Cmdr. Donal M. Billig, the heart surgeon charged in connection with four deaths at Bethesda Naval Hospital, was recommended for a commission as a surgeon after Navy recruiters discounted written correspondence from a New Jersey hospital in which administrators outlined serious concerns about Billig's competence.
According to Navy documents obtained under the Freedom of Information Act, a Navy medical recruiter from Pittsburgh, where Billig was processed into service, said the allegations from Monmouth Medical Center stemmed from "acrimony and professional jealousy." The recruiter considered letters from Billig and other doctors who defended Billig's record and then "most highly recommended" the doctor for commission in August 1982.
The Navy made no further written inquiries, Monmouth hospital administrators said yesterday.
The wording of the arguments to commission Billig, found in naval recruiting documents written by Lt. Cmdr. Jerry Penn, closely resemble the defense that Billig made in 1980 when a peer review team at Monmouth said he lacked good surgical judgment, proper motivation, competence and honesty and asked him to leave. As a result of that review, Billig left New Jersey and settled in Pittsburgh where he practiced at five hospitals. New Jersey state medical officials say they made no formal inquiry about Billig but that he surrendered his license.
Billig was commissioned in the Navy in December 1982 based on the reports of recruiters in Pittsburgh and Washington. At the time that he was recruited, the Pittsburgh office was under pressure to boost its recruiting numbers, according to Navy sources.
Billig went to Bethesda in January 1983 and became the chief of head and chest surgery in June, according to Navy records. Between January 1983 and November 1984, he operated or assisted in 228 open heart procedures, out of 356 done by the unit, according to the Navy.
This week the Navy charged him with four counts of involuntary manslaughter and ordered him to face a general court-martial, the most severe of military courts. He is also charged with dereliction of duty in 22 counts, alleging that he performed that many open heart surgeries without proper supervision, according to Navy officials.
The investigation leading to those charges revealed that Billig suffers from severe loss of vision in his right eye and has problems with depth perception that impede eye and hand coordination, Navy spokesmen said.
Penn, the former recruiter from Pittsburgh, and Capt. Reginald E. Newman, the former recruiter from Washington, now are being investigated on charges of "willfully withholding during the recruiting process information concerning Billig's physical and professional unsuitability." They are being charged with contributing to the death of the four patients.
Attempts yesterday to reach Billig, Penn and Newman through their attorneys or the Navy were unsuccessful. Navy spokesmen would not identify the dead patients or those involved in the other incidents. The spokesmen said they are still in the process of notifying relatives.
Federal law precludes active duty personnel from suing for medical injury incurred during military service.
The Billig case, in which he could face dismissal from the Navy and 23 years at hard labor, is only the second time that the Navy has ordered a court-martial for manslaughter in connection with medical practice, Navy officials said yesterday. It is the first time that a doctor at Bethesda, one of the Navy's premier medical centers, has faced such accusations.
Eight other officers have received or are facing disciplinary sanctions for their roles. Navy officials said yesterday that Commodore James J. Quinn, the commander of the Bethesda hospital when Billig was appointed in January 1983, has gone on leave and requested retirement. Other officers, responsible for approving Billig as a heart surgeon and reviewing his progress, have been transferred to nonsupervisory positions in the Navy.
The findings on Billig come at a time when the quality of military medical care is under scrutiny after internal audits earlier this year found problems in the way doctors were evaluated. Defense Department health officials have since ordered various reforms, such as more comprehensive reviews of doctors' credentials.
Officials said this week that those reforms are responsible for the inquiry into Billig, who had his privileges suspended in November 1984 and then revoked in April based on what Navy personnel then said were questions about his competence.
Navy officials said yesterday that they believe that the evaluation system used to commission Billig is sound but was thwarted by "conscious acts by certain individuals to override the system."
Why those acts occurred may be answered when the final report on Billig, submitted by a special board of Naval officers, is released.
But physicians who worked at Bethesda during the time that Billig was there, and who still work there, have said that they believe there was pressure from the highest officer on down to secure another senior heart and chest surgeon for the hospital at the time Billig was looking for a job.
Naval hospital administrators were making an effort to cut costs during that time, physicians said, and officers at the hospital apparently believed having enough heart surgeons would assure that fewer Navy patients would have to be sent to private hospitals for more expensive care.
"At the time, we had two fulltime surgeons and we were going to lose one to a transfer," said one doctor who asked not to be identified. Billig came along at the right time."
Billig was also willing to accept an annual salary far lower than the average for his specialty, which in private practice can be well in the six-figure range.
According to records obtained through the Freedom of Information Act, Billig told his Pittsburgh recruiter that he wanted to leave private practice because "he no longer wants the distractions of administration and personnel management that are so much part of the civilian medical community."
The Navy commission gave him monthly payments of $2,516.90 for base pay, $552.30 for living quarters, $106.18 for food and another $249.61 for housing. With other bonuses and supplements, Billig received $62,099.80 a year, according to Navy records.
Billig was accepted at Bethesda on the condition that he undergo retraining as a heart surgeon for three to six months, the records show. Cmdr. Judy Schwartz, then head of the heart-chest unit at Bethesda, evaluated Billig during a meeting in September 1982 as "sincere, pleasant, intelligent, forthright and assured," according to those records.
He had quit performing open heart surgery about four or five years before that, she said. But "he has not forgotten the essentials necessary to care for post-op open heart patients and discusses such matters fluently," she said.
Billig, a cum laude graduate of the University of Louisville School of Medicine, had trained under renowned heart surgeon Dr. Michael DeBakey in the 1960s and had taught surgery at several university medical schools. Schwartz, describing him as a "well-trained, very experienced" surgeon, said she would "very much" like him on her staff.
Schwartz, who is now in charge of quality control at the San Diego Naval Hospital, has declined to discuss the Billig case.
According to persons who worked with Billig during his training period, he was "very good" in many respects. But one physician, Cmdr. Reginald Peniston, who was acting head of the department in the spring of 1983, recommended that Billig be supervised when he operated.
Peniston's recommendation was made in late May 1983. In June, Peniston found out Billig had been given privileges to operate alone. Peniston retired from the Navy that month and now is a surgeon at Howard University Hospital.
According to persons who worked with Billig,, he appeared to enjoy the practice at Bethesda and worked well with residents.. According to the Navy, his credentials were lifted for one month in October 1983 when minor questions were raised about his operating room performance.
His privileges were restored, however, and Billig began taking on more and more cases by himself. At that point, doctors familiar with Billig's work approached other officers at the hospital to voice concern about what they perceived to be a sharp increase in patient deaths, according to hospital sources.
The Navy would not confirm that such allegations were raised.
This week, the court-martial orders and recommended sanctions handed down by Rear Adm. William M. McDermott Jr. have pointed out to some in and outside the Navy that the Billig recruitment was a serious mistake not to be repeated.
"I won't say for a second that the Billig case couldn't occur," said Rep. Ron Wyden (D-Ore.) who introduced a bill this week to provide better supervision of the hiring of military health care professionals. "But I think now, the Pentagon recognizes the serious of the problem."