In a follow up to an investigative report, Ellen Gabler at the New York Times reports that North Carolina Children’s Hospital has suspended pediatric cardiac surgeries in its most complex cases. The University of North Carolina Health Care, which runs the hospital, further committed to publicly release mortality data and introduced initiatives to create an external advisory board of medical experts to recommend improvements, create a family advisory council to provide feedback to hospital leaders, and develop a new system for quality and safety reporting.

The University’s decision to release mortality data is notable for its long-term refusal to do so. The New York Times was in fact, according to the article, engaged in a year-long legal battle with the UNC Health Care system to release those statistics. The recent release comes quickly on the heels of the Times’s original investigative report. The statistics bear out the concerns expressed by hospital surgeons: that the hospitals mortality rates were alarmingly high. Hospital administrators, while denying any issues with patient care, blamed “difficult team dynamics” that they claimed had been resolved. The “team dynamic” language reflects the concerns expressed in a [recent blog post](http://cmglaw.com/Blog/2019/07/Unprofessional-Surgeons-have-more-S) here about surgical outcomes of unprofessional surgeons. The mortality statistics do not provide sufficient specificity to evaluate whether there exists a correlation at UNC consistent with the national averages reflected in the blog post.

The New York Times’ article inspired further changes by way of an investigation into the children’s hospital by the North Carolina secretary of health. A report is forthcoming.

The mortality rates released by UNC showed an overall mortality rate for pediatric heart surgery that was nearly double the national average (5.4% v. 2.8%) and a mortality rate for the most complex cases 3.5 times the national average (risk-adjusted average of 47.4% v. 14%).

Their hospital noted that the mortality rate for the past eleven months has fallen to 3%, after having managed personnel changes.

It could be said that the Times’ investigation helped force the hospital system’s hand. Perhaps the biggest takeaway is that transparency is giving patients the information they need and leading to improved quality of care. The article noted that in the US about 115 hospitals perform pediatric heart surgery; until UNC released these mortality statistics, it was one of the 25% of those hospitals that did not publish that data. The system committed to publishing these statistics annually online.

It seems frustrating that the infrastructural investment required by an investigative report, coupled with a year long legal battle, is what it took to force the system to actually make patient improvement changes to its system. That is more power than one or a number of medical malpractice lawsuits can bear, but demonstrate the difficulty in bringing about institutional change, even when peoples’ lives are at stake.

Read the Ms. Gabler’s followup piece [here](https://www.nytimes.com/2019/06/17/us/heart-surgery-children-unc.html).