Hospital Seeks Profitable Niche With Bloodless Surgery

Times Staff Writer

Coast Plaza Medical Center in Norwalk was losing money until 1984, when it found a cure that generated substantial profits and attracted patients from around the world.

Today, in Orange County, another small community hospital has decided to take the same prescription.

Like Coast Plaza, Midwood Community Hospital in Stanton has established a program claiming to offer advanced surgical techniques that it says can nearly eliminate the need for blood transfusions.


So far, the primary demand for the “blood-free” or “bloodless” surgery offered by Coast Plaza and Midwood has come from Jehovah’s Witnesses, who adhere to a religious prohibition against blood transfusions.

Expanding Market for Bloodless Surgery

But Midwood officials believe that growing concern about AIDS and other blood-borne diseases has greatly expanded the potential market for blood-free surgery.

“We recognize there is a growing panic in the public’s mind about AIDS and hepatitis and other possible dangers in the use of blood,” said Dr. Stanley Mayberg, chairman of the board of Midwood and a member of a physician group that bought the 110-bed hospital in a foreclosure sale in 1979.

In response to that new aversion to blood transfusions, Mayberg said hospital officials decided to try to develop Midwood into a national center for bloodless surgery.

Like other hospitals nationwide, Midwood is seeking new ways to cope with cost constraints and increasing competition. At least 10 other hospitals are located within a 10-mile radius of Midwood, which is operating at only 45% to 50% of its patient capacity.

“It is very important for hospitals today to identify market niches, especially smaller hospitals that may not be able to provide all the services of the major institutions,” said Richard Carpe, a partner with the firm of Laventhol & Horwath who is Midwood’s financial consultant.

Bloodless Surgery Team Joins Staff

So last January, the hospital persuaded Dr. Fred Garcia, an anesthesiologist, to leave Coast Plaza to join the Midwood staff. He brought with him the nucleus of a bloodless medical team that included a surgeon, a cardiologist, a gynecologist and a gastroneurologist.

To date, Midwood has performed more than 30 surgeries without backup blood, representing about 15% of all the surgeries performed at the hospital. Most of the operations were performed on Jehovah’s Witnesses, who have come to the hospital from as far away as Florida and Alaska.

Garcia, a 44-year-old graduate of the UC Irvine College of Medicine, declined to discuss in detail why he ended his association with Ron Lapin, a controversial surgeon who is generally considered the pioneer of the blood-free surgery movement in Southern California and who heads the program at Coast Plaza.

Lapin said he considers Garcia’s decision to start his own bloodless surgery program “a compliment. . . . He has been a very good pupil and I wish him well.”

But Garcia objects to Lapin’s characterization of him as a protege. Garcia contends that he, not Lapin, perfected the anesthesiology techniques that he said are necessary to performing surgery with a minimum of blood loss.

Midwood’s “Stop Blood” program is the second bloodless surgery program in Orange County founded by former associates of Lapin. The other program, called Network for Bloodless Health Care, is based at Santa Ana Hospital Medical Center and Doctors Hospital of Santa Ana. Both hospitals are owned by Summit Health Ltd., a health-care corporation based in Century City. Unlike Midwood’s program, the Santa Ana group says it strives to maintain a low profile.

Dr. Vinod Malhotra, medical director of the Network for Bloodless Health Care, said that despite the lack of heavy marketing, the 20 surgeons and 10 other physicians in his group perform two to three bloodless surgeries a day. Almost all of the patients are Jehovah’s Witnesses, although the group does not restrict its practice to that religious group.

So far, hospitals that have tried to market bloodless surgery to non-Jehovah’s Witnesses have encountered an uphill struggle. One reason is that many physicians who refer patients to hospitals do not consider bloodless surgery to be a legitimate specialty. They note that the Board of Bloodless Surgery, to which both Lapin and Garcia belong, is not one of the 23 boards recognized by the American Medical Assn. or the American Board of Medical Specialties.

‘Making a Big Deal Out of It’

“They (bloodless surgery teams) don’t have any equipment that is not present at major medical centers throughout Southern California, nor do they have doctors that are trained in techniques that are any different,” said Dr. Kenneth Waxman, a surgeon and director of trauma and surgical critical care at UCI Medical Center in Orange.

Like Coast Plaza and Midwood, Waxman said, UCI Medical Center will guarantee not to use blood and will use every technique available to reduce bleeding if an adult patient signs a form releasing the hospital from liability.

“The bloodless surgery people are making a big deal out of it for marketing reasons, and sometimes they are not the best or most ethical surgeons,” said Dr. Michael Kennedy, a general and vascular surgeon and past president of the Orange County Medical Assn. “This is entrepreneur medicine you are dealing with.”

Garcia contends that American surgeons use a lot more blood transfusions than necessary and often refuse to honor the wishes of their Jehovah’s Witnesses patients who would rather die than accept a transfusion.

He advocates using a combination of blood-conserving techniques in surgery, including lowering the patient’s body temperature and blood pressure, diluting the blood with fluids and using equipment that can recycle blood lost during surgery. And Garcia said he uses extensive body monitoring to make sure that the body is obtaining enough oxygen and the heart is functioning properly.

In bloodless surgery, Garcia said, the surgeon uses an electric cauterizing knife, lasers and staples--rather than sutures--to reduce trauma and minimize blood loss. The bloodless surgeon puts an emphasis on speed and precision, he added.

By using these procedures, Garcia contends that almost all surgeries, including open-heart and orthopedic, can be performed even on highly anemic patients without blood transfusions.

“Blood is a backup for sloppy anesthesia and sloppy surgery,” Garcia said.

He said he has administered anesthesia in 7,000 surgeries without backup blood supplies in the last seven years.

Garcia said he and other physicians were taught in medical school that surgery patients who become so anemic that the hemoglobin in their blood drops below 10 grams per deciliter should immediately receive a transfusion. He said they were warned that otherwise the patient might suffer a stroke, heart attack or other serious damage because of a shortage of oxygen, which hemoglobin carries to vital organs of the body, including the heart and brain.

But Garcia said that, contrary to what he was taught, he has successfully performed surgeries on patients with hemoglobin counts as low as 1.7 grams per deciliter.

Over those seven years, Garcia said, he knows of only three deaths that might have been prevented by blood transfusions. He said Midwood is requiring people who don’t want blood to sign refusal forms that release the hospital from legal responsibility if withholding blood results in death.

‘Morally Obligated’

Garcia said he feels “morally obligated” now to share with the rest of the world the knowledge and expertise he has acquired by operating without blood transfusions on Jehovah’s Witnesses.

He is doing so through an aggressive marketing campaign launched by Midwood. Bloodless surgery flyers were passed out to crowds at the Los Angeles Marathon in March, and Garcia has appeared on a call-in radio show in Orange County. The hospital has begun to hold local educational seminars and plans to expand the sessions to other parts of the country.

“Today the American Red Cross is telling us that blood is safe. I am here to tell you that it is not,” Garcia told his audience at a recent seminar held at Midwood, ticking off reports of diseases and immune system dysfunctions blamed on blood transfusions.

Those attending the seminar were told that they could obtain an identification bracelet or necklace to alert emergency room doctors that they do not want blood or blood byproducts and listing a hot-line telephone number for the Blood Free Medical & Surgical Center located next to Midwood.

Garcia said the hospital has made arrangements with an air ambulance service that will provide a Lear jet to pick up surgical patients from various parts of the country and bring them to Midwood.

Garcia warned his audience that it is risky to trust surgical teams at other hospitals not to use blood during an operation. Even if a surgeon has promised not to transfuse, he said, the anesthesiologist might do so anyway or the hospital might demand a transfusion for fear of a malpractice suit. “Today, if you go into a hospital and a medical team decides you need blood, you get blood,” he said.

Searched for a Doctor

June Aiken, a Jehovah’s Witness from Jacksonville, Fla., said she and her husband searched for more than a year but were unable to find a doctor in their hometown who “would even consider” performing surgery required on her colon without a blood transfusion. Last month, she responded to a Midwood brochure and traveled to the Stanton hospital. She had bloodless surgery there and now is on the mend, she said.

Some doctors accuse Garcia and Lapin of using scare tactics to build their practices. Waxman said they “misrepresent other good medical centers,” noting that UCI Medical Center has been very successful in treating patients who refuse blood.

Donald Daniels, chief of staff at Santa Ana Hospital Medical Center and Doctors Hospital of Santa Ana and a former associate of Lapin, also objected to Garcia’s contention that bloodless surgery requires specialized techniques.

“We do not want to imply that it is a big deal. It does not take special training at any special institute,” Daniels said. “I think anybody could do it if they wanted to. It just takes commitment.”

Moreover, Daniels said that in recent years he has noticed that the general medical community, concerned about the AIDS menace, has made an effort to use less blood or to advise patients to bank their own blood for elective surgery.

Cheryle Babbitt, spokeswoman for the Los Angeles/Orange County Region of the American Red Cross, said Red Cross statistics indicate that the AIDS scare may be having an effect on blood usage by physicians. She said that for the last three to four years, the amount of blood used for transfusions in the two-county region has remained the same, whereas for the previous 40 years the demand steadily increased.

More Using Own Blood

And the American Assn. of Blood Banks, which represents about 80% of the nation’s hospital blood banking and transfusion services, reports that the number of patients receiving their own banked blood increased 91% from 1985 to 1986, while the use of blood salvaging and recycling during surgery jumped 15.6%.

Jackie Campbell, spokeswoman for the association, said the use of such techniques probably increased by a similar percentage in 1987 and continues to grow.

Nonetheless, sponsors of bloodless surgery programs say they have observed a noticeable, if not overwhelming, increase in the level of interest from outside the Jehovah’s Witnesses community.

The Santa Ana group said the percentage of patients other than Jehovah’s Witnesses that it treats has increased to about 6% from 1% of its total patient load.

“I would say the interest hasn’t grown as much as expected,” said Malhotra. “I think that is because some people are still afraid if they don’t have blood they might die. The problem is fear of the unknown.”

In the last two years, Lapin said the non-Jehovah’s Witness population has come to account for 10% of the hospital’s bloodless surgery patients.

Art Gerrick, executive director of Coast Plaza, said the hospital has advertised extensively over the past year with little apparent benefit. He said he believes that people who see the ads ask their family physicians about them. “The patients go to a physician, and if he doesn’t believe in bloodless surgery, he is going to say it is a hoax,” Gerrick said.

But Midwood’s Garcia said he believes that doctors ultimately will be forced to use bloodless surgical techniques by their patients. “Right now, patients are requesting that blood not be used. Soon they will be demanding it,” he said.