Extra oversight for children’s heart surgery signed into law

Outside physicians will now be allowed to inspect Florida heart surgery programs. The change follows problems at Johns Hopkins All Children’s Hospital.
Johns Hopkins All Children's Hospital, St. Petersburg.  (SCOTT KEELER   |   Times)
Johns Hopkins All Children's Hospital, St. Petersburg. (SCOTT KEELER | Times)
Published June 26, 2019

Children’s heart surgery departments across Florida will soon be subject to more oversight.

Gov. Ron DeSantis signed a bill late Tuesday that will let physician experts visit struggling programs and make recommendations for improvement.

Lawmakers proposed the measure after the Tampa Bay Times reported the mortality rate for pediatric heart surgery patients at Johns Hopkins All Children’s Hospital in St. Petersburg reached nearly 10 percent in 2017. The rate was the highest any Florida hospital had seen in a decade.

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

The Times also found that hospital leaders had disregarded medical staff members’ concerns about surgical problems as early as 2015.

All Children’s stopped performing heart surgeries late last year. Six top officials resigned shortly after the Times report published.

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

“Now we will have the oversight that is necessary to make sure we have the best programs here in Florida,” said Sen. Gayle Harrell, a Stuart Republican who championed the bill.

“It will be a major change in how we do things,” she added.

The problems in the All Children’s Heart Institute had been whispered about in heart surgery circles for months before surgeries were stopped.

Last August — after the Times had reported the program was struggling, but before it revealed the increased mortality rate — the president of the Florida Chapter of the American Academy of Pediatrics wrote a letter to the state health care regulator, suggesting that a panel of doctors review the hospital’s surgeries. The agency’s head declined, saying the law didn’t allow it.

At the time, only state inspectors could make site visits. But the Times reported that they missed the heart program’s problems last year, even after promising a thorough investigation.

The bill signed into law Tuesday makes significant changes.

It lets a committee called the Pediatric Cardiac Technical Advisory Panel appoint physician experts to visit Florida’s 10 children’s heart surgery programs. They will be able to examine surgical results, review death reports, inspect the facilities and interview employees.

Dr. David Nykanen, the chairman of the advisory panel and a pediatric cardiologist at Arnold Palmer Hospital for Children in Orlando, called site visits “crucially important,” especially when departments are having problems.

He said visits could start within the next six months.

The children’s heart surgery measure passed as part of a larger proposal on health care (HB 843). The original bill on the subject was gutted in the House in late March.

Rep. Mike Beltran, the Lithia Republican who pushed the idea in the House, said he had worked hard to keep it alive. “I am very pleased that we were able to address the problems at All Children’s Hospital by enhancing the Pediatric Cardiac Technical Advisory Panel,” he said.

DeSantis’ office did not respond to requests for comment.

Many hospitals have struggled with pediatric heart surgery, a complicated specialty area that can be very lucrative.

In 2015, St. Mary’s Medical Center in West Palm Beach closed its program amid media reports of a high mortality rate. Earlier this month, North Carolina Children’s Hospital said it would stop performing complex heart procedures. The announcement came after a New York Times investigation revealed that doctors had raised concerns about an increase in deaths.

For All Children’s, the fallout is ongoing.

A recent financial report showed that operating profit for the entire Johns Hopkins Health System fell $31.7 million in the first quarter of 2019 compared to the first quarter last year.

System leaders attributed the 70 percent decline “mainly” to problems in the All Children’s Heart Institute.

The hospital has not yet resumed heart surgeries. The results of a review commissioned by the Johns Hopkins Medicine board are expected soon.

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