A report on child deaths prompts an investigation into NC Children’s Hospital surgeries

The state has launched an investigation into practices at North Carolina Children’s Hospital following a New York Times report on the deaths of children after heart surgery, including some surgeries considered low-risk.

The New York Times investigation found high death rates for children who had heart surgery at the UNC-run hospital in Chapel Hill. The Times obtained secret audio recordings of cardiologists worried about the care children were receiving. In one recording, a cardiologist said he wouldn’t send his children for surgery there. Another doctor, the chief of cardiology, said in the recording they were in “crisis.”

The state Division of Health Services Regulation, which is part of the NC Department of Health and Human Services and investigates medical facilities, went to the hospital Thursday, the day the Times report was published.

“As a mother and a doctor my heart goes out to any family that loses a child,” DHHS Secretary Mandy Cohen said in an emailed statement. “Patient safety, particularly for the most vulnerable children, is paramount. On Thursday, I directed the Division of Health Services Regulation to assemble a team to conduct a thorough investigation into these events. Their work has begun, and they are coordinating their efforts with our federal oversight agency, the U.S. Centers for Medicare & Medicaid (CMS).”

DHHS would not say what investigators are looking for. A spokeswoman for the agency said she could not discuss an ongoing investigation. Typically, investigators review medical records, and interview staff members and patients’ families.

Lisa Schiller, chief of communications and marketing for UNC Health Care and the UNC School of Medicine, said the hospital anticipated the state action. “We certainly welcome their coming in,” she said in an interview.

Two doctors interviewed Friday consigned events highlighted in the New York Times to the past and emphasized changes in hospital leadership. A new chair for the Surgery Department, Dr. Melina Kibbe, took over in 2016, and a new chair of the Pediatrics Department, Dr. Stephanie D. Davis, started last year.

The hospital provided a list of quality improvements dating to 2009 that noted more staff, including three new pediatric cardiologists starting this summer.

“We are putting in quite a bit of resources into our program right now,” Davis said. “This is our top priority for Children’s right now.”

Dr. Peggy McNaull, associate professor of anesthesiology and pediatrics, said that the hospital stands by the care it gave patients in 2016 and 2017, “but “we did have team cultural challenges” in those years.

NcNaull, who is vice chair for patient safety & quality improvement, said the hospital for years has refined its practices, always asking, ’How can we care for these very complex kids?’” she said.

McNaull said she could not respond to specific concerns from doctors in the recordings the Times obtained because she did not know the context.

“We had a lack of trust among our team members,” she said. “We feel strongly that UNC responded in the best way. We worked hard to rebuild our team.”

The New York Times reported that the hospital does not make public its mortality data for congenital heart surgeries on a Society of Thoracic Surgeons website. About 74 percent of hospitals that perform those surgeries make their statistics public.

UNC recently posted some information on patient deaths on its own website. The data is not adjusted to account for various patient risk factors, as is the STS reported data.

UNC posted its information in raw numbers, but does not include percentages or the expected mortality rate, making it difficult to know how Children’s Hospital compares to others.

Schiller said the UNC data is easier for patients to find and interpret.

The Times said it is suing UNC for the risk-adjusted information.