Reprimanded Navy Doctor Cites Example of Waste : Surgery: Mitchell J. Grayson says a recent $25,000 operation shows just how petty it was for the Navy to criticize his use of its medical instruments to do charity work in Tijuana.

The admiral in charge of the San Diego Navy hospital sent a servicewoman to Atlanta this year for $25,000 in surgery that could have been done at the hospital here at no extra cost to the government, according to a former Navy physician who said he had offered to do the surgery in San Diego.

Rear Adm. R.B. Halder authorized the surgery because the woman had become disgruntled over being turned down for surgery by a visiting Atlanta expert when he visited San Diego on a teaching trip last August, said the former Navy doctor, Mitchell J. Grayson.

“I knew that someone was intervening on her behalf,” Grayson said. “I’m not sure whether someone told me or whether I just kind of knew--I mean, that’s the way the system works.”

Grayson made the charges public this week after receiving final notice that his ties with the Navy are severed. Grayson was held in the Navy beyond his original February discharge date until an investigation of his use of Navy surgical instruments for charity care in Tijuana was completed.

Acknowledging that he is bitter over a subsequent reprimand from Halder for “inexcusable” conduct, Grayson said the case of the $25,000 spent for out-of-state surgery points out how petty the investigation of him was.

“This really points out the hypocrisy of the Navy, and particularly of my commanding officer (Halder),” Grayson said. Pointing to a Navy regulation, he added, “The same gentleman who castigated me is I think guilty of the waste, fraud and abuse that is defined in that Navy handout.”

The incident Grayson detailed is supported by letters between him and the Atlanta doctor, whom he declined to identify. However, The Times learned elsewhere that the plastic surgeon was Dr. Carl Hartrampf Jr.

Hartrampf could not be reached for comment.

A letter from Hartrampf, dated June 15, said the Navy woman was sent to Atlanta three times for the surgery and follow-up procedures.

The woman had her initial breast reconstruction operation “on Feb. 1, 1990, and her nipple/areola reconstruction on March 20,” the letter says. “She is scheduled to return for her nipple tattoo this month, and I am happy to report that she is doing well. The Navy paid my usual fee for the breast reconstruction and nipple/areolar reconstruction.”

The operation the woman had is called a TRAM flap; the acronym stands for “transverse rectus abdominus myocutaneous.” In this surgery, part of a lower-abdominal muscle and abdominal skin are partially detached, rotated and then reconnected to blood vessels in the chest.

The muscle tissue is used to reconstruct a cancer patient’s breast after mastectomy, said Dr. Jack Fisher, head of the division of plastic surgery at UC San Diego Medical Center. In some women, the method is preferable to artificial implants, he said.

Plastic surgeons at the Naval Hospital are “very high quality” and are easily qualified to do the TRAM operation, Fisher said.

The surgery has been in use for several years, and Hartrampf is one of its developers, so he teaches classes in it for plastic surgeons, Fisher said.

During a teaching visit to San Diego last August, Hartrampf arranged to do a demonstration of a TRAM flap operation at Naval Hospital, Grayson said.

Grayson found one 56-year-old woman who appeared to be the perfect candidate for the surgery, and asked a second woman--an active-duty Navy servicewoman in San Diego--to be ready for surgery that day in case the first patient couldn’t be used, he said.

On the day of surgery, Aug. 24, the Atlanta doctor concluded that the 56-year-old woman was indeed an ideal candidate, so the second woman was sent home, Grayson said.

Grayson, who was head of the plastic surgery division at Naval Hospital, wrote in a Sept. 6 letter to Hartrampf that this woman had lodged a formal complaint about not having the surgery done.

Grayson said he had several conversations with Halder and a patient advocate at the hospital about the woman’s case, and it was clear to him that this was being treated as a special case. He recounts them this way:

“Our first interviews were, ‘What happened?’ Then the thrust came, ‘Can we take care of her expeditiously?’ And so we got her scheduled promptly (at Naval Hospital) for Sept. 21,” Grayson said. “Then, the next conversations were that (the Atlanta doctor) had agreed to do the operation for half price, and it’s just going to cost us $25,000, so we’ll send her over there for three or four trips.”

He was surprised by the action, Grayson said, because the operation could have been done at the Naval Hospital or--if a civilian doctor was deemed necessary--by other plastic surgeons in San Diego.

Dr. Stephen Krant, a La Jolla plastic surgeon who is head of the division at Scripps Memorial Hospital-La Jolla, agreed.

“There are a lot of very well-qualified plastic and reconstructive surgeons in San Diego who are well qualified to do a TRAM flap,” Krant said.

Contacted for comment on the case, Adm. Halder said patients at Naval Hospital can be referred out for civilian care under a variety of mechanisms and circumstances. He declined to comment on any specific case, he said, because of legal restrictions on invading patient privacy by talking about their cases.

He also declined to comment on whether he had authorized $25,000, including travel costs, to be spent on a breast reconstruction, again citing privacy restrictions.

Officials of the Navy branch for which the woman works could not be reached for comment.

Grayson was reprimanded by Halder on May 24 for using $4,472 worth of surgical equipment in Operation Smile, a charity effort to correct cleft lips and palates in Tijuana children. Halder’s citation against him said this “wrongful appropriation is inexcusable and falls well below the moral standards expected of a Naval officer.”

Grayson accepted the reprimand, but still protests that he returned all the instruments and that hospital officials had been aware all the time that he was borrowing them.

Indeed, his performance review for the year that ended in August, 1989, cites him for “outstanding” surgical performance and for his Operation Smile work because it “has brought much favorable publicity to Navy medicine.”

Grayson, released by the Navy last month, plans to move later this month to take a job at Pennsylvania’s Guthrie Clinic.