Feds open re­view of hos­pi­tal

The inquiry into All Chil­dren’s comes af­ter the Times re­ported prob­lems at its Heart In­sti­tute.

Tampa Bay Times - - Front Page - BY KATHLEEN MCGRORY AND NEIL BEDI Times Staff Writ­ers

The fed­eral govern­ment has opened an in­ves­ti­ga­tion of Johns Hop­kins All Chil­dren’s Hos­pi­tal, days af­ter a state agency cited the hos­pi­tal for not re­port­ing two se­ri­ous med­i­cal er­rors.

The fed­eral re­view, by the Cen­ters for Medi­care and Med­i­caid Ser­vices, could be more widereach­ing than the state’s, which fo­cused on the hos­pi­tal’s pro­ce­dures for min­i­miz­ing risk and han­dling med­i­cal mis­takes.

In an email to the Tampa Bay Times late Thurs­day, the hos­pi­tal said it has been “trans­par­ent.”

“Pa­tient safety and pro­vid­ing the high­est qual­ity care are foun­da­tional to our mission and the man­ner in which we care for chil­dren,” the state­ment said. “We work closely with lo­cal and fed­eral reg­u­la­tory agencies and will con­tinue to col­lab­o­rate in the in­ter­est of our pa­tients and their fam­i­lies, who are al­ways our num­ber one pri­or­ity.”

The CMS re­view will make sure the hos­pi­tal is fol­low­ing fed­eral rules and reg­u­la­tions, spokes­woman April

Washington said. The fed­eral agency con­tracts in­spec­tions re­lated to its rules to the state Agency for Health Care Ad­min­is­tra­tion.

In­spec­tors typ­i­cally per­form what’s known as a Qual­ity As­sur­ance and Per­for­mance Im­prove­ment re­view to con­firm hos­pi­tals are op­er­at­ing at ac­cept­able stan­dards and med­i­cal out­comes re­quired to re­ceive fed­eral dol­lars. If they find prob­lems, they give the hos­pi­tal 10 days to de­vise a plan for cor­rect­ing them.

Although the AHCA is the agency that li­censes

health care fa­cil­i­ties in Florida, the fed­eral CMS wields tremen­dous power. In the most ex­treme cases, the agency can shut hos­pi­tals out of the Med­i­caid pro­gram, which pro­vides health in­sur­ance to low-in­come adults and kids.

That would be dev­as­tat­ing for any hos­pi­tal. All Chil­dren’s billed the pro­gram more than $550 mil­lion in 2016 — about 66 per­cent of its to­tal charges, ac­cord- ing to state data.

Prob­lems within the hos­pi­tal’s Heart In­sti­tute were first made pub­lic in a Times re­port in April. The news­pa­per high­lighted a 2016 case in which a nee­dle was left in 3-day-old Kate­lynn Whip­ple af­ter surgery. Kate­lynn’s par­ents told the Times they did not learn about the nee­dle un­til af­ter their daugh­ter was dis­charged. Later, they said, the sur­geon who per­formed the pro­ce­dure de­nied it ex­isted.

In April, hos­pi­tal lead­ers told the Times that sur­gi­cal needles had been left be­hind in two pa­tients since 2016. Dr. Jonathan Ellen, the CEO, also said the mor­tal­ity rate among heart surgery pa­tients had gone up in 2017, but de­clined to re­lease the ex­act fig­ure. The hos­pi­tal’s lat­est four-year av­er­age is roughly the na­tional av­er­age.

Ellen said the hos­pi­tal was re­spond­ing to those and other “chal­lenges” by per­form­ing fewer heart surg­eries and re­fer­ring some com­pli­cated cases to other hos­pi­tals. In ad­di­tion, he

said, one of the Heart In­sti­tute’s three sur­geons, Dr. Tom Karl, is not op­er­at­ing at this time.

Med­i­cal records in­di­cate Karl was in­volved in Kate­lynn’s case. Karl did not re­turn an email from the Times.

The state launched a re­view into the news­pa­per’s find­ings in late April.

An AHCA spokes­woman said All Chil­dren’s was due for a re­view into how it han­dles and pre­vents haz­ardous con­di­tions, in­clud­ing med­i­cal er­rors. But the agency ac­cel­er­ated its in­ves­ti­ga­tion af­ter learn­ing about the two nee­dle in­ci­dents.

In its re­port, re­leased Tues­day, the state cited All Chil­dren’s for not re­port­ing two so-called “ad­verse in­ci­dents” within 15

days, as re­quired by law. The state also found that All Chil­dren’s vi­o­lated Florida law by not dis­clos­ing one of the in­ci­dents to the pa­tient or a pa­tient rep­re­sen­ta­tive.

The copy of the re­port pro­vided to the Times did not in­clude iden­ti­fy­ing in­for­ma­tion on the pa­tient. But many of the de­tails matched Kate­lynn’s med­i­cal records.

The AHCA shared the re­sults with the fed­eral govern­ment. The CMS then quickly asked for a wider re­view.

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