Health group leader resigns

Home care chief leaves 4 months after girl's death

Hopkins says move is unrelated

Patient's IV mix was fatal

other safety lapses found

April 17, 2004|By Erika Niedowski | Erika Niedowski,SUN STAFF

Four months after medical errors at the Johns Hopkins Home Care Group resulted in the death of a 2 1/2 -year-old cancer patient, the president of that organization has resigned.

Steven A. Johnson announced this week that he was stepping down, effective immediately, after five years at the helm of the home care agency, which is jointly owned by the university and the health system.

Hopkins officials insist his departure is unrelated to the December death of Brianna Cohen, who was given an improperly mixed IV solution, or to numerous other safety lapses uncovered in a state investigation.

Staci Vernick, a Hopkins spokeswoman, called Johnson's resignation "entirely voluntary" and said it was based on "mutually determined long-range planning needs for leadership."

Johnson could not be reached yesterday for comment. Through Vernick, he has repeatedly declined previous requests to be interviewed about the home care group's problems.

Brianna was recovering at home from a bone marrow transplant at the Hopkins Children's Center when she was given an intravenous mixture that contained nearly five times the prescribed dosage of potassium. Hopkins officials, who said the mistake likely triggered an irregular heartbeat that caused her heart to stop, accepted "full responsibility" for her death.

An investigation by the Maryland Office of Health Care Quality found multiple safety problems at the home care group - which provides in-home health services to some 5,000 patients - in areas ranging from record-keeping to medication-ordering.

A state report released in February said the pharmacist who oversaw the preparation of Brianna's nutritional solution failed to "clarify orders, coordinate care and ensure that [IV] infusions were provided in a timely manner." It also found the pharmacist, provided to the home care group by an outside agency, had less than half the required two years' experience at the time he was hired.

In addition, the state cited communication problems between the home care group and Hopkins Hospital. A physician at the outpatient oncology clinic had ordered a new solution for Brianna in response to her rising potassium levels, but the solution was not prepared on the day it was prescribed. Brianna died the next morning.

The safety lapses, the state said, went beyond Brianna's death. Among the problems were other drug mix-ups - one that sent another child to the emergency room in a "comatose" state - and the hiring of under-qualified staff.

As required, Johnson submitted to the state last month a corrective action plan, detailing how the cited deficiencies would be corrected. This month, he submitted an amended plan after state officials said the first had not satisfactorily addressed all the issues.

According to the plan, the home care group is, among other things, auditing pediatric pharmacy records, redesigning daily pharmacy rounds, re-educating staff on policies and procedures and reviewing personnel files to ensure that staff members meet qualifications.

The most drastic step Hopkins took in the wake of Brianna's death was to order the inpatient pharmacies at the hospital and children's center to take over the preparation of all outpatient nutritional solutions.

Hopkins officials declined yesterday to elaborate on its improvement measures. Said Vernick: "We really feel that the corrective action plan speaks for itself."

With the immediate departure of Johnson as president, the leadership of the 350-employee home care group falls - at least temporarily - to Dan Smith, the vice president of finance there. Smith also is executive director of finance for Johns Hopkins Medicine.

Johnson's resignation was announced in an internal e-mail sent this week to Hopkins employees. The message, dated April 14, was signed by Ronald R. Peterson, president of the hospital and health system, and Richard A. Grossi, chief financial officer of Hopkins Medicine and chairman of the home care group's board of trustees.

"During his tenure, Steve has successfully directed the Home Care companies through a number of operational challenges while steadily improving annual margins to the current level of $1+ million," they wrote. "Product line development, productivity improvements, and compliance management are just a few of the major initiatives he has overseen.

"Steve has also recruited a talented and dedicated management team, which has fully integrated Home Care into the Johns Hopkins Medicine continuum of care," they went on. "The companies within the Johns Hopkins Home Care Group have benefited greatly from Steve's leadership."

Johnson earned $208,728 from the health system in the year ending June 30, 2001, according to public tax records filed by the home care group. No other salary information was available.

Mark S. Cohen, Brianna's father, said yesterday that he welcomed news of Johnson's resignation. "I think that's a good start in the right direction, but the other folks that were intimately involved should suffer the consequences as well," he said.

In January, Cohen and his wife, Mindell, who live in Owings Mills, filed a malpractice complaint with the state's Health Claims Arbitration Office, the first step required before filing suit in court. But the Cohens reached an out-of-court settlement with Hopkins weeks later. The terms of that agreement have not been disclosed.

So far, the Brianna Rose Cohen Foundation, which the family established to help other patients with cancer, has received about $750 in donations - including two from Hopkins employees. The Cohens plan to make a sizable donation with proceeds from the settlement.

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