An unusual survey has found a wide difference in the post-surgical death rate in Maryland hospitals, including a Baltimore hospital that has nearly eight times the death rate from a common prostate operation as a hospital that does twice as many of the operations.
The results, based on computer data, were released yesterday by the Public Citizen Health Research Group, a consumer group backed by Ralph Nader. Among the findings was that one surgeon has a 9.8 percent mortality rate among patients who have prostate surgery.
The doctor, identified only by a code name, works at Church Hospital in Baltimore. The survey found that Church Hospital had the highest mortality rate among prostatectomy patients -- 4.1 percent, nearly eight times the number at nearby St. Agnes Hospital, where surgeons performed more than twice as many prostatectomies.
The Health Research Group, which studied records on 12 routinely performed operations in 53 Maryland hospitals in 1979 and 1980, found that the Church Hospital surgeon accounted for five of the six deaths from such operations.
"This doctor can easily be identified and it's about time the hospital did something about it," said study coauthor, Dr. Eve Bargmann. "For too long, having surgery has meant paying your money and taking your chance."
Church Hospital officials, who like officials of other hospitals mentioned in the report learned of the findings just yesterday morning, declined to respond immediately.
The study found wide variance in charges for the operations as well, and some hospitals came out badly in both categories.
Generally, the teaching hospitals have higher mortality rates than other hospitals, and the report suggests that the policy known as "see one, do one, teach one" may be the cause.
"The University of Maryland has both very high charges and high mortality rates . . . . It makes you wonder what sort of care you're getting there," Bargmann said.
A spokesman for the University of Maryland said last night she was not surprised by the findings about the high charges. "We fully recognize we are expensive and that the community could make better use of its resources," she said. "But we are a high-technology hospital and our teaching program for interns and residents can also increase costs."
She stressed that students do not perform surgery without strict supervision.
On the higher mortality figures, she noted that the hospitals' patients tended to be in poorer health when admitted than elsewhere. That explanation also was offered by several other hospitals contacted yesterday. It was pointed out that hospitals in the inner city in Baltimore, which generally rated low in the survey, tended to have sicker and poorer patients than elsewhere.
Bargmann said, however, that statistics did not bear out the explanation on a range of specific operations.
Southern Maryland Medical Center in Prince George's County reportedly charges the most for prostate surgery. In 1978, as a result of what it called an "oversight," the hospital refunded more than $800,000 to 3,000 patients who were charged an extra $276 each for one hour more than they spent in the hospital's operating room.
The report dwells at length on gall bladder operations because they are among the most commonly performed and because they are usually not urgent. If armed with sufficient information, the report suggested, the patient could make a choice of hospitals.
Each year, more than 400,000 Americans have gall bladders removed. Last year, 13,000 such operations were performed in Maryland, where 1.3 percent of the patients died as a result of the surgery. In five Maryland hospitals, the death rate was 3.3 percent, more than twice the state average, with the worst at Lutheran Hospital in Baltimore.
At Lutheran Hospital, surgeons who carried out fewer than 10 such operations each year accounted for all of the deaths from gall bladder operations, the report said. Lutheran Hospital officials declined immediate comment.
Death rates were also high at Johns Hopkins Hospital in Baltimore, where seven of the 11 patients who died were under the care of doctors also doing fewer than 10 such operations a year.
"Three of the remaining four patients were under the care of a single doctor who lost an unusual number of patients--a high-mortality doctor," the report said. Johns Hopkins officials declined comment yesterday.
The figures were similarly high at Washington Adventist Hospital in the Washington metropolitan area. "Right around the Beltway, at the Suburban Hospital, the deaths from prostatectomy were three times less with nearly three times as many patients," Bargmann said. Washington Adventist also declined comment.
The charges for operations, ranging from hernias to hysterectomies, were highest in the Baltimore hospitals and Dr. Sidney Wolfe, director of the consumer group, said possibly those hospitals had a higher proportion of Medicaid patients.
"They might increase the overall fees to allow for those patients who can't pay the amount the state has decided is appropriate," he said.
Average charges for gall bladder operations were five times higher at the University of Maryland Hospital ($8,887) as at Kent and Queen Anne's Hospital in Chestertown, where they were $1,783. Lutheran Hospital charged three times more for hernia operations ($2,691) than the Frederick Memorial Hospital which charged $813.