How we got the story on a surgery program where ‘children were dying at a stunning rate’

Ed. Note: Kathleen McGrory of the Tampa Bay Times spoke to 2019 National Fellows this week about managing big reporting projects. To mark the occassion, we're reposting this piece on her high-impact investigation into the pediatric surgery program at John Hopkins All Children's Hospital in Florida.

Early last year, I learned that physicians at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, had left a surgical needle in a baby’s chest.

The hospital’s CEO confirmed the incident. He said the heart surgery department had faced “challenges” and seen an uptick in surgical deaths — but wouldn’t elaborate.

Seven months later, my reporting partner Neil Bedi and I had the details the hospital wouldn’t share: Surgeons had made mistakes. Infections had spiked. And children and families had suffered catastrophic consequences.

Here’s how we got the story. 

Our initial reporting on the All Children’s Heart Institute got started when a tipster alerted us to some unusual personnel moves in the unit. Top physicians had been dismissed and other employees were being told to tell patients’ families “the truth.” Our immediate instinct was to pull paper. We looked for lawsuits, state and federal inspection reports, complaints against physicians and any other public records we could think of. It didn’t get us far. 

Next, we sought data that could shed light on the quality of care. Little was publicly available; unlike general hospitals, children’s hospitals aren’t covered by the federal government’s Hospital Compare, a site that posts quality of care data. We asked the All Children’s CEO to provide the results of all heart surgeries from 2017. He declined and instead pointed us to the Society of Thoracic Surgeons website, which publishes four-year rolling averages for most pediatric heart centers.

We knew, however, that four-year rolling averages could hide problems. And our sources were telling us that the four-year stats for All Children’s didn’t tell the whole story. So we turned to hospital discharge data from the Florida Agency for Health Care Administration, a dataset the Tampa Bay Times has been requesting for years. It contains patient-level information on diagnoses, procedures, physicians, outcome, insurance and billing.

We identified children who had at least one congenital heart surgery, then calculated the share who had certain complications or died. For cases before October 2015, we used a method created by the federal Agency for Healthcare Research and Quality and Boston Children’s Hospital we had found by reviewing the research. More recent cases were trickier. The billing codes had changed and the federal government had not updated its methodology for calculating pediatric heart surgery deaths. To do those calculations, we designed an updated methodology, ran it by experts and hand-reviewed our findings. We documented all the steps in an extensive story online.

The data told a stunning story: One in 10 heart surgery patients at All Children’s Hospital had died in 2017 — nearly three times the statewide average. Complication rates had also surged.

But our work was far from finished. We needed to connect with patients’ families. To find them, we reached out to community and religious leaders. Social media was hugely helpful. The administrators of a Facebook group for mothers of children with congenital heart conditions let me join and post messages. Neil identified other families by searching public Facebook posts, GoFundMe campaigns and legacy.com. Within months, parents were introducing us to other parents.

The families shared their stories, which photojournalist Eve Edelheit captured in powerful images and video. They also let us review their children’s medical records. That enabled us to understand the details of each child’s case and look for patterns among them. If the parents didn’t already have the documents, we secured permission to request them on their behalf.

Finding insiders who could help us understand what had changed in the hospital presented another challenge. We searched LinkedIn for people who had worked in the Heart Institute and in other key departments in the hospital. We found other employees by using the Wayback Machine to view older versions of the hospital’s website. We made sure to ask each person we connected with for suggestions on who else to call.

Slowly, the bigger story came into focus. This wasn’t a case of a specialized program receiving sicker-than-usual patients. Instead, it was a program beset with problems. Operations that surgeons described as low risk had failed in unusual ways. Complications mounted. The problems had gotten worse, even as frontline workers brought concerns about two heart surgeons to their supervisors.

Neil and I broadened the reporting to show that state and federal officials missed multiple warnings about the problems, including one from a cardiologist who told state regulators under oath that “multiple levels of administration had actually tried to hide some outcomes.” We showed that federal officials who promised an investigation actually left a broad review of the program to the independent Joint Commission.

We then examined the broader network of Johns Hopkins hospitals by reviewing lawsuits and inspection reports and interviewing frontline workers. We found that Johns Hopkins had written many of the rules on patient-safety — but its hospitals weren’t always following them. 

After the series ran, Johns Hopkins took swift action. The All Children’s CEO resigned, as did three vice presidents and two surgeons. Johns Hopkins hired a former federal prosecutor to conduct an internal investigation of the Heart Institute. And it convened a panel of experts to help determine next steps for the program.

Johns Hopkins also said it would take steps to prioritize safety across its health system. “The Tampa Bay Times has identified occasions where it is apparent that as an organization we failed to act quickly enough, we failed to listen closely enough and, in some instances, we failed to deliver the care our patients and their families deserve,” the health system said in a statement. “This is unacceptable.”

In January, state and federal inspectors issued a finding of immediate jeopardy at All Children’s, giving the hospital just weeks to correct problems or lose public funding. Weeks later, the health system’s president Kevin Sowers acknowledged more than a dozen incidents in which heart surgery patients were harmed by the care they received. He apologized to hospital employees in an emotional town hall meeting.

We’re waiting to see what happens next and continuing to report the story in real time.

Investigations like this take a great deal of time and resources, which are increasingly scarce in today’s besieged newsrooms. But stories that hold  powerful institutions to account on matters of life and death remain the most urgent and gratifying ones to tell.