Listen to What Doctors, in a Time of ‘Crisis,’ Said Behind Closed Doors

Cardiologists at North Carolina Children’s Hospital had worried for several years that children with complex conditions were dying at higher-than-expected rates. By 2016, it seemed that even patients undergoing lower-risk heart surgeries were suffering more complications. In meetings in 2016 and 2017, captured on secret recordings provided to The New York Times, doctors urged their bosses to take action.

The hospital, part of the University of North Carolina health system, defends its pediatric heart surgery program. UNC administrators described it as “very strong” today and denied any past problems affecting patient care. They told The Times there was “a dysfunctional group” in 2016 that sowed mistrust, creating “team culture issues,” and noted that today there are “new team members.”

A Times investigation found that as the doctors were weighing their ethical obligations to patients, hospital leaders also worried about harming the surgical program.

Some cardiologists wondered whether they should stop referring patients to surgeons inside their own hospital

The cardiologists weren’t the only ones worried

The pediatric cardiology chief told his team that leaders of other departments had concerns too. He noted possible vulnerabilities in the system with staffing and infrastructure.

But they couldn’t pinpoint what might be going wrong

Heart surgery requires an intertwined system involving surgeons, anesthesiologists, intensive care doctors and support staff. The cardiologists said they had been trying for several years to review the hospital’s mortality data for heart surgery, but they couldn’t get it. A majority of the hospitals performing pediatric heart surgeries in the United States share this information publicly. UNC does not.

Some doctors expressed concerns about the chief pediatric heart surgeon

They cited, as an example, that recently he hadn’t come to the hospital on a weekend to perform a transplant for a baby when a heart became available. The surgeon’s reason for not coming in wasn’t clear, but the episode angered several cardiologists.

Their bosses recognized that the hospital was at a turning point

But they made it clear there would be no quick fix

The head of the children’s hospital warned that performing fewer surgeries at UNC could hurt revenues and lead to job cuts

He advised the doctors to let their ethics guide them