North Carolina Children’s Hospital announced it would suspend heart surgeries for the most complex cases, some of which had a mortality rate approaching 50 percent in recent years, pending investigations by state and federal regulators and a group of outside experts.
In a statement on Monday, UNC Health Care, which runs the hospital and is affiliated with the University of North Carolina, also introduced several initiatives to “restore confidence in its pediatric heart surgery program.” These include creating the external advisory board of medical experts to recommend improvements, and committing to publicly release mortality data for that program, which it has refused to do in past years.
The actions are in response to a New York Times investigation last month into the medical institution, where cardiologists, department leaders and even the former head of the children’s hospital expressed concerns about patients faring poorly after heart surgery there. Secret audio recordings provided to The Times captured doctors talking openly, some even saying they might not feel comfortable allowing their own children to have surgery at the hospital.
The Times sued for the program’s mortality data and was still in a yearlong legal battle to obtain it when UNC Health Care released previously undisclosed statistics on Monday. The data shows that the mortality rate for heart surgery patients continued to rise after doctors warned administrators several years ago of possible problems.
[Read the Times investigation into North Carolina Children’s Hospital.]
The data, for four years through December 2018, showed that the hospital’s mortality rate for pediatric heart surgery was higher than those of most of the 82 hospitals in the United States that publicly report such data. The death rate at the North Carolina hospital was especially high among children with the most complex heart conditions — nearly 50 percent, the data shows. Those are the types of cases that some doctors had urged the hospital to temporarily stop handling in 2016 and 2017.
UNC administrators previously denied that there were any problems affecting patient care in the heart surgery program, saying only that there had been difficult team dynamics at the time of the doctors’ warnings, and that they had since been resolved by staffing and leadership changes.
Concerns about the quality of pediatric heart surgery programs have been noted at hospitals across the country. At least five programs were suspended or shut down in the last decade after questions were raised about their performance. At least a half-dozen hospitals have merged their programs with larger ones to achieve more consistent results. And more institutions are considering such partnerships.
After the Times article was published, the North Carolina secretary of health opened an investigation into the children’s hospital. In addition to an on-site investigation that finished on Friday after more than two weeks, state regulators have reached out to former UNC medical staff, asking to meet and interview them about concerns they had while employed there.
A spokeswoman for the state health department said it would submit a report to federal regulators from The Centers for Medicare & Medicaid Services within 10 business days.
In the statistics released on Monday, UNC Health Care included for the first time the hospital’s risk-adjusted data. Risk-adjustment helps account for prematurity, some genetic abnormalities and other factors that could make a child less likely to survive, and to more fairly assess hospitals that take on the most compromised patients. The statistical method also helps evaluate if hospitals are losing patients who wouldn’t be expected to die.
The health system first told The Times it was “critically important” to use risk-adjusted data, but then later released only raw, unadjusted numbers. The hospital subsequently said that no current risk adjustment adequately accounted for the breadth and severity of its patients’ medical issues.
The hospital’s overall mortality rate for pediatric heart surgery in the four years ending in 2018 was 5.4 percent, compared with a national average of 2.8 percent. The hospital’s risk-adjusted mortality rate was 5.6 percent.
Mortality rates for the most complex cases at UNC were especially high: 58.3 percent, or seven deaths out of 12 surgeries; the risk-adjusted mortality rate was 47.4 percent. The national rate for the most complex surgeries was 14 percent.
About three-quarters of the roughly 115 hospitals that perform pediatric heart surgery in the United States publicly share their mortality statistics on a website run by the Society of Thoracic Surgeons. In its statement on Monday, UNC said it would publicly report its data through the site in the future.
The hospital maintains that it is “extremely difficult to evaluate a surgical program’s success” based solely on the data, but said it was releasing the figures to “help restore public confidence in the program.”
In the statement, the hospital said that personnel changes and other improvements had helped make the heart surgery program “very strong” today, with a mortality rate of 3 percent over the past 11 months.
In addition to convening a group of outside experts, UNC said it would create a family advisory council to provide feedback to hospital leaders and would develop a new system for quality and safety reporting to keep administrators and UNC’s board of directors better informed.
The hospital said it would also complete a planned investment of $10 million dollars into the program over three years.
Charlie Owen, chairman of the board, said in a statement that while the medical system and the board “have strong confidence in our extraordinary current pediatric heart surgery team, we believe it is vitally important that both current and future patients, our medical colleagues, key regulators and the public share this confidence.”
Dr. Wesley Burks, chief executive of UNC Health Care, said the hospital would resume the most complex surgeries only after regulators and the doctors on the external advisory board agreed it was appropriate.
In an editorial after the Times investigation, The News & Observer, a newspaper in Raleigh, wrote that it would “take leaders outside of the self-serving ranks of UNC’s leadership to crack its culture of arrogant denial and bring it back to being a servant of the people.” The newspaper raised the question of whether Dr. William L. Roper, who served as chief executive of UNC Health Care and UNC Hospitals through 2018, “was part of the problem or can be part of the solution.”
Dr. Roper is a member of the medical system’s board of directors.
The secret recordings provided to The Times offer an inside look at the hospital, where doctors suspected for years that children undergoing surgery for complex conditions were dying at higher-than-expected rates. By 2016, they were also concerned about lower-risk patients who had unexpected complications. The cardiologists had tried to get mortality data to help them decide where to refer patients. But the hospital didn’t have the information to share at the time, even internally.
In the recorded meetings, hospital leaders acknowledged that the cardiologists weren’t the only ones with concerns.
“We are in crisis, and everyone is aware of that,” Dr. Tim Hoffman, the chief of pediatric cardiology, said in one 2016 meeting.
Later, Dr. Kevin Kelly, the head of the hospital at the time, told cardiologists to “do what your conscience says” when referring patients, according to one of the recordings.
But, he warned, performing fewer surgeries at UNC could hurt revenues and lead to job cuts. “If it reduces the volume of things,” he said, “I’ll just — we’ll just reduce the number of people that we have.”
The cardiologists — who diagnose and treat heart conditions but don’t perform surgeries — could not pinpoint what might be going wrong, but considered everything from inadequate resources to misgivings about the chief pediatric cardiac surgeon to whether the hospital was taking on patients it was not equipped to handle.
