ROME (AP) — When doctors and nurses at the Vatican's showcase children's hospital complained in 2014 that corners were being cut and medical protocols ignored, the Vatican responded by ordering up a secret in-house investigation. The diagnosis: The original mission of "the pope's hospital" had been lost and was "today more aimed at profit than on caring for children."
Three years later, an Associated Press investigation found that Bambino Gesu (Baby Jesus) Pediatric Hospital did indeed shift its focus in ways big and small under its past administration, which governed from 2008 to 2015. As the hospital expanded services and tried to make a money-losing Vatican enterprise turn a profit, children sometimes paid the price.
Among the AP's findings:
— Overcrowding and poor hygiene contributed to deadly infection, including one 21-month superbug outbreak in the cancer ward that killed eight children.
— To save money, disposable equipment and other materials were at times used improperly, with a one-time order of cheap needles breaking when injected into tiny veins.
— Doctors were so pressured to maximize operating-room turnover that patients were sometimes brought out of anesthesia too quickly.
Some of the issues — such as early awakening and the focus on profits — had been identified in 2014 by the Vatican-authorized task force of current and former hospital doctors, nurses, administrators and outsiders, who spent three months gathering information and interviewing staff off-campus. The AP corroborated those findings through interviews with more than a dozen current and former Bambino Gesu employees, as well as patients, their families and health officials. The AP reviewed medical records, civil court rulings, hospital and Vatican emails, and five years of union complaints.
Vincenzo Di Ciommo Laurora, a retired Bambino Gesu epidemiologist, described the hospital's past culture this way: "The more you do to a patient, the more money you bring in. You have to produce, produce, produce."
Bambino Gesu denied the AP's findings in a statement Monday, calling the AP report a "hoax" and threatening legal action. It said the AP report "contained false, dated and gravely defamatory accusations and conjectures that had been denied by an independent report of the Holy See."
That report, by an American team, spent three days at the hospital in 2015 and "disproved" all the allegations in the first report, except that there wasn't enough space.
The Vatican, for its part, denied there were any "serious threats" to children at the hospital, though it said it welcomed efforts to improve care, "including reports of practices that might be below standard."
Vatican spokesman Greg Burke acknowledged the Vatican had investigated staff complaints at the hospital but also pointed to the follow-up three-day clinical visit that determined they were "unfounded."
"No hospital is perfect, but it is false and unjust to suggest that there are serious threats to the health of children at Bambino Gesu," he said.
Arthur Caplan, head of medical ethics at NYU School of Medicine, said the problems detailed by the AP were extremely worrying if true: "These are inexcusable violations of children's rights." He called for an "independent audit by child health care experts not connected in any way to either the Vatican or even Italy."
Founded in 1869 to treat poor children, Bambino Gesu (Baby Jesus) is now the main pediatric hospital serving southern Italy. In 2015, the 607-bed facility performed over 26,000 surgical procedures — more than a third of all children's operations nationwide. It draws top-notch surgeons to work there and celebrity visits, including U.S. First Lady Melania Trump in May.
Perched on a hillside just up the road from Vatican City, the hospital's main campus enjoys extraterritorial status, making the Italian taxpayer-funded institution immune to the surprise inspections that other Italian hospitals undergo.
The Italian health ministry certifies Bambino Gesu for its research activities and in 2015 reported it had "characteristics of excellence." Provided with AP's findings, the health ministry promised to investigate.
The employees who spoke to the AP requested anonymity, fearing they would lose their jobs. Out of concern for the children, they said, they broke what the hospital's union has called the "omerta," the Italian code of silence.
Staff members told the AP that some of the conditions have improved since the administration changed in early 2015. The new leadership, they said, focuses less on volume and has more respect for following protocols.
Within weeks of the task force report being delivered to the Vatican in April 2014, member Coleen McMahon — an American nurse — grew impatient and emailed the group's coordinator that she planned to press for action. He told her to stand down.
"We are dealing with the Secretary of State of His Holyness (sic), the man that God Himself appointed to lead His Church," Dr. Steven Masotti emailed her back. "Our job is over!"
Other task force members went over Masotti's head and met in September 2014 with Vatican money czar George Pell, delivering a memo warning that "risky conditions" in the hospital still persisted.
Pell, who last week was charged in his native Australia with criminal sex assault, asked Sister Carol Keehan, president and CEO of Catholic Health Association in the U.S., to investigate. She led a second Vatican-commissioned assessment in January 2015.
She spent three days in the hospital observing procedures and speaking with on-duty staff. None of her team spoke Italian. She reviewed meeting minutes and OR schedules, but not union complaints or "adverse event" reports that are filed when things go wrong. Her final report "disproved" many of the findings of the first report and found the hospital in many ways "best in class."
"We came expecting to have to do a big expose and we found no basis for those complaints at all," Keehan said in an interview. "Can I say they've never made a mistake? Absolutely not. . But can I say that that is a hospital that gives exceptional care to children? Absolutely and positively yes."
Both Bambino Gesu and the Vatican pointed to her conclusions Monday.
But the Vatican's first investigator, Masotti, fully stood by the report he delivered to the Vatican in 2014.
"What we wrote in that report was the exact truth," Masotti said in a June 2 telephone interview. He said, however, that despite the problems Bambino Gesu has "very good standards."
The hospital also issued a lengthy statement repeating the responses previously provided to AP and reported. It said its hospital infection rates were below national and international benchmarks, that its post-anesthesia protocols were based on best evidence, and that it procured its equipment from the best suppliers.
On the needles that broke, the hospital said it never bought cheap needles but that it did test new equipment in selected wards before buying it. It said there were 11 cases of faulty equipment that were reported to authorities in the last two years, and that in one reported case a syringe broke but that the child didn't suffer any harm.
Pope Francis himself used a Christmas 2016 audience with thousands of hospital employees and patients last year to warn caregivers against falling prey to corruption, which he called the "greatest cancer" that can strike a hospital.
"Bambino Gesu has had a history that hasn't always been good," the pope said, citing the temptation for doctors and nurses to become businessmen.
"Look at the children," Francis said in Italian, pointing to the young patients gathered at his feet in the Vatican auditorium. "And let each one of us think: 'Can I make corrupt business off these children? No!'"