KQED: Death prompts family's questions about risky surgery

Jerry Magner’s headstone still sits in the backyard of the Hidden Valley Lake home he shared with his wife for a quarter century. (Kelley Weiss/CHCF Center for Health Reporting)

This story originally aired on KQED Public Radio.

When it comes to health care, where you live matters. Not just for getting in to see a doctor but for what your odds are of having surgery. And if your chances for surgery are higher, that means your risk of having complications with the procedure are also higher.

Chuck Magner says the thing he misses most about his dad is all the projects he’d have going at once in his shop or around his yard.

He said his dad, Jerry Magner, was always in his backyard at his house in a quiet town near Clearlake, about two hours north of San Francisco. His father, 79, had some ongoing health issues. But Chuck Magner said you wouldn’t know it because he was usually outside digging trenches or building a deck.

But in July Jerry Magner did have some health problems. Chuck Magner says it all went so fast. He was out of town on business when his dad ended up at St. Helena Hospital, part of a chain of non-profit Adventist Health facilities. He reported having a blackout when he was driving.

"I got a call on the phone that he was going to go through some extensive testing and he might have surgery,” he said. “My dad was used to saying he might have surgery a lot of times.” 

That’s because Jerry Magner had a history of vascular disease. He’d had at least two surgeries, called a carotid endarterectomy, at a different hospital. The artery in his neck was opened to remove plaque build up before it blocked blood supply to the brain and caused a stroke.

This time the artery on the other side of Jerry Magner’s neck was nearly three-quarters blocked. So a surgeon at St. Helena Hospital recommended the procedure again. Chuck Magner was taking this all in as he was about to board a plane back home. He says he tried to stop his dad and convince him to wait until he got back. 

“The last thing my father said to me was ‘don’t worry I got it all taken care of,” Magner said.

By the time Chuck Magner landed his dad’s surgery was over.  And, something had gone wrong. He went to St. Helena hospital to find his dad was unresponsive.

It turns out Jerry Magner had a stroke from the very surgery that was meant to prevent that stroke from happening. He died two weeks later. 

Stroke and death are actually known complications from this procedure – sometimes opening the artery can dislodge the plaque into the brain.

Dr. Dennis Baker, a professor of surgery at UCLA, says you have to carefully weigh if the procedure should be done, saying “there is always an alternative, you can always not operate.”

He says for the right patient, about 95 percent of the time there are no complications. But for the other roughly 5 percent, he said the stakes can be high – heart attack, stroke or death.

Instead of surgery Baker says some patients have other options.  They can take medications or get a stent to open the artery. And with these alternatives available Baker says fewer carotid endarterectomies are being done around California and the nation.

But that’s not the case at St. Helena Hospital, where Jerry Magner had his operation.

“You start out by saying, they’re X percent above the average for the state, what’s going on?” Baker said.

State data show in 2005 St. Helena Hospital did 46 of these stroke prevention surgeries. In 2009, the total was 85. Stanford Professor Laurence Baker used data like this from around the state to determine how often people got this surgery.

His recently released report found the Clearlake region had the second highest rate in the state – people living there are two and a half times more likely than other Californians to have the surgery. St. Helena Hospital officials declined to do a recorded interview. But they dispute the study’s findings saying the methodology was flawed.

At neighboring hospital Sutter Lakeside, Dr. Anne Tait says she’s not surprised by these numbers. She specializes in internal medicine and often refers patients to surgeons for evaluation. She says she’s noticed that many of her patients have had multiple heart and stroke prevention surgeries at St. Helena Hospital. And she doesn’t think they all were sick enough to warrant so many procedures.

“Yes there are people in Lake County who are unhealthy,” she said. “But not two and a half times the state rate.”

St. Helena hospital officials contend that people in Lake County are that sick. They point to the fact that for Lake County residents the rates of smoking, heart disease and diabetes are above the state average.

But Tait says the real reason behind why some hospitals do many more surgeries than others comes down to how the doctors practice. She believes at St. Helena Hospital some of the doctors there are more aggressive, pushing ahead with surgery instead of trying other treatments.

“We waste an awful lot of money and we expose people to an awful lot of risk because we jump into the high tech stuff rather than the low tech stuff,” Tait said.

Hospital officials say the stroke prevention surgeries are done only when necessary. They added that these procedures are safe, citing that their rates of stroke and death from the procedure are lower than the national benchmarks.

The doctor who performed the surgery on Jerry Magner – Dr. Emmett Tetz – said on a phone call:

“We don’t do carotid endarterectomies without good cause – that’s how it’s done at this hospital and I can say because I’ve done most of them,” Tetz said.

But Chuck Magner still isn’t convinced his dad needed that surgery. He says he doesn’t know why it was so rushed.

“It’s all just becoming more questions, after more questions, after more questions,” he said.

Magner would like to get some answers but said he’s not even sure how he’d go about doing that.

“I think having been through this I think we oughta put up a college course on medical care for your family,” he said.

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Kelley Weiss

Broadcast reporter Kelley Weiss is based in our Sacramento office where she’s helping lead the center’s expansion into public broadcasting. Her stories have appeared on NPR,Marketplace, The World, KQED Public Radio, Southern California Public Radio and World Vision Report. She’s produced series about the illegal sale of prescription drugs at swap meets and preventable patient deaths and money mismanagement in Missouri’s mental health system. She won a 2009 national Edward R. Murrow award for investigative reporting and has received several honors in the Association of Health Care Journalists awards competition. She was named a Livingston Finalist in 2011 for a multi-platform project about how tribal sovereignty makes it nearly impossible for mothers to collect child support. Weiss previously worked as a health care reporter at Capital Public Radio in Sacramento and KCUR in Kansas City. Her work has also appeared in Reuters, the San Francisco Chronicle and theCenter for Investigative Reporting. She’s completed a health reporting fellowship from the Association of Health Care Journalists and has a journalism degree from the University of Kansas.

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