By Anne Blythe
It’s unclear how long a state health department team will take to investigate questions raised in The New York Times about pediatric heart surgeries performed at the North Carolina Children’s Hospital in Chapel Hill.
State regulators were at the UNC Medical Center on Monday as part of an inquiry launched last week by Mandy Cohen, secretary of the state Department of Health and Human Services.
On May 30, The New York Times published an investigative piece by Ellen Gabler spotlighting high death rates in 2016 and 2017 in the pediatric heart surgery program that so troubled pediatric cardiologists in the department they questioned whether to send their own patients or children there.
As part of their report, the Times obtained secret audio recorded from meetings in 2016 and 2017 in which cardiologists pressed their division chief for answers.
At one meeting, according to the Times, Blair Robinson, a pediatric cardiologist at WakeMed, said: “I ask myself, ‘Would I have my children have surgery here?’ In the past, I’d always felt like the answer was ‘yes’ for something simple. …
“But now when I look myself in the mirror, and what’s gone on the past month, I can’t say that. And if I can’t say it for my kids — and that should be our group discussion — if we can’t all look ourselves in the mirror and think we’re doing the right thing, then we need to change what we’re doing.”
The Times sought risk-adjusted mortality data for the pediatric heart surgeries done on young children with congenital heart defects, statistics that 74 percent of hospitals performing such surgeries report on a Society of Thoracic Surgeons website.
But UNC Health Care did not provide that information, the Times filed a lawsuit in state court seeking the records.
‘Conduct a thorough investigation’
Cohen announced late last week that she had assembled a team from the state Division of Health Service Regulation, which licenses and oversees health care facilities, to “conduct a thorough investigation into these events.” They are coordinating with the U.S. Centers for Medicare & Medicaid Services, a federal oversight agency.
“As a mother and a doctor my heart goes out to any family that loses a child,” Cohen said in a statement released May 31. “Patient safety, particularly for the most vulnerable children, is paramount.”
Cohen said in her statement she could not discuss any ongoing investigation.
Kelly Haight Connor, a spokeswoman for the state health department, said Monday it’s difficult to know how long an investigation will take. In other DHHS investigations, a team often interviews a range of people, from caregivers, staff and those in their care.
Wesley Burks, CEO of UNC Health Care since December 2018 and dean of the UNC School of Medicine, sent a five-paragraph email to staff on May 30 at 10:16 a.m. and attached the Times’ article he described as “critical of UNC Medical Center’s pediatric congenital heart surgery program.”
“While this program faced culture challenges in the 2016-2017 timeframe, we believe the Times’ criticism is overstated and does not consider the quality improvements we’ve made within this program over many years,” Burks wrote in the email. “As the State’s leading public hospital, UNC Medical Center often gets the most complex and serious cases in its pediatric congenital heart program. For many of these very sick children, we are often parents’ last hope.
“Recognizing that the loss of one child is too many, a number of quality improvement measures were implemented over many years.” Burks continued. “In fact, as you know from your own areas, we will forever work on continuous quality improvement (CQI) efforts. In addition to process changes, hospital leadership determined that certain personnel changes were required to improve the culture and new physicians and staff were recruited. All of these efforts have led to improvements in the program’s outcomes.
“UNC Health Care is dedicated to continuous improvement of our programs and the medical outcomes they produce,” Burks said. “We’ve invested significant time and resources in our pediatric congenital heart surgery program and will continue to do so in the future. We are proud of the pediatric congenital heart surgery program, and our team is currently receiving top results that would place us among the best in the nation.”
Melina Kibbe, chair of the UNC department of surgery since July 2016, and Stephanie Duggins Davis, chair of the UNC Department of Pediatrics and physician in chief at NC Children’s Hospital since July 2018, also wrote a response to the Times’ article in an opinion piece published by The News & Observer.
They, too, mentioned “cultural challenges related to personality conflicts and difficult group dynamics” during 2016 and 2017 and noted the turnover and new leadership since then.
On Monday, UNC Health Care spokesman Phil Bridges released a “timeline of Continuous Quality Improvement within the program over the past 10 years.”
The timeline mentions a four-month period from June to September in 2016 in which “concerns and allegations against specific individuals in the Congenital Heart Program” were “independently investigated and reviewed” by the dean’s office and the chief medical officer.
“Allegations of misconduct and concerns determined to be unfounded,” the document states, adding “allegations against specific individuals and results of the investigations constitute personnel records, which may not be disclosed,” citing public records law.
An ongoing initiative, according to the document, calls for a Department of Pediatrics review after every death in the Pediatric Intensive Care Unit, including pediatric cardiac patients, to assess the care provided and evaluate any opportunities for improvement.