Shadow Emergency Physicians Las Vegas Nv - Bad things happen that you can't explain. "We have to be honest with the patients," he said. Now it's a nightmare. "
A secret recording captured doctors' concerns that many children looked worse after heart surgery. Their hospital went ahead with the operation.
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Tasha and Thomas Jones sit next to their 2-year-old daughter as she receives treatment at Children's Hospital of North Carolina. Her parents were told that Skyler had just come out of heart surgery and should be on the mend. But that night she was down. Doctors and nurses crowded around her, compressing her chest for almost an hour before they put the little girl on life support.
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Five days later, in June 2016, pediatric cardiologists at the hospital met downstairs for an awkward conversation. Some doctors suspect that patients with critical conditions have died at a higher rate than expected in recent years. Now, even children like Skyler, who undergo surgeries that can be dangerous, are not doing well
As cardiologists press their bosses about what's happening at the hospital, part of the prestigious University of North Carolina Medical Center in Chapel Hill, they are struggling to decide whether to continue sending patients to UNC for heart surgery.
But now when I look at myself in the mirror, and what's been going on this past month, I don't know And if I can't say this to my kids -- and that should be our group discussion -- if we can all look in the mirror and think we're doing the right thing, then we have to change. to do
That same March, the baby died after surgery that was found to have destroyed a muscle in his heart. At least two patients who underwent minimally invasive surgery experienced complications. In May, a baby girl with a heart attack died two weeks after surgery. Two days later, Skylar went into surgery.
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Dr. Timothy Hoffman, chief of pediatric cardiology at the doctors' meeting, was unclear. "It's a nightmare right now," he said. We are in trouble and everyone knows it. "
Those comments and more — captured in a confidential audio recording provided to The New York Times — offer a rare, unsolicited look inside the medical establishment as doctors shirk their ethical obligations to patients while their bosses worry about harming surgical plans.
At meetings in 2016 and 2017, all nine cardiologists expressed concern about the program's effectiveness. According to the recorded report, the head of the hospital and other leaders there were also shocked. Cardiologists—those who diagnose and treat the heart but don't perform surgery—can't pinpoint what might go wrong in an accurate system that includes surgeons, anesthesiologists, palliative care physicians and support staff. But they discussed issues ranging from a lack of resources to misunderstandings about a senior pediatric heart surgeon and whether the hospital is accepting patients. Many doctors began to send more children to other places for surgery.
The cardiologists asked to review the Institute for Cardiac Surgery's death statistics - data that other hospitals do - but said they had not been able to get them for several years. Last month, after repeated requests by The Times, UNC released limited data showing that its death rate for the four years to June 2017 was higher than that of about 82 institutions nationwide that reported publicly.
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UNC Health Care defends the surgery plan, describing it today as "very robust" and citing its latest data to support it. It discards any past problems with patient care. Benny Joyner, chief of critical care at Children's Hospital. Risk, low risk, no risk. "
Some managers said in joint interviews that in 2016 there was an "anti-social group" that sowed distrust and created "group culture problems." "They were handled appropriately and we have new team members today," department spokeswoman Lisa Schiller said in a statement. UNC has cited leadership changes — most of which take effect in 2017 or 2018 — including the hiring of a surgeon general last year to help improve capacity.
The unrest at UNC raises concerns about the quality and consistency of care provided by dozens of pediatric heart surgery programs across the country. About 40,000 babies are born with heart problems in the United States each year; About 10,000 need surgery or other procedures before their first birth
The best outcomes for patients with complex heart disease are associated with hospitals that perform the highest volume of surgeries -- several hundred a year -- the study found. But the proliferation of surgical programs has made it difficult for many institutions, including UNC, to reach that number: North Carolina hospitals do about 100 to 150 a year. The researchers found that low numbers could leave surgeons and staff at other hospitals with insufficient knowledge and resources to provide adequate results and services.
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“We can do better. And it's not hard to do, said Dr. Carl Backer, former president of the Society of Congenital Heart Surgeons, who works at Lurie Children's Hospital in Chicago. "There is no need for us to build new hospitals. We don't need to build new ICUs We just need to move patients to the most suitable facilities. "
Children's Hospital of North Carolina, part of the University of North Carolina Medical Center, performs approximately 100 to 150 pediatric heart surgeries per year.
Studies have shown that the best outcomes for patients with complex heart disease are associated with hospitals that perform the highest volume of surgeries -- several hundred per year.
At least five pediatric heart surgery programs across the country have been suspended or closed in the past decade; In 2018, the Tampa Bay Times reported that the Florida facility, operated by the prestigious Johns Hopkins Medical System, had ceased operations. And many institutions are considering such relationships
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There is no way to know if Skyler or the other patients at the North Carolina hospital would have been treated or fared better elsewhere. Surgery to repair a child's heart can be dangerous, and death and some complications are inevitable. But doctors and advocates have called for more transparency about the outcomes of pediatric heart surgery, so that facilities can feel pressure to improve and parents can better assess their child's care.
About 75 percent of the 115 hospitals that perform pediatric heart surgery in the United States publicly share their death statistics on a website maintained by the Society of Thoracic Surgeons. UNC is not among them
That information is being processed to allow hospitals to carefully screen immature patients, other genetic diseases and other factors that can reduce a baby's chances of survival, and high-risk patients. Statistical methods also help assess whether hospitals are losing patients who are not expected to die. Although there is debate about whether the data fully captures the complexity of heart surgery, many experts say it is a strong indicator of hospital performance.
"You should think twice about going to an institution that does not report publicly," said Dr. Backer. People don't buy cars without knowing the gas mileage. "
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UNC Health Care says using mortality data is not an accurate way to evaluate its surgical program. The health system initially told the Times that using risk-adjusted data was "very important," but later released the raw and random numbers. The hospital later said no current risk adjustment adequately accounted for the scope and severity of patients' medical problems. The Times sued UNC over compromised data.
This account is drawn from nearly two dozen interviews with UNC doctors and nurses from multiple departments, as well as patients' families and doctors from other institutions. Others spoke on condition of anonymity because they feared UNC would retaliate. The Times also reviewed emails, state death records, medical records and audio recordings, which found the facility was not responding to public concerns about the surgical program.
The recordings captured hours of cardiology department meetings and other discussions witnessed by multiple participants. The Times provided UNC with transcripts of relevant parts of the interview and some audio clips, but did not share the full recording to protect the identity of the person who provided it.
UNC said it would not comment on the Times' findings without having a chance to hear the tapes. The chief surgeon at that time was Dr. Michael Mill; Dr H Hoffman; And four other cardiologists remaining at the hospital have declined for similar reasons. Dr. Kevin Kelly, who led the children's hospital until he retired last year, did not respond to repeated requests for comment.
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In 2016, he met a cardiologist, who immediately discussed his problem
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