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Editorial: Johns Hopkins All Children's Hospital owes Tampa Bay answers

 
Published Dec. 7, 2018

Johns Hopkins All Children's Hospital owes some answers to the community that has supported it for generations. The stunning death rate of patients in the St. Petersburg hospital's pediatric heart surgery unit, the documented errors by the program's surgeons and the administration's inadequate response to safety concerns require a candid response and a clear plan forward. One positive step would be more disclosure about what went wrong, because whether it's fair or not the revelations about the heart surgery unit stain the reputation of an entire hospital that remains a highly regarded community asset.

A Tampa Bay Times investigation by staff writers Kathleen McGrory and Neil Bedi details serious problems in the All Children's Heart Institute that were hidden from the public. Nearly one in 10 patients died last year, with the mortality rate tripling since 2015 and becoming the highest of any pediatric heart program in Florida. The investigation found surgeons repeatedly made serious mistakes: needles were lost in at least two infants' chests. Sutures burst. Infections mounted. Johns Hopkins' handpicked administrators disregarded safety concerns the program's staff raised as early as 2015. Parents were kept in the dark about the institute's troubles, including some that affected their children's care. It's a deeply disturbing portrait of a program that was in serious trouble even as the St. Petersburg hospital promoted it internally and aggressively marketed it externally.

THE LATEST: State, federal officials missed warnings at All Children's heart unit

Inside All Children's, the Heart Institute's problems should have been clear for years. In 2015, four physician assistants who worked in the operating room called for a meeting with their supervisor and the chief of surgery and expressed doubts about the surgical abilities of two surgeons, Dr. Jeffrey Jacobs and Dr. Tom Karl. Four other medical professionals working in the institute told the Times they were worried about patient safety and met with hospital officials in 2015 or 2016. For much of 2017, All Children's CEO Dr. Jonathan Ellen told the Times this spring, the hospital had been performing only low-complexity heart operations. But records and interviews show the hospital couldn't handle less complicated cases, either. The hospital now says it halted all pediatric heart surgeries in October and is conducting a review of the program.

If those surgeries resume, they should not commence until there is an independent investigation by state or federal regulatory officials. The hospital also has to explain what happened to the Tampa Bay community that has supported it for so long, and it has to be less defensive and more open. It can start to rebuild that trust by releasing a review of the heart surgery unit that All Children's sought in November 2017 by a team from the top-ranked Texas Children's Hospital. It also should release the results of its ongoing review and clarify the status of the surgeons who were performing the operations before the surgeries were halted.

All of the answers should not come from St. Petersburg. They also should come from Baltimore. That's the home base for Johns Hopkins, which took control of All Children's in 2011 and by the end of 2012 sent Ellen to be the CEO and Dr. Paul Colombani to be the chief of pediatric surgery. The issues in the Heart Institute occurred after Johns Hopkins took control, after the administration changed the way cases were distributed among surgeons, after Johns Hopkins let relationships with teams of private-practice cardiologists and critical care doctors fall away as it preferred to use its own employees. The problems in St. Petersburg are problems for Baltimore and for Johns Hopkins' international reputation for quality.

All Children's isn't the first hospital to experience difficulties with pediatric heart surgeries. But the Times investigation reveals a systemic failure that played out over years. Ellen indicated this spring the Heart Institute's "challenges'' were under control. Now the surgeries have been stopped. The community that has trusted All Children's for generations deserves answers about what went wrong and the plan to restore that trust.