is doing a good job. If the unit closes down and veterans are sent to either of the VA hospitals in Los Angeles or San Diego with cardiac surgery units, Detrano said, it would increase those hospitals' workload, burden the veterans who would have to leave the Long Beach area for treatment, including emergency care, and potentially cost lives.

Decision Called 'Political'

Detrano called the decision to close down the unit "political."

"It's a way that the (VA) administration (in Washington) can show it can cut costs, (but) they are doing it to the detriment of the veterans," Detrano said.

Caird, a spokesman in Los Angeles for the VA's western region, disagreed that costs were the motivating factor. He also pointed out that an increase in workload at San Diego and Los Angeles will work to the doctors' and patients' benefit, according to studies that show "the more of these you do, the better your technique becomes."

But local veterans are upset that the unit will be closed. And doctors at the Long Beach facility said September's deadline does not give them enough time to phase out the program.

Jim Moriarty, one of several local veterans who said he has begun a letter-writing campaign to legislators, said, "I wouldn't be alive if it weren't for that hospital and those doctors down there."

Thomas F. Mayfield, service director for the American Legion Los Angeles County Council, said the VA's decision has the potential to adversely affect a number of the 1.7 million veterans in Southern California. His group has adopted a resolution opposing the unit's closure.

Abramovitz, of the Disabled American Veterans, said he is not sure how successful the veterans' campaign will be. But the veterans want to get the word out, he said, and that means "raise enough hell and get the citizenry to realize how important this service is."

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