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The families of two children who were paralyzed after heart surgeries at Johns Hopkins All Children’s Hospital will receive $26 million and $12.75 million in settlements with the hospital, state records show.

Although the identities of the children are not public, the records describing their cases match two of the patients featured in a Tampa Bay Times investigation into the hospital’s troubled heart unit. Both families were struggling with the costs of caring for a permanently disabled child with no relief in sight.

A third family that lost a child after heart surgery will receive $750,000.

Last year, the Times reported that the death and complication rates in the All Children’s heart surgery unit had spiked in recent years, even after frontline workers warned supervisors about problems. The CEO, three other executives and two surgeons and stepped down after the Times investigation published and regulators demanded sweeping changes. The hospital has halted heart surgeries while it restructures the department.

RELATED COVERAGE: Johns Hopkins promised to elevate All Children’s Heart Institute. Then patients started to die at an alarming rate.

All Children’s spokeswoman Danielle Caci said she could not comment on the settlements “due to privacy concerns.”

In June, Johns Hopkins Health System CEO Kevin Sowers told the Times that he and hospital leaders had reached out to the families of children who died or were injured in the hospital’s heart surgery unit.

“We made a mistake, and we need to make sure we help support these families and make it right,” he said.

The three newly disclosed settlements raise the amount the hospital has paid to families who sought treatment in the Heart Institute to more than $40 million. A fourth family whose daughter died after a heart transplant settled a legal claim for $2.35 million in May.

Additional settlements are expected. The health system disclosed to investors in February that it was negotiating with 11 families, admitting liability in most cases.

RELATED COVERAGE: These eight children went to the All Children’s Heart Institute. Here’s what happened to them.

Most of the families featured in the Times story didn’t know the unit had systemic safety issues before reporters approached them last year. The parents who believed problems had occurred with their children’s care said that before the investigation published, they struggled to find lawyers willing to take their cases.

Malpractice settlements often include nondisclosure clauses that prohibit patients and their representatives from discussing the arrangements publicly.

But the settlements were recorded in an online database maintained by Florida’s insurance regulator, along with some basic details on each case. Although the database does not typically list patient names, other details match two patients featured in the Times’ reporting last year.

The $26 million settlement was for a male patient who suffered brain damage and lost the use of his limbs following a March 2017 heart transplant. His principal injury is described as a broken suture, the medical term for a stitch that holds tissues together after an injury or surgery.

Those details match the case of Jean Kariel Viera Maldonado, who suffered a massive stroke after a heart transplant in March 2017. His medical records, which his parents shared with reporters, show that the stitching connecting his new heart to a vein called the inferior vena cava had broken, causing him to bleed internally for 20 minutes.

Karen Maldonado and John Viera put their son, Jean Kariel, to bed. Jean Kariel had a stroke after a heart transplant at All Children's last year. His parents care for him full time. [NEIL BEDI | Tampa Bay Times] [ NEIL BEDI | Tampa Bay Times ]

Before the surgery, Jean Kariel was a vibrant 5-year-old who played soccer and rode horses. Since the transplant, he has been unable to walk, speak or feed himself.

His mother became his full-time caregiver in their small Central Florida apartment. But 18 months after the surgery, she was already having trouble maneuvering him into the car. She was worried about the day she could no longer lift him.

Reached by phone Wednesday, Jean Kariel’s father, John Viera, declined to comment.

The $12.75 million settlement went to a female patient who had had a heart surgery known as a Fontan procedure in June 2016. The settlement record says the patient had internal bleeding and a stroke. She suffered severe brain damage and lost the use of her limbs.

Alexcia Escamilla had a Fontan procedure in June 2016.

Her medical records, which her family shared with the Times, show that the chance of complications was in the 2 percent to 3 percent range. But after the operation, a vein burst and blood began pooling around her lungs.

The 3-year-old suffered a stroke, a rare complication of pediatric heart surgery. It was so serious that neurosurgeons had to put her in a coma and remove a portion of her skull so her brain could swell.

Alexcia can no longer speak or control her body. She sees multiple therapists and doctors each week.

“She lost everything I loved about her,” her mother Rosana Escamilla told the Times last year.

Rosana Escamilla bathes her daughter Alexcia in their home in August 2018. During heart surgery at All Children’s, Alexcia suffered from a stroke that left her unable to communicate. Alexcia has a special bed she uses while taking baths because she can't sit up by herself. [EVE EDELHEIT | Tampa Bay Times] [ EVE EDELHEIT | Tampa Bay Times ]

Escamilla declined to comment this week.

The family that will receive $750,000 lost a child who was injured in the hospital in the spring of 2017. Reporters were unable to identify the child based on the description of the case.

All three settlements, as well as the one from May, were reached outside of court, records show.

RELATED COVERAGE: Read all the Times’ stories on the All Children’s Heart Institute.

Experts say settlement amounts are typically based on the injured patient’s medical expenses, the cost of future care and lost earning capacity, as well as pain and suffering. They also take into account what a jury might decide if the case went to trial.

Jorge E. Silva, a Miami-based medical malpractice attorney and adjunct professor at Florida International University College of Law, said it isn’t unusual for claims involving children who suffered brain damage to result in multi-million dollar awards.

“If you get a life-care planner to say that taking care of this kid who is profoundly disabled is going to cost millions for the rest of their life, and you add to that the pain or suffering of this child, you can easily arrive at $10, $20, $30, $40 million,” he said.

Families that lose children tend to receive smaller settlements because they do not have to shoulder the same long-term medical expenses. But each case is different. In 2018, St. Mary’s Medical Center in West Palm Beach paid $8.9 million to the family of a child who died in its now-closed children’s heart surgery department, records show.

In some high-profile cases, the hospital or doctor has an incentive to settle out of court, said Scott McMillen, an Orlando-based medical malpractice attorney who was not involved in the Heart Institute cases. That’s because a jury may also choose to award punitive damages.

“It’s what amount of money will it take to get the attention of the defendant,” he said.

The problems in the All Children’s heart surgery program began after Johns Hopkins took over the hospital in 2011 and made a series of personnel changes. Nurses and other frontline workers began noticing unusual complications as early as 2015 and warned their supervisors that children were being injured or dying after straightforward procedures. But the surgeries continued.

By 2017, All Children’s had the highest death rate of any pediatric heart surgery program in the state in the last decade, a Times analysis of state data found. The rates of complications such as sepsis and wound ruptures had also spiked.

After the Times investigation, the hospital had to enter into a 12-month contract with the government promising additional oversight to avoid losing federal funding. State lawmakers also passed a law increasing oversight for pediatric heart surgery programs.

Johns Hopkins has vowed to make sweeping changes to its policies and structure, including new checks and balances on the hospital’s president, more thorough vetting of doctors and improved monitoring of patient safety and quality metrics.