Ace investigative reporters reveal what happens when money trumps children’s lives at hospitals

The New York Times’ tour de force in late May illuminating the deaths of babies undergoing heart surgeries at North Carolina Children’s Hospital in Chapel Hill, a respected hospital with a well-cultivated reputation, is important not only for its sad stories about very ill children but also for what it says about the transformation of American hospitals. No longer benign places to cure the sick, hospitals have increasingly morphed into corporate behemoths focused on the bottom line, just like any other American business.

What made the Times story so significant is that the paper is the fourth news outlet since 2014 to tackle the difficult subject of how and why children are dying after surgeries to repair damaged hearts. CNN, The Philadelphia Inquirer, and last year The Tampa Bay Times have also tackled the subject. If you add in the work of The Detroit News in 2016 that found children undergoing procedures at Children’s Hospital of Michigan were at risk from harm caused by dirty instruments, this body of investigative work presents a vivid and horrifying picture of what might befall families whose kids are born with cardiac abnormalities. Taken together, these series show how journalists still have a strong voice in pointing out how the influence of the profit motive corrupts good care.

The New York Times estimates that about 40,000 babies in the U.S. are born with heart defects every year, and 10,000 are likely to need surgery or procedures before their first birthday. Healing them has become a lucrative specialty for the medical establishment, even as dangers for families lurk along the way.

Reporting all this is vitally important journalism, hard to do, and time-consuming in an age in which fast-paced storytelling is king and bite-sized narratives are the currency of the realm. These deeply reported series question health care’s pie-in-the-sky promises of lower prices and better outcomes while unraveling a disturbing tale of compromised safety, medical errors, and the reluctance of the medical profession to fess up to its own mistakes.

The tale began in early 2014 when CNN medical correspondent Elizabeth Cohen filed a story about pediatric heart surgeries resuming at Kentucky Children’s Hospital “without any reported investigation by the state health department and without oversight by anyone,” as she noted. The program had been closed in 2012 after its fifth death.  The hospital commissioned an internal report, but the 102-page document didn’t explain how the babies died. In fact, it didn’t even acknowledge any of the deaths, Cohen reported.

The parents of one of the dead children asked the important questions about the investigation the hospital had conducted. Kevin Allen whose daughter died, told CNN, “How do you know when the problems have been fixed when they're not identified? I mean, they could say they fixed them. But is an internal review really objective?” The child’s mother added: “I expect nothing more from a health care facility than honest answers. Whether it’s good or bad, we should know. That’s not too much to ask.”

Cohen followed up in 2015 with more stories based on her year-long investigation of the pediatric cardiac surgery program at St. Mary’s Medical Center in West Palm Beach, Florida, a facility owned by for-profit Tenet Healthcare. She quickly found herself in a thicket of controversy over mortality rates; drew a dispute with the state agency in charge of hospital oversight; and landed in the middle of a debate over data maintained by the Society of Thoracic Surgeons, a physicians group that collects data from hospitals that voluntarily publicize their surgical outcomes.

CNN is now involved in two lawsuits involving former hospital personnel.

At the time, I took a critical look at Cohen’s work for CJR and urged aggressive coverage of this topic. “If the press fails to push for more transparency, who will?” I asked in 2015.  

RELATED: Key takeaways for your own reporting on hospitals 

In 2016 and 2017, The Philadelphia Inquirer published five stories by Dylan Purcell and Tom Avril detailing infant deaths at St. Christopher’s Hospital for Children in Philadelphia, where nearly 25% of the babies less than a month old died after highly risky heart operations between 2009 and 2014. After the paper’s revelations, state investigators conducted a surprise three-day inspection and found the hospital had failed to fully investigate why nine of its patients died after surgery. The hospital, which was also owned at the time by Tenet Healthcare, stopped doing non-emergency heart surgeries but resumed them over a year later after dozens of nurses and technicians received specialized training, and the hospital hired doctors with specialized expertise.

The Inquirer has continued to chronicle the fortunes of the hospital, including its sale to a private equity firm and the ensuing turmoil that included the firing of a new CEO after two months on the job, and the layoffs targeting 7% of its workforce.

Last year the Tampa Bay Times took on the pediatric heart program at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida in a big way, publishing 30 stories between April 2018 and the end of May 2019 that showed the hospital’s vaunted program was in serious trouble. It’s investigative reporting at its best. Beginning over a year ago with a story about a child who had a needle left in her heart following surgery, Kathleen McGrory and Neil Bedi produced story after story detailing the problems with the hospital’s troubled heart program, ranging from the deaths of 11 children whose cases were examined by the paper to the state’s lax regulation of the program.

“When programs have had troubles, they’ve been reluctant to address these problems immediately. It’s the confluence of difficult surgeries and big money. These programs for better or worse are generating big money for these hospitals.” — Kathleen McGrory, Tampa Bay Times

The paper found that nearly one in 10 pediatric heart surgery patients had died in 2017 and that the mortality rate, the highest in Florida, had tripled between 2015 and 2017. It reported that surgeons had made “serious mistakes” and that Hopkins’ hand-picked administrators disregarded safety concerns raised by the staff years earlier. In a year and a half, at least 11 children died after operations by the hospital’s two principal heart surgeons. Families were kept in the dark. 

I talked to McGrory about the series and why there were continued problems with pediatric surgeries at so many institutions. “When programs have had troubles,” she said, “they’ve been reluctant to address these problems immediately. It’s the confluence of difficult surgeries and big money. These programs for better or worse are generating big money for these hospitals.” Children’s surgery programs bring prestige and that helps explain why Florida alone has 10 separate programs throughout the state. No hospital wants to turn off the spigot. “There’s a lot at stake, and they do bring in an incredible amount of money,” McGrory told me.

That’s evidenced by the paper’s most recent story published at the end of May. It reported the operating profit for the Johns Hopkins Health System dropped 70 percent in the first quarter of 2019, due largely to the problems with the All Children’s Hospital heart surgery program. The latest financial report revealed that the system’s operating profit margin fell by a total of $31.7 million compared to the same quarter last year. The closing of All Children’s Heart Institute was a major contributor to that hospital’s quarterly loss of $11.5 million from operations.

While the hospital said the losses were “temporary,” this year’s numbers make clear what the race to have the biggest, the best, and the most heavily advertised medical profit center is all about.

That point was central to The New York Times’ 7,000-word piece. Reporter Ellen Gabler obtained secret audio recordings, that, as the Times put it, “offer a rare, unfiltered look inside a medical institution as physicians weighed their ethical obligations to patients while their bosses also worried about harming the surgical program.” In one conversation Dr. Kevin Kelly, who led the hospital until last year, issued a blunt warning. If performing fewer surgeries “reduces the volume of things, I’ll just — we’ll just reduce the number of people that we have.” Another time Dr. Kelly discussed internal referrals to the hospital’s pediatric surgery program, that is referrals from other hospital doctors. Again Dr. Kelly told those doctors to let ethics guide their decisions about referring patients but warned a drop in internal referrals would hurt revenues and could lead to job cuts. In the meantime, the Times pointed out, babies were dying.

As money has clouded the profession of healing, the work of these news outlets raises many questions and invites further exploration by journalists interested in covering the rapidly consolidating hospital industry and what it means for patients.  Axios’ Bob Herman, who writes admirably about hospital finances, recently explained that hospitals are paying hundreds of millions of dollars to bankers and financial advisers to help them issue more debt to finance new hospitals and new equipment. One of his sources was candid: “Everyone likes to have the newest and fanciest toys. It might allow hospitals to attract doctors or reputation. Whether you’re getting improved effectiveness is an open question.”  

Even though these stories illuminating how hospital care can go awry are hard to do and fraught with stumbling blocks, they are essential journalism, and reporters are the only ones suited and honest enough to give America’s places of healing the check-ups they themselves sorely need. The questions and comments from the Allen family CNN interviewed so long ago are good guideposts. “How do you know when the problems have been fixed when they're not identified?” The public deserves more honesty and transparency from the institutions we entrust with our lives.

In the accompanying sidebar I offer suggestions for reporters who want to dig deeper into the issues their colleagues have raised.

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Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care blog.