Prince of Hearts

Dr. Michael Teodori holds the hearts of many Valley children - often literally - in his hands

The people who run St. Joseph's strongly disagreed with Teodori's remarks, but the doctor reiterated his concerns more specifically in a letter to the then-chief executive officer of St. Joe's. He wrote of the frustrations he felt at the deaths of two children on whom he had operated.

"Both of these deaths have been the results of unsuccessful intensive care management for patients who had an excellent operative result," Teodori wrote in part.

His decision to abandon St. Joe's stunned the state's medical community, which generally is unwilling to make waves so loudly.

Anita Robinson with her daughters Maya (left) and Adriana at their home in Surprise, September 10, 2002.
Paul Rubin
Anita Robinson with her daughters Maya (left) and Adriana at their home in Surprise, September 10, 2002.
Samantha Blier tends to Xzavion one day after his surgery at Phoenix Children's Hospital.
Paul Rubin
Samantha Blier tends to Xzavion one day after his surgery at Phoenix Children's Hospital.

"I'm not going to shy away from taking on any hospital or any other doctor who I don't think is doing the job," Teodori says.

Dr. Bill Peoples, a member of the Arizona Pediatric Cardiology Consultants group, says that "Mike is absolutely aboveboard and honest, and says just what he feels. What he says carries a lot of weight. One reason is that, as a surgeon, he gets the best results of anyone here, and he does the most complex of the most complex."

Soon after Teodori quit operating at St. Joe's, three intensive-care doctors also left St. Joe's for Phoenix Children's, as did 10 nurses whose specialty was pediatric hearts. Some took pay cuts to join the surgeon.

By then, Phoenix Children's already was securing funding for its proposed new facility on East Thomas. (Since it had first opened in 1983, the hospital had leased space inside of Good Samaritan Hospital, on East McDowell Road.)

Even without his CRS/St. Joseph's cases, Teodori by then already had as many patients as he could handle. Congenital heart disease still ranks first in the United States among the causes of infant mortality. According to the American Heart Association, about 35,000 babies, or one of about 150, are born with heart defects each year in the U.S.

In 2001, Teodori performed 247 cardiovascular surgeries at Phoenix Children's, a large percentage of which were considered highly complex.

But his increasing caseload hadn't solely been the result of the Valley's surge in population. Monumental advances in pediatric heart care have meant that children who surely would have been sent home to die as recently as a decade or so ago now fill about half of the nation's 3,000 pediatric intensive-care beds.

Pediatric cardiology is a relatively new field. Until the late 1980s, most doctors hesitated to operate on newborns with complex heart defects, choosing to wait until years had passed. But it seems that operating as soon as possible -- sometimes within hours after birth -- significantly lowers the mortality rate, and gives many more kids a fighting chance.

"I remember sending kids home to die," Dr. Teodori says of his early days as a surgeon. "Just didn't have the expertise yet -- few of us did. There were fascist doctors who'd suggest that a mom get an abortion when a heart defect showed up before birth. But things were moving forward in light-years as I gained experience and started to get better and better outcomes."

Teodori's growth as a surgeon paralleled that of the pediatric heart surgery world. Though there's no such thing as simple heart surgery, studies indicate that between 1984 and 1994, the rate of infant deaths from congenital heart defects dropped nationwide by 26 percent, even as the surgeries were getting more and more complex.

A comprehensive national study released last year indicates that the average surgical mortality rate for pediatric hearts is 6.2 percent. Statistics provided by Phoenix Children's Hospital indicate that the mortality rate there last year was 5 percent.

But Arizona Department of Health Services officials concede they currently have no mechanism to organize, evaluate or analyze diagnostic data, therapeutic data or outcomes data when it comes to treating pediatric heart patients -- CRS patients or otherwise.

Not surprisingly, treating those patients is extremely expensive. Says Chris Atherton, a Scottsdale mother of eight, including two born with major heart defects, "Hearts are about life and death, and fixing hearts costs a lot of money. It's a big, big business."

For example, one of the most treacherous operations Teodori does is the Norwood, named after the Delaware surgeon who developed it in the early 1980s.

The Norwood is the first in a series of three operations designed to treat a grave defect called hypoplastic left heart syndrome. It occurs when the left side of the heart, which supplies blood to the body, is grossly undeveloped.

Until the last decade or so, a hypoplastic left heart diagnosis was a guaranteed death sentence; about 95 percent of the afflicted infants died in their first four months of life. But these days, nationwide, more than half survive the third stage of the surgical series, which usually is completed before a child's fifth birthday.

Teodori says the average life expectancy of Norwood patients remains uncertain, because the procedure is still so new, but adds that some of Dr. Norwood's first patients from the early 1980s are still alive.

The total cost of a first-stage Norwood, including pre- and postoperative care, and the operation itself? About $150,000, approximately $50,000 more than an average Ross procedure -- the one Xzavion Gonzales underwent.

In late April, Samantha Blier and her son, Xzavion, met with Dr. Teodori for the first time. The boy's father, Pete Gonzales, and maternal grandfather Don Blier joined the meeting.

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