TAMPA, Fla. _ Sandra Vazquez paced the heart unit at Johns Hopkins All Children's Hospital.
Her 5-month-old son, Sebastian Vixtha, lay unconscious in his hospital crib, breathing faintly through a tube. Two surgeries to fix his heart had failed, even the one that was supposed to be straightforward.
Vazquez saw another mom in the room next door crying. Her baby was also in bad shape.
Down the hall, 4-month-old Leslie Lugo had developed a serious infection in the surgical incision that snaked down her chest. Her parents argued with the doctors. They didn't believe the hospital room had been kept sterile.
By the end of the week, all three babies would die.
The string of deaths in mid-2017 was unprecedented. Nurses sobbed in their cars. The head of cardiovascular intensive care sent an email urging his staff to take care of themselves and each other.
The internationally renowned Johns Hopkins had taken over All Children's six years earlier and vowed to transform its heart surgery unit into one of the nation's best.
Instead, the program got worse and worse until children were dying at a stunning rate, a Tampa Bay Times investigation has found.
Nearly 1 in 10 patients died last year. The mortality rate, suddenly the highest in Florida, had tripled since 2015.
Other children suffered life-changing injuries. Jean Kariel Viera Maldonado had a heart transplant at All Children's in March 2017. Soon after, the stitching connecting the 5-year-old's new heart to his body broke, and he had a massive stroke. Today, he can no longer walk, speak or feed himself. His parents care for him full time.
Times reporters spent a year examining the All Children's Heart Institute _ a small, but important division of the larger hospital devoted to caring for children born with heart defects.
They compared Florida's 10 pediatric heart surgery programs by analyzing a state database of 27 million hospital admissions spanning a decade. Then they reviewed thousands of pages of medical reports, interviewed current and former hospital workers, spoke with top health care safety experts and tracked down families across Central Florida coping with catastrophic outcomes.
They discovered a program beset with problems that were whispered about in heart surgery circles but hidden from the public.
Among the findings:
_ All Children's surgeons made serious mistakes, and their procedures went wrong in unusual ways. They lost needles in at least two infants' chests. Sutures burst. Infections mounted. Patches designed to cover holes in tiny hearts failed.
_ Johns Hopkins' handpicked administrators disregarded safety concerns the program's staff had raised as early as 2015. It wasn't until early 2017 that All Children's stopped performing the most complex procedures. And it wasn't until late that year that it pulled one of its main surgeons from the operating room.
_ Even after the hospital stopped the most complex procedures, children continued to suffer. A doctor told Cash Beni-King's parents his operation would be easy. His mother and father imagined him growing up, playing football. Instead multiple surgeries failed, and he died.
_ In just a year and a half, at least 11 patients died after operations by the hospital's two principal heart surgeons. The 2017 death rate was the highest any Florida pediatric heart program had seen in the last decade.
_ Parents were kept in the dark about the institute's troubles, including some that affected their children's care. Leslie Lugo's family didn't know their daughter caught pneumonia in the hospital until they read her autopsy report. The parents of another child didn't learn a surgical needle was left inside their baby until after she was sent home.
The Times presented its findings to hospital leaders in a series of memos in November. They declined interview requests and did not make the institute's doctors available to comment.
In a statement, All Children's did not dispute the Times' reporting. The hospital said it halted all pediatric heart surgeries in October and is conducting a review of the program.
"Johns Hopkins All Children's Hospital is defined by our commitment to patient safety and providing the highest quality care possible to the children and families we serve," the hospital wrote. "An important part of that commitment is a willingness to learn."
All Children's isn't the first hospital to struggle with pediatric heart surgeries. Several heart programs, including one at St. Mary's Medical Center in West Palm Beach, have shut down after reports of high mortality rates.
Most pediatric heart surgeries involve stopping a child's heart and operating in a space no larger than a walnut shell. But advances in science and technology have made them strikingly safe. In Florida, the survival rate for children who have surgery to correct a heart defect is now 97 percent, the Times found.
All Children's had earned a reputation as a community treasure that parents could trust to guide them through the terrifying experience of having a seriously ill child. Under Johns Hopkins, everyone assumed it would only get better.
"You hear Johns Hopkins, there's a sense of prestige," said Rosana Escamilla, whose daughter Alexcia suffered a stroke after heart surgery in 2016. "You think your child is in the best hands."
Instead, operations that surgeons described as low-risk began failing.
"Somebody has to do something," Sandra Vazquez remembers one of the other mothers telling her in a quiet corner of the unit, "because they are killing our children."
In interviews in April and May, All Children's CEO Dr. Jonathan Ellen told the Times that the Heart Institute had its "challenges" under control. It had slowed surgeries to the lowest level possible without shutting down.
"We've already self-policed our way out," Ellen said, noting that the hospital had been performing only low-complexity heart operations for much of 2017.
It was a tacit acknowledgment that All Children's hadn't been able to perform the hardest heart procedures.
But the hospital couldn't handle the less-complicated cases either, records and interviews show.
