After All Children’s deaths, proposal aims to catch heart surgery problems

The bill would allow a panel of doctors to inspect programs’ internal results.
Sen. Gayle Harrell, R-Stuart, filed a proposal to increase oversight of pediatric heart surgery programs and institute site reviews by a state panel of doctors.
Sen. Gayle Harrell, R-Stuart, filed a proposal to increase oversight of pediatric heart surgery programs and institute site reviews by a state panel of doctors.
Published Feb. 19, 2019|Updated Feb. 20, 2019

TALLAHASSEE — The chairwoman of a powerful Florida Senate committee has filed a bill to dramatically increase oversight of children’s heart surgery programs.

The bill is designed to prevent problems like those at Johns Hopkins All Children’s Hospital. The St. Petersburg hospital experienced a sharp rise in heart surgery deaths that came to the attention of the public and regulators as the result of a Tampa Bay Times investigation published three months ago.

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

Florida Senate Health Policy Chairwoman Gayle Harrell, R-Stuart, said she filed the proposal in response to the issues at All Children’s and at St. Mary’s Medical Center in West Palm Beach, which stopped performing children’s heart surgeries in 2015 after CNN reported on the program’s high death rate.

She said the bill’s changes could have caught some of the issues sooner.

“These are the most fragile of children,” she said. “We want to make sure that we have standards in place and our cardiac centers are doing all they can to make sure children get the very best care.”

The bill, SB 1126, would let teams of pediatric heart doctors make unannounced visits to struggling programs. They would be able to review death records, inspect facilities and interview support staff and administrators.

After each site visit, the team would submit a report to the state’s Pediatric Cardiology Technical Advisory Panel, which would then recommend corrective action.

“We need to do things a little differently and make sure that there is the review of the standards that are expected to be met,” Harrell said.

The problems in the All Children’s heart surgery unit started after the Baltimore-based Johns Hopkins took over the hospital and made changes to the staff, the Times reported.

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

Frontline workers started noticing problems with surgeries and unusual complications in 2015. Within two years, the death rate for heart surgery patients had surged to nearly 10 percent — the highest of any program in Florida.

The data available to the public showed barely any increase. State and federal regulators promised to inspect the program, then didn’t.

After the Times story ran in November, the hospital replaced six top executives and hired a former federal prosecutor to figure out what went wrong in the heart department. Johns Hopkins Health System President Kevin Sowers has since apologized and said some former employees “did not act in the best interest of the children.”

[ 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 ]

The hospital filed a corrective plan with federal health regulators.

State lawmakers created the Pediatric Cardiac Technical Advisory Panel in 2017 to create standards to evaluate programs across the state.

In August, before the Times ran data on the All Children’s mortality rate, the Florida chapter of the American Academy of Pediatrics wrote to the state health agency and recommended the panel review All Children’s.

The agency said state law didn’t allow it.

Harrell’s proposal would let the panel recommend physician experts to visit existing programs and examine information that is not typically made available, including death records dating back one year.

The panel would also be able to make advisory recommendations on hospitals looking to open new pediatric heart surgery programs.

Since its inception, the panel had been led by Dr. Jeffrey Jacobs, one of the All Children’s surgeons highlighted in the Times report. Jacobs stepped down from the position and left All Children’s in December.

Separately from the new legislation, the panel is working a series of new rules for Florida heart surgery programs. Proposals under consideration include publishing far more detailed data online about heart surgery programs’ mortality rates. The new standards would need to be approved by the Agency for Health Care Administration.