State bans Muir from treating some kids

In wake of Chronicle investigations, regulators flagged 47 deficiencies

California health regulators have barred John Muir Medical Center from treating some of the state’s most seriously ill children after flagging dozens of wide-ranging and serious issues in the Walnut Creek hospital’s pediatric intensive care unit, The Chronicle has learned.

The violations documented last week by the Department of Health Care Services, or DHCS, call into question the qualifications and competency of the unit’s doctors and nurses, as well as the care they were providing to children in the pediatric intensive care unit, or PICU. The unprecedented move by DHCS means that the unit is now unable to admit patients through California Children’s Services, or CCS, a public health program that has boosted the PICU’s profits and profile since it first obtained certification to treat these children in 2017.

The state review of the PICU — which opened in 2015 under the branding and partnership of national health care powerhouse Stanford Medicine Children’s Health — was prompted by a series of Chronicle investigations into four potentially preventable deaths, as well as DHCS’s failure to provide oversight of more than two dozen units throughout California with CCS certification.

In a May 2 report reviewed by The Chronicle, state investigators told John Muir they had found “moderate to serious issues that merit immediate atten

tion” after a review of patient medical records. Their findings indicate that the PICU was “operating outside its stated scope of practice.”

Ben Drew, a spokesperson for John Muir, denied that the problems cited by DHCS were related to quality of patient care, calling the findings “administrative” in a statement.

“The recommendations are to assist our PICU with coming into compliance and are being implemented,” said Drew, adding that “more than a dozen of the CCS report findings were resolved prior to our receipt of the report.”

Drew did not respond to questions about how many CCS patients John Muir typically admits to its PICU, which has continued to see patients who are not part of the state program.

In an email, a spokesperson for Stanford Medicine

Children’s Health said it was working with John Muir to cooperate with the DHCS investigation.

DHCS spokesperson Anthony Cava said in a statement that the patient ban at John Muir is the first time the agency has taken such action against a PICU and did so after finding “various health and safety concerns.”

“DHCS is committed to ensuring… approved pediatric intensive care units (PICU) are accountable for delivering quality health care to our youngest and most vulnerable Californians,” Cava said.

Earlier this year, the Centers for Medicare & Medicaid Services found that John Muir had violated state and federal laws related to its pediatric program, putting hundreds of millions of dollars in Medicare funding at risk. John Muir has submitted a separate plan of correction to the federal agency, which said it will make an unannounced visit to the hospital this summer.

The state’s onsite review of John Muir’s PICU began in late February and included interviews with 30 staff members and a review of 98 medical records, according to records reviewed by The Chronicle.

Investigators detailed 47 deficiencies and made 62 recommendations, including several immediate stop orders, in areas related to patient care, staff qualifications and program oversight.

Among the violations, DHCS found “gaps in existing patient care policies and procedures.” Officials overseeing John Muir’s PICU had not adequately outlined how to treat certain major illnesses, “creating concerns for patient care and safety,” the investigators wrote.

Additionally, the PICU did not have clear policies regarding which patients to admit to the unit and which to transfer to dedicated children’s hospitals or academic centers — leading the unit to sometimes treat children outside their stated abilities and expertise.

DHCS also determined that the unit did not appear to be tracking whether basic procedures, such as intubations — the insertion of a breathing tube — were being done competently, an issue that arose in two of the pediatric deaths covered by The Chronicle.

The state found that PICU leaders did not appear to have full “administrative control” or oversight of employees in the unit. Some doctors, nurses and other specialists also lacked documentation of certifications or experience to care for children in the CCS program.

As part of its recommendations, DHCS ordered John Muir to “immediately” remove any nurses that did not have necessary certifications and to start holding monthly, PICU-specific meetings to discuss pediatric critical care issues. The state further requested that John Muir implement a formal policy for annually reviewing the skills of its PICU doctors on intubation and other basic procedures.

Moving forward, DHCS said, John Muir should transfer patients with especially severe conditions “to a PICU equipped to provide the appropriate higher level of care” and to provide the state with data showing compliance.

In emails sent last week, state officials instructed Bay Area health departments and surrounding local hospitals to not transfer CCS patients to John Muir’s PICU. Failure to fix the problems, these officials said, could result in John Muir’s PICU permanently losing its CCS certification.

In his statement, Drew denied that John Muir had “accepted patient transfers that are outside of our scope of practice,” but did not provide additional details. He said that the hospital has addressed all the recommendations which it was asked to immediately complete and plans to submit a full plan of correction by the state’s May 16 deadline.

Dr. Bela Matyas, director of Solano County’s public health department, called the state action “a clear indictment of the management of the (PICU) program.”

“This is clearly very concerning,” Matyas said.

Tom Jong, whose 2year-old daughter, Ailee, died at John Muir during a complex liver surgery in 2019, said the state’s actions allowed him “to feel some sense of purpose to Ailee’s passing.”

“We shared Ailee’s story in hopes that it’ll spark a chain of events that leads to change and saves children’s lives,” Jong said. “We hope these changes are sustainable because it’s even more clear now that the pain and suffering of many families could have been avoided.”

Brontë Wittpenn/The Chronicle Tom and Truc-Co Jong are the parents of Ailee Jong, who died during surgery at John Muir Medical Center in Walnut Creek.