Chasing profits, Pope’s hospital put children at risk
Doctors and nurses at the Vatican’s showcase pediatric hospital were angry: Corners were being cut. Safety protocols were being ignored. And sick children were suffering. The Vatican’s response was swift. A secret three-month investigation in early 2014 gathered testimony and documentation from dozens of current and former staff members and confirmed that the mission of “the pope’s hospital” had been lost and was “today more aimed at profit than on caring for children.”
What happened next surprised many involved: The report was never made public. While some of the recommendations were carried out, others were not. And the Vatican commissioned a second inquiry in 2015 that after a three-day hospital visit - concluded nothing was amiss after all. An Associated Press investigation has found that Bambino Gesu (Baby Jesus) Pediatric Hospital, a cornerstone of Italy’s health care system, did indeed shift its focus in ways big and small under its past administration. Under leadership that governed from 2008 to 2015, the hospital expanded services and tried to make a moneylosing Vatican enterprise turn a profit - and children sometimes paid the price.
Among the AP’s findings: Overcrowding and poor hygiene contributed to deadly infection, including one 21-month superbug outbreak in the cancer ward that killed eight children. To save money, disposable equipment and other materials were at times used improperly, with a one-time order of cheap needles breaking when injected into tiny veins. Doctors were so pressured to maximize operating-room turnover that patients were sometimes brought out of anesthesia too quickly.
Some of the issues - such as early awakening and the focus on profits - had been identified in 2014 by the Vatican-authorized task force of current and former hospital doctors, nurses, administrators and outsiders. The AP corroborated those findings through interviews with more than a dozen current and former Bambino Gesu employees, as well as patients, their families and health officials. The AP reviewed medical records, civil court rulings, hospital and Vatican emails, and five years of union complaints.
Bambino Gesu disputed the AP’s findings and threatened legal action. It said the AP investigation was based on information that was “in some ways false, in other ways seriously unfounded and out of date by two years but above all clinically implausible and defamatory on a moral and ethical level.” The hospital cited its reputation as a center of excellence. It draws top-notch surgeons to work there and celebrity visits, including one by US First Lady Melania Trump in May.
Bambino Gesu also pointed to the Vatican’s second investigation, led by American Catholic health care expert Sister Carol Keehan, as evidence that the allegations were false. “While there are many things we could have missed or been misled about, we came away from this evaluation with a real sense that on the major charges and the major issues alleged, we have been able to disprove them,” Keehan’s report said.
Facts are hard to come by in the secretive halls of Bambino Gesu, which does not make public financial details or its mortality and infection rates. Perched on a Roman hillside just up the road from Vatican City, the private hospital sits on Holy See territory and enjoys the same extraterritorial status as a foreign embassy - making the Italian taxpayer-funded institution immune to the surprise inspections other Italian hospitals undergo. It is financed by Italy’s public health system, but its main campus isn’t even technically in Italy.
A myth has fallen
There is no indication that the Vatican ever shared the results of either in-house investigation with the Italian health ministry, which in 2015 reported that the hospital offered quality care “in such a way that assumes characteristics of excellence.” Provided with AP’s findings in December, the health ministry promised to investigate. “If this is true, a myth has fallen,” the ministry’s then-spokesman Fabio Mazzeo said. “We have to verify.” Mazzeo’s successor, reached in June, said he had no further information, saying the hospital belongs to the Vatican.
All of the hospital employees who talked to the AP spoke on condition of anonymity, fearing they would lose their jobs if their names were used. Out of concern for the children, they said, they broke what the hospital’s union has called the “omerta,” the Italian code of silence Staff members told AP that some of the conditions they first reported in early 2014 have improved since the surprise resignation of Bambino Gesu’s president in 2015.
The new administration, they said, focuses less on volume and shows more respect for protocols. But some of the task force’s most important recommendations have not been implemented, including the replacement of Bambino Gesu’s medical director. And in its July 2016 newsletter, the hospital’s main union said problems remain.
“Ten years ago, the ERs were jammed and they still are. Ten years ago, patients waited on stretchers and they still do. Ten years ago you entered with one illness and left with two hospital infections, and still do,” it wrote. “What has changed in 10 years? The machines are better, the pharmaceuticals are better, but the level of care is not.” Pope Francis himself used the occasion of a 2016 Christmas audience with thousands of hospital staff members and patients to exhort Bambino Gesu not to fall prey to corruption, which he called the “greatest cancer” that can strike a hospital.
“Bambino Gesu has had a history that hasn’t always been good,” the pope said, jettisoning his prepared remarks to decry the temptation to “transform a good thing like a children’s hospital into a business, and make a business where doctors become businessmen and nurses become businessmen, everyone’s a businessman!” “Look at the children,” Francis said in Italian, pointing to the young patients gathered at his feet in the Vatican auditorium. “And let each one of us think: ‘Can I make corrupt business off these children? No!’”
Produce, produce, produce
The sequence of events that resulted in the two investigations began in early 2014, when the Vatican began receiving reports that the quality of care was suffering under the hospital’s then-president, Giuseppe Profiti. Since he was appointed in 2008, Profiti’s administration had been focused on boosting volume and opening satellite branches around southern Italy while cutting costs. Vincenzo Di Ciommo Laurora, a retired Bambino Gesu epidemiologist, described the hospital’s culture at the time this way: “The more you do to a patient, the more money you bring in. You have to produce, produce, produce.”
As part of an unrelated study, he reviewed the charts of 11 cancer patients who had died and said he was struck by the “extreme number of medical interventions,” including kidney dialysis performed on children who were nearly dead. “When these children don’t have any organs working, when nothing is working, when they’re full of infection, should we continue to do dialysis and heroic therapies?” he asked. His concern reflected a long-standing ethical debate about when palliative care is more appropriate for terminally ill children - a debate that can be even more acute in a Catholic hospital.
Founded in 1869 by a Roman noble family to treat poor children, Bambino Gesu was donated to the Vatican in 1924 and has grown to become the main pediatric hospital serving southern Italy. In 2015, the 607-bed facility performed over 26,000 surgical procedures more than a third of all children’s operations nationwide. The Italian health service reimburses it for most of its services and a leaked audit reported that, in 2012 alone, the hospital received reimbursements and research grants that totaled 270 million euros ($290 million).
One of the main areas of expansion during the Profiti administration was in transplant services and oncology, where thousands of children have been successfully treated. But in 2011, a 4-year-old with acute leukemia caught an infection, an extremely drug-resistant form of Pseudomonas aeruginosa, one of the leading causes of blood infections and pneumonia in hospitals. The outbreak infected 27 children and wore on for 21 months - from March 2011 to December 2012 - before the hospital brought it under control.
Eight children dead
By then, eight children were dead. “All wards of the onco-hematological department were involved,” Bambino Gesu staff wrote in 2014 in the journal BMC Infectious Diseases. The bug’s spread, they wrote, could have stemmed from the “hands of health care workers or use of non-critical medical equipment” a clear violation of good hygiene practice.
All hospitals have problems controlling infections, many are plagued by overcrowding and even the best struggle to contain outbreaks of drug-resistant bacteria. But several experts contacted by AP called the Bambino Gesu outbreak “extreme,” unusual in its duration and rare for this particular strain to be found in children. Nigel Brown, an emeritus professor of microbiology at the University of Edinburgh, said the problem should have been identified “within a matter of days” and that more aggressive management could have quickly confined the outbreak.
In a statement, the hospital said it was “absurd and specious” to cite the outbreak against the hospital, calling its infection control achievements “an example of good practice.” The hospital said it had successfully brought infection rates under international and national benchmarks in recent years, though it doesn’t publish the information in its annual reports. Bambino Gesu’s union, a branch of Italy’s largest trade association CGIL, has repeatedly complained about hygiene problems, noting that the hospital has gone through five cleaning firms in as many years with unsanitary results.
In its November 2014 monthly magazine, the union noted that the neonatal surgery ward had “sadly become famous” internally for its rates of infection and death. Part of the problem, the union said, was the route some staff would take from the changing room to the ward. “The path they have to take is equivalent to an open sewer, past garbage bins where various types of refuse are positioned,” the union wrote the previous month. “And we ask why hospital infections increase? If even such a simple problem is ignored, imagine those that are more complicated.”
In 2011, pharmacist Eugenio Ciacco wrote the hospital president to alert him that the pharmacy had stopped sterilizing needles and other equipment properly, a practice Ciacco said was leading to “extreme danger for the health of our young patients.” In 2013, the hospital was ordered by Rome’s civil tribunal to pay 2.2 million euros to a family whose child was left partially paralyzed and brain-damaged by a hospital-borne infection in 2006 that wasn’t diagnosed or treated quickly enough.
Staffers in the pharmacy reported other concerns: One told AP two common antibiotics intended to be consumed within a few hours sometimes were used for up to two days to save money. Overcrowding and hygiene problems were still an issue in October 2015 when Federica Bianchi’s 17-month-old son Edoardo was treated for breathing problems in an ER examination room where she said other children had been receiving intravenous rehydration drips. Two days later, Edoardo began suffering bouts of severe diarrhea and vomiting. — AP
Pope Francis is surrounded by children as he speaks with patients and caregivers from the Vatican’s Bambino Gesu Pediatric Hospital. During the audience in the Vatican’s Paul VI hall, Francis exhorted hospital staff not to fall prey to corruption, which he called the “greatest cancer” that can strike a hospital. — AP Photos
Federica Bianchi’s twin sons play in their room at home in Rome. In October 2015, Bianchi brought Edoardo to Bambino Gesu’s emergency room with breathing problems. He improved, but came down with another illness two days later that caused severe diarrhea and vomiting.
This illustration made available by the Centers for Disease Control and Prevention in Atlanta depicts Pseudomonas aeruginosa bacteria.