The Washington Hospital Center, which has the largest cardiac care program in the metropolitan area, has been so crowded in recent weeks that surgeons have been forced to postpone some nonemergency operations and send patients home because there are not enough beds to put them in.
In some ways, the hospital, the flagship of Medlantic Healthcare Group, which is running a radio and television advertising campaign for its coronary care services, is a victim of its own success.
"It's a very bad situation," said Dr. Jorge M. Garcia, chief of cardiac surgery at the hospital. He said he and four other surgeons in his group have postponed several elective procedures this week. "I'm in a very big bind now, so I've started doing some of my cases at the Washington Adventist Hospital."
Dr. Louis Kanda, another heart surgeon, said that during the last several months he too had postponed operations due to lack of space in the intensive care unit where patients are initially sent to recover. "We need more beds," Kanda said, noting that heart surgeons at the hospital center are "doing sicker patients, so they're staying in the hospital longer than usual" and therefore making the space problem more critical.
The heart surgery patients are competing for recovery space in the 33-bed intensive care unit, which serves surgical patients as well as accident victims who come in through the hospital's MedStar shock trauma unit, said hospital spokeswoman Clare Fiore. She added that a majority of doctors throughout the hospital cite the bed shortage as a major problem.
D.C. Hospital Association spokeswoman Joan Lewis said such complaints are not surprising because the Washington Hospital Center averages a 90 percent occupancy rate, "the highest in the city." Occupancy at most District hospitals is 75 to 80 percent, higher than the national average, Lewis said.
Frustrated physicans complain that the hospital is restricted by the city's health planning laws that require institutions to apply for permission to increase their patient capacity. The situation has prompted hospital officials to apply to the District's health planning agency for permission to add 51 beds to the hospital's complement of 821. The hospital center was forced by planners to close 101 beds in 1985 in exchange for permission to renovate and expand the existing structure.
"We'll have to take a real close look at their utilization to make sure that they are running over the brim," said health planner Barbara Cobb.
Carlissia Hussein, director of the planning agency, noted that Medlantic could shift some of the overflow to other hospitals in their system, such as Capitol Hill Hospital, which is not nearly as busy.
"That's a situation we are giving some consideration to," Medlantic spokesman Phillip Sneider said.
A decision on the application for more beds is expected in September.
Meanwhile, as surgeons are all but turning patients away, the ads for the hospital's coronary service continue. Sneider as well as physicians at the hospital insist that the advertising campaign has little to do with the crowding. The ads are directed at the general public to promote "name recognition," hospital administrator Dunlop Ecker said last week.
Referring physicians, not patients, usually determine where an operation will be performed.
Washington Hospital Center has for several years enjoyed a reputation as a center of excellence in the field of heart surgery. Surgeons there perform about half of all open heart operations in the metropolitan area. Hospital officials say the medical staff draws patients from beyond the Capital Beltway and a few cases from other countries.
Data collected by health planners show the hospital center performed 1,288 such operations in 1985 and 1,400 to 1,600 last year. Two weeks ago, the first heart transplants in the city were performed there.
Fairfax Hospital also has a high volume heart surgery program where several heart transplants were performed this year and that service is also occasionally overwhelmed by patients, said hospital spokesman Lon Walls. Patients are not turned away, he said, "we do a careful job of scheduling."
"Our census is high, but it's rarely 100 percent," said Terry Hartnett, a representative for George Washington University Hospital, explaining that a bed for a post-surgery patient can usually be found.
The patients who have been sent home at least temporarily are usually not happy, said the hospital center's Garcia. He scheduled a triple bypass on May 14 for 48-year-old Richard Totaro, a banker from Columbia, but sent him home the morning of the scheduled operation because there was no room in the intensive care unit.
The bypass was successfully completed five days later at the hospital, but the delay was traumatic for everyone in the family, Totaro said yesterday. He said that when he was told he would have to come back for the operation another day, "I was so emotionally devastated, I almost broke down in tears."