Intro ROBERT MacNEIL: Good evening. Leading the news this Thursday, Senator Robert Dole announced support for the Intermediate range missile treaty. A newly found memo says Vice President Bush fully supported selling arms to Iran to free American hostages. The prosecutor who got a guilty verdict against Michael Deaver attacked Reagan Administration ethics. The FAA ordered all airline employees, including flight crews, to pass airport security checkpoints. We'll have details in our news summary in a moment. Jim? JIM LEHRER: After the news summary, we look at ethics in government with Deaver prosecutor White North Seymour. Then Jeffrey Kaye reports on a California story about organ transplants for children. We have a disagreement over the release of hospital mortality rates, and we close with a block buster story. News Summary MacNEIL: Senator Robert Dole, presidential candidate and Republican senate leader, announced his support for the Intermediate range Missile Treaty signed last week. Dole ended his fence sitting position on the treaty in a White House appearance with President Reagan, who said he welcomes the support. Until today, Vice President Bush was the only Republican candidate clearly supporting the treaty. Dole was asked if he was doing this because he was slipping in the polls against Bush.
Sen. ROBERT DOLE, Presidential candidate: I don't want to get into this Bob Dole/George Bush thing, but we just have different roles. Mine is an active role, mine is leader of the Senate. He doesn't even vote on the treaty. I'm the only Republican candidate who's even going to vote for the treaty, one way or the other. And I'm here to keep my promise to the President. He wanted my support. He has my support. And I'm going to be very active as I have in the past to try to get the treaty ratified. MacNEIL: In answering reporters' questions, the President denied that he was playing presidential politics.
Pres. RONALD REAGAN: There's nothing of that kind. I have always been neutral with regard to the political race -- I'll answer that when we get that in the clear. He is the leader for our side in the Senate, and I was here to bring him here because we have a common interest in getting the treaty ratified. REPORTER: Were you afraid to stand on the platform with him when he spoke? Pres. REAGAN: No. In the business I used to be in, I thought it was a courteous thing to do. MacNEIL: A newly discovered memo shows that Vice President Bush fully supported the Iran initiative that President Reagan has said became an arms for hostages deal. The White House memo was made public by the Senate Iran contra committee, which said it is the first evidence found concerning Bush's position. Bush himself has not said publicly what degree of support he gave. The memo, written by then National Security Advisor John Poindexter in February 1986, describes the operation as ''risky'' but adds ''most importantly, President and VP are solid in taking the position that we have to try. Meanwhile, CIA Director William Webster said today he had fired, demoted or reprimanded employees who acted improperly in the Iran contra affair. Jim? LEHRER: The man who prosecuted Michael Deaver spoke out today about the state of ethics in the federal government. Whitney North Seymour, Jr. , said there was too much loose money and too little concern in Washington about ethics. A federal jury yesterday convicted former Reagan White House aide Deaver on three counts of lying to a grand jury and to a congressional community about his lobbying activities. North, speaking at a news conference -- Seymour, speaking at a news conference, accused the Reagan administration of tolerating back door and back stairway favor buying. He also criticized Secretary of State Shultz for testifying on Deaver's behalf.
WHITNEY NORTH SEYMOUR, independent counsel: Secretary Shultz came in and voluntarily -- during his cross examination he was not even called as a defense witness. He stepped forward in his cross examination, gave a ringing endorsem*nt of the honesty and integrity of a defendant on trial in a criminal case, charged with a serious felony, and he never even bothered to read what the charges were. I think the jury decided that was irresponsible. I don't see how any right thinking citizen could conclude otherwise. LEHRER: First Lady Nancy Reagan today expressed her sorrow over Michael Deaver's conviction. She told the Associated Press she and the President were advised to suspend their relationship with Deaver until his appeals are completed. Mrs. Reagan also said she agrees with Democrat Gary Hart that politicians have a right to private life, and on a personal note, Mrs. Reagan said 1987 was a hard year, ''the lowest I think you can get,'' she said. MacNEIL: Investigators from Congress's General Accounting Office disclosed today that 6000 employee ID badges could not be accounted for in a major U. S. airport. The GAO didn't name it, but sources said it was Los Angeles International. Ten days ago, a former Pacific Southwest Airlines employee, dismissed for theft, boarded a plane at the Los Angeles airport with a handgun. All 43 people onboard the plane were killed in a crash after the ex airline employee opened fire. Investigators believe he was able to smuggle the gun onboard because of his past employment. The GAO gave this assessment of general airport security at a House hearing today.
KENNETH MEAD, General Accounting Office: Inadequate control over personnel identification systems, in access to those parts of the airport where aircraft operate. The nature and extent of the problems varied among airports. However, the types of deficiencies were such that if left uncorrected, they could allow unauthorized persons access to air operations areas and aircraft. MacNEIL: The FAA responded to charges of lax security by ordering airlines to require all employees, including uniformed flight crews, to pass through airport security checkpoints. Correspondent Jeffrey Kaye of Public Station KCET of Los Angeles has a report.
JEFFREY KAYE: Today at Los Angeles Airport, uniformed personnel avoided metal detectors to get to the boarding areas. All they had to do was show their badges. But come Monday, that will change, and under a new FAA decree, all employees must be screened by magnetometers. Today, the Airlines Pilots Association called the new regulation ''overkill. '' This pilot's reaction was typical of those we spoke to. PILOT: It's gonna be tough on everybody. Really tough. You know, instead of showing up 45 minutes early, we're going to be showing up an hour, an hour and 15 minutes early, and it's going to delay everything. It's -- I don't really think it's going to help.
KAYE: However, the Association of Flight Attendants endorsed the regulation, as did their members. WOMAN: Well, I think it's great. WOMAN: I think if they need to do that to make it safer, then that's right. KAYE: L. A. Airport manager Stephen Yee disputed today's GAO report, contending that 6000 airport badges were missing. But he didn't provide details. However, he also said his airport will take additional security measures. STEPHEN YEE, L. A. Airport Manager: We are going to revalidate every photo ID that has been issued by the Department of Airports. And this basically is our photo IDs that permit authorized access to the airfield operations area.
KAYE: Yee said only 5000 of the 38,000 employees at L. A. Airport will be issued new badges. That's because no one agency has overall jurisdiction over airport security. That, said Yee, is a problem. LEHRER: The Federal Government released a detailed look at nearly 6000 U. S. hospitals today. The study by the Health Care Financing Administration analyzed the mortality rates for Medicare patients. The research was designed to give consumers a means of screening hospitals, and hospital staff a way of evaluating their work. The report's data was presented in seven large telephone book size volumes, organized by state. The study did not reach conclusions about particular institutions. MacNEIL: The government reported today that the economy was growing even faster than previously thought just before the Wall Street crash in October. Revised figures for the third quarter, July through September, put the growth in gross national product, at 4. 3% instead of the previously estimated 4. 1. The good news did not inspire Wall Street, where prices were generally lower today, after the dollar again fell to new lows against all major currencies. The Dow Jones industrial average lost more than 50 points, to close at 1924. 40. LEHRER: Overseas, a judge in India today ordered interim relief to victims of the 1984 Bhopal gas leak. The judge told the Union Carbide Company to pay $270 million immediately, pending the final outcome of lawsuits over the accident. More than 2000 people were killed in the leak at the Union Carbide plant. The money will go to the families of the dead and thousands of others who were injured. The government of India has sued the company for three billion dollars. Criminal charges have also been filed. MacNEIL: The winner of yesterday's election in South Korea, now president elect Roh Tae Woo, called today for national harmony. But the opposition response was a new wave of street demonstrations in Kwangju and other five other cities. In Kwangju, 175 miles south of Seoul, as many as 2000 protestors clashed with riot police. The opposition claims yesterday's election was marked by fraud, with Noh winning 37% of the votes in ballots counted so far, while three opposition candidates split the rest. LEHRER: And that's it for the news summary tonight. Now it's on to ethics in government, organ transplants for children, and a block buster story. Government of Greed LEHRER: We go first tonight to corruption in Washington. The man who prosecuted former White House aide Michael Deaver said today there was a lot of it because there was too much loose money and too little concern about Washington in Washington. The Prosecutor is Whitney North Seymour, Jr. He is with us now in a newsmaker interview to explain what he means. Mr. Seymour, welcome. I called you Mr. North earlier, but I corrected myself. Okay. Too much loose money in Washington. Where does the money come from? WHITNEY NORTH SEYMOUR, Jr., Deaver prosecutor: Oh, big business, defense contractors, lots of it there, and foreign governments. They want special access in this town, they've got the money for it, and give them the opportunity, they'll spend it. LEHRER: How do they spend it? Mr. SEYMOUR: Hiring consultants. Also obviously in Congress, in campaign contributions. But consultants who got special access to the executive branch is the phenomenon that we've been concentrating on. And there are a lot of them. They get paid a lot of money. And they're supposed to open doors. LEHRER: Open doors -- is that in your opinion a corruption to do that? Mr. SEYMOUR: Well, it's an undermining of the way we like to have government run in this country. Everybody's supposed to be equal here. And you're supposed to walk in the front door with -- make your case, whatever it is, on the merits, and have it dealt with that way if you've got business with the government. You don't go in the back door. You don't go see your buddy. You don't make special appeals. That's the wrong way to do it. LEHRER: Now you said there was -- in connection with the money, there was also a lack of concern over ethics. Now, explain what you mean by that. Mr. SEYMOUR: Well, I think the reaction to the actual prosecution of the Deaver case is a perfect example. Really, the only official voice that has been exercised from any of the agencies was from the Department of Justice, which looked for every opportunity they could to attack the constitutionality of the statute, to attack independent counsel. Personally I was attacked by the Justice Department a couple of times when we tried to get some witnesses to testify in our trial from Canada. I really was saddened by the President's comments yesterday after the jury returned its verdict. I feel as a human being concerned about a friend of his being convicted -- but that was a personal matter. He should have dealt with that personally. He should not have publicly said that he was ''sorry'' the jury had done justice. That was not the right message for the American people. He should have either kept it shut about his views, or at least said something about the fact that the jury system shows that this is still a country where everyone is treated the same. LEHRER: Is it your position that matters are worse now under President Reagan than they have been under previous administrations? Mr. SEYMOUR: Oh, gee, I don't think anybody can say that. I know enough of American history to know that we've had some pretty bad times. I think the pressures are always there, and they always will be there. The key to it is that those in office have got to set high standards, and they should not be ashamed of saying, ''You know, we're going to run this government honest, and fair and square. '' Citizens ought to have confidence that when we make decisions they're made on the merits, and that nobody's got our ear. We want to do the right thing here, and not just take care of our friends. And when that message doesn't get across, I think people get fed up with the people in Washington. I never knew there was such a phrase as ''inside the beltway'' until I came here to start this case. And you know, I will say just as an observer, I think inside the beltway people look at these things quite differently than outside the beltway. I think outside the beltway people believe in Oliver Wendell Holmes' old phrase that ''People who deal with government should turn square corners. '' Inside the beltway you cut the corners. And that's not right. LEHRER: But Mr. Seymour, what's your evidence for that? That the view outside is different from the view inside. All of these things have been given tremendous publicity. They were given, for instance, tremendous publicity by Walter Mondale against Ronald Reagan in the 1984 elections. Mr. Reagan was returned to office by an overwhelming majority. Mr. SEYMOUR: And I think outside the beltway -- well, you're -- LEHRER: That's where the voters are -- Mr. SEYMOUR: Yeah, but I think you're oversimplifying -- I bet if you ask people outside the beltway what they expect of those in government, they will say that they expect the highest of standards. I think if you ask people at least to move in fast circles in this town what they expect, essentially they expect people to look out for themselves. That's a different view of government. And I -- maybe it's a mind set. But I don't mean to dwell on that. I mean to say that I for one as a citizen, am terribly disappointed by the official response to the evidence of misconduct by people in or near high office. I would expect them to be leading the way to find the solution. And I think the people outside are going to make sure that happens. LEHRER: Leading the way where? Where should they be leading? Mr. SEYMOUR: Well, as I indicated earlier today, I really was stunned when the third highest ranking member of the Administration, who stands three steps away from being President, didn't even bother to find out what the charges were -- LEHRER: You're talking about Secretary of State Shultz -- Mr. SEYMOUR: Yes, when he was willing to go in and testify to the honesty of the defendant. Now, he may be a friend, and he is entitled to his personal opinion. But he spoke as Secretary of State. He used the power of his office imprimatur of his office to essentially say, ''I don't care what this man is charged with. I tell you he's a fine fellow. '' I think that's a misuse of a position of trust to do that. LEHRER: But as a matter of practice, isn't that rather common, that people come into a courtroom no matter what crime a person is charged with, a person comes and testifies, ''Based on my relationship with him, I can say my relationship, everything I've had to do -- all my dealings with him have been honest and aboveboard. '' Isn't that common? Mr. SEYMOUR: Not as common as you think. If you think about it, there was only one of those in this case. LEHRER: I don't mean in this case. Mr. SEYMOUR: Well, but (unintelligible) -- search your mind, do you think this fellow might have asked others to do it? Think others might have had the judgment to say, ''No, I'm not going to do that. I hold a position of public trust. I may have my personal views, but I can't use my official position where I'm supposed to be a leader of thought and standards, to go in and say I don't care about standards in this case. '' LEHRER: Is that your position? That's what George Shultz did? He said he didn't care about what the crime was? Mr. SEYMOUR: Well, absolutely. I asked him, ''Would anything change your mind?'' He said, ''No. '' LEHRER: You asked him that on the witness stand? Mr. SEYMOUR: Yes. It's in the record. The testimony is available for public view. But that's really a detail. The basic point is that it's the atmosphere and attitude of the leaders in government that really affect the quality of government in terms of ethics. It should not be up to a special prosecutor. I have no business being in here. Obviously if the job's to be done, it should be done. But we can't rely on special prosecutors to police integrity in government. We expect the leaders to say, ''Honest Administration, and we won't tolerate anything short of that. '' LEHRER: Do you agree with those who say for every criticism that can be made of this executive branch, or any prior administration executive branch, it goes equal if not more so for the Congress as well? Mr. SEYMOUR: It applies to everybody in public office. The same problem is there, and the only remedy for it is for those in public office to say, ''We will not tolerate misconduct. '' I can remember plenty of people in public office who said, ''We will not tolerate misconduct,'' and they enforced it. LEHRER: Give me an example. Mr. SEYMOUR: Fiorello LaGuardia. I still look upon him as one of the great guys who never put up with any nonsense. LEHRER: Well, why don't they do it? Mr. SEYMOUR: Oh, I think it's a little bit the larger climate. I think business leadership is prepared to turn corners, I think probably part of it is general agreement that you look out for the buck, for the bottom line and you can do whatever is necessary to get to that point. LEHRER: So we get as good a government as we demand. Is that what you're suggesting? Mr. SEYMOUR: Well, I think again you gotta look at where your -- what your constituency is. And if your constituency is outside the beltway, I'd think you really believe you're getting a better government than you may be. And once you put the people in office, if you know what the voters really believe in their minds and hearts, you will give them honest government, and you will just make it intolerable for people to do the kinds of things that have occurred here and have occurred in other administrations and can occur in the next administration. Unless you have leadership, don't rely on independent counsel to deal with it. LEHRER: Whitney North Seymour, Jr. , thank you very much. MacNEIL: Still to come on the NewsHour, controversial infant organ transplants. The death rate in American hospitals, and the story of a block buster novel. Transplant Ethics MacNEIL: Now we shift from political ethics to medical ethics. Our story comes from the Loma Linda Medical Center in Southern California. Any day now, the hospital plans to deliver a baby that's expected to be born with most of its brain missing. The medical term for such births is anencephaly. Most babies born with this condition die within a week of birth. It happens more than 3000 times a year in this country. What makes this birth different and has attracted so much publicity is that the parents have asked that their baby be kept alive by artificial means until his or her organs can be transplanted into other babies. And Loma Linda was the only hospital in the country that agreed to do so. It's just the latest case that's thrust Loma Linda into a difficult debate over the ethics of infant transplants. At the center of the debate is the hospital's controversial surgeon, Dr. Leonard Bailey, who first attracted worldwide attention by transplanting a baboon heart into an infant three years ago. Correspondent Jeffrey Kaye of Public Station KCET, Los Angeles, reports on Bailey's work.
KAYE: Leonard Bailey has made international headlines as a result of the heart transplants he has performed on young children. But he spends most of his time dealing with what he calls his ordinary openheart surgery cases. Bailey performs more than 100 open heart operations a year on children. At the same time he works on his transplant techniques. Since 1984, Bailey has performed heart transplants on 11 babies. Eight of the children are still living. Dr. LEONARD BAILEY, heart surgeon: I recognized early on in training that if we were going to seriously help about 10% or so of the children born with heart disease, it was going to be with heart replacement.
KAYE: Bailey received his premed training at Columbia Union College in Maryland, where he graduated in 1964. As a medical student at Loma Linda University, he became interested in children's heart surgery. His wife Nancy, a pediatric nurse, says Bailey has always gotten emotionally involved with the children he tries to save. NANCY BAILEY, pediatric nurse: Sometimes I think he wills a child to recover, and I wonder if he loses something of himself as he gives this energy over to the child. KAYE: He invests a lot of emotion? Ms. BAILEY: -- invests a lot emotionally and just strength wise and energy.
KAYE: In 1968, Nancy Bailey filmed her husband, then a junior year medical student, performing heart transplants in dogs. Bailey said he was experimenting with what he called the technology of the future. A technology which has since put Loma Linda University Medical Center on the map. The hospital, 60 miles east of downtown Los Angeles, is one in a worldwide chain operated by the Seventh Day Adventist Church. The church is a Christian denomination that believes a combination of divine power and human effort can relieve suffering. The efforts of Leonard Bailey, the hospital's 44 year old chief pediatric surgeon, have placed him and his institution in the center of a major ethical dispute. Critics raise a spectre of harvesting organs, while Bailey and the hospital say they just want to save lives. The issue came to a head October 16, 1987, when Bailey transplanted the heart of a brain dead baby, into newborn Paul Hope, whose own heart was defective. To the joy of his parents and brother, baby Paul survived the operation. Without it, he would have died. Paul owes his life to the daughter of this couple in London, Ontario, in Canada. A couple identified only as Karen and Fred. Their baby, Gabriel, was born with only a fraction of a brain, a disease called Anencephaly. FRED: We can touch our baby. As a matter of fact, one time I picked up little Gabriel, and I took her to the window and I showed her (can't continue) KAREN: -- showed her all the colors.
KAYE: Karen and Fred knew before Gabriel's birth that she would have no chance for survival. But they wanted her heart to be used by a baby who might die without it. Soon after she was born, the hospital placed Gabriel on a respirator like this one. Two days later she was declared brain dead and, still connected to the respirator, flown to California, where Dr. Leonard Bailey transplanted her heart. FRED: It makes you feel so proud of what your baby's done.
KAYE: Gabriel's heart now beats in Paul Holt. Paul was operated on only three hours after birth, making him the youngest heart recipient ever. Paul's middle names are Gabriel, for the donor, and Bailey, for the surgeon who performed the operation. Because the donor in Paul Holt's case had been kept alive for the sole purpose of transplanting her heart, some in the medical community feel those involved with the operation stepped across an ethical boundary. Paul Holt's heart donor was one of about 3500 American children born each year with anencephaly, a fatal brain defect. Leonard Bailey feels anenoncephalic babies make ideal organ donors. A display of birth defects in a Loma Linda anatomy classroom shows a typical anencephalic baby, born missing parts of its skull and most of its brain. Such babies have no chance for survival. They generally die within hours or days of birth. Nonetheless, some observers, including a prominent medical ethicist at UCLA Hospital, feel Dr. Bailey's desire to use anencephalics as organ donors is dangerously misguided. Leslie Rothenberg is a lawyer who consults with doctors on such issues as when to disconnect life support systems. Rothenberg feels it sets a terrifying precedent to keep a dying newborn alive for the sole purpose of extracting organs. LESLIE ROTHENBERG, ethicist: It brings back visions of Robin Cook's Coma movie, where you essentially treat beings as parts factories to be scavenged for whatever you need for somebody else. Dr. BAILEY: It's really an altruistic notion to help these youngsters -- that we're not a bunch of monsters going out trying to dig up parts from people who don't qualify and that sort of thing. Mr. ROTHENBERG: I don't question Dr. Bailey's humanitarian goals. I believe he's very sincere. But I think that the danger is that Dr. Bailey is so committed to saving the lives of those infants at any cost, and by any means, that he may have in effect a set of moral or ethical blinders on.
KAYE: One month after his historic operation on Baby Paul Holt, Leonard Bailey arrived at a Loma Linda University seminar, prepared to confront his critic Leonard Rothenberg. The forum was on the use of anencephalic babies as organ donors. Bailey says he feels an obligation to speak out on the subject. He believes there's a lot at stake since there are so many infants born with defective hearts. He began by explaining the importance of the Paul Holt case. Dr. BAILEY: I thought at the time -- and I think some other people did, too -- that the most important thing about that transplant is that we might have gotten a foot in the door on utilizing a very important resource -- that is organs from anencephalic babies. They don't think or act or feel anything like you and me. They are not persons by anyone's stretch of anyone's imagination. Mr. ROTHENBERG: To attempt to define anencephalic infants as dead ignores the fact that we can only determine death. We can't redefine it. The phrase brain death is unfortunate. Brains don't die. People do. Dr. BAILEY: Why is it better to have intensive care nurses wrap the baby in blankets and put it over there in the corner and try to ignore it and let it die? Why is that better somehow than, say, utilizing the organs. They're useful to perhaps not just another baby, but as many as four or five people can live from that one baby. Mr. ROTHENBERG: There are a lot of people in this room today who have very nice organs. And we have a lot of people, I'm sure, at this medical center and at others who can benefit from those organs.
KAYE: For Leonard Bailey, facing down critics has come with the territory since October 1984 when he transplanted the heart of a baboon into a 12 day old infant known as Baby Fae. Fae lived for 20 days. During her short life, some of the international media played up the ghoulish aspects of the operation. Others asked why a human heart wasn't selected instead. During a news conference at the time Bailey was defensive. Dr. BAILEY: I thought what I'd do this morning was take you through a bit of the history of where we're coming from so that you don't think we're out half co*cked doing some wild, crazy thing here. But that we've actually approached it as near a humanistic and scientific way as we can.
KAYE: Bailey described years of experiments, transplanting hearts from one newborn animal to another before he became convinced he could try the same thing in children. Dr. BAILEY: Here is another recipient in the newborn period, a male. And his donor, and celebrating his first birthday, a big, healthy pup.
KAYE: During Bailey's press conference, activists outside the hospital protested the surgeon's experimental use of animals. But Bailey is continuing his animal experiments undaunted by the objections of animal rights activists. Dr. BAILEY: It isn't that we hate animals, but we happen to love people more, that's all. I like animals, too. I'm a member of the human species. I feel like my first obligation is to my species.
KAYE: Bailey expects to transplant another animal heart into a baby in the near future. He says he learned valuable lessons from the Baby Fae operation, which he considers a successful experiment. Dr. BAILEY: She barely had any heartbeat. Having said that, once she had the new heart in, she was a totally different baby. She was just great thereafter -- duration of her short life. But she lived 20 days longer than she would have otherwise. There's something to be said for that. It isn't much, but she is -- gracious, she's a milestone in cross species transplantation.
KAYE: If there are to be more milestones in infant transplant operations, cross species and otherwise, much of the groundwork will take place in this laboratory. Here, technicians try to match donor organ organs with recipients. And they monitor the progress of transplant patients. They want to know whether newborn hearts developed adequately over time, and they are concerned about any side effects of the anti rejection drugs that all organ recipients must take. Because of such questions, Bailey's detractors within the medical community consider infant heart transplants experimental, a notion Bailey feels is shortsighted. Dr. BAILEY: It's no more experimental than many other things I'm called upon to do (unintelligible) every day in pediatric heart surgery. We're invariably inventing new ways to get around problems.
KAYE: Bailey believes heart transplants are the only real hope for many babies born with incurable heart disease. He hopes that infant heart transplants might one day be considered routine. But now, with a limited supply of donors, Loma Linda makes difficult choices about the recipients. Dr. BAILEY: I don't think we play God at all. I think every once and a while there are little miracles that happen. But that's done in spite of us.
KAYE: One of those Bailey considers a ''little miracle'' is Eddie Anguiano, who was born with a fatal heart condition. Eddie received his new human heart in November 1985. Dr. BAILEY: He was a bit of a (unintelligible). He was the first human transplant we did at four days of age. He's now two years old, and doing well.
KAYE: Eddie's mother Maria says it's pretty easy going now. But the first year, Eddie went through a spate of childhood diseases and required constant vigilance. MARIA ANGUIANO: I was checking his heart every day, I was getting his heartbeats, I was taking his temperature, every time I would bathe him I would check him from head to toe to see if he had any rashes or anything unusual. Now he looks normal and he acts normal, and (unintelligible) pretty normal now.
KAYE: Eddie is one of the stars of a sort of music video distributed by Loma Linda Hospital's efficient Public Relations Dept. The tape shows five of Bailey's success stories, stories that have been well publicized. Bailey believes the reason he has received worldwide attention is that the public craves good news to compensate for the bad. Dr. BAILEY: What does bother me is I may work all day on one or two babies in the operating room, and on that same day there are half a dozen or a dozen young men wiped in a war somewhere else on the globe. I think when you can save a baby is whenever possible. That says something about us as a society.
KAYE: Bailey has traveled the globe as a member of the Loma Linda team of doctors performing heart surgery on children, and consulting with physicians. Their mission is to help develop heart surgery programs, and to show other doctors how to push back the boundaries of medical technology. Charting Care MacNEIL: Next tonight, we look at the Federal Government's report on hospital death rates from Medicare patients. As we reported in the news summary, the Health Care Financing Administration today released statistics that show mortality rates for Medicare patients treated at nearly 6000 hospitals across the country in 1986, statistics that required seven volumes the size of telephone books. This is the second year that such information has been compiled. Last year's report caused an uproar among many in the medical community. Some health experts said the mortality data can help the public make important decisions about medical care. While others say reliance on the statistics can be misleading. Here to answer questions about this year's report is Dr. William Roper, head of the Health Care Financing Administration. Dr. Roper, first of all, why is this information released to the public? Dr. WILLIAM ROPER, Health Care Financing Administration: Because it's valuable information. We think it is important that doctors and hospitals especially see how they are doing in comparison with a statistical model that we have put together using the best researchers we can muster. And we think it's also valuable to the general public when used carefully. MacNEIL: I thought you were going to say, ''Well, we didn't release it until the New York Times go hold of some under the Freedom of Information Act last year, and then we had to release it. Dr. ROPER: Well, that was the case last time around. That was in March of 1986. But after that experience we learned some lessons. One of them is you can do a better job at something if you can plan ahead. And the second lesson we learned is that the public wants this kind of information. And so we made a conscious decision to prepare this information and release it. Not because we have to, but because we think it's the right thing to do. MacNEIL: Now, presumably newspapers, hundreds of thousands of them all over this country, are going to be looking at these volumes or wire service reports of these big volumes, and in the papers tomorrow morning, people in any city will see perhaps here's how the hospitals in this city ranked according to their -- how many Medicare patients died after they were treated there -- can people use that in decisions on which hospitals to go to? Dr. ROPER: Well, first of all, the information is compiled -- is the result of more than a year consultation process that we've had with the best experts in and out of government, the hospital community, the medical community and others. And what we've put together is information that's useful as a screening tool. What we expect consumers to do is look at the information, as you describe it, and then pose thoughtful questions for their doctor and hospital and proceed on the basis of the answers to those questions. The information shouldn't be used on its own as an independent guide to quality. It's not that. It's a screening tool. MacNEIL: Is it -- are the mortality figures a measure of the quality of care at a hospital? Dr. ROPER: Well, they're a step towards that. Our first commitment, our highest priority is to improve the quality of care in the Medicare program. If one's going to improve quality, we got to decide, first of all, what it is. It's not enough just to be for motherhood and apple pie in quality and health care. We've got to define it and measure it. And this is a first step towards that end. And the statistics put forward here are beginning a longer process that we're engaged in with our research community to come up with yet better measures of quality. This is not a perfect one, but we think it's a good first step. MacNEIL: Tell us briefly the kind of criteria by which these statistics are arrived at. I mean, people die from different causes, and for different reasons with all sorts of variables. How do you sort that out? Dr. ROPER: Well, first of all, we're dealing with Medicare population, which is 31 million people. They are admitted ten million times a year to 6000 hospitals. And what we have done is rank the hospital by state and for each hospital this information is the number of Medicare admissions they had in 1986, the number of those patients who actually died within 30 days of admission to the hospital. And then using a statistical model that predicted percentage range that we would have expected, based on the age and the sex, the diagnosis and other conditions related to those patients. It's a highly tuned, finely honed statistical model, not a perfect one, though. MacNEIL: Okay. We'll come back. Joining us now is Dr. James Todd, senior deputy executive vice president of the American Medical Association. Dr. Todd, last year the medical community was very upset about the release of these figures. How do you feel this year? Dr. JAMES TODD, American Medical Association: Well, we're somewhat less upset this year than last year. But still, terribly upset. We understand what the government is trying to do, and we really applaud their effort, but our concern is the data that they have released really is of no value to the average consumer of the average patient trying to make a decision with their doctor. There's no reason to believe that patients aren't able to ask questions on their own. Dr. Roper has said this is not a measure of quality that is something that can be used by hospitals. And it's somewhat naive to think that hospitals aren't looking at their own performance and trying to improve it in any fashion that they can. The information that is here can be used in dangerous fashion in terms of hospital's advertising, because they happen to be at the top of the level. It may disrupt doctor/patient -- MacNEIL: Let's stop at that a moment -- why would that be bad for a hospital to boast that its mortality rates were better -- fewer people on a ratio died than in the next hospital. Dr. TODD: Because we don't believe based on the statistics that have been produced, because they ignore in a large measure the severity of illness -- -- that just because a hospital's mortality is higher or lower necessarily explains anythingabout the quality of care in that hospital. For example, a hospital here in New York City who has excessive mortality in cardiovascular disease, according to this report, has that mortality because they have a large number of patients waiting for heart transplants and the hearts aren't available. So that the figure of mortality really doesn't help the individual patient decide whether that is a good hospital or a bad hospital. Patients don't go to hospitals. They go to physicians. And the important part of that doctor/patient relationship is the fact that no physician is going to take the patient into a hospital where they believe the care is going to be substandard. MacNEIL: What about -- it's been pointed out by other people that these statistics can be helpful if a patient is -- needs a certain procedure, and he looks at the statistics and finds that the death rate from the procedure in a particular hospital is higher than another one -- it may be because the hospital has just begun doing that operation. Now, shouldn't a consumer know about that? Dr. TODD: Well, I think that the average consumer, or as we call the patient, going to a physician in that sort of a serious situation is clearly going to want to know on their own, without the expense of this sort of a study, what sort of chances they can expect in that hospital. And also, just because the hospital mortality in that particular procedure may exceed that of the average, it doesn't mean that that particular physician's mortality is going to exceed that. It's perfectly possible for a patient to receive superb care and for a physician in a hospital with above average mortality to not have any mortality among his patients. MacNEIL: Dr. Roper, Dr. Todd thinks this is very dangerous. You heard why. Dr. ROPER: I appreciate his concerns. We talked many times before. I respectfully disagree. We think this is useful information. We have -- as I said earlier -- a very sophisticated statistical model, not a perfect one. As he points out a major shortcoming is our inability at the present time fully to adjust these statistics for the severity of illness of the patients. But we've done an important thing. And that is we gave this information to hospitals back in September, gave them a month to review it, and to give us their comments. And the volume you've got in front of you contains not only our statistics, but printed actually their comments back to us. And we urge people to look at those comments. Because hospitals do vary. And there's some very good reasons why they vary. MacNEIL: Well, what about Dr. Todd's point that it isn't people who choose hospitals -- people choose doctors. And the doctors choose the hospitals. Dr. ROPER: He's right. I'm a physician. My wife's a physician. And that's right. And that's why we're anxious to push this agenda forward to measure the quality of services rendered not only by hospitals, but doctors. You have to fall before you can walk, and we're headed in that direction. Perhaps there was a time when patients were totally in the dark about health care. That's no longer the case. MacNEIL: You mean this is an aid to doctors in advising their patients -- is that what you mean? Dr. ROPER: It's an aid to doctors and hospitals and the people who review the care in hospitals. But it's also an aid to consumers. And we are anxious to inform them in an appropriate, proper way. If you believe, as I do, in a more competitive health care system, it seems to me you have to believe in giving out appropriate information to the public. And we're going to be doing it. MacNEIL: Well, what's wrong with that? Dr. TODD: Nothing's wrong with it if indeed it is appropriate, if it is relevant and if it can be easily obtained and easily understood by the patient. I don't think you can look in that book and find an easily understood information, particularly when even HECFA admits that the severity of illness -- MacNEIL: HECFA's the acronym for his organization -- Dr. TODD: Right. The Health Care Financing Administration. But even they will admit that because severity of illness is not included in these mortality figures, they cannot be used as a measure of quality. They're covering letter suggests that they should not be used as a measure of quality, that they are for information purposes only. And it would have made much more sense if really the purpose of this information to push hospitals toward better quality. To have shared the information with the hospitals, asked them to respond to it, but not put this out on the street, disrupting long term doctor/patient relationships, causing a lot of -- MacNEIL: How would it disrupt doctor/patient relationships? Dr. TODD: Well, suppose a patient looked in the book or saw in the newspapers, you suggested, that the hospital their doctor had used for a good many years had a higher than average mortality. Patient goes to the doctor, asks the doctor about it, the doctor gives an explanation. The patient is still concerned. And decides, well, maybe I should go to another hospital -- MacNEIL: You mean going to another hospital? Dr. TODD: Which means potentially going to another doctor. Now, doctor/patient relationships particularly in the elderly are just so terribly important, because they're longstanding, they know one another, they trust one another. In fact, the whole doctor/patient relation is predicated in large measure on (unintelligible). MacNEIL: Let's ask Dr. Roper on that. How does HECFA feel about that? That you could be undermining the doctor/patient relationship? Dr. ROPER: I believe it's fundamentally important to preserve the relationship that doctors have with their patients, and vice versa. But I have to believe in better informing those patients is in everybody's interest. Let me make a point that's important in all this. We plan annually to release this kind of information. We'll do it again next fall. We'll do it better ad more extensively. The fact that there are some shortcomings in what we are doing now we readily admit. But we think this is a good effort that renders good public service. MacNEIL: Let me ask you this finally -- Dr. ROPER: Let me just say -- MacNEIL: Oh, sorry -- Dr. ROPER: -- perfect should not be the enemy of the good. MacNEIL: All right. We just have a minute or so left. What -- do I understand you to say a moment ago that you also have data on the performance of doctors who are reimbursed by Medicare? Dr. ROPER: No, I said we are working to do that and in subsequent years we hope to produce that information. MacNEIL: You were going to release reports on the mortality rates produced by doctors? Dr. ROPER: Well, larger measures of quality. Of course, mortality rates are very crude measure of the quality of health care, and we're looking to refine that. After all, what we're seeking is a measure of how quickly patients get well under the care of a given doctor in a given hospital. MacNEIL: Just let me take a moment here -- how would the AMA respond to that? Dr. TODD: Well, I think our main concern is, is the information relevant? And is the methodology -- MacNEIL: I mean, would you try to prevent the release of such information? Dr. TODD: Not if it could be done in a proper fashion. But bear in mind no individual doctor has the myriads of patients that a hospital does. And it would be very difficult to reach a statistically meaningful conclusion about the mortality rates of patients. Our problem is at the moment, nobody knows how to define quality in an understandable reproducible fashion. And our concern is that for reasons not clearly understood that the government feels pressed to release information which is imperfect by their own admission, which may cause confusion -- MacNEIL: Gentlemen, I think we're going to have to leave it there. I think we know where both you stand. Dr. Todd, Dr. Roper, thank you. Block Buster Bust LEHRER: Finally a report tonight on the travails of a blockbuster novel, Whirlwind by James Clavell. Two years ago Clavell made the Guiness Book of Records when he received the largest advance in literary history for his novel. One year ago, the hardcover edition hit the stands. Last month it came out in paperback. Special business correspondent Paul Solman has been following the economic fate of Whirlwind. Here is his chronicle of the best seller.
PAUL SOLMAN: This is the $8 million book. Three million to print and promote it, and five million to its author, one of the richest and most popular in the world, James Clavell. It's November 10, 1986. Whirlwind has just hit the bookstores, and Clavell is launching his Whirlwind media tour. TALK SHOW HOSTESS: James Clavell is my guest. I'm Joanie Hinberg for WOR Radio 710, the talk station, talking about the new blockbuster already what, number five on the list? Number four? JAMES CLAVELL, writer: I think it's number two. TALK SHOW HOSTESS: Ah! Number Two! SOLMAN: With thousands of advance orders, Whirlwind is already a best seller on its first day. But that doesn't mean the publisher will earn back its $8 million investment, much less make a profit. So why bet a kingdom on Clavell? Because this author has done it before. Clavell's epic novel (Shogun) sold millions, then became a TV miniseries and sold millions more. His most recent historical novel, Noble House topped the charts for a year. Clavell's name nearly as prominent as the title. And a third Clavell blockbuster, Taipan, was just being made into a movie to be released as Whirlwind would hit the bookstores. [clip from movie]
SOLMAN: So when the new Clavell manuscript came across his desk a year ago, publishing mogul Larry Hughes sprung for the biggest advance in history. LARRY HUGHES, book publisher: Paying big advances is like the piano moving business. It's a great business unless you drop one.
SOLMAN: But Hughes didn't figure to drop this one. On the other hand, no one had ever invested $8 million in one book before. Mr. HUGHES: I could justify that quite easily. In today's market it is not unusual for a hardcover book to sell a million copies.
SOLMAN: Not unusual if you're James Clavell maybe or some other household name in the book industry. For the typical not so famous author, selling as many as 20,000 copies would be a success. By contrast, for Clavell's book, they print one million. Increasingly the book industry has been interested in the mass market, honed to the likes of James Clavell. In the mass market, the sales are plenty, the titles few. Discount chains dominate the business. Selling hardcover bestsellers at discount prices. PAUL GILMAN, Simon & Schuster: The dominance of the chains as far as individual books are concerned is absolutely incredible. You know, they select, they make a book or they can kill a book.
SOLMAN: So the chains help create the mass market. And in the mass market, brand names sell the product. Even though publishers are loathe to admit it. Mr. HUGHES: I don't like it very much, because brand names to me connote grocery stores and not literature and reading. But that's the name that's been applied, and I guess we'll have to call it that.
SOLMAN: Clavell himself was offended at the comparison. Mr. CLAVELL: My books are unique. Unique meaning individual. There's no parallel. There's no -- it's not like motorcars or Heinz Baked Beans, or Band aids, or something like that.
SOLMAN: But despite protests to the contrary, Clavell is a brand name. He turns out a consistent product, and the publisher markets him accordingly. Printing a million copies at a cost of $2. 5 million, advertising heavily, a half million more. This investment assures that the chain stores, which often don't carry smaller printings, will feature Whirlwind prominently. The valuable item here, as in any mass market store, is shelf space. And getting the merchandise to move quickly. So publishers actually pay chains to move the product. Renting display space like this. Finally, the brand name sells himself. Here at NBC for a Today Show appearance, for example, Clavell is pushing the product even before he goes on. Mr. CLAVELL: You start reading any one of the books, you could say, like Whirlwind, and if I haven't caught you in a quarter of an hour, then I've failed. Because it has its own sort of turn the page (unintelligible) -- HOSTESS on Today Show: We're talking about your $5 million price tag for Whirlwind. And he said, ''I bet the publisher is nervous. '' Mr. CLAVELL: Well, the publisher is nervous, and it wasn't $5 million actually. No, it wasn't. HOSTESS: What was it actually? Mr. CLAVELL: Well, perhaps it was more. TALK SHOW HOST: Five million dollars. You still have some of it? Mr. CLAVELL: Well, whether it's true or not doesn't matter. The amount of money notwithstanding, anyone who has read any of my books I think will relish this one.
SOLMAN: But as novelty attraction or matinee idol, James Clavell presses on. WOR TALK SHOW HOSTESS: How many pages is Whirlwind? I finished it last night. Mr. CLAVELL: You did? WOR TALK SHOW HOSTESS: I did. Mr. CLAVELL: Honest to God? WOR TALK SHOW HOSTESS: Look at it -- I took it into the bathtub. I'm still covered with blue dye. You've got to tell your publisher to put a better dye on it next time.
SOLMAN: So in November 1986 everybody's bullish. Mr. HUGHES: Well, I'm not nervous because at this particular point I know it's a success. Mr. CLAVELL: There are many millions of people, fortunately, who know my work. And they will relish this if they like my work. So the publisher I think is home free.
SOLMAN: It's now December. Taipan, the movie, makes its debut. James Clavell and those who bank on him are ready to celebrate his latest triumph. And in December the New York Times rates Whirlwind: ''Reviewing James Clavell's most recent work poses an interesting ethical question. When you've been engaged by a responsible journal to report on an 1147 page novel that bores you bandylegged, how many pages do you have to read before you can bail out and still fulfill your professional obligations?'' And on December 22, Whirlwind actually makes People Magazine's Pan of the Year list. ''Judging by its length, Clavell seems to have gotten about one dollar a word. '' By January, Whirlwind is still a major bestseller. But it's beginning to look like something of a financial flop. DEBRA PALLOW, Waldenbooks: Unfortunately, Whirlwind is not exactly doing what we expected. It's been a very disappointing title, all things considered.
SOLMAN: In fact, Walden stores have returned about half the 250,000 Whirlwinds the chain had ordered, an enormous number for the publisher to be stuck with. Play that out nationally, and it would mean that of the roughly one million hardcover copies printed, the publisher sold half a million retail, and will have to get rid of the rest at a huge loss. Ms. PALLOW: We were beginning to think we wouldn't be able to give it away (laugh). Come in, just come in, we'll give you a copy!
SOLMAN: Slowly, surely, and well ahead of schedule, Whirlwind begins to slip down the Times Bestseller list. And finally, after six months on the charts, it has fallen off entirely. So, does this mean that the $8 million investment is down the drain? Will publishers finally stop paying such huge advances? No. Because even though it's a terrible disappointment, Whirlwind still sells half a million in hardcover, which when you combine it with paperback sales will probably cover the cost of investment. Won't make any money, but it probably won't lose any either. And so, the self fulfilling prophecy of the big bucks bestseller has been fulfilled. Two years after the record advance, one year after it was first published, James Clavell's Whirlwind is returned to the paperback bestseller list. Once again, the brand name has prevailed. LEHRER: And last Sunday, Whirlwind was number four on the New York Times paperback bestseller list. It's been on that list ever since it came out in soft cover seven weeks ago. Recap MacNEIL: Again, the major stories of this Thursday. Senate Minority Leader and Republican presidential candidate Robert Dole endorsed the intermediate range missile treaty. A new memo surfaced which said Vice President Bush supported the Iranian arms deal. And the prosecutor in the Michael Deaver case said loose money and poor ethics are being tolerated in the federal government. Good night, Jim. LEHRER: Good night, Robin. We'll see you tomorrow night. I'm Jim Lehrer. Thank you and good night.
