Angioplasties Not Often Done at Hospitals Without Heart Surgery Units

In 1986, 96 state-licensed hospitals in California had heart surgery units and 130 hospitals had catheterization labs, according to the Office of Statewide Health Planning and Development.

It is not known for certain how often coronary angioplasties are performed at hospitals that lack heart surgery services, but the situation appears to occur infrequently. One facility that does do angioplasties with no cardiac surgery unit is Peralta Hospital in Oakland, a 204-bed private facility that is part of the Merritt Peralta Medical Center.

The practice appears to be in violation of the California Health and Safety Code, which limits coronary angioplasty to hospitals that also have heart surgery services.

“The regulations do not permit (angioplasty without a cardiac surgery unit),” said Dr. Patricia Chase of the licensing and certification division of the state Department of Health Services, who said she had been unaware of the Peralta situation. “I thought that hospitals clearly understood this. The few places where it has come up, we have told them to cease and desist.”

These regulations apply only to state-licensed facilities, such as Peralta, not to federal hospitals such as the Long Beach Veterans Administration Hospital.

Angioplasties have been performed at Peralta since 1982, according to Dr. General Hilliard, the director of Peralta’s catheterization laboratory. About 100 angioplasties a year are now being done.

Angioplasties are performed in cardiac catheterization laboratories. According to state regulations, hospitals that don’t perform heart surgery may have cardiac catheterization laboratories, but only “diagnostic” procedures may be performed. (During a diagnostic catheterization, for example, cardiologists may inject dye into the heart arteries to assess the adequacy of the blood supply. The dye is injected through a long fine tube called a catheter.)

Angioplasty is considered a therapeutic, not a diagnostic, procedure because the goal is to restore blood flow in a clogged heart artery by widening the artery with an inflated balloon. Complications are far more common following an angioplasty than after a routine heart catheterization.

Peralta’s heart surgery emergencies are sent via ambulance to Samuel Merritt Hospital, a 364-bed private hospital that is several blocks away and that is also part of the Merritt Peralta Medical Center.

It is “malpractice” to perform angioplasties at Peralta, according to Dr. Earl Holloway, medical director of Merritt’s catheterization laboratory. “It just can’t go on,” Holloway said in a telephone interview. “I know patients of mine are alive because of the rapid trip to the operating room. I have watched people come from the other hospital and die in our hospital.”

Merritt is one of the busiest angioplasty hospitals in the state; about 900 cases are performed there each year. Cardiologists based at Peralta also have privileges to perform catheterizations and angioplasties at Merritt.

Peralta’s Hilliard said “we haven’t had any problems” with the current surgical backup arrangements. “We have certainly had patients die after angioplasty but not as a result of the transport.” But Hilliard acknowledged that “I think we will change our policy.”

Merritt Peralta Medical Center has no regulations about where angioplasties should be performed, according to Dr. Roderick Snow, the medical center’s administrator. In an interview, Snow acknowledged that the situation would now be reassessed. “It is lunacy for me to say we have no areas to discuss,” he said.