State health investigators probing Children's Hospital Oakland over its handling of Jahi McMath concluded that the hospital complied with medical regulatory standards in her case, according to the long-awaited report obtained Wednesday through a public records request.
The report answers some questions but leaves many more unanswered about what happened to the 13-year-old Oakland girl -- who came to Children's Hospital Oakland on Dec. 9 for tonsil surgery and two other procedures to treat her sleep apnea and left brain-dead.
Investigators reviewed Jahi's patient file and 28 others chosen at random from the same time period. Their report includes no specifics from her case and does not identify any patients by name.
The state's survey found one area of "deficiency" in how the hospital handled the patients' medical records, which were not always entered into an electronic medical database before surgery. Due to medical confidentiality laws, it is unclear if Jahi's case was one of those mishandled cases.
"We are very pleased with the results of the Centers for Medicare & Medicaid Services validation survey," said Dr. David Durand, Children's Hospital Oakland's chief medical officer. "We were found to be in compliance with CMS standards in every area. No deficiencies of quality of care were identified in the survey."
The report angered Christopher Dolan, Jahi's family attorney, who said the results illustrate why medical negligence lawsuits are necessary.
"The report is evidence of what the family has faced from day one, doctors covering for other doctors," Dolan said. "The family was not even interviewed, to my knowledge. How can a 13-year-old girl bleed to death in an ICU, and there is no evaluation or finding explaining that?"
A call to Jahi's family was not immediately returned.
State officials confirmed that the investigation was initiated after a complaint was lodged about how the East Bay facility cared for Jahi after she was admitted Dec. 9. Hours after surgery, while in the pediatric intensive care unit, Jahi began bleeding profusely before suffering a heart attack. Doctors soon declared her brain-dead.
Jahi's mother, Nailah Winkfield, criticized the reaction of nurses who told her the bleeding was "routine," according to court documents and a letter she released to media and an interview. She said the nurses left it to her and her mother to stem the flow of blood from Jahi's mouth and nose.
State investigators conducted the probe over Jan. 7-10, focusing on the hospital's governing body, patient rights, nursing services, surgical services and anesthesia services. They interviewed doctors, nurses and managers and reviewed records.
"CDPH determined that Children's Hospital and Research Center-Oakland was in compliance with the Medicare Conditions of Participation," state enforcement manager Rufus Arther wrote the hospital Feb. 18. General acute care hospitals must follow certain federal standards to receive Medicare and Medicaid funding.
The state found one area of deficiency under the hospital's "operating room policies." In eight of 29 patients reviewed, the state found the preoperative checklist was not completed; on some occasions not all the boxes on intake forms were checked off, and on others, the patients' histories and physicals were not included in an electronic medical file before surgery.
In one instance, detailed in the report, a 5-year-old boy admitted for eye surgery had no physical or history scanned into his electronic medical file. The assistant director of perioperative services told state investigators, "if there is no history and physical in the record there should be a 'Hard Stop' and the patient would not go into the operating room until it was completed and on the record." The child still had surgery.
Children's Hospital voluntarily reported a plan of correction for the deficiency on March 5.
The hospital acknowledged "inconsistencies" on checklists completed before surgery, and pointed to two issues: lack of education of staff and the November 2013 implementation of a new electronic medical record system, which required hospital employees to update medical records in a computer rather than paper documents. The hospital in its written response said all the proper documentation was there, just not all in electronic form.
Children's Hospital identified nine corrective measures taken since the survey results, including increased education on the electronic system and audits on the program.
The hospital has not commented on Jahi's care at the Oakland facility, citing patient confidentiality laws, only saying in court documents that she underwent a "complicated" series of procedures.
According to California surgery statistics, Children's Hospital Oakland had bleed rates following tonsil surgeries below the state average among more than 400 other hospitals.
The state statistics found one death following tonsil surgery at Children's Hospital Oakland, but bleeding is not the only possible complication. On Sept. 6, 2011, Rebecca Jimenez, of Rodeo, went to the facility for an outpatient tonsillectomy to treat her sleep apnea and suffered severe brain damage after brain swelling after surgery. The family of the 8-year-old sued and won a large settlement.
Children's Hospital Oakland has not received any penalties or citations related to tonsillectomies from the state in the past, according to the Department of Public Health.
As far as overall hospital care, according to state public health numbers, since 2004, Children's Hospital Oakland has received 44 complaints, 41 self-reported incidents, four state enforcement actions and 35 survey deficiencies. By comparison, Lucile Packard Children's Hospital in Palo Alto has received 43 complaints, 53 self-reported incidents, 10 state enforcement actions and 102 survey deficiencies during the same time period.
A claim is an alleged violation of federal or state law and reported by someone outside the hospital; a self-reported incident is reported by the hospital; a state-enforcement action is a penalty or citation issued; and a survey deficiency documents an action or nonaction that violates state or federal statutes.
Contact Matthias Gafni at 925-952-5026. Follow him at Twitter.com/mgafni.
Centers for Medicare & Medicaid Services develops Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) that health care organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs. These health and safety standards are the foundation for improving quality and protecting the health and safety of beneficiaries.
During a hospital survey, these are the possible findings:
Source: California Department of Public Health