Federal officials threaten All Children’s funding, citing problems

The hospital has just 10 days to outline a plan to meet federal rules. Inspectors visited the hospital in January following a Times investigation.
The Centers for Medicare and Medicaid Services sent a letter on Thursday saying problems at the John Hopkins All Children's Hospital had placed members of the public in "immediate jeopardy." [CHRIS URSO   |   Times]
The Centers for Medicare and Medicaid Services sent a letter on Thursday saying problems at the John Hopkins All Children's Hospital had placed members of the public in "immediate jeopardy." [CHRIS URSO | Times]
Published Feb. 1, 2019|Updated Feb. 2, 2019

The federal government said a recent inspection of Johns Hopkins All Children’s Hospital found serious problems and threatened to cut off the institution’s public funding unless the issues are addressed in a matter of weeks.

The hospital was cited for not meeting federal rules on infection control, quality improvement, how it hires and manages doctors, and its leadership structure, according to a letter the Centers for Medicare and Medicaid Services sent the hospital Thursday.

The inspectors’ full report was not available Friday. But the letter says the findings were severe enough to constitute “an immediate or serious threat to patient health and safety.”

The agency placed the hospital in a rare status called “immediate jeopardy,” which federal guidelines describe as “a crisis situation.”

The move represented a stunning turn for one of Florida’s most prestigious children’s hospitals. The hospital was locally operated until 2011, when it was absorbed by Johns Hopkins, one of the most renowned names in medicine.

Federal and state inspectors descended on the hospital after a Tampa Bay Times investigation found a dramatic increase in deaths and complications in its heart surgery unit.

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

Federal regulators do not directly control whether hospitals are allowed to operate. But they can cut hospitals off from public funds — a potentially devastating situation that could result in closure. Most hospitals are able to correct deficiencies and escape immediate jeopardy status before losing the money.

All Children’s has until Feb. 10 to provide a written plan to address the inspectors’ findings. If it does not correct the problems by Feb. 23, the government will stop allowing the hospital to bill it for new patients.

All Children’s spokeswoman Kim Hoppe said the hospital took the findings “seriously” and did not plan to appeal.

“We have developed — and are actively implementing — a comprehensive action plan to address areas that were identified by the surveyors as needing corrective action,” she said.

The patient safety problems at All Children’s were first made public in a Times report in April that found surgeons had left a needle in a newborn’s chest. At the time, federal inspectors promised a thorough investigation. But they never performed a broad review of results or the overall hospital.

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

In November, a Times investigation revealed that the surgical mortality rate in the hospital’s Heart Institute had tripled between 2015 and 2017. The Times also found that hospital leaders did not aggressively respond to warnings that frontline medical workers raised about procedures as early as 2015.

After that, several members of Congress from Tampa Bay called for a federal investigation.

The reporting also led to sweeping changes at the hospital. The hospital’s chief executive, three vice presidents and two surgeons resigned. The president of the Johns Hopkins Health System personally took over All Children’s on an interim basis.

[ Read more: Top All Children’s executives resign following Times report on heart surgeries ]

[ Also: Three more All Children’s officials resign following Times investigation ]

Those changes were made before federal and state inspectors visited the hospital from Jan. 7 to Jan. 11. It’s unclear whether the inspectors found new safety issues, or whether they were citing the hospital for not having policies in place to prevent the Heart Institute’s problems, which All Children’s has since acknowledged.

A spokesman for the federal agency said that an “ongoing immediate jeopardy was identified dating back to September 20, 2018” that related to violations of federal rules around the hospital’s governance structure. He said the inspector’s detailed report would not be made available until All Children’s filed a corrective plan.

Alan Levine, a former secretary of the Florida Agency for Health Care Administration who also served as co-chairman of Gov. Ron DeSantis’ transition team on health, said hospital executives were likely expecting the sanction.

“This gives them a definitive roadmap for what needs to be addressed,” he said.

All Children’s relies heavily on public funding. About 65 percent of patients were billed to public health insurance programs in 2017, according to a Times analysis of state data.

About 5 percent of hospitals across the country received an immediate jeopardy citation last fiscal year, a spokesman for the federal agency said. There were seven citations in Florida. Just three hospitals across the country lost funding.

U.S. Rep. Kathy Castor, one of the lawmakers who called for an investigation, said she hoped to see “greater accountability for a hospital that used to be renowned for high quality care.”

“Johns Hopkins and state regulators allowed the quality of care to deteriorate and children died and were injured unnecessarily,” she said. “Our community deserves and demands so much better.”

[ Click here to read all of the Times' coverage of All Children‘s Heart Institute ]

Data reporter Connie Humburg contributed to this report. Contact Kathleen McGrory at Follow @kmcgrory. Contact Neil Bedi at Follow @_neilbedi.