Heartbreaking investigations report on pediatric cardiac surgery

A medical helicopter lands at the University of North Carolina Medical Center at Chapel Hill. (William Yeung/Flickr)

By Meryl Kornfield

In an investigation by The New York Times published May 30, reporter Ellen Gabler takes readers into the room where pediatric cardiologists alarmingly question the mortality rates of North Carolina Children’s Hospital at the University of North Carolina medical center in Chapel Hill — a respected program by all standards.

Screenshot of The New York Times’ investigation of the University of North Carolina medical center in Chapel Hill.

Audio obtained by Gabler and The Times reveals serious concerns doctors shared during meetings in 2016 and 2017, including the division’s chief who can be heard saying: “Our house is in total disarray. This is crazy what we’re doing. I should be as pissed as anybody, and in fact maybe more.” The article details internal squabbles as children died from complications after surgeries — some of which had low mortality rates or were considered relatively safe.

UNC’s program is not the first to be impugned; the Times reported at least five U.S. pediatric heart surgery programs were suspended or closed within the last decade after their performance was questioned. A Tampa Bay Times’ 2018 investigation into All Children’s Heart Institute launched state and federal investigations into the Johns Hopkins program in St. Petersburg, Florida. The newspaper found that nearly one in 10 patients died, the highest mortality rate in Florida.

Both journalistic inquiries not only illustrate the harrowing stories of parents who lost their infants and children in the operating rooms of award-winning hospitals but also seek to prompt greater transparency about the pediatric heart programs’ successes or failures. The New York Times has since sued the North Carolina hospital after it refused to release risk-adjusted mortality data, which accounts for factors that could affect a child’s survival in surgery. In Florida, state lawmakers considered legislation that would broaden oversight, but it never reached the governor’s desk.

Still, the cases of both hospitals differ. While the Florida hospital began reducing the number of risky surgeries it did at the earliest indications of concerns, UNC’s Dr. Kevin Kelly, who led the North Carolina hospital until retiring last year, warned in internal meetings that performing fewer surgeries would cost the cardiologists their jobs. All Children’s found that its staff erred in more than a dozen cases. Meanwhile, UNC told The New York Times it investigated itself and that “criticism of the program was found to be unsubstantiated.”

Sources in the New York Times’ story, including a former president of the Congenital Heart Surgeons’ Society, Dr. Carl Backer, suggest hospitals with more surgical cases gain better experience and skills at performing others. However, Backer, who researched the locations of hospitals that offer these surgeries, said their regional proximity means they compete to treat the same patients. According to Backer’s study, 66 percent of the hospitals doing the surgeries were within 25 miles of another one. The New York Times estimates 115 hospitals perform pediatric cardiac surgeries. Even one of the doctors mentioned by the Tampa Bay Times was quoted by another Florida newspaper a year before the investigation about a different hospital, questioning why Orlando had three hospitals with pediatric heart surgery programs.

Because The New York Times investigation was only just released, it remains to be seen what impact, if any, it will have on UNC’s operations. Prior investigations have closed programs. Mortality rate data from 75 percent of the 115 hospitals with these programs is accessible at the Society of Thoracic Surgeons’ website.