Letter to the editor: State ranking system flawed

May 6, 2013


I am a proponent of public reporting and transparency in medicine but sometimes statistics and rankings can be misleading. This is the case with Dr Freyaldenhoven and his ranking as one of the bottom five cardiac surgeons in the state.

As a busy cardiologist, I can tell you first hand that he is an outstanding cardiac surgeon and doctor. I would not hesitate to have him operate on me or a loved one. He is one of the few cardiac surgeons I have met throughout my career who will do whatever is best for the patient in each situation regardless of surrounding circumstances.

He is willing to take on cases that other cardiac surgeons, including his partners, decline or refuse. In doing so, he will accept a patient who is facing certain death without a high risk operation but may have a 50-50 chance of survival with the procedure. I have personally referred him several such patients and he has saved many lives by accepting them. He does so regardless of insurance coverage, social status, or other factors. In doing so, he risks his statistical reputation and “ranking.”

Yes, the statistics are supposedly “risk adjusted” but there is no way to accurately risk adjust the cases Dr Freyaldenhoven accepts. In addition, many hospitals are well aware of the risk adjusting model and game the system to make all of the routine cases appear as high risk as possible. This is why I finding it ironic that French Hospital could be ranked as low as it is in the state while Marian Hospital has the same cardiac surgeons perform its operations and was ranked much higher. This clearly shows the inexact methods and flaws in the ranking system.

So, while the report published by Cal Coast News earlier is factual, I find it very unfortunate because it does not tell the complete story and will make it unlikely that good cardiac surgeons like Dr Freyaldenhoven will continue to be willing to accept these high risk patients for potential lifesaving operations. It would be a tragic loss to the central coast if Dr Freyaldenhoven is forced to decide who to offer an operation to based upon his concern for his ranking within the state. I hope no one ever has a friend or loved one dying and in need of a potential lifesaving cardiac operation but is unable to find a surgeon to accept the case because the surgeon is afraid of being publicly belittled later for having poor outcomes.

Alex Harrison, M.D., is a board certified cardiologist serving the community of Santa Maria.


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The statistics are based on death records by the coroner.

It is true that French took over and monopolized the cardiac cath labs. It is true the doctors had a vested interest in French Hospital. The doctors initially took the Cardiac Cath Lab director to Twin Cities Hospital from Sierra Vista Hospital which in turn closed down Siera Vista Cath Lab. When the Cardiac Doctors had a vested interest in French, they then recruited him to French along with many of the Cardiac Cath Lab nurses which in turn Dissolved the Cardiac Cath Lab at Twin Cites. It’s all about MONEY!

This is what I was trying to get at with my post in the original piece on CCN. Sure, it was there (I provided the hyperlinks to OSHPoD’s data), but what I could not find was the metrics used for “risk adjusted” or RAMR values… the closest thing I found was here but it is not necessarily the same metrics as used by the gubmint.

I am glad someone is speaking up to the gaming of the system, as is always the case when the system is tied to money (just look at all the cheating in education assessments going on around the country). No one is impervious to it.

Great article, sir.

Touche Dr. Harrison. As Mark Twain once said “there are lies, damn lies and statistics”.

I have always been told that Santa Barbara County has higher hospital standards than San Luis Obispo County. That could be the reason that Marian Hospital in Santa Maria would be scored higher than a hospital in SLO. On the other hand, I personally have seen no data or supporting evidence on this.

Thank you, Glad that you clarified how these stats are compiled. I have no reason to doubt your input, none what so ever.

I completely agree with Dr. Harrison. Dr. Freyaldenhoven replaced a heart valve several years ago. He was recommended by other doctors and did an outstanding job. I was pleased with the before, after and the surgery. I agree with Dr. Harrison also this type of story will most likely mean chances to save a life might not happen. What a shame.

the guy that did my leg was the “go to guy” for high risk. just a leg, i know, but he didn’t know how i’d walk. 1 plate, 7 screws, 4 cable ties and i’m back to surfing. thanks Doc(s)!


Now, there’s a side of the coin I had not considered.

Thanks for speaking up, Doc!

Very well put. Another statistical game being played out. Thank you Dr. Harrison for stepping up and telling it how it is. The degree of risk will definetly skew the final report. Those doctors that do not chose to take on high risk patients then put the burden on those doctors, like Dr.Freyaldenhoven, who chose to. I would be willing to surmise that part of that decision is due to the ambulance chasing attorneys that wait in the halls of hospitals looking for bait. The more that risk taking doctors are challenged the greater the chance that they will disappear and at sometime medical care may become very difficult to obtain if someone is a high risk factor.

Negilgence in the medical field should never be accepted and should be challenged. In this case I have not heard of any negligence on the fact that this doctor takes on high risks patients.