The former chief of heart surgery at Bethesda Naval Hospital, who lost his right to practice there last week, was hired by the Navy in 1982, about three years after fellow doctors at a private hospital in New Jersey said he lacked good surgical judgment, proper motivation, competence and honesty.
Dr. Donal M. Billig, 54, was told by administrators at Monmouth Medical Center in 1980 that he could not operate without supervision and he would have to resign or be suspended based on that evaluation, according to Superior Court records filed in the Monmouth County courthouse.
Information about Billig was sent to the Navy prior to his commission in December 1982, according to a source familiar with the Monmouth case. Navy spokesmen would not say yesterday when they knew about Billig's critical evaluation.
Billig, who was named to the staff at Bethesda in January 1983 and became head of the cardio-thoracic unit in June, refused to comment on the matter.
The harsh evaluation of Billig is contained in a thick packet of court papers filed in 1980 as the physician made an unsuccessful attempt in court to bar the hospital from eliminating him from the hospital staff.
In those court documents, Billig said that he was the focus of an unfair and malicious evaluation by six doctors who reviewed 150 cases and had questions about 27.
No doctors from Monmouth would comment yesterday on their former colleague. However, an affidavit contained in the court file and dated May 2, 1980, offers a withering assessment of Billig by Dr. Cyril Arvanitis. Arvanitis, one of the defendants in that case who was identified as the director of surgery at Monmouth, said he noted deviations by Billig in what he considered "accepted standards of professional conduct and competency."
Arvanitis said that Billig operated on chronically ill and elderly patients who were poor candidates for surgery; performed "duplicative, unnecessary and premature procedures;" consistently ignored patients' medical histories, and had a number of "unacceptable" deaths occur under his supervision.
Arvanitis said Billig's "charts were poorly documented and the judgments he made and the courses of cure which he advocated and chose unmistakably demonstrated his inability to properly conduct his practice."
Arvanitis cited six cases in which he said Billig acted improperly. In one of those cases, he said, Billig ignored the advice of a cardiologist and the diagnosis of another doctor who said a 61-year-old patient had a rupture in his abdomen. Billig "insisted" that the patient did not have that problem, Arvanitis said. The patient later had to undergo emergency surgery for the rupture and died in the operating room. "Dr. Billig missed and ignored the appropriate diagnosis of this patient," Arvanitis said.
Billig filed testimony from three independent doctors, who said he had followed standard procedures in the cases under review.
"I cannot comprehend why this is the subject of any criticism," said Dr. David Bregman, a Columbia University professor, about one case. Dr. David Befeler, consultant in surgery to the New Jersey Board of Medical Examiners, said, "To reduce or suspend [Dr. Billig's] surgical privileges based upon the material reviewed would be a travesty."
On May 9, 1980, Superior Court Judge Thomas L. Yaccarino refused to ban the hospital from requiring Billig to consult with other surgeons before operating.
The New Jersey Medical Board began its own investigation of Billig but stopped that inquiry in June 1981, according to a board spokesman, when Billig wrote to the board and said he was retiring from practice in New Jersey.
According to the Navy, Billig is currently licensed in New York, Texas, Pennsylvania and Massachusetts. A spokesman for the medical licensing board in Massachusetts, however, said that the board had no current license for Billig.
Navy spokesmen said yesterday that the action taken recently against Billig was the second time the Navy had scrutinized him in his two years at the Bethesda hospital. Billig was suspended in October 1983 for one month, when questions were raised about his "overall performance" there, said Diane LaMacchia, a public affairs spokeswoman.
The most recent action against Billig by the Navy came after a review team investigated specific incidents, Navy spokesmen said.
Billig, a commander in the Navy, is working in an administrative position at the Naval Medical Command in Bethesda. He is the focus of a hearing scheduled April 29 to determine how he was recruited and received credentials to practice in the Navy.