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Problems At All Children's Hospital Could Lead To More Transparency Rules

Jan 9, 2019

Johns Hopkins Medicine has hired a former federal prosecutor to investigate the heart institute at All Children's Hospital in St. Petersburg.

The external review was prompted by multiple reports by the Tampa Bay Times about problems at the center which could have contributed to its mortality rate tripling between 2015 and 2017. 

A number of officials left the hospital following the reports. And now there may be change in state policy.

Health News Florida's Stephanie Colombini talked about what could come next with Kathleen McGrory, one of the lead reporters.

This interview has been edited lightly for clarity.

One of the big problems you uncovered in your reporting was the lack of available data about mortality rates at a lot of these heart surgery programs.

Officials have either refused to release it or they only release four-year averages, which could mislead families about the current state of the program they’re choosing.

How is the state looking at making these programs more transparent?

There were some problems at another pediatric heart surgery program in 2015 in Palm Beach County (St. Mary's Medical Center), and after those problems surfaced, the legislature put together a panel (Pediatric Cardiology Technical Advisory Panel) tasked with looking at transparency and ways we could, as a state, make these programs better and more accountable.

That panel is in the middle of doing its work right now and in fact has come close to finalizing some recommendations.

The panel would like all of these heart surgery programs to be reporting their one-year data (on mortality rates) rather than their four-year data because that four-year data can sometimes hide serious problems.

The proposal wouldn’t have to go through the State Legislature, that could go directly to the Agency for Health Care Administration.

ACHA would need to give it a “thumbs-up,” and then it would have to go through the rule-making process. Now we know that the rule-making process is sometimes very slow, so whether or not they could get some type of priority status remains to be seen.

Is there a reason that reporting four-year averages is what is being done right now, is it challenging to release annual data or is this something that could be easily implemented?

That’s a good question, there is a reason for having the four-year rolling averages.

These (heart surgery) programs are often quite small, and I think the thinking behind it was when you are dealing with small numbers, they (health officials) didn’t want it to be that one bad year could really affect an outcome, which on some levels does make sense, but it really does also hide serious problems.

So I think right now the folks on this panel in Florida are kind of having this moment where they are weighing the pros and cons of each and are starting to think now that the more transparency, the better.

Have you heard from other members of the medical field of what they think of this proposal?

In light of everything that's happened at All Children's, I think people in the medical community are thinking about reporting a little bit differently. I mean this is the second time there have been serious issues at a pediatric heart center in Florida in just the past few years.

So whereas in the past maybe people thought the four-year rolling averages method was the best, people are really starting to question that.

For example, there are some places that are already reporting their one-year averages.

We see Nicklaus Children’s Hospital in Miami reporting their pediatric heart surgery outcomes in real-time.

I think the folks there recognize there is some level of risk involved in that, they could take a hard case, they could lose a child and that could then reflect poorly on them. But they believe it’s important for the parents to have the most information that they can so that they can make the best decisions for their children.

So the state is looking into making heart surgery programs more accountable, but is anyone calling for change when it comes to the government’s role in this?

You reported that multiple times state and federal regulators were alerted to problems at All Children’s and yet little, to no action was taken.

We saw U.S. Reps. Kathy Castor and Charlie Crist put some really tough questions to federal regulators asking what they had investigated and when. We haven’t heard back yet on that front but we know it’s something they’ll be looking into.

The state told us that they did the best they could do with the information that they had, same thing with the federal government.

But ACHA has a new chief (Mary Mayhew). We haven’t gotten a chance to connect with her yet and see what her thoughts are on this, but we certainly will do that in the new year.