There is a proposal by the Department of Health that would reduce state oversight of hospitals where cardiac surgery is performed on children in pediatric cardiac units. Children’s Medical Services, a state program, oversees care for tens of thousands of children with special health-care needs. It also has standards of care that hospitals can choose to meet – but they are not required to by law. Recently, the Department of Health held a hearing on a proposal to repeal a rule for the Children’s Medical Services program to drop the standards. More than 30 years ago, the rule established standards and criteria for staffing, minimum physician and facility volumes, and data reporting for hospitals that perform pediatric cardiology surgery. But the law behind the rule was abolished in 2001, and the Department of Health says it must fix the problem. Their proposal is to drop the requirements. According to Jennifer Tschetter, Department of Health’s COO, she thinks the standards have value but they are not law.
To date, there are eight hospitals statewide approved by Children’s Medical Services to perform heart surgery on infants.
Tallahassee attorney Jon Moyle, who represents a group of pediatric cardiologists from around the state, says that the program’s standards are nationally respected. Moyle argues that no one had filed a challenge to the rule, but Tschetter said the department had been reviewing all its rules and weeding out those that didn’t reflect the intent of the Legislature. Moyle rebuts her argument finding that lawmakers had never indicated a wish to dismantle the Children’s Medical Services cardiac standards. Tschetter fires back by stating that the department can’t force their way into hospitals.
This proposal is also concerning to several families who lost young children at St. Mary’s Medical Center in West Palm Beach in the past several years. There were nine infants who died after heart surgery at St Mary’s over four years, a death toll that drew national attention when CNN reported it in early June. At the time, St. Mary’s and the state disputed CNN’s allegations. But in August, the hospital shuttered its pediatric cardiology unit; its chief executive resigned.
St. Mary’s never received approval from Children’s Medical Services for its pediatric-cardiology program and was not required do so. But after some children died, it allowed a team of pediatric cardiologists from the state’s CMS Cardiac Technical Advisory Panel to visit in 2014. While the doctors advised the hospital not to operate on babies younger than 6 months old until it had upgraded its standards, St. Mary’s was free to disregard the advice – and did. That prompted doctors affiliated with Children’s Medical Services to call for more state control over infant cardiac surgery programs. Some wanted the standards put into state law, as was the case before 2001. Such standards would have required the St. Mary’s program, in part, to reach a certain volume of infant cardiac surgeries.
Tschetter says the plan to repeal the rule was not related to the St. Mary’s issue, but the plan to repeal had been a goal since 2013.
This is very concerning to those of us who represent families of those who have died as a result of avoidable medical complications in hospitals. Will doing away with these standards cause more deaths? I sure hope not, but it is concerning.