Health

Saturday, Apr 27 2013 04:59 PM

Heart Hospital, doctor fare "worse" for bypass surgery deaths

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    By Casey Christie / The Californian

    Bakersfield Heart Hospital.

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BY RACHEL COOK Californian staff writer rcook@bakersfield.com

Bakersfield Heart Hospital and a local surgeon were among only a handful of California providers that fared worse than the state average for heart bypass surgery deaths in a new report .

The hospital was one of four to get a "worse" mark, while Dr. Sarabjit Purewal was one of seven surgeons deemed below the state average in the report released by the California Office of Statewide Health Planning and Development (OSHPD) last week.

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The agency measured hospitals' and surgeons' risk-adjusted mortality results -- an estimate of what a provider's mortality rate would be if their mix of patient cases was the same as the state average, the report said.

The rate included patients who died during the hospitalization when the heart bypass surgery occurred, no matter how long the hospital stay was, and deaths that happened within 30 days of surgery.

"We could say that their mortality rate, after taking into consideration the severity of illness of patients that they took care of, was worse than the state average," said Joseph Parker, manager of the Healthcare Outcomes Center at OSHPD.

The hospital mortality rates were based on 2010 data reported to the state agency, while the surgeons' rates were based on 2009 and 2010 information.

The report also evaluated hospitals based on 30-day readmission rates and post-operation stroke rates. All three local hospitals studied -- Bakersfield Heart, San Joaquin Community and Bakersfield Memorial -- were classified as in line with the state average in those categories.

Though the data is a few years old, Parker said healthcare consumers can use it as a starting point to ask questions of their surgeon or cardiologist.

"We view these data as empowering to consumers," he said. "It brings up an opportunity for dialogue about quality, which is something that we didn't used to talk" about with our surgeons.

"Hospitals are sometimes sort of slow-moving bureaucratic organizations. We hope that once a hospital observes that it's not doing very well, that it will make changes," Parker said.

A statement from the Bakersfield Heart Hospital said it "reported adverse outcomes to the state in a prompt manner" in 2010, and that "extenuating circumstances relating to family preference in some patients led to deviation from expected mortality."

But hospital President Randall Rolfe said that was not the only factor in the high morality rate.

"We don't disagree with the numbers. They are not where we want them to be," Rolfe said.

The hospital "initiated a rigorous review of our policies and procedures and found them to be in compliance," the statement said.

"We continue to maintain a strict vigilance on a real-time basis using both internal and external review," the statement said.

Rolfe and the hospital's statement pointed to positive reviews the hospital has received, including Consumer Reports rating the hospital as the safest hospital in California last year. That group also reported that the hospital had better-than-average mortality for hospital safety.

"If you look at our numbers historically, we have always been in a range that made us consistent with other hospitals in our region," Rolfe said.

State data show that local hospitals have varied in their mortality rates through the years, with San Joaquin Community and Bakersfield Memorial hospitals also appearing on the worse list in the past.

But those hospitals both fell within the state average for death rates in the most recent report. Memorial had two deaths out of 110 bypass surgeries during which no other major procedures were performed, and San Joaquin had two deaths out of 72 surgeries.

The Heart Hospital had seven deaths out of 105 such surgeries.

In 2009 and 2010, Purewal performed 317 isolated heart bypass surgeries between the three local hospitals and had 13 deaths, according to the report. Eight of those deaths were related to surgeries performed at the Heart Hospital, two at Memorial and three at San Joaquin.

Purewal performed more isolated heart bypass surgeries at the local hospitals in 2009 and 2010 than any of the other three surgeons listed in the report.

A spokesman for OSHPD said the agency could not break down the numbers by year.

In an email sent by Sara Mendez, CEO of Mendez Media Marketing and who works with the Heart Hospital, Purewal wrote that he works with many high-risk cardiac patients. He wrote that in 2009 and 2010, he did more cardiac surgeries than usual "on high-risk, elderly patients" at the Heart Hospital that influenced the increased mortality rate.

"As a surgeon, it is always my intention to do my best in all I do for each person. I am still doing that everyday, at all of the hospitals I work with," Purewal wrote.

"In those years, unfortunately, there were simply an increased number of high-risk patients undergoing surgery and we didn't have good health and younger ages on our side to keep the mortality rates low."

After a reporter repeated that the study was adjusted to take into account that some surgeons treated sicker patients, Purewal maintained that his rate was influenced by the type of patients he treated.

"It was just a batch of patients I got stuck with in that particular hospital," he said.

According to prior reports, Purewal's risk-adjusted mortality rate has fluctuated over the years: 1.91 percent for 2007 and 2008, 2.81 percent for 2005 and 2006, and 5.09 percent for 2004 and 2003. Purewal said his mortality rate was about 2 percent for the first six months of 2012.

Rolfe said the hospital's medical staff has reviewed -- and continues to review -- Purewal's work and has found it to be appropriate for the patients he treats.

Purewal attended Punjab University, Government Medical College in India and his medical license was issued in 1982. He has been practicing in Bakersfield since 1988 and is one of three surgeons at the medical group California Cardiac Surgeons.

Purewal is board-certified in thoracic surgery and the Medical Board of California's website site shows no disciplinary actions against him.

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