Cardiologists at UNC Children's Hospital in Chapel Hill expressed serious concerns about the safety and quality of the hospital's pediatric heart surgery program in 2016, after noticing an uptick in surgical complications and deaths, according to a 7,000-word investigative report from The New York Times.
For the investigation, NYT reporters interviewed nearly two dozen current and former physicians and nurses at UNC; spoke with patients' families and physicians from other hospitals; and reviewed emails, state death data, medical records and audio recordings of cardiology department meetings in 2016 and 2017 that were corroborated by several sources.
Six takeaways from the report:
1. Nine cardiologists on staff at UNC Health Care began expressing concerns about the quality of its pediatric heart surgery program in 2016. The physicians had noticed more children were experiencing surgical complications after low-risk procedures or dying after high-risk surgeries. They did not identify a specific reason for these issues but pointed to a lack of program resources and shared apprehensions about the program's chief pediatric cardiac surgeon.
"I mean, our house is in total disarray. This is crazy what we're doing," Timothy Hoffman, MD, division chief of pediatric cardiology at UNC Children's, said of the program in an audio recording cited by NYT. "I've never seen anything like it, quite frankly. And we're going backwards, not forward."
2. Some cardiologists questioned whether they should refer patients to heart surgeons at UNC Children's Hospital. Jennifer Whitham, MD, a former cardiologist at the hospital, said she would often send patients to get second opinions at other hospitals in the area with comprehensive pediatric heart programs.
"As a mother of three children, oh my God. ... It's inexcusable. As a physician, I mean, we all took the oath. We are supposed to do what's right for our patients," she said in audio recordings of a cardiology meeting in which physicians shared their concerns about the program. "I can't get past this. This is beyond horrifying."
3. Former hospital president Kevin Kelly, MD, met with the cardiologists after they expressed these concerns and urged them to listen to their conscience when deciding where to refer patients. However, he also warned the physicians that fewer surgeries at UNC would affect revenues and put some of their jobs at risk, according to NYT. Dr. Kelly, who retired last year, did not respond to the publication's request for comment. 
4. Of the 115 hospitals that perform pediatric heart surgery in the U.S., 82 publicly share mortality data; UNC does not. Between July 2013 and June 2017, the hospital's cardiac surgery mortality rate was 4.7 percent, according to limited data shared with NYT after several requests. This figure exceeds the mortality rates reported by most of the hospitals that publicly share data.
5. UNC claims that mortality data doesn't provide an accurate measure of its surgical program and that any risk adjustment could not adequately account for the high volume of patients with complex medical conditions it serves. NYT is suing the health system for access to its risk-adjusted mortality data.
6. UNC Children's Hospital stands behind its heart program, which administrators call "very strong" today. Leaders denied any past issues with patient care and told NYT "a dysfunctional group" generated mistrust and created "team culture issues" in 2016. Since then, four of the nine pediatric cardiologists at UNC have left. The health system hired a new cardiologist last year and plans for three more to start this summer. UNC also plans to hire more cardiac intensive care doctors and open a cardiac intensive care unit, although it denies that the program lacked adequate resources in 2016.
NYT wants to hear from other medical professionals who believe their concerns over care quality or patient safety have been overlooked by their organizations. A submission form is available in the full report, which can be accessed here.