Posted by Bill Sandweg on 03 June 2019.
Over the years I have discussed a number of topics which relate to patient safety. These include secrecy, money, training, medical ethics, and surgical experience. Every once in a while a story comes along which touches on all of these topics. Last week such a story appeared in the New York Times. I hope you can use this link to read the story. Although it deals with pediatric heart surgery in North Carolina, it has application everywhere, including here in Arizona.
In 2016, pediatric cardiologists at the University of North Carolina Children’s Hospital began to have grave concerns about the quality of the surgeries being performed at their hospital. (Although cardiologists are heart doctors, they do not perform surgeries. That is the role of pediatric heart surgeons.) Children undergoing heart surgery at the their hospital were dying at an unacceptably high rate. They complained about it and wondered if their medical ethics permitted them to continue to recommend their pediatric patients have surgery at the hospital, as opposed to sending them somewhere else where survival rates were higher.
Secrecy: While the pediatric cardiologists had concerns and tried to do something about them, there is no indication in the Times story that the parents of their tiny patients were told of these concerns or of the higher than normal death and complication rates at the hospital. To the contrary, the hospital refused to disclose to the public its mortality and complication rates, even though many of the best hospitals in the country do disclose this information. Without the mortality and complication information, parents had no way of knowing that they were placing their children at risk by allowing their surgeries to be performed at this hospital.
Hiding information about surgical outcomes for Medicare patients does not happen as hospitals are required to provide it to Medicare, which publishes it. This is not the case for non-Medicare patients and many hospitals, especially those with substandard outcomes, keep that information a closely guarded secret. After all, who would want to come to one of these hospitals, if they knew there was a safer alternative nearby? Who would want to come even if the safer alternative was in another city? How far would you take your child to increase the chance he or she would have a successful surgery?
According to the Times’ article, two hospitals in Arizona do not report data on their pediatric heart surgeries. They are both Banner Health hospitals. The two are Banner University Medical Center Tucson and Banner Cardon Children’s Medical Center in Mesa. Since the data is regularly reported by most successful hospitals throughout the United States, you have to ask yourself two questions: Why won’t these two hospitals disclose their data and do I want to take my child for heart surgery to a hospital that won’t tell me how their patients do? Given the propensity of hospitals to brag about whatever they do that is good, you have to be concerned about this refusal to provide the data.
Experience: The Times’ story pointed out that the more pediatric heart surgeries a hospital did, the more successful its outcomes. This is true across the board when it comes to surgery and is not limited to pediatric heart surgery. Practice does indeed make perfect and the more operations a surgeon performs, the better she and her operating room team do. The more surgeries done at a hospital, the better the post-surgical care is likely to be as well.
Money: At the University of North Carolina Children’s Hospital, they were doing far fewer pediatric heart surgeries than the most successful hospitals in other states. Why didn’t they let another hospital in the state take over these cases? The answer is that surgeries and post-surgical care are big money makers for a hospital. Having a pediatric heart surgery program is also a reputation builder for hospitals. It is very difficult for hospitals to refuse these opportunities to make money, even when patient welfare suggests they should send these patients elsewhere.
After reading the Times’ story, it is hard to escape the conclusion that when the administrators at the North Carolina Children’s Hospital were faced with troubling problems in their pediatric surgery program that would take years to fix, they sacrificed patient safety to keep the money and prestige of the program. They say their program is better now but still refuse to release all the data backing up their claim. Even if the program is better now, that is cold comfort to the parents whose children died while undergoing heart surgery during the troubled period at the hospital.
After reading this story, I am left with feelings of helplessness and anger. Money and secrecy took precedence over patient safety and there is little the government, the hospitals, or the medical community are willing to do to put an end to it. There is little patients can do when hospitals hide their data. I guess the best advice is to go only to hospitals that are transparent about their surgical successes and failures and choose those which are most successful. Good luck.
June 17, 2019
After word leaked out about the problems it was having with its pediatric heart surgery program, the North Carolina Children’s Hospital has announced that it will suspend heart surgeries for the most complex cases in an effort to restore the confidence of the public in its program.