and later, all look at the scottish parliament to make on the release of a pan am lockerbie bombing. -- bomber. . ♪ >> >> dr. john garrett, chairman of the board of directors, can you remember the first moment

you thought you might want to be a doctor? >> i think so. my stepfather was a surgeon and four lots of reasons i wanted to be like my stepfather. -- for lots of reasons i wanted to be like my stepfather. i wanted to copy him i think it got a little more serious than that when i injured my hip and high school in a skiing accident. i had to be in the hospital for seven weeks and i was able to observe people in the hospital and in my mind, i decided that i was want to do it. >> where to grow up? >> mangum rick, alabama. -- montgomery, alabama. i went to medical school at the

university of alabama in birmingham. >> when did the hard part of this coming to your life -- the heart part of this come into your life? >> jon kirkland was one of the world's greatest cardiac surgeons. party hacks surgery -- cardiac surgery was where i got to see heart surgery for the first time and when i began my surgery training, i did an internship. one thing i rotated through was cardiac surgery and dr. kirkland was my mentor. it was a brutal six weeks of very little sleep and hard work. but when you finished it, you felt like you were going through marine boot camp, you are proud of what you did.

when i finished, dr. kirkland put his arm around my shoulder and said that you ought to consider doing this. from that moment on, even though my stepfather was a general surgeon and we always talk about me doing that, after that, i was cardiac all the way. >> win was the first time -- when was the first time you open the chest and where was it? >> it takes a long time to be a surgeon and it takes even longer to be a heart surgeon. it is not like you wake up one day into a heart operation. you have someone training new. from the time that i was in alabama as an intern, i did parts of park operations -- park operations -- heart operations.

in cardiac surgery, you would do one part. over time, you would have done a whole operation, but never the whole operation yourself. it was only when i went to houston tx to train in cardiac surgery with another very notable, famous man. it was there, after about half a year, that i was left alone to do a cardiac operations. i remember it. by that time, i was an experienced surgeon. i knew how to operate, but it was still an unforgettable rol thrill to be involved in that patient did >> have you ever done a heart transplant? >> yes. >> what is that like? >> i think it's something that

most people think is more glamorous than it is. the beauty of a heart transplant is seeing a desperately ill patient that looks sick and looks like he is dying and you put the heart in him and the actual technical part is not very difficult. there are big stitches, but instantly, by the next morning, the patient has a different lighook. it just takes no time at all for the patient to look magnitudes better. >> are you ever frightened in the middle of an operation? >> no, i don't think frightened is the right term. sometimes, after an operation, i

think about what could have happened or why didn't something happen. that is after the fact. you might get scared about what the consequences could have been. sometimes, during a really desperate sorts of operations, where it really is like for death, you are so focused in what you are doing that you don't think about the consequences. >> what is the long as you have ever been on your feet? >> probably low over 24 hours? >> doing what? >> we were doing a patient that had a torn aorta, and i was working with one of my partners. the patient bled and we could

not stop the bleeding. if there had been one of us there, not together, we might have stopped, but we were there together. it was in our program, here, and the nurses still talk about it because the shipfts change but e do not. we were sitting on stools, dozing off, waiting for this position -- this patient. the patient eventually stopped bleeding and walked out of the hospital and was well. >> i know you will not name the person. i will just ask the question. the most difficult situation that you have ever had? >> i have it.

>> ago. >> it is a great story. i was operating on a priest. i had just taken a vein out of the priests le's leg. a surgeon came in and needed my help. he had a young lady who had an appendectomy, but she had cardiac arrest. her heart stopped and we are not sure what is wrong with her. she was about 28 years old. i went over and looked, and i thought she had a big blood clot to her lon -- lung.

because of who the patient was, i made the decision to move the patient. i moved her into the operating room and i open her chest and open the artery were i thought the blood clot was, to save her life. the blood clot was not there. there was no blood clot. there i was, with a patient i had moved out and his patient i had made the wrong call on. i could feel some blockages around her heart. blindly, this is very substandard, i did three bypasses into these blocked arteries. she came off of the heart/lung machine with a little difficulty.

the next day, i woke the priest up and said that we have some good news and bad news. the good news is that you have saved another lady's life tonight and the bad news is that we did not do your operation today. the end of that story was that the girl lived. sheik was a beautiful girl. she became friends with the priest -- she was a beautiful girl. she became friends with the priest. we ended up cathing, which means you stick a catheter into the arteries and it puts in die and you can see the arteries. we did that after i had bypassed because when i by pastor i did not know what was wrong.

-- when i bypassed her, i did not know what was wrong. the grass that i did were just the ones that she needed -- of the grthe grafts that i did wert the ones that she needed. she got what she needed. but it was not the standard way that you get that. >> when patients come to you, what can you predict they are going to do when you start to talk about their condition? >> more than you think, at least in cardiac surgery, patients have a high degree of trust for you and a lot of patience to not want to know a lot of detail. -- patients do not want to know

a lot of detail. more and more patients will go on the internet and read and learn things. but so many patients just want you to do what you do. they are grateful for it. they do not need to know details. they want to know when they can go back to work. they are interested in the likelihood of them dying. a lot of the other details, i think they are not too interested in. it puts a burden on us because there are certain things you need to know. we try to tell patients those things even if they are not too interested. >> let's say you are doing a bypass surgery, what do all these people do? >> before i answer that, the

team in heart surgery is critical. i have been blessed with a teeam wthat has been together for 20 years. it is like family. there is an anesthesiologist. he is the doctor that puts the patient to sleep and manages the drugs. he has a helper. at the operating table, i have an assistant, and i operate with a nurse, and are rn first assistant. i am more comfortable doing a case with one of my rn first assistance because- -- first assistants because they are

extremely skilled nurses. the person that passes my instruments is the scrub. in cardiac surgery, we have one other person at the table called a second assistant who is there to hold the heart back into retract the hearts alike can see where i need to operate. -- and to retract the heart so i can see where i need to operate. another person does other duties. that is pretty much a standard open-heart team. that is bigger than a typical teen in a typical operating room. >> you said you have done this for 20 years at the va hospital center.

did you come here in 1989? >> i did. >> from where? >> i finished my cardiac trading in houston in 1986. in heart surgery, you cannot just go somewhere and start doing heart operations. it takes a hospital that will give you the equipment and the team that you need. it takes a lot of resources. one of my friends started a program in alabama. we were there for about two years and we brought nurses from birmingham and i brought a staff from houston and we started this program. during that time, the hospital,

here, began plans to have heart surgery here. they went on a national search to recruit surgeons and we were included in that. we came up and looked at the facility. i had always wanted to live in washington, but in 1986, there was no opportunity for me to come here. this gave us the opportunity and we left on good terms and alabama and removed at year-end 1989. >> wanted to want to live here? >>-- on good terms and alabama d moved at year-end, 1989. >> why did you want to live here? >> we were not too happy in alabama.

we wanted to raise our family in this area. >> where did you meet your wife? >> i was a cheap resident in surgery at one of the medical students was on my service -- a chief resident in surgery at one of the medical staff -- and one of the medical students was on my team. her friend is my wife. my car had holes in the floor and all the girls i would go out with would spend about the first 15 minutes complaining about the car and she got in the car and never even noticed there were holes in the floor. that was the first thing i liked about her. >> mary does what to do? >> she is a pediatrician -- mary does what today? >> she is a pediatrician. >> so you all worked together? >> we do.

>> there is a big difference between being a pediatrician and a heart surgeon. >> there is a big difference. >> there is a difference in what you make. >> pediatricians are not very well paid. it was down you -- it would astound you to know what a pediatrician makes. if you consider the amount of training that they have to go through and the expense they have to incur to get to where they go. >> for the last 11 years, you have been chairman of the board of trustees. this is a community hospital. is it non-profit? if so, why? >> we are a not-for-profit hospital. if i could, let me describe what

that means. not-for-profit hospital does not mean that we don't make money. we have to make money, but it means that we do not have shareholders. we are not responsible to anybody but our community. we are a 5013c, tax-exempt. basically, what we do here is we try to break even or had a small margin of profit. last year, we had a 1.6% margin. what we do with that profit is that we invested back into equipment. we try to have the latest and greatest of that medical science has to offer. -- greatest that medical science

has to offer. last year we bought a very specialized piece of radiation equipment. that is what we do with our money. we do not get out to shareholders. that is not to say that we do not need to make income, we employ a lot of people. this is not charity. >> of gross revenues for a year? >> [unintelligible] >> how many people work here? >> a couple of thousand. >> , many of those are doctors? >> we have 300 on our active medical staff. only a handful of those doctors are employed by the hospital. most of the medical staff is an

independent medical staff. >> there is noise in the background right now. you know what that is? >> it is some sort of alarm. i do not know what it is because i do not work down there. >> this is where in the hospital? >> this is the emergency room. this is the fast track part of the d.r. -- of the e r. this is a part of our er where we try to avoid that. we get you in and get you out without having to wait so long. i do not know what that alarm is. >> we will just stop, but we do not normally do this. it is not annoying to us. it is annoying to the audience. oh, it stopped. >20 to take on the job of

chairman of the board and how long do you spend -- why did to take on the job of chairman of the board and how long do you spend doing that job? >> i worked my way up through leadership here in the hospital. i got on the hospital board. i felt like i've made some reasonable contributions, but i did not feel i had any special ability. the previous chairman a man by the name of pat healy, he encouraged me to run for the chairmanship. i really did not think that i had much to offer.

but i did and i was elected. i have grown into the job over the years. i think that -- i work here. my office is here. i hear a lot. -- i am here a lot. i deal with chairman sorts of things, but the one thing that i have done is to provide vision for excellence in clinical care , in the programs that we have developed here. an example would be the bureau surgery program, my cardiac surgery program, the nationally accredited center for breast health, these are programs that

we have had the vision to bring forward. in the hospital that we have built, would offer all private rooms to patients, regardless of their need for their ability to pay. >> why? >> because we could. it is the best thing for the statpatient. >> years ago, you could stay in the hospital for five days in ammonia and it was not so bad sharing a room with someone. these days, if you are in the hospital, you are sick, otherwise you are discharged. i think it is unacceptable to share a room in this age with another sick person. it is better for the patient to have a private room. that is the main thing that we

have pushed, to try to do what is best for the patient. >> you have 320 rooms. >> 350. >> i was just reading the literature. all lot of us use this hospital. a lot of our employees come here and a lot of members of congress. as you sit and listen to the debate over health care, what is the first thing you would want to tell somebody if they don't know what they're talking about? >> i guess everybody knows that it is complicated. ok, for starters, the hospital, half of what we do here is medicare and medicaid.

half of our patients, we lose money on all medicare and medicaid patients. medicare and medicaid called for -- covers about 80% of the cost, not the charges, but the cost. the thing that i guess i want to tell people is that, so far, we have seen is the way that the government controls costs, they just pay you less. we take that, we accept that, but we would have to change what we do, if not for the private insurance carriers, whom we aggressively negotiate with to get rates that are 140% of

medicare. because we are able to do that, we are able to make it 1.5% margin so that we can buy a piece of equipment for $7 million. >> our company has full insurance. you are saying that we are paying to make up the difference between medicare and what it costs? >> yes, your insurance does. >> if we did not get that extra money from your company, it all we got was what medicare paid, then do the math. we lose 20%. we are a business. we cannot lose money we either go out of business or we offer less so that we can break even. offering less in health care means that we do not give you the latest and greatest, which

is not as good. >> who sets the cost? in other words, you say -- let me ask you this, what does a heart bypass cost? >> let me tell you how works. doctors charge separately then the hospital. so, if i do a medicare operation, medicare coronary bypass surgery, i except what medicare pays me. >> what is that? >> it is about $2,000. >> what do you do for $2,000? what is the total amount of your time spent doing? >> surgeons are paid locally. -- globally.

for that month, until i get you well, that is what i get paid. i could see you 10 times a day, if you have complications, what ever it is, i get that one payment. for the hospital, it is similar. they get what is called a drg payment. it is based on the diagnosis. for vice pass surgery -- for bypass surgery, i think is $18,000 from medicare -- i think it is $18,000 from medicare to take care of whatever happens to that patient. >> it is a total of $20,000 for a bypass that medicare will pay. >> yes. >> what does it really cost? >> it costs more than that, but i am not sure exactly how much more.

we are way beyond what we charge. what we charge and what we collect is totally different. >> at that point, if medicare is one to pay 20,000, who determines what the insurance company will pay? >> we negotiate with the insurance company. >> due to negotiate of the medicare price? >> absolutely. -- do they negotiate of the medicare price? -- of the medicare price --off the medicare price? how does medicare set the rate? >> i do not know. >> do not know? >> no. >> does that frustrate you? >> i am past being frustrated. it is the law. it is different than what it

used to be. >> what did he used to be? -- why did it used to be? >> anesthesia and respiratory therapy, stat to room 738. >> even if you were deaf, you could hear that. >> there used to be more money in the system. >> why? >> medical care gets better and better. new technology is expensive, but it is better and better. things used to be cheaper. we are of the mind that there is nothing that is too expensive and we want the latest and greatest and we're willing to pay for it.

and we have. that occurs in parallel with when we are getting paid less. >> every year? >> absolutely. >> why? >> that is part of what medicare has the ability to do, is to lower what they pay you. we have nothing to say about that. physician fees, every year they have a 10% decrease in our reimbursement and for the past several years, they do not do it and we have a sigh of relief. >> if i am in your position -- first of all, how much are you motivated by money? >> i'm not. >> code bleu, 7b room 738.

>> that is a little more startling. >> most doctors truly do not go into medicine to make a big income. you are attracted because of what you can do for people. the idea that you can be independent and work for yourself and be your turn person. >> code blue 7b room 738. >> what does " bluhm mean? >> code bleu is when somebody has a cardiac arrest -- >> what does code bleu mean? >>ue mean?

>> code blue is when someone goes into cardiac arrest and we descend on the patient. >> is that what you do? >> no. this is what we do in the hospital. our default is to help. it is to save people. in doing that, we do not think about the money. it is the last thing on a physician's mind, is what money we are spending to bring someone back. i think that illustrates a very important point. it is not part of what a doctor does. >> we have been hearing, and i think in another conversation we

had, some of the younger people coming into the business have a different attitude about money and their time than people your age. >> it is clearly different. i think that the reasons are justified, but i think that young physicians see a different horizon than guys were girls in my era. >> what is their horizon? >> elthey are more protective of their private time they want to be employed and not have the responsibility to run their practice. part of that is because it is hard to hang out your own shingle. it is too expensive. you cannot afford it. so young people do not want to take that risk.

there is more of a shift mentality. in my group, we never get away from it. even on our nights off, it is still part of your life. i think that the newer generation of positions -- of physicians, you are really off and you have your life. that is what it is. >> back to my original question. what do you want to say in this debate that you do not think is being heard? >> let me make a point about tort reform. >> explain what that is. >> in everything that we do as physicians and as a hospital, we have the possibility of being sued by patients or family or

whatever. it is not something that is in the front of your mind, but it is ingrained in you. it has unintended consequences. i will give you a really pertinent example that honestly just happened this week i had an 86-year-old this week. i had an 86-year-old chronically ill man. he had a ruptured aneurysm. a big artery in his abdomen had popped. he was still alive. he had had recent abdominal surgery, so he had abdomen that have been opened before. his pressure was at about 60.

he was dying. i had absolutely no problem saying that this patient is too sick to have emergency surgery. he is not going to survive. we have a new technology, new expensive technology called sti nt grafts. these are placed up in the aneurysm. we have that capability. because we have that capability, i sent this patient who normally i would have said to stop, down to radiology and, and they call me and say that we can save him, but if we save him, he will lose his kidneys. we are sure of that. ok? if i did not have the family that i could talk to at that point, i would have said go

ahead. that would have committed that man to dialysis and he probably would have died within a month. but i would have been afraid to not proceed on the pier of -- on the fear of what if the family did not want us to go ahead? fortunately, i had a family that elected to stop. my point is, if the family had not been available, we would have done what we do, which is to take the next up. a lot of times it is easier than just saying stop. that drives up the cost of health care. >> we are right in the middle of the fast track wearing for the

emergency room. it is in this type of place that you have a lot of defensive medicine, based on the tort reform you're talking about and based on one end to cover yourself. could you explain that? >> a lot of people that go to emergency room does not want to be there. it they did not plan to be there -- to do not want to be there. they did not plan to be there. you come in and you do not want to be there and you do not know anybody and nobody knows you. there are a lot of things going on things can drop to the cracks without tight protocols. sometimes, more things are done, kind of like a shotgun approach it is easier to do everything so you do not leave anything out

than to pick and choose. that drives up costs. >> go back to your mention of the cyber knife. a $7 million mcshane. the first one in this area was at georgetown hospital. is this the first one in virginia? >> yes. >> how do you pay for that? you have a $7 million mcshane -- mcshane -- machine. what does it do? >> it focuses a beam of radiation to a target, regardless of the motion such as long as ore body movements. it is a precise way to deliver radiation. -- such as lawns or body

movements -- olungs or body movements. it is a precise way to deliver radiation. >> due to pay overtime? >> we usually pay cash. >> is that where your profit comes in? >> exactly. >> what would go through the entire board's decision to bring this in here. what would have been the reason? >> well, we do a needs assessment. we compare to other technology. at the time, we are recruiting world-class radiation oncologist. they believed in the -- radiation oncologists.

they believed in the technology. that was the prime reason that we decided to do it. we had a business plan that predicted ahow many years it would take to pay for itself. we try not to do things that are going to lose money over time. we lose enough money doing our routine. >> come much of the money that you taken comes from patients and how much comes from donations to a community hospital? >> yeah, we have a foundation that is pretty new. we were out of the fund raising business for about a decade. we are back in it now. last year, we raised about $1.5

million. not a whole lot. we are hopeful that that is one to grow. in these economic times, we have seen a downturn in what people are able to do to support hospital. >> how often is your hospital full? >> it is full all lot. i do not know the exact -- is full all lalot. i do not know the exact number. when we can get a patient in, they have to go to another hospital. >> what motivates someone to have a not-for-profit hospital verses a all profit and witchews better for the patient? >> what motivates the for-profit

is the profit. i think not for profit is the best for the country because i think it is cheaper. i think that if not-for-profit hospitals can adopt some of the physical restraints that for- profit hospitals have, it would be viable to do. but keep that savings as opposed to giving it out to shareholders. we did a joint venture with columbia in the mid-1990s and during that time, it was a valuable experience for us. we learned some restraint that we still benefit from. we save money in areas that we normally wouldn't have. in a for-profit system, that

savings goes to shareholders. in our system, it goes back into this hospital. >> patients have spent less and less time in hospitals than they used to. you come in and have an operation and you were in the hospital for two days. it used to be a week. what happened? >> a lot of what happened is that insurance companies started paying on what is a drg basis. you have a diagnosis, and instead of paying you piecemeal, they pay you a lump sum for pneumonia. when that happened, there became pressure on the position to get the cost -- of the patient out of the hospital sooner. the sooner the patient got out of the hospital, the less money

that would be spent. if the patients stayed in the hospital an extra two days, then any part of the profit that might be present would be dissipated. >> is that good or bad in your opinion? >> i think it is good. i think it has been good. >> we really did not need to spend all that time in the hospital? >> but a lot of time she did not know where you can get away with until you are pushed to do so. in cardiac surgery, we used to keep people in the hospital for eight days. that was state of the art. and now we get patients out in three or four days. quite honestly, a lot of that was pushed from limited reimbursement. if you want to have a successful

cardiac surgery program, you cannot spend all the money. you have to have enough money left over to buy the equipment that you need. >> from your perspective, what is the worst thing that you hear on a day-to-day basis? are there people in this town hall meetings -- these town hall meetings or congress? >> i think what scares me the most is the thought of having a massive medicare or medicaid. having all the inefficiencies that that brings. ending up with a system that is poor, a hospital system that is poor and not being able to offer the best to our patients.

that is what scares me the most. >> what would that happene in that kind of a system? >> the only thing i say is that -- i can say is that we lose 20 percent -- 20%. if we lost 20% on everyone that came in, we would have to do something different. as a hospital the ministry, the first thing that i would do -- as a hospital administrator, the first thing that i would do is limit our capital. we would buy $30 million worth of equipment, and that would have to stop. we would have to lay off people because we would have to make up the 20%. the easiest way is to not buy new stuff, and that is what we do in our personal life, but we are talking about health care.

new technology is expensive. the people that are driving new technology expect a return on their investment. if nobody is buying it, it is only a matter of time before nobody is making it and nobody is thinking about it. that is a disaster for health care. >> knowing what you know about hospitals and doctors and operations, what would you tell a patient coming in the door. they are afraid, so what should they do to give themselves more peace of mind if possible? >> i am not sure. i think everybody needs insurance. if you do not have insurance, you need to get insurance. >> what if you cannot afford it? >> well, i think -- i am not a

politician, but there is something to be said about insurance reform and making insurance more competitive so that even people that do not have a lot of money can have some insurance. what you do not want to happen -- everybody can get care. you can get care. the problem is that someone who does not make a lot of money and does not have insurance, they are responsible to pay for the bill that they got for that care. that is the problem, paying for it. the only person that asks me about how much something cost is somebody that has money but no insurance -- something costs is somebody that has money but no insurance. somehow, we need to feel some of

the pain of -- other than writing a check for the insurance company, we need to feel that cost issue. but i do think there needs to be insurance reform. i think that everybody needs insurance. i would start with trying to make there be more competition between insurance carriers so that there is affordable insurance. >> who is your biggest competition in the hospital business? >> you mean what other hospital? >> douville competition? >> absolutely. -- do you mean competition? >> absolutely.

when you go home at night, you hook up with your wife, mary, a pediatrician. what are the difference in your two lives when you talk about your day? >> i am speaking for myself. i tend to feel more a burden. i worry more. my wife has a lot of well patients, well babies. when she does have a sick child, she is totally worry that night -- at ninthght. most pediatricians see well babies. as opposed to my practice, my patients are pretty sick.

it is an inescapable burden that i do not run away from. it is just part of our life. sometimes patients did not survive. that is an awful -- it is a terrible struggle. over the years, it gets harder because you have a sense that your ability the should be so much greater that it was 20 years ago. we are not always successful. >> if you were to pass on to somebody else this job, we only have two minutes, what would you tell the next chairman to worry about? >> i would tell the next chairman that regardless -- i would tell the next chairman to

have an effect on patient care. i would encourage him not to do anything that affected patient care. keep an edge of pressure on the administration, on the board, to never cut corners. it to never let this thing that we have built, where we give our patients the absolute best, do not let that change. that is my biggest fear. at the end of the day, you have to pay. >> last question. if you are a cardiac doctor or a heart surgeon, what would you be doing? >> i would be a chef. i would be a chef. i would own a restaurant and i

would work in my restaurant. that is my second love. >> and your favorite food? >> battalion. -- italian. >> you've finally smiled after this interview. thank you very much. >> thank you, brian. ♪ >> for a dvd copy of this program, called 1-877-662-7726. visit us at q&a.org. q&a anis also available as a podcast.

>> and dr. john garrett, featured on q&a will be our guest on washington journal. he will take your phone calls and questions starting at 8:30 a.m. eastern. we will look at the hospitals perspectives and its doctors. the top administrators will join us in the emergency room to take your phone calls and provide context to the health- care debate that is currently before congress. >> we will continue on the team of health care next weekend on "q&a." that is next sunday on "q&a." >> next, the scottish parliament

debate on the lockerbie bomb release. after that, the biography of senator mitch mcconnell and then on "you and dave," a health-care discussion with dr. john ger arret. c-span is health care hub is a key resource on the health-care debate. follow the links. what's the latest events -- watch the latest events. including any town hall meetings. >> the british house of commons is in summer recess until october. prime minister's questions will return on wednesday, october 14. tonight, we will show you a debate from the scottish parliament.

the scottish government released the lockerbie bomber on compassionate grounds. he was diagnosed with cancer and was originally convicted of the lockerbie bombing. this is the scottish parliament on the government's decision to release him to libya. this event is about one hour 50 minutes. -- one hour and 15 minutes. >> good afternoon. there is just one item of business today which is a statement by the secretary of justice on the decision. this is of utmost seriousness.