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  1. Investigations

Top All Children’s executives resign following Times report on heart surgeries

‘The events described in recent news reports are unacceptable,’ the hospital’s parent company said.
Johns Hopkins All Children's Hospital [SCOTT KEELER | Times]
Published Dec. 11, 2018
Updated Dec. 12, 2018

The CEO of Johns Hopkins All Children’s Hospital and two other hospital administrators have resigned following a Tampa Bay Times investigation that found dramatic increases in the hospital’s mortality rates for heart surgeries, Johns Hopkins announced Tuesday.

In a statement, the health system said All Children’s CEO Dr. Jonathan Ellen, Vice President Jackie Crain and deputy director of the hospital’s Heart Institute Dr. Jeffrey Jacobs had resigned.

Dr. Paul Colombani also stepped down as chair of the department of surgery, the statement said. He will “continue in a clinical capacity” at the hospital, a Johns Hopkins spokeswoman said.

The Times investigation, “Heartbroken,” reported that the mortality rate at the hospital’s Heart Institute tripled between 2015 and 2017. Last year, it was the highest of any pediatric heart surgery program in Florida.

[ Read the investigation: Johns Hopkins promised to elevate All Children’s Heart Institute. Then patients started to die at an alarming rate. ]

The increase came after at least eight hospital employees warned supervisors about problems with the program’s surgeries.

Several employees spoke with Colombani directly, the Times reported. Jacobs was a codirector of the institute at the time of the problems and was one of the surgeons highlighted in the Times report. Crain was the hospital’s chief strategy officer and its lead executive for risk and claims management.

Crain and Colombani declined to comment. Ellen did not return requests for comment.

An attorney for Jacobs, James Roosevelt, Jr., said in a statement that Jacobs had been “forced out of his position and prevented from speaking out on his own behalf.”

“In performing more than 4,250 operations during his highly-regarded career that spanned more than two decades at All Children’s Hospital, Dr. Jeffrey Jacobs devoted his professional career to the care of very sick children. … He looks forward to the opportunity to set the public record straight and defend himself from those who have not been given the facts,” the statement said.

In addition to making leadership changes, the board of Johns Hopkins Medicine, which owns and operates All Children’s, also commissioned an external review of the issues within the heart program.

“We will share the lessons learned from that review to ensure that Johns Hopkins, Johns Hopkins All Children’s and other hospitals around the country can learn from and avoid the mistakes that were made,” the health system’s statement said.

“Losing a child is something no family should have to endure, and we are committed to learning everything we can about what happened at the Heart Institute, including a top-to-bottom evaluation of its leadership and key processes," the statement continued. “The events described in recent news reports are unacceptable.”

The Times investigation reported that four physician assistants asked for a meeting with their supervisor and Colombani in 2015 to raise concerns about the surgeries performed by Jacobs and Dr. Tom Karl. At least four other employees also raised safety concerns. Three of them named Karl, Jacobs or both surgeons.

In June 2016, a third surgeon who had handled many of the most complex procedures was pushed out of the program, the Times reported. Jacobs and Karl began performing all of the institute’s hardest surgeries.

In the next 18 months, at least 11 children died after their procedures, even as the hospital began to turn away the most difficult cases, the Times found.

[ Read more: State, federal officials missed warnings at All Children’s heart unit ]

In an interview, U.S. Rep. Kathy Castor said the CEO of Johns Hopkins Medicine told her late last month that that the health system’s leaders didn’t know All Children’s Heart Institute employees had raised safety concerns before learning it from the newspaper.

Castor said she reached out to the CEO, Dr. Paul Rothman, to express “deep concern over the death rate and the problems.”

She urged Rothman to be “proactive” and to “talk to the parents and medical community and larger community that has high expectations for Johns Hopkins and the quality of care,” she said.

A spokeswoman for the health system confirmed Tuesday that Rothman was “unaware that employees had raised safety concerns, which is why he is strongly supportive of the external review commissioned by the Johns Hopkins Medicine board of trustees.”

She declined to make Rothman available for an interview.

Kevin Sowers, the president of the Johns Hopkins Health System, will run All Children’s temporarily, the health system’s statement said.

In a statement, U.S. Rep. Charlie Crist said a change of leadership was “the right call in wake of reports on All Children’s severe medical failings.”

“Our community demands accountability and corrective action to restore the standing and quality of care provided by what had for decades been a proud and respected institution,” he said.

Some parents who had taken children to the Heart Institute saw the moves as a sign of progress.

“Hopefully, children won’t continue dying,” said Sandra Vázquez, whose son Sebastián died after heart surgery in 2017 and was featured in the Times investigation. “For many families it’s too late, but other children can be saved.”

Said Rosana Escamilla, whose daughter Alexcia was paralyzed after heart surgery in 2016: “It’s a step forward.”

Both Ellen and Colombani were longtime Johns Hopkins administrators who were moved into key roles at All Children’s after the larger health system absorbed the hospital in 2011. Before then, the hospital had been locally run for nearly a century.

Ellen holds a number of leadership positions in the community, including chairman of the University of South Florida Consolidation Task Force, chairman of the board of trustees for the Foundation for a Healthier St. Petersburg and President of the St. Pete Innovation District.

It was unclear late Tuesday if he would continue in those roles.

Last week, Castor and Crist asked the federal Centers for Medicare and Medicaid Services whether it was investigating the hospital. The federal agency had said in May that it would investigate after a prior story by the Times. But a formal review never actually happened, the Times reported.

[ Read all the Times' reporting on the All Children’s Heart Institute ]

Read Johns Hopkins' statement

Here is the full text of the statement from Johns Hopkins Medicine:

Effective immediately, and in consultation with the Johns Hopkins All Children’s Hospital board leadership, we have accepted the resignation of Dr. Jonathan Ellen, president, vice dean and physician-in-chief. We have also accepted the resignations, effective immediately, of Dr. Jeffrey Jacobs, chief of the Division of Cardiovascular Surgery and director of the Andrews/Daicoff Cardiovascular Program, and Jackie Crain, vice president, chief of staff and until recently lead risk-management executive. Dr. Paul Colombani has resigned as chair of the surgery department.

Kevin W. Sowers, M.S.N., R.N., F.A.A.N., president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine, will step in and lead the hospital in a temporary capacity while a plan for interim leadership is put into place. Dr. George Jallo, current medical director of the Institute for Brain Protection Sciences and chief of pediatric neurosurgery, will serve as interim vice dean and physician-in-chief. Dr. Paul Danielson, current chief of the Division of Pediatric Surgery at Johns Hopkins All Children’s Hospital, will serve as interim chair of the surgery department.

The board of Johns Hopkins Medicine has commissioned a comprehensive external review of the issues within the program. We will share the lessons learned from that review to ensure that Johns Hopkins, Johns Hopkins All Children’s and other hospitals around the country can learn from and avoid the mistakes that were made.

The leadership transition announced today marks a new chapter as we work to earn back the trust of the children, families and community we serve. We are devastated when children suffer. Losing a child is something no family should have to endure, and we are committed to learning everything we can about what happened at the Heart Institute, including a top-to-bottom evaluation of its leadership and key processes. The events described in recent news reports are unacceptable.

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