Chuck Magner says the thing he misses most about his dad is all the projects he'd have going at once.

He said his dad, Jerry Magner, 79, was always in the backyard at his house in Hidden Valley Lake, a quiet town near Clearlake, about two hours north of San Francisco. Jerry Manger had some ongoing health issues. But Chuck Magner said you wouldn't know it because his dad was often outside digging trenches or building a deck.

But last July, Jerry Magner did experience some health problems. Chuck Magner said 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. Jerry Magner 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," the son 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 to see him.

"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. The son 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 known complications from this procedure, as opening the artery can dislodge the plaque into the brain.

Dr. Dennis Baker, a professor of surgery at UCLA, cautions that doctors and patients have to carefully weigh if the procedure should be done at all, saying "there is always an alternative, you can always not operate."

He said about 95 percent of the time there are no complications. But with the other five percent, the stakes can be high -- heart attack, stroke or death.

Instead of surgery, Baker said some patients have other options. They can take medications or get a stent to open the artery. And with these alternatives available, Baker said 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.

An analysis of state data showed that in 2005 St. Helena Hospital performed 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. Professor Baker's 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.

In a four-page written statement [pdf], St. Helena Hospital vice president, Joshua Cowan, said, "Our community is facing enormous health challenges for which we do not believe Professor Baker has been able to appropriately adjust in his research."

At a neighboring hospital called Sutter Lakeside, Dr. Anne Tait says she's not surprised by St. Helena's numbers. Tait 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 in Lake County, rates for smoking, heart disease and diabetes are above the state average.

Tait says the real reason behind why some hospitals do many more surgeries than others comes down to how the doctors practice. She believes some of the St. Helena Hospital doctors 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. Cowan said, "We have every confidence and indication that the medical staff exercised appropriate judgment on each case."

Cowan 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, also defended the hospital's record. "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."

But Chuck Magner still isn't convinced his dad needed that surgery. And, he said 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 he's not even sure how he'd go about doing that.

"I think having been through this I think we ought to put up a college course on medical care for your family."

This story was produced with the California HealthCare Foundation Center for Health Reporting.

About This Project:

This project is a partnership of KQED Public Radio, the San Francisco Chronicle and the California HealthCare Foundation Center for Health Reporting.   The center is funded by the nonpartisan California HealthCare Foundation.

The study of medical procedures and geographical variation was conducted by Dr. Laurence Baker of Stanford University and was also funded by the California HealthCare Foundation. The work was commissioned by the Campaign for Effective Patient Care, an interest group that promoted the involvement of patients in making medical decisions. Formed during the health reform debate, the group recently disbanded.

The Center for Health Reporting, based at the USC Annenberg School for Communication & Journalism, is editorially independent of the foundation and had no role in Baker’s study.