NORTH COUNTY -- Tri-City Medical Center had higher than average death rates in 2007 in three categories of patient care, according to a state report released this week.

The report, by the Office of Statewide Health Planning and Development, also said that Pomerado Hospital in Poway had higher than average death rates in one area of care.

The two hospitals were the only ones in North County tagged in the report, which rates 381 hospitals throughout California on patient deaths in eight categories ranging from angioplasty to stroke.

Tri-City was rated worse than average in acute stroke care, craniotomies and gastrointestinal hemorrhages. Pomerado rated worse than average in craniotomies. During that procedure, surgeons remove a small piece of bone from a patient's skull to provide access for various types of brain surgery.

Tri-City's top doctor and the hospital's interim chief executive said Friday they were puzzled by the poor ratings and will look at possible causes. But they said the report doesn't mean that patients aren't receiving top-quality care at Tri-City.

"This is just one statistical window to look at hospital care," said Dr. Richard Burruss, chief of the public hospital's medical staff. "We are going back and examining the charts for every one of these patients to determine if there are any trends."

Joe Parker, director of the health care outcomes center at the Office of State Health Planning and Development, said the report is designed to give patients and their employers better information to make decisions about health care.

He cautioned that the data are reported to his agency by hospitals and has not been verified. Data have also been adjusted based on how sick each patient was when he or she came to the hospital.

Parker said the adjustment to take a patient's initial condition into account makes it possible to compare hospitals that serve vastly different populations.

He said a hospital with three categories rated worse than average should be concerned.

"I would worry that there might be something possibly systemic," Parker said.

Burruss said Friday that Tri-City's Quality Assurance Committee reviews all patient deaths to make sure proper health care was provided. He noted that mortality data alone does not provide enough information on patient care.

"It doesn't say anything about quality, it just says how many patients died," Burruss said.

Larry Anderson, Tri-City's interim chief operating officer, said Friday that he was especially surprised to see a low mark in stroke care, given that the hospital earned a bronze medal from the American Stroke Association for following national guidelines in stroke care.

Anderson, who was brought in only one week ago, said he has personally reviewed patient safety records, and also talked with all directors of the hospital's medical staff, and has found everything to be in order.

"The quality of care is as good as I've ever seen at any other hospital," Anderson said.

He added that hospital administrators will confer with doctors after they examine patient charts for the deaths referenced in the report.

"I think it provides us an opportunity to review the data. If there's something that the medical staff tells us we need to change, then we'll take immediate action," Anderson said.

Administrators at Palomar Pomerado Health, the parent organization that runs Pomerado Hospital in Poway, had only one case to review.

Opal Reinbold, chief quality officer with Palomar Pomerado said Friday that the state report gave the hospital an worse-than-average rating based on one patient who died during a craniotomy procedure in 2006. The patient was one of six who underwent the procedure at Pomerado in 2007.

Reinbold said one of six patients died, but added that the patient came to the hospital with "a massive bleed in the brain." She said that, although the patient's family asked Pomerado doctors to do all they could to save the patient, there was never much hope.

"It was really an expected death," Reinbold said.

The patient's case had already been reviewed by the hospital's medical staff, which concluded that proper procedures were used, Reinbold said. She said the way the case was documented caused it to pop up in the statewide report.

"It's really more of an issue of quality of documentation, rather than quality of care," Reinbold said.

Contact staff writer Paul Sisson at (760) 901-4087 or psisson@nctimes.com.