Heart Service Performance Review Urged : Medicine: California hospitals could be subject to probation, suspension or loss of license if their mortality rates for cardiovasular procedures are too high.

California hospitals with high mortality rates or low volumes of cardiovascular procedures such as open-heart surgery and angioplasty would be subject to independent performance reviews and possible revocation of their permit to offer such services, under regulations being proposed by the state Department of Health Services.

The regulations would authorize the department to “place the cardiovascular service on probation, or if appropriate, suspend or revoke” its license to do certain procedures when “substantial quality of care problems are identified.” A copy of the draft regulations was obtained by The Times last week.

Current regulations “don’t really give us any kind of clout,” said Teresa Hawkes, the department’s deputy director for licensing and certification. Hawkes termed the proposed regulations “a positive step forward” because they put facilities on notice when “there is going to be a review” and possible action.

The draft regulations are in part a response to a series of articles in The Times in 1988 and 1989, which identified low-volume and high-mortality heart surgery hospitals. The articles suggested that many lives could be saved and complications averted if more patients were cared for at high-volume, low-mortality facilities.

The Times found that about 15% of the state’s approximately 100 heart surgery hospitals had heart-bypass surgery mortality rates at least 50% above the state average. In addition, about a third did not meet the 150-cases-a year minimum for all heart surgeries recommended by the state and the American College of Surgeons. The minimum is designed to maintain the skills of doctors and nurses. Under the proposed regulations, such hospitals would be subject to state review.

“It is the first time in California that regulation of cardiovascular services has included explicit quality standards related to the volume and outcome of the procedures,” said Jonathan Showstack of UC San Francisco’s Institute for Health Policy Studies. Showstack helped The Times prepare its studies and served on an expert advisory committee that assisted the state in drafting the guidelines.

A public hearing on the draft regulations is likely in about 90 days. If the process continues on schedule, the final regulations will take effect in early 1991.

Under the proposal, all hospitals would report to the state annually on their total number of procedures and mortality rates in categories such as heart surgery, angioplasty, and catheterizations. Newly approved cardiovascular services would make quarterly reports during their first year of operation.

(Angioplasty is a method in which a balloon-tipped catheter is used to unclog heart arteries and catheterization is a technique for diagnosing heart diseases).

Hospitals would be required to maintain detailed data on cases. The data would include the reasons procedures were performed, elective or emergency status, all diagnoses, complications and mortality rates that are adjusted for the severity of illness of the patients before the procedure.

For adults, the recommended annual minimums for each hospital are 200 catheterizations, 100 interventional procedures such as angioplasty and 150 surgeries. For pediatric heart services, the recommended yearly minimums are 100 catheterizations and 50 surgeries.

Hospitals that “do not meet the recommended minimums and/or whose mortality rates are 50% above the state average for that year” would be reviewed by the state, according to the proposal. A hospital also could be required to conduct at its expense and forward to the health services department “an independent review of its cardiovascular service” by an expert group approved by the state.

The proposed cardiovascular regulations are part of an ongoing review by the state of all its regulations of acute care hospitals, including nursing, emergency services and neonatal care.