By Anne Blythe
The North Carolina Children’s Hospital got a bit of good news last week from a state agency that sent a team of investigators on-site for 11 days of questioning and review of the pediatric heart surgery program.
The state Department of Health and Human Services says the program currently is in compliance with U.S. Centers for Medicare and Medicaid Services requirements.
The statement comes almost two months after The New York Times published an investigative story, raising questions about the pediatric congenital heart surgery program, higher than normal death-rates there and concerns that physicians the hospital had in 2016 and 2017 who were wary of sending their patients or own children there for surgeries during that time.
In the wake of the report, which included audio secretly recorded from meetings those cardiologists had with administrators, UNC Health Care announced changes to the program.
Not only had there been staffing changes that preceded the Times’ piece, the UNC Health Care board, which oversees the North Carolina Children’s Hospital, put a halt to performing more complex surgeries in the pediatric cardiology unit.
An external review board was tapped to evaluate the program and new Quality and Safety reporting procedures were put in place.
The external review board has had one telephone conference meeting, according to Alan Wolf, a spokesman for the health care system, and has plans to meet in person soon.
Despite the state health department’s findings, the UNC Health Care system has no plans to schedule those types of surgeries before the external review is complete, according to Wolf.
Articles prompt review
State investigators were at the North Carolina Children’s Hospital for 11 days, interviewing doctors, staff and others about current and past practices.
The first visit was May 30. Investigators were back at the hospital from June 3 to June 7, and again from June 10 to June 14.
In a letter sent to Gary Park, president of the UNC Hospitals, on Aug. 1, Azzie Conley, section chief in the state’s Acute and Home Care Licensure and Certification Section, said the investigation focused on 2016 to 2019 and focused on Conditions of Participation, or COPS, requirements in respect to patient rights, quality assessment and performance improvement, medical staff, nursing, laboratory and surgical services, the governing body and discharge planning.
“Based on the investigative findings and current hospital processes and systems, the survey team did not identify current noncompliance,” Conley stated in the letter.
The UNC Health Care system did not make a statement last week in response to the letter and the state’s findings.
After publication of The NY Times’ story, UNC Health Care officials linked the problems to personality conflicts that no longer were an issue because of personnel changes.
But after state investigators completed their on-site visits at the hospital, UNC Health Care announced additional steps being taken.
In addition to setting up the external advisory board, the Children’s Hospital made mortality data publicly available that they had only been using for internal reviews.
The New York Times sued top UNC officials over the mortality data. In a settlement reached recently, according to The New York Times reporter who broke the story, UNC agreed to pay the news company’s legal fees.
Are two programs too many?
The Times’ report has highlighted the push and pull between operating low-volume pediatric surgery programs, such as the one at UNC, in such close proximity to a similar program at Duke.
The physician in the top post at the North Carolina Children’s Hospital cautioned the pediatric cardiologists pressing UNC administrators for answers in 2016 and 2017 that revenue would be lost if fewer surgeries were performed, according to the tapes obtained by The Times.
It’s unclear whether Duke’s program has seen an increase in pediatric heart surgery patients since the Times’ report and the temporary halt to the more complex surgeries at UNC. It also is unclear whether Duke and UNC have talked about blending their programs since the Times’ article.
“Duke and UNC have a successful record of partnering across many services and programs,” Duke Health officials said in a statement released by Sarah Avery, a spokesperson for Duke Medicine. “We welcome the opportunity to further enhance these relationships with our shared goal of providing the highest quality and safest care for citizens of North Carolina and beyond.”