Children’s Hospital Comes Under Official Scrutiny

The primary pediatric teaching hospital for Harvard Medical School has come under the scrutiny of state and federal health officials for four cases of miscommunication that resulted in the deaths of three children.

Over the span of one year at Children’s Hospital, a seizure went unmonitored, a patient did not receive enough antibiotics, a catheter was inserted into the wrong kidney and blood pressure was not checked closely during surgery, according to reports in The Boston Globe.

The cases and the ensuing investigations have rendered dramatic changes in Children’s Hospital’s health care policies and practices.

“The hospital apologizes to the families involved. We will take full responsibility for the problems, and we will correct them,” said Michelle Davis, vice president of public affairs.

Davis said the incidents were due to miscommunication between physicians, residents in training and other health care professionals.

After each case, Children’s Hospital filed a report with the Massachusetts Department of Public Health (DPH).

After the fourth incident, the DPH decided that conditions were serious enough to bring in the Centers for Medicare and Medicaid Services to determine whether “violations of conditions of participation” occurred. Such a finding would jeopardize the hospital’s eligibility to receive Medicare and Medicaid funds.

The DPH issued a report of corrective actions, which Children’s Hospital has accepted and implemented.

The problem of miscommunication is not uncommon at large hospitals, said Dr. Anthony D. Whittemore, chief medical officer of Brigham and Women’s Hospital—also a Harvard affiliate.

Whittemore said that the residency program is an essential aspect of training future doctors to be able to make crucial decisions.

Nevertheless, he stipulated that the allocation of responsibility to residents should be a gradual one. Moreover, he emphasized the importance of residents collaborating closely with the senior attending physician in “educated communication” to arrive at the correct choice for patient care.

Ideally, more medical personnel, such as physician assistants and nurses, may help with communication issues. However, for many Boston hospitals, current unstable revenues may preclude such a plan.

According to Whittemore, constrained space and limited finances make providing quality health care to patients increasingly difficult. For example, up to 30 percent of beds have been eliminated over the last eight years. Also, 90 percent of cutbacks in the 1996 federal balanced budget came from the Medicare allocation, effectively eliminating $113 billion from hospitals’ budgets.

Yet unlike some other Harvard-affiliated associations such as Caregroup—an umbrella organization for several hospitals, including the Beth Israel Deaconess Medical Center—Children’s Hospital is fiscally secure. After going through six years of financial turmoil, the hospital has righted itself and is even pulling in a slight surplus, Davis said.

Children’s Hospital is taking immediate measures in “developing better coordination and communication between services and among attending physicians, residents and other clinical staff responsible for the care of patients,” President and CEO James Mandell said in a statement.

Harvard Medical School remains confident about the financial stability of all its teaching affiliates.

“Our hospitals have very good managers, and they’ve proven their ability to ride through difficult positions,” said Don Gibbons, Harvard Medical School associate dean for public affairs.