Health Care

UNC Health continued its children’s heart surgery program after a 2016 investigation

Dr. Bill Roper, now interim president of the UNC System, was dean of UNC’s medical school and head of UNC Health Care when reports of problems with the pediatric heart surgery program reached his office.

In an interview Tuesday, Roper said he and other hospital officials investigated the heart surgery program at the UNC-run Children’s Hospital in 2016.

“This matter, at the time it was raised in 2016, was thoroughly investigated with all of the relevant, credentialed people involved in the review, both internally and externally,” Roper said. “And the leadership of UNC Health Care, and the medical school, and the board to which we report were satisfied with the review and we continued the program.”

Roper was CEO of UNC Health Care, dean of the medical school, and vice chancellor for medical affairs from 2004 until he was named interim president of the UNC System last year. Dr. Wesley Burks succeeded him as CEO.

“I and Dr. Burks and lots of others were very much involved in the investigation,” Roper said. “We did an investigation with all the tools available.”

On Monday, UNC Health Care announced the North Carolina Children’s Hospital will stop doing some complex pediatric heart surgeries until it receives recommendations from an advisory board of outside experts and the results of a state investigation into hospital practices.

The decision to suspend some children’s heart surgeries came after The New York Times reported last month on higher than average mortality rates and complications in some young patients who had surgeries that were considered low-risk. The newspaper obtained audio recordings of meetings in 2016 and 2017 where cardiologists were alarmed that young patients were not doing well after heart surgery.

Roper said he would not discuss the specific issues doctors raised in those recordings, but said he wanted to counter the impression that concerns about pediatric heart surgery were “swept under the rug.”

The hospital did not make public information on death rates in the program until earlier this year, when it released partial data. This week, it posted on its website risk-adjusted data that The New York Times had sued to get.

The information shows that over four years ending in December 2018, seven of the 12 most complicated neonatal, infant and child heart surgeries resulted in death. The 58.3% mortality rate was far higher than the expected mortality rate of 17.3%. The surgeries are rated on a level of complexity from one through five, with five being the most complicated.

The mortality rate for newborns, infants and children who received surgeries at level four was 13.6%, when the expected rate was 7.8%. The mortality rates at UNC were higher than expected at all but one level of complexity.

UNC said the data is only one measure of quality and does not take into account all patient risk factors.

A narrative of pediatric cardiac care program improvements provided by the UNC Health Care press office says that from June 2016 to September 2016 “concerns and allegations against specific individuals in the Congenital Heart Program were independently investigated and reviewed by the Dean’s office and the Chief Medical Officer. Allegations of misconduct and concerns (were) determined to be unfounded.”

In an interview last month, hospital officials emphasized changes in hospital staff and leadership in the last two years, including new leaders for the surgery and pediatric departments.

Roper said the 2016 investigation involved examining each case, watching how the health-care team worked, and talking to experts from around the country.

“You have to look at each case and examine whether whatever happened is properly documented,” and look at explanations for each event, he said.

“It was a case-by-case examination of things,” Roper said. “The statistics are important, but they are not the end of the process. They are the beginning that leads to a case-by-case examination of each patient and each episode of care.”

UNC is again turning to outside experts for help. Hospital officials assembled an advisory board of pediatric cardiologists that will make recommendations for improvements in the children’s heart surgery program.

An initial telephone meeting in the next few weeks will establish guidelines and a timeline, according to the UNC Health Care media office. In the next month or two, the advisory board members are expected to travel to Chapel Hill to talk to doctors, administrators and other staff at the hospital.

The advisory board will report its recommendations to the UNC Health Care board of directors.