Decertification Urged for Cardiac Program at CHOC

A state agency that provides money for the care of pediatric heart patients has withdrawn its approval of the cardiac program at Childrens Hospital of Orange County.

According to a hospital spokeswoman, investigators for the agency, California Children Services (CCS), cited inadequate record keeping and outdated diagnostic techniques in recommending decertification of the program, the only one of its kind in Orange County.

The decision means that the agency will no longer pay for heart surgery and diagnostic tests such as heart catheterizations for patients covered by the Orange hospital’s program or by Medi-Cal.

However, the recommendation does not prevent the hospital from treating privately insured cardiac patients. Doctors have also agreed to perform emergency procedures on patients covered by CCS without reimbursement, a hospital spokeswoman said.

Hospital officials estimated that about 30% of the 150 to 200 heart catheter patients a year are covered by CCS or Medi-Cal. The number of cardiac surgeries performed was not immediately available.

Some patients covered by CCS who need cardiac care will be referred to hospitals outside the county.

“Unfortunately, this will have a significant effect on those patients least able to afford to go else where,” said Dr. Melville Singer, one of three private physicians who care for heart patients at CHOC.

Three private physicians who care for heart patients at CHOC have appealed the decision and questioned the fairness of the agency’s review, which was conducted in January, and the delay in notifying doctors of its outcome.

“We received absolutely no correspondence from the agency between January of 1988 and Nov. 18, when we got a letter saying that as of Nov. 28 we would no longer have CCS approval,” Singer said.

“It would seem that after that length of time, it would have been more appropriate to suspend the decision and give us an opportunity to appeal before it went into effect.”

Meanwhile, an official with the certification division of the state Department of Health Services, which licenses hospitals and nursing homes, said the agency will also review the pediatric heart program at CHOC because of the other agency’s conclusions.

“It’s really a routine matter, that we would look at the program after that decision,” regional administrator Joan Dowling said. “The scope of the investigation will depend on the seriousness of the situation.”

Officials with CCS could not be reached for comment Wednesday.

Hospital officials said that they expect to regain certification and that much of the criticism of the cardiac program’s record-keeping was caused by the lack of an in-house cardiology department to answer inspectors’ questions.

“The program is run by physicians in the community, which is the gist of a big part of the problem,” CHOC spokeswoman Maureen Williams said. “Most of the records are kept in their offices. A lot of the correspondence does not come to CHOC.”

Singer conceded that record-keeping is “awkward” because the physicians keep most of the documents detailing patient care in their private offices.

But a complete set of records summarizing the results of examinations and treatment are kept in CCS’s own Santa Ana office, Singer said.

He said CHOC doctors argued that inspectors should review records from the local CCS office, but they refused and depended solely on the records obtained at the hospital.

Singer also disputed the criticism of CHOC’s diagnostic techniques.

According to CHOC, two inspectors reviewed records of 100 catheter procedures and several surgeries that were performed at the hospital, faulting technique or documentation in 25 of the catheter cases. Heart catheters are hollow tubes that can be inserted through a vein or artery and into the heart to detect diseases or abnormalities.

“They felt that we used a catheter procedure that sometimes didn’t give us the appropriate information,” Singer said. “They assumed that if a diagnosis wasn’t made by using the procedure, then a diagnosis wasn’t made at all. But frequently we are able to make the diagnosis with other tests that are not reflected in hospital records.”

Singer said that if the agency reinstates its approval of the cardiac program, the hospital will try to centralize records so future inspectors can read them.