Georgetown and George Washington University hospitals have "unacceptable" heart surgery programs with too many patients dying from open heart operations performed there, a special study group has found.
The study said that the "best intersts" of adults needing open heart surgery are served only at the Washing ton Hospital Center and Fairfax Hospital.
In addition, the group has recommended that open heart surgery on children be stopped at all hospitals except Children's Hospital National Medical Center, the only facility that does enough of the operations to justify such a program.
The group also recommended that no new or expanded specialized adult heart care programs be started until their need can be demonstrated.
The panel said that Prince George's County General Hospital should not start a heart surgery catheterization program, despite a go-ahead from the Southern Maryland Health Systems Agency. That procedure permits the circulatory system to be studied through the use of radioactive dyes.
The approval of the Prince George's program caused an uproar among health officials in other jurisdictions because there had been a gentlemen's agreement that no programs would be expanded until the panel's study was completed.
The study group, the Technical Adivsory Panel on Cardiac Surgery and Catheterization of the area's health planning agencies, represents the first time health planning has been done on a metropolitan-wide basis. The group consists of 14 doctors and the administrator of George Washington University Hospital.
The panel's guidelines call for a minimum of 200 open heart procedures annually for any hospital. But in 1978, Georgetown performed only 83 such operations, George Washington, 25, and Howard University Hospital, 26.
The panel has recommended that no hospital performing fewer than 100 heart operations a year on children remain in that business. In 1978, one such operation was performed at Georgetown, one at Fairfax, seven at Howard and 283 at Children's.
No more than five patients in 100 should die within 30 days of coronary artery bypass surgery, and no more than 10 in 100 should die during the 30 days following other types of heart surgery, the panel determined.
But in 1978, Georgetown experienced an 11.8 percent death rate after bypss surgery and a 10.6 percent death rate after other open-heart surgery.
Howard experienced a 15 percent death rate following open heart surgery, the report stated. However, the group said that rate was acceptable at Howard because its patients were often terminally ill before the surgery was performed.
The panel said that George Washington's mortality rate has been unacceptable "in recent years," having been as high as 33.3 percent in 1975. But, it said, "Hospital representatives are aware of previous problems in the program and are making efforts to improve its performance" -- to the point where the mortality rate last year was 4.5 percent for bypass surgery and zero for other open heart surgery.
Hospital officials have objected in the past to a ranking of mortality rates, contending that each hospital has a different group of patients, and some very ill patients may be attracted to certain hospitals because of the reputation of particular surgeons.
The guidelines used by the task force for numbers of operations performed at hospitals were drawn up six years ago by a national Intersociety Commission for Heart Disease Reurces.
The task force has recommended that any hospital not meeting its guidelines draw up and submit plans for doing so, and be reviewed "on the basis of its 1979 performance" to see if it is meeting those criteria.
The panel has also called for more cooperation among hospitals, with Georgetown and Howard transfering children needing heart surgery to Children's.
It also pointed out that while university hospitals performed the bulk of sophisticated heart surgery in the past, two nonuniversity hospitals -- Washington Hospital Center and Fairfax -- have the only acceptable adult programs in the region.
While acknowledging that teaching hospitals need to maintain such programs for training purposes, the panle said that other ssuch hospitals around the country are able to attract an acceptable amount of business, and the city's teaching hospitals must do so if they are going to continue the programs.
The panel also recommended that only hospitals that perform cardiac surgery maintain cardiac catherterization services.
The report will now be submitted to a special task force of the various health planning agencies, which could put the recommendations into effect.