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From the staff of the Tampa Bay Times

State muses dropping standards for children's cardiac medicine program



State health care officials could soon do away with a set of quality standards at the eight hospitals responsible for most of the children’s heart procedures in the state.

The issue is not with the rules themselves, Jennifer Tschetter, chief operating officer of the Department of Health, said in a hearing Monday. Rather, officials worry that standards used to certify hospitals in the Children’s Medical Services program have been illegal for about 15 years.

“We think these standards do have value,” Tschetter said. “They’re just not lawful.”

But in a hearing Monday, Tschetter and other health department officials heard objections from pediatric cardiac surgeons who say that the policy benefits of having regulations on the books outweigh any possible legal question. Besides, said lawyer John Moyle, there haven’t been challenges saying that the regulations are out of line.

Pediatric cardiac care is difficult, and it’s expensive, doctors said. And that makes minimum standards important.

“Why is the state of Florida wanting to abolish proven medical standards?” said Dr. William Blanchard, medical director of the Florida Association of Children’s Hospitals. “No pediatric cardiovascular professors, no hospitals, none of the team of experts in pediatric cardiology...have announced support for repeal of these rules.”

Dr. Louis St. Petery, a pediatric cardiologist in Tallahassee, said repealing the standards will hurt the state’s reputation for providing high-quality care to poor children.

“Over time, Florida has become famous for the fact that all of the kids in Florida have access to that quality of care,” he said. “Removing these standards makes absolutely no sense.”

The standards in question only apply to Children’s Medical Services (CMS), a state-run health care program for disabled children, but the eight heart facilities in the program also account for most of the pediatric cardiac procedures done outside that program.

Doctors say it isn’t hard to find examples of what can happen without standards.

Reporting by CNN showed that one Florida hospital — St. Mary’s Medical Center in West Palm Beach — had high mortality rates. St. Mary’s, which did not have a CMS-certified cardiac program, was not subject to any standards.

Nneka Campbell felt this all too personally.

In 2012, Campbell took her 10-month-old daughter Amelia to St. Mary’s for surgery. Her daughter had been born with a heart valve that was too tight.

But there were complications in the surgery, and on Oct. 12, 2012, three years to the day before this hearing, Amelia Campbell died.

“When a mom walks through the doors of any hospital with her child who has special health care needs, she is very aware of the risk that she is taking when she entrusts her child’s life to another,” Campbell said in the hearing. “The mere fact that her child is sick and that she cannot personally fix her herself causes her to rely on what she believes she knows about hospitals and regulatory agencies.”

The health department should be actively pushing for more regulations, more standards, she said.

“In the face of the St. Mary’s Medical Center crisis, it appears that leadership has decided not to responsibly self-correct, but rather to cede responsibility and lower the standards of care,” Campbell said.

Tschetter reaffirmed that the goal is not to eliminate regulations for the sake of eliminating them. The department decided two years ago to repeal the rule because the state law giving it authority to regulate the pediatric cardiac programs in CMS was itself repealed 15 years ago.

But all of this could be moot.

Sen. Aaron Bean, R-Fernandina Beach, has filed legislation (SB 378) giving the Department of Health the authority to keep these standards on the books.

And while the public hearing phase of the process to repeal this rule has finished, the health department has no deadline to finalize its decision.

[Last modified: Monday, October 12, 2015 5:58pm]


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