Johns Hopkins All Children’s faces record state fines

The planned $800,000 penalty is the latest fallout from problems in the hospital’s heart surgery department.
State regulators plan to fine Johns Hopkins All Children’s Hospital in St. Petersburg a total of more than $800,000.
State regulators plan to fine Johns Hopkins All Children’s Hospital in St. Petersburg a total of more than $800,000. [ SCOTT KEELER | Times ]
Published Sept. 7, 2019

State regulators intend to hit Johns Hopkins All Children’s Hospital with some of the largest fines levied against a Florida hospital in recent memory, delivering a stinging rebuke to the prestigious institution.

The fines will add up to $804,000.

Four of them are for $197,000 — each more than twice as much as any other individual fine the state Agency for Health Care Administration has levied on a hospital since 2010, a Tampa Bay Times analysis of published state records shows.

The agency says the fines will be issued “shortly” and they will not be negotiated. The hospital can still appeal.

The extraordinary action comes nine months after the Times unearthed problems in the hospital’s heart department that had caused an increase in the death and complication rates.

The St. Petersburg hospital has suspended heart surgeries while it restructures the unit.

“When deficient practices are identified we will act swiftly to hold the facilities we license and regulate accountable,” Agency for Health Care Administration Secretary Mary Mayhew said in a statement. “Parents should have the peace of mind when their children are admitted to a hospital that the facility, doctors and attending staff are providing the highest quality care.”

The hospital did not respond to repeated requests for comment Friday. In financial filings published Aug. 29, its parent company, the Johns Hopkins Health System, said it had been notified of a potential fine and the violations had been corrected.

The Times found that surgeons in the hospital’s Heart Institute made serious mistakes and their procedures went wrong in unusual ways. It also found that the hospital continued to perform heart surgeries for years after frontline workers raised safety concerns to their supervisions.

RELATED COVERAGE: Johns Hopkins promised to elevate All Children’s Heart Institute. Then patients started to die at an alarming rate.

After the report published, federal regulators identified broader issues with quality and infection control, as well as the hospital’s leadership structure and its hiring and firing processes. The findings constituted “an immediate or serious threat to patient health and safety,” and the federal government threatened to withhold public funding if all problems were not immediately addressed.

RELATED COVERAGE: New federal report details widespread problems at All Children’s

The state can revoke or suspend a hospital’s license, but mostly enforces its rules through citations and fines.

State regulators performed multiple inspections this year. They plan to fine All Children’s for infractions ranging from poor infection control to failure to secure oxygen tanks to their carts. (Johns Hopkins Health System President Kevin Sowers likened an exploding oxygen tank to a “missile” at an employee town hall earlier this year.)

The four largest fines will be for the hospital’s failure to track quality-of-care data, and because the hospital’s board did not have management structures in place to ensure patient safety and physician competence.

State records show six-figure fines are extraordinarily rare. The largest single fine state regulators have imposed on a hospital is $75,259, according to the records the state posts online, which are incomplete before 2010.

That fine went to a Panama City hospital that filed its audited financial statement more than a year late.

The fines against All Children’s won’t be the first action the state has taken against the hospital for the problems in its heart unit. Earlier this year, the hospital was fined for not reporting nine cases in which its care hurt patients.

The penalties for those infractions could have reached into the millions, the Times reported in March. Instead, they added up to $4,500.

An outside expert who reviewed the earlier fines for the Times described the total amount as “lunch for an executive meeting.”

RELATED COVERAGE: Florida could have fined All Children’s millions for late reports. It went with $4,500.

Even though the new round of fines will be much larger, they pale in comparison to both the hospital’s budget and the amount it has already spent dealing with the fallout from the Heart Institute.

To date, the hospital has agreed to nearly $43 million in settlements with the families of children who died or were hurt in the unit.

That includes two additional settlements beyond those previously reported.

The family of a child who died after heart surgery will receive $750,000, records show. The family of a child who had a needle left in his body during surgery will receive $50,000.

Last month, the Times reported that two other families received eight-figure settlements. Both are caring for children who were permanently disabled after the procedures they underwent went wrong.

More agreements are expected. The hospital has declined to comment on the settlements, citing patient privacy.

Separately, the state agency that regulates doctors filed an administrative complaint against one of the surgeons in the Times report.

The complaint alleges that Dr. Tom Karl left a needle in a 3-month-old boy’s body following a 2016 surgery. The needle was removed during a subsequent surgery more than a year later.

The Times in April 2018 reported on a different case in which Karl left a needle in a patient. In that case, the patient was a newborn girl who had heart surgery in 2016. The girl’s mother told the Times she had demanded Karl remove the needle, but he said it didn’t exist. The needle was later removed during a surgery at St. Joseph’s Children’s Hospital.

Under Florida law, leaving a surgical instrument in a patient’s body is grounds for disciplinary action. The penalty for a first offense could include mandatory education, a letter from the state Board of Medicine, a fine of up to $10,000 or license revocation.

Karl, who left the hospital last year and now lists his address in California, could not be reached for comment.

Florida Department of Health spokesman Brad Dalton said Karl had elected to contest the charges and have a hearing in front of an administrative law judge.

RELATED COVERAGE: Read all the Times’ stories on the All Children’s Heart Institute.