The state Health Department is stepping in to review Landmark Medical Center’s cardiac surgery program amid fears that the three-year-old program is jeopardizing the hospital’s financial survival because it has not attracted enough patients.

Under conditions set by the state when the program was approved, Landmark is required to perform 500 heart surgeries a year by its third year of operation. The program’s third anniversary is in May, but a hospital spokesman said Landmark has been averaging only 100 surgeries a year.

Dr. David R. Gifford, state health director, said the expensive, money-losing cardiac program may be contributing to Landmark’s financial troubles and threatening the Woonsocket hospital’s ability to provide services essential to the surrounding community, such as cancer care and outpatient surgery. Landmark has no endowment and can’t sustain such losses, he said.

Landmark spokesman Bill Fischer said that the heart surgery program was only “one minor variable” in the hospital’s financial woes. He said Landmark projects a net loss of only $300,000 from the cardiac program in the current fiscal year. In the year that ended Sept. 30, 2007, Landmark lost $7 million — the same amount of money it spent on uncompensated care, according to Fischer. He said low reimbursements and uncompensated care are the main factors driving the fiscal crisis at Landmark and other community hospitals.

But Fischer acknowledged that the cardiac program is not meeting volume standards. He said it was premature to discuss whether the hospital’s commitment to heart surgery remains steadfast. Gifford also would not say whether he intends to pull the program’s license because of the low volume. He said he wanted to evaluate the cardiac surgery at Landmark and start weighing options well before the May anniversary.

The volume standards were set to ensure that cardiac teams maintain their skills, but Gifford said his primary worry is financial.

“This is not a quality issue,” Gifford said. “Our concern is making sure we preserve the hospital. I am concerned that this could be threatening the hospital.”

Landmark’s heart program, done in collaboration with Beth Israel Deaconess Medical Center, in Boston, was established with the expectation that patients from central Massachusetts would be drawn to Woonsocket and that an aging population would have growing heart-surgery needs. But the Massachusetts patients apparently did not come to Landmark, and cardiac surgery is on the decline nationally because more patients are undergoing angioplasty instead.

Under Health Department rules, a hospital cannot perform angioplasty — a procedure in which doctors thread a slender tube into the heart to open clogged arteries — unless it also has the ability to do heart surgery, in case of complications from the angioplasty. But a year ago, the Health Department granted Kent Hospital a variance from those rules after doctors testified that they were outdated; fewer than 1 percent of angioplasty patients requires emergency surgery.

If Landmark obtained a similar variance, potentially Landmark could continue its angioplasty program without doing heart surgery. Landmark does almost 400 angioplasties a year, Fischer said.

The other two heart surgery programs in Rhode Island — at Miriam and Rhode Island hospitals — are not meeting the 500-a-year requirement either, although they are doing more than 400, Gifford said. Gifford granted a waiver to those hospitals while the Health Department’s Tertiary Care Advisory Committee studies whether to change the standard. New evidence suggests that heart surgery programs may not need to do 500 a year to maintain quality.

But whatever new standard the committee adopts, it won’t be anywhere near as low as 100, Gifford said.

Gifford said a Health Department team would be meeting with Landmark officials starting next week.

“We look forward to discussing these important issues with Dr. Gifford,” Fischer said. “We’re going to work with the Department of Health and bring a spirit of cooperation to this process.” Fischer said he hoped discussions would go beyond the cardiac program and consider the many other factors affecting Landmark’s finances.

When Landmark proposed its cardiac surgery program in the late 1990s, Lifespan, the parent company of Rhode Island and Miriam hospitals, vigorously opposed it. Lifespan officials said it would be wasteful to start a new surgery program from scratch and predicted there would not be enough patients to sustain three cardiac surgery programs in Rhode Island.

Now, Landmark — which has been looking for a merger partner — is talking with Lifespan. Fischer called them “informal discussions” and noted that Landmark is talking with others, too. “I would not characterize those [talks with Lifespan] as negotiations,” he said.

ffreyer@projo.com