Medicine: A Naval Surgeon in the Dock

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Bethesda Naval is the hospital of Presidents. Ronald Reagan went there last year to have a cancerous polyp removed from his colon. Richard Nixon was treated for viral pneumonia at the 500-bed facility in 1973. Lyndon Johnson had his gall bladder excised at the hospital in 1965 then proudly displayed his scar to anyone who cared to see it. Bethesda, in the northwest outskirts of Washington, D.C., is also a jewel in the crown of the U.S. military health care system, whose 688 facilities care for the nation's wounded in time of war. But presidential patronage notwithstanding, the massive system, and Bethesda in particular, has been sorely wounded in recent weeks and may be slow to recover from the strange case of Commander Donal M. Billig, whose court-martial was still under way last week at the Washington Navy Yard.

Billig, 55, was chief of Bethesda's cardiothoracic surgery in 1983 and '84. He is charged with five counts of involuntary manslaughter resulting from technical foul-ups and poor judgment in the operating room. A five-page list detailing the charges specifies that Billig "wrongfully sewed" and tied blood vessels during bypass surgery, "improperly manipulated" heart tissue and, in one case, "tore" a woman's aorta and "improperly repaired" it. Also listed are 24 counts of dereliction of duty for performing unauthorized operations. If he is convicted on all counts, the surgeon, who was commissioned in December 1982, faces dismissal from the Navy and a maximum of 21 years in prison. Meanwhile, 15 of Billig's former patients or dependents of former patients have sued the Federal Government for $75.7 million in malpractice claims.

The beleaguered surgeon suffers from an appalling handicap: 20/400 vision in his right eye, the result of a 1978 tennis accident. Because of the damage, which is only partially correctable, the prosecution contends that Billig cannot accurately judge depth and distances. A number of his former colleagues have stated under oath that he is unable to see small blood vessels in tissues and has difficulty clamping arteries and veins. Army Colonel Russ Zajtchuk, who had worked with Billig in the operating room, described his technique as that of "a first-year resident."

Billig's substandard performance at Bethesda should have come as no surprise. Before joining the staff there, he had been fired from two previous jobs, one at Monmouth Medical Center in Long Branch, N.J., in 1980, and another with a Pittsburgh physicians' group in 1982. When he arrived at Bethesda the following year, he had not performed open-heart surgery in six years. Nonetheless, the Navy permitted him to undertake such operations after only six months of retraining. Last month Monmouth's chairman of surgery, Dr. Cyril Arvanitis, revealed that he had begun to suspect Billig after examining weekly reports of patient deaths. "Dr. Billig's cases began to appear with increasing frequency," Arvanitis testified. "We kept seeing new cases, and his explanations weren't satisfactory."