The Navy surgeon who wrote a recommendation that Cmdr. Donal M. Billig receive full operating privileges at Bethesda Naval Hospital testified yesterday that she "had reservations" about the letter.
Capt. Judy Schwartz, head of cardiothoracic surgery at Bethesda before Billig was appointed to that post in June 1983, testified at Billig's court-martial on manslaughter and dereliction charges that she wrote the letter after meeting in June 1983 with some of the hospital's top officials.
The letter recommended that Billig be allowed to undertake all heart operations, but she and others, including Billig, agreed in conversation, Schwartz testified, that the surgeon could undertake only those operations approved by more experienced surgeons.
When asked by members of the court why she wrote the recommendation, Schwartz replied: "I had reservations and I was quite concerned about doing it." Asked then who ordered her to do it, she said: "I don't remember anyone specifically ordering it . . . . The consensus of the group that attended the June 1983 meeting was that's the way they wanted it done." Asked why that would be the case, she said: "They felt it would be a 'saving face' for Dr. Billig."
Lt. Neil Worden, who is defending Billig against five counts of involuntary manslaughter in deaths of patients and 24 of dereliction of duty, attacked the last statement, asserting that Schwartz and others who attended the meeting were more concerned about Bethesda, the Navy's premier medical center, than the newly commissioned heart surgeon.
"Wasn't that saving face for Bethesda?" Worden asked. "Wasn't it because it would be a problem for Bethesda to have a head of a department without full credentials?"
"No, sir," Schwartz said. Worden, in a loud voice, again challenged Schwartz. She again responded: "No, sir."
Schwartz testified that the meeting that preceded the letter of recommendation was attended by Capt. James Quinn, commanding officer at Bethesda; Capt. Robert Cochran, chief of surgery; Capt. Leon Georges, credentials committee chairman; and Col. Russ Zajtchuk, an Army heart surgeon, and that the meeting also resulted in Billig's being named head of the cardiothoracic unit. Georges denied in testimony yesterday that he had attended the meeting.
Cross-examining Schwartz, Worden asked: "It seems, in that meeting, Dr. Billig would have had one set of credentials on paper but you agreed to something different in conversation."
"Yes, sir," Schwartz replied.
By July of 1983, Quinn, Georges, Cochran and Schwartz had left Bethesda. It was in that month that Billig, according to evidence filed this week in court, wrote a letter to the new chairman of the credentials' committee asking to have unrestricted privileges at the hospital. He referred to the recommendation by Schwartz to receive such privileges as an endorsement of his skill.
Georges, who has been censured along with Quinn for his role in the Billig case, testified not only that he did not attend the June meeting, but that he did not agree to give Billig full operating privileges. Schwartz' letter arrived a week before he was ready to leave Bethesda, he said, and he told "others about it."
"I was distressed" to be censured by the secretary of the Navy after Billig was named in the court-martial, Georges testified. "I feel it was a great personal injustice . . . . I am very proud of my record of 21 years of service."