A doctor trained by Cmdr. Donal M. Billig yesterday recounted three of the five deaths the heart surgeon is charged with causing, including one that left the patient's heart so swollen his chest couldn't be closed and that Billig -- who left the gravely ill patient in intensive care and returned two hours later dressed in his blue Navy uniform -- tried futilely to repair outside the operating room.
That coronary bypass operation on retired Lt. Col. John Kas Jr. was "probably the worst" operation he has seen, Cmdr. George Haggerson said during the court-martial of the former chief of heart surgery at Bethesda Naval Hospital. Death came, he said, when Kas' heart ripped open, weak from surgery and massage.
Haggerson, who trained in cardiothoracic surgery from July 1983 through 1984 when Billig was suspended, testified for nine hours yesterday, often expressing doubt about the older surgeon's techniques.
At one point, during the Kas operation on Oct. 29, 1984, Billig put a vent into the heart while preparing to replace an aortic valve. "He hadn't discussed that with me," Haggerson said. "I wasn't familiar with it and I was surprised he did it . . . . I think ultimately it was a bad choice."
Billig, 54, is charged with involuntary manslaughter in connection with the deaths of five patients at Bethesda in 1983 and 1984 and 24 counts of dereliction of duty for operations he has been charged with undertaking without proper supervision.
In the Kas operation as well as those on retired Army Maj. William F. Grubb and retired Navy Petty Officer Joe B. Estep, Billig was the first assistant or supervising surgeon; Haggerson was the primary surgeon and resident in Bethesda's cardiothoracic training program headed by Billig.
Billig has been charged with killing all three patients through culpable negligence. In the Kas case, he has been charged with improperly placing or allowing improper placing of a vent in the heart, improperly identifying or allowing the improper identification of a vein for grafting and overmanipulating or allowing the overmanipulation of the heart.
Haggerson said the two-vessel bypass and aortic valve operation on Kas, 67, had a slow start when the surgeons inadvertently sewed one vein, meant to be connected to an artery, to another vein. Haggerson said he was caught unaware later when Billig placed a vent in the apex of the patient's left ventricle, a procedure the young doctor said yesterday he disagreed with. Haggerson also disagreed with the manner in which Billig was suturing the heart and he and another surgeon complained again when Billig lifted the heart, at least twice, from the chest to repair the sutures.
Kas went into severe cardiac failure after those repairs, Haggerson said. The surgeons then, in vain, attempted to close his chest and place him in the intensive care unit.
Twice, they tried to pull Kas' breastbone shut. Then they tried to stretch just the skin of his chest over the exposed heart. Each time, the patient's blood pressure dropped perilously. The doctors opted to cover the open chest with gauze and remove him from the operating room, Haggerson said.
Haggerson said yesterday he and other doctors watched over Kas for 90 minutes and noticed about 7:30 p.m. that the patient was losing blood pressure and bleeding from the heart. Haggerson and another surgeon attempted to sustain the heart by massaging it. Haggerson said he did not know where Billig was during those two hours.
About 8 p.m., Billig, dressed in his Navy uniform, returned to the intensive care unit. He asked for a surgical tray and suture material and attempted an operation in the intensive care unit, Haggerson said.
"It didn't work," Haggerson said. The younger surgeon continued to massage the heart. At about 8:30, the right ventricle of the heart ruptured, he said.
"Have you ever seen a more poorly conducted surgery?" a prosecutor asked Haggerson.
"No," said Haggerson. "This was probably the worst."