Becker's Hospital Review

79 FINANCE CMO / CARE DELIVERY CMS investigating Florida hospital where surgeons left needle in baby's heart By Alyssa Rege C MS is investigating St. Petersburg, Fla.- based Johns Hopkins All Children's Hospital aer the state's healthcare agency cited the hospital for not reporting two medical errors in which needles were le in patients' hearts aer surgery, according to the Tampa Bay Times. Here are five things to know about CMS' in- vestigation into the St. Petersburg hospital: 1. A CMS spokesperson told the Tampa Bay Times the review aims to ensure the hospital is following all federal health regulations. e agency contracts with the Florida Agency for Health Care Administration to conduct in- spections. e publication reports state offi- cials typically perform a quality assurance and performance improvement review, which aims to confirm hospitals are operating at acceptable standards to receive federal reimbursement. 2. In an email to the Tampa Bay Times, Johns Hopkins All Children's said the institution has been "transparent" with regulators. "Patient safety and providing the highest quality care are foundational to our mission and the manner in which we care for children. We work closely with local and federal regula- tory agencies and will continue to collaborate in the interest of our patients and their fami- lies, who are always our number one priority," the hospital said. 3. Federal and state regulators began investi- gating the hospital aer a Tampa Bay Times investigation in April revealed a needle was found in 3-day-old Katelynn Whipple's heart during a follow-up visit to the hospital aer she underwent heart surgery in 2016. Howev- er, the surgeon who operated on the child told her parents the needle did not exist. Ten days later, Katelynn's parents took her to a differ- ent hospital for emergency surgery unrelated to the needle. e surgeon operating on the child reportedly discovered the needle 30 minutes into the operation. 4. In April, hospital leaders told the publi- cation surgical needles had been left behind in two patients since 2016. Jonathan Ellen, MD, president, CEO and physician-in-chief of Johns Hopkins All Children's, said at the time the hospital has since performed fewer heart surgeries and is referring complicat- ed cases to other hospitals, according to the report. Dr. Ellen also confirmed one of the hospital's three heart surgeons, Tom Karl, MD, is not operating at this time. Medical records obtained by the Tampa Bay Times indicate Dr. Karl was involved in Katelynn's surgery. 5. e AHCA told the Tampa Bay Times Johns Hopkins All Children's was due for a review, but the agency decided to accelerate its inves- tigation into the hospital aer learning of the two needle incidents. e results of the April investigation, released May 15 and obtained by the Tampa Bay Times, cited the hospital for not reporting the two "adverse incidents" within 15 days as required by law. e hospi- tal also violated state law by not disclosing the incident to the patient or a patient represen- tative. AHCA shared the results of its investigation with CMS, who proceeded to ask for a wider review of the hospital's operations. n Why airlines hope physicians aren't on board during medical emergencies By Leo Vartorella P hysicians and other clinicians are called upon to help passengers during in-flight medical emergencies, but airlines often prefer the guidance of on-the-ground con- sultants in order to avoid diversions, according to Bloomberg. A medical emergency occurs once every 604 flights, with 7.3 percent leading to diversions that ground the plane, ac- cording to a study The New England Journal of Medicine. While it is standard protocol to first find out if a medical professional is on board before calling a consultant, a di- version can cost as much as $200,000, and airlines look to avoid these diversions whenever possible. Passenger clinicians are more likely to recommend diver- sions, so airlines rely on contracted consultants on the ground, who are less likely to recommend such action, to guide pilots. Though the final decision rests with pilots and dispatchers, they rely heavily on the advice of consultants. "It's fairly expensive to divert an aircraft, and so a captain has to take into account a whole host of issues," Jose Nable, MD, an assistant professor at Washington, D.C-based Med- Star Georgetown University Hospital, told Bloomberg. Paulo Alves, MD, global medical director of aviation health for Medaire, which provides in-flight consulting for over 100 airlines, acknowledged that his consultants recom- mend fewer diversions than on-board clinicians, but said these passengers are often overly cautious. "If the model was not financially interesting for [airlines], then they wouldn't hire us," Dr. Alves told Bloomberg. "Doc- tors, they tend to recommend diversions more than we do, because of course they don't want to assume the long-term responsibility." n

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