The recommendation racket: who do we think we're kidding?

• Author: Barrett, Paul M.

THE RECOMMENDATION RACKET: Who Do We Think We're Kidding?

Until a year ago, Commodore Donal Billig directed the heart and chest surgery unit at Bethesda Naval Hospital, flagship of the Navy's medical division. Located Just north of the capital in Maryland, the hospital specializes in curing top Pentagon brass and other Washington eminences; President Reagan had his cancerous polyp removed there this summer. Not surprisingly, quite a stir resulted when the Navy revealed in June that many of Dr. Billig's patients had been leaving his operating room in far worse shape than they had been in when they entered. As of this writing, Billig has been charged with involuntary manslaughter in the deaths of five heart patients and dereliction of duty in operations on 24 other patients.

Witnesses in a pretrial investigation have testified that in the five years before coming to Bethesda in June 1983, Billig had not performed any heart surgery. And here are some other curious facts about the case: a week before applying for the Navy position in 1982, Billig sought a job as an Air Force physician but was discouraged because his eyesight was found "unacceptable.' A subsequent test revealed that he is legally blind in his right eye. The Navy has conceded that it received results from the Air Force physical but refuses to say whether it knew about Billig's sight problem. Finally, and perhaps most perplexing, Navy documents show that despite previous indications of incompetence, Billig came to Bethesda well recommended.

As recently as 1980, Billig admitted in writing that he had a sight problem. He did so in connection with his having been asked to leave Monmouth Medical Center in New Jersey because of questions about his ability. The Washington Post reported that Billig was also asked to leave at least one other medical job, a position with Thoracovascular Associates in Pittsburgh. In spite of this spotty record, the Navy received a letter of recommendation in August 1982 from one Manfred L. Cohen, a surgeon and former colleague of Billig's at Thoracovascular Associates. Dr. Cohen, according to the Post, wrote that Billig's performance had been "most satisfactory.'

Granted, Billig's is an extreme case; letters of recommendation rarely contribute to multiple fatalities. Written references, whether in medicine, academia, or business, generally consist of euphemism and puffery: "It would be impossible to overstate Mr. McGillicuddy's abilities,' and the like. But there's reason for concern, because as a society we pump out millions of letters of recommendation every year. The cumulative effect, demonstrated with unusual drama in the Billig affair, is a form of mass anesthesia. Questions of quality and standards are muddled by a foggy dialect of doublespeak. Everyone becomes "a fine candidate' for whatever position they seek. The unimaginative are "highly cooperative'; the obstinate, "independent minded.'

It's not that middling performers should be penalized for being ordinary. Rather, evaluations formally committed to paper should have a special value, reflecting serious consideration by an author who feels some responsiblity for the deeds of the person recommended. Most people have come to accept casually the corrupted language of recommendations. After all, if everyone knows what's going on, who's going to get hurt? This attitude ignores, however, the danger of the corruption creeping into other forms of evaluation. Testimony in the Billig case revealed that although Bethesda Hospital officials knew Billig was unqualified to perform heart surgery, they nevertheless gave him written permission to operate. "There was some concern how we could have a head of the department without credentials,' admitted Dr. Robert Cochran, former chief of surgery at Bethesda. As a result, Cochran testified, Billig was told that he would be supervised whenever the attempted heart surgery. "He was given full credentials on paper . . . but what was meant was something else,' Cochran...