- Five hospitals had low death rates for three or more of the conditions--Anaheim Memorial Hospital, CIGNA Hospital of Los Angeles, Green Hospital of the Scripps Clinic in La Jolla, Hoag Memorial Hospital Presbyterian in Newport Beach and Kaiser Foundation Hospital in Bellflower.
- Six hospitals had low death rates for some diseases but high death rates for others--Kaiser Foundation Hospital in Los Angeles, Kaiser Foundation Hospital in West Los Angeles, Pioneers Memorial Hospital District in Brawley, Sharp Memorial Hospital in San Diego, Twin Cities Community Hospital in Templeton and UCLA Medical Center.
Only about 15% of hospitals with high death rates offered specific explanations to California Medical Review of why this was the case. All the hospitals had been sent advance copies of their data and given the opportunity to submit written comments, which were made public by the oversight organization in April as well. The specific comments included detailed letters from some institutions, including Torrance Memorial Hospital Medical Center and Pacific Hospital of Long Beach.
"The failure of many hospitals with high death rates to offer any explanation is worrisome," said Dr. Sidney M. Wolfe of the Washington-based Public Citizens Health Research Group, a leading advocate of health-care data disclosure. "Until they do so, people have good reason to be fearful about going to these hospitals."
Some of the hospitals that did not provide specific explanations of their high death rates, such as Hollywood Presbyterian Medical Center and Mercy Hospital of Bakersfield, told The Times that they are conducting audits of patient deaths to see if any problems exist.
Daniel Freeman Memorial Hospital initially sent a brief letter to California Medical Review citing its generally "very favorable mortality statistics." But after its mortality data was made public, it prepared a detailed explanation for its 21.1% death rate for heart bypass surgery, compared to the statewide average of 7.2%.
Shock Patients Cited
That explanation cited the high number of patients who "went into surgery in shock or in the middle of a heart attack."
Not all hospitals with low death rates took credit for providing better-than-average care.
"It doesn't mean a goddamn thing," said Dr. Mark S. Blumberg, director of special studies for the Kaiser Foundation Health Plan Inc. in Oakland. "It is too much of a scatter-gun to know what is going on."
When asked specifically about the nine instances in which Kaiser Foundation Hospitals had low death rates, Blumberg said: "I wish you could say we are doing a great job, but I don't think you can get there from this data."
In contrast, Eisenhower Medical Center in Rancho Mirage maintains that the data is very meaningful.
"You are going to find very few doctors agreeing with me, but the data should be available to make institutions better," said Dr. Jack J. Sternlieb, chief of cardiac surgery at Eisenhower. "Something is needed to assure a certain degree of quality, and the most basic thing in quality is life and death."
Health-care experts caution that such mortality data should be used only to compare individual hospitals to average death rates for groups of hospitals--and not to rank individual hospitals. But that statistical caveat has not stopped at least one hospital, Eisenhower Medical Center, from doing just that.
The hospital has a 0.7% death rate for heart bypass surgery, compared to the statewide average of 7.2%, according to the California Medical Review data. And it has advertised in The Times, The Wall Street Journal and other newspapers boasting that it has "the lowest mortality in the country" for heart bypass surgery.
Officials at hospitals that had low death rates for some conditions but high death rates for others said the statistics needed to be interpreted differently for each condition.
'Complexity' of Cases
At Sharp Memorial Hospital in San Diego, spokeswoman Cindy Cohagen said the hospital's high death rate for pneumonia patients resulted from the "severity and complexity" of the cases, while the low death rate for heart attack patients reflected the "very best care" that the patients received.
Dr. Raymond Schultze, director of the UCLA Medical Center, said he was satisfied that the hospital's low death rates for orthopedic surgery and heart failure patients resulted from "very good performance."
On the other hand, Schultze said UCLA's death rate of 12.3% for heart bypass surgery reflected the sickness of the patients, not a quality of care problem.
When California Medical Review, the Medicare watchdog group, finds clusters of an apparently excessive number of patient deaths, it has the power to audit the patients' medical records. If it concludes that the care had been substandard, the organization can bring sanctions against physicians or hospitals, including fines or dismissal from the Medicare program.