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2019 The University of Florida Award for Investigative Data Journalism, Large Newsroom finalist

Heartbroken

About the Project

For decades, All Children’s Hospital was considered one of the best in Florida. So when the world renowned Johns Hopkins health system took it over in 2011, the community believed it would get even better.

But behind the scenes, the hospital’s heart department became strikingly worse. Even low-complexity procedures began going wrong. Sutures burst. Infections mounted. Patches designed to cover holes in tiny hearts failed. The hospital left needles in at least two patients. By 2017, All Children’s had the highest mortality rate of any pediatric heart surgery program in Florida. One in 10 patients died. Others were left unable to walk or talk.

That didn’t have to happen. Johns Hopkins’ handpicked administrators disregarded safety concerns the program’s staff raised as early as 2015, long before the mortality rate spiked. Hospital leaders kept parents in the dark about the troubles. The heart program was a major source of revenue, and the hospital tried to expand it after the problems were evident.

State and federal regulators missed signs of serious problems. And even though Johns Hopkins created many of the safety protocols in use around the world, its own hospitals haven’t always followed them.

To get the story, reporters Kathleen McGrory and Neil Bedi started with old-fashioned reporting to build a massive pool of records. They criss-crossed the region to collect thousands of pages of medical records from families who had taken children to the Heart Institute. When parents couldn’t afford them, the reporters secured permission to purchase them on the family’s behalf, at a cost of thousands of dollars. They mined the records for similarities and cross-referenced them against peer-reviewed research to identify unusual patterns. At times, they found medical mistakes that the parents themselves didn’t know about.

Next, they performed a complex data analysis to place those failures in context. To do so, they obtained millions of patient billing records from the state. They identified children who had at least one heart surgery, then calculated the share who had certain complications or died. For cases before October 2015, they used a method created by the federal government that they found in the academic research. More recent cases were trickier. The billing codes had changed and the government had not updated its methodology. To do those calculations, the reporters designed an updated methodology, ran it by experts and then hand-reviewed their findings.

It was high-stakes work. Hospital leaders wouldn’t provide their numbers and suggested what they were attempting was impossible.

Once the analysis seemed solid, the reporters spent weeks trying to come up with every potential objection they could. They knocked each down with additional reporting and analysis. Top experts ultimately reviewed and blessed their work.

When it was time to tell the story, they presented their analysis with tremendous transparency. It was seamlessly integrated into the digital story as interactive charts. They also wrote a lengthy explainer, readable by laymen but containing interactive annotations for experts. They published all of their results and the computer code.