Although big hospitals may love to pat themselves on the back and boost their profits and professional standings by claiming to offer “comprehensive” services, children may suffer and die due to the reality versus the hubris of institutions’ excessive initiatives with specialized care.
Officials at the University of North Carolina blew past anguished warnings from their own pediatric cardiology staff of significant problems in the pediatric heart surgery program at the medical center’s children’s hospital, the New York Times reported. Brushing aside their concerns about a lack of resources within and to support the program, UNC declined to make public, as most similar specialty efforts do, key performance measures. They would show that the UNC pediatric heart surgery program had a higher death rate than “nearly all 82 institutions that do publicly report” this and other measures of patient care.
The newspaper, in a rare move, has internal tape recordings of doctors disputing among themselves whether dwindling resources, staff departures, and other problems meant that UNC should do what many of the specialists demanded — take a long hard look at what was going wrong, and, in the meantime, refer sick kids to other institutions to safeguard their care.
That, UNC officials feared, would damage and might kill their children’s heart surgery program — a blow to institutional finances and prestige, with a “competing” program at nearby Duke University a likely beneficiary.
Still, the institution’s own staff pointed out the mounting problems with the children’s heart program, the newspaper reported:
In 2015, UNC had lost two pediatric cardiac intensivists, who care for critically ill heart patients. The children’s hospital also had closed its CIC unit, a specialized area for cardiac patients coming out of intensive care; nurses experienced with those patients left. And unlike some larger hospitals, UNC didn’t have a dedicated cardiac intensive care unit, or CICU.
As administrators kept promising to act and the internal debates raged, young patients who needed heart operations and typically would have good outcomes, underwent surgeries at UNC. Several died.
If this tragic and unacceptable scenario sounds familiar, it should. It echoes what happened when Johns Hopkins sought to expand its respected “brand” at All Children’s, a Tampa, Fla., hospital it acquired in 2011. The Tampa Times reported that Johns Hopkins, with various administrative and other moves, worsened care at the facility until youngsters in its pediatric heart program were dying at a “stunning rate.”
The New York Times explains the problems with pediatric heart programs and hospitals’ push to add and build specialized programs like them:
The turmoil at UNC underscores concerns about the quality and consistency of care provided by dozens of pediatric heart surgery programs across the country. Each year in the United States about 40,000 babies are born with heart defects; about 10,000 are likely to need surgery or other procedures before their first birthday. The best outcomes for patients with complex heart problems correlate with hospitals that perform a high volume of surgeries — several hundred a year — studies show. But a proliferation of the surgery programs has made it difficult for many institutions, including UNC, to reach those numbers: The North Carolina hospital does about 100 to 150 a year. Lower numbers can leave surgeons and staff at some hospitals with insufficient experience and resources to achieve better results, researchers have found …At least five pediatric heart surgery programs across the country were suspended or shut down in the last decade after questions were raised about their performance … At least a half-dozen hospitals have merged their programs with larger ones to achieve more consistent results. And more institutions are considering such partnerships.
UNC officials defend their children’s heart program and say they have made major changes in it and with the support for it. The surgeon who headed the program, and who gets considerable attention in the New York Times story, no longer is the pediatric heart surgery chief. A new surgeon and new associates have been hired. The institution lags still on releasing performance data, saying that to do so would create privacy problems, since, for several years, there was only one surgeon operating in the program and results could be too identifiable to him.
As the newspaper reported:
In October 2017, three babies with complex conditions died after undergoing heart surgery at UNC. In a morbidity and mortality conference the next month, one cardiologist suggested that UNC temporarily stop handling some complex cases, according to a person who was in the room … [T]he surgery department chairwoman said in a recent interview that the hospital had never restricted surgeries. In December, another child died after undergoing surgery a few months earlier for a complex condition. The four deaths were confirmed by The Times but are not among those disclosed by UNC. It has declined to publicly release mortality data from July 2017 through June 2018, saying that because the hospital had only one surgeon during most of that period, releasing the data would violate ‘peer review’ protections.
In my practice, I see the harms that patients suffer while seeking medical services, particularly in hospitals, and especially as the injuries afflict babies and children. Recent research indicates that preventable hospital deaths claim the lives of as many as 160,000 Americans each year. They are a portion of the research-estimated 250,000 lives claimed each year by preventable medical error, which has become the third leading cause of death in the U.S., behind only heart disease and cancer. It is unacceptable that patients, already injured and sick, should lose their lives to preventable causes while seeking medical care. It is intolerable that hospitals dither instead of acting when they know that their specialized care areas may be lacking for various reasons and experiencing demonstrable poor outcomes, especially with vulnerable kids.
Johns Hopkins has felt the sting of its debacle in pediatric heart surgery at All Children’s, where such operations have been shut down. Top leaders at the institutions were ousted or left, as Johns Hopkins retained a well-known law firm to investigate what went wrong. Federal officials also have stepped in, determining that not only were there issues in the hospital’s pediatric heart surgery area but also with its infection control, physician competence, and quality improvement systems. The hospital has agreed to a year-long federal monitoring and oversight to ensure improvements in the defective areas.
Meantime, the Tampa Times also reported this:
The Johns Hopkins Health System’s operating profit dropped 70% in the first quarter of 2019, in large part because of problems in the All Children’s Hospital heart surgery program, according to the system’s latest financial report. The health system’s operating profit margin fell by a total of $31.7 million compared to the same period last year. The disclosure said the decrease was ‘mainly driven by lower net patient service revenue at (All Children’s) as a result of the closing of the Heart Institute.’ All Children’s, typically among the system’s most profitable hospitals, finished the quarter with an $11.5 million loss from operations. It was nearly $11 million in the black at the same time last year.
