All Children’s deaths led to a bill adding oversight. The Florida House just gutted it.

The original bill allowed extra inspections of children’s heart surgery programs. The new one doesn’t, and even shuts down an existing committee of doctors tasked with proposing improvements.
State Rep. Mike Beltran, R-Lithia, speaks before the Florida House’s Health Market Reform Subcommittee on Tuesday about a bill that would shut down the state panel of doctors trying to improve children’s heart surgery programs. [The Florida Channel]
State Rep. Mike Beltran, R-Lithia, speaks before the Florida House’s Health Market Reform Subcommittee on Tuesday about a bill that would shut down the state panel of doctors trying to improve children’s heart surgery programs. [The Florida Channel]
Published March 27, 2019|Updated March 27, 2019

After Johns Hopkins All Children’s and another Florida hospital experienced serious safety problems within their pediatric heart surgery departments, state lawmakers filed proposals to increase oversight of the procedures.

On Tuesday, the Florida House gutted its version of the bill.

The House’s Health Market Reform Subcommittee scrapped a provision to let physician experts make unannounced visits to struggling programs and recommend corrective action.

And it added language to shut down the Pediatric Cardiology Technical Advisory Panel, a group of cardiologists and cardiac surgeons that has been developing standards for evaluating programs across Florida.

Rep. Mike Beltran, a Lithia Republican who sponsored both the original bill and the amendment, said he was committed to making sure “all the hospitals in Florida have all the quality controls that they need” in light of the recent issues at St. Mary’s Medical Center in West Palm Beach and All Children’s in St. Petersburg.

But Beltran said visits to troubled programs should be conducted by state regulators. As for the advisory committee, he said the group had “completed the work for which it was commissioned.”

The move reflected the House’s focus on health care deregulation. House Speaker José Oliva, R-Miami Lakes, has said he considers deregulating the market among his top priorities for this year’s legislative session.

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

But it also flew counter to recent calls for increased oversight of children’s heart surgeries following a November Tampa Bay Times investigation that showed the mortality rate for heart surgery patients at All Children’s had climbed to 10 percent — the highest rate of any program in Florida.

The spike in surgical deaths had gone unaddressed by state and federal regulators, despite the hospital’s CEO admitting to an increase amid “challenges” in an interview with the Times months earlier.

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

The Senate first proposed the bill in February, and the move to defang it left the two chambers at odds.

Sen. Gayle Harrell, who is sponsoring the measure in the Senate and chairs the Health Policy Committee, remained resolute that pediatric heart departments need more oversight and that teams of doctors should be able to evaluate them.

“I’m going to continue to work very hard to pass our bill,” the Stuart Republican said Tuesday. “I believe we are taking the correct approach. We are very carefully establishing the parameters under which we want these very specialized hospitals and procedures to proceed.”

Pediatric heart surgery standards have been an issue in Tallahassee since 2015, when CNN reported that the mortality rate for babies having open-heart surgery at St. Mary’s had surged.

Lawmakers created the Pediatric Cardiology Technical Advisory Panel two years later. The group met regularly in 2018 and submitted a first draft of its recommendations to the state earlier this year. Its next meeting is scheduled for Thursday.

Harrell said she filed Senate Bill 1126 to identify problems at programs across the state.

A key component, she said, was allowing the technical advisory panel to recommend physicians for the site visits. The inspections would include reviews of medical records and mortality reports.

Beltran originally filed a bill identical to Harrell’s. He then amended it in its first committee stop in the House.

“I’m trying to keep this bill alive, keep this bill moving,” Beltran said.

The new version of his proposal found support from Health Market Reform Subcommittee Chairman Cary Pigman, who said there was nothing stopping state regulators from getting “into the weeds” on site visits.

Pigman, an Avon Park Republican and ER physician, also expressed support for setting a September deadline to shut down the Pediatric Cardiology Technical Advisory Panel.

“It is the feeling of the committee staff that if we do not sunset it, we do not get work,” he said.

Late Tuesday, the advisory panel’s chairman, Dr. David Nykanen, told the Times that the committee had more work to do, especially around increasing transparency and standardizing how programs report their surgical results.

Nykanen said the group felt strongly about allowing expert physicians to conduct site visits and will continue recommending the measure be written into state rules whether the law passes or not.

State regulators, he said, lacked the expertise to evaluate the quality of children’s heart surgery programs.

“This isn’t tonsils and appendixes,” he said.

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