Broward Health March Board meeting, was I at the right meeting?

MeetingNeverHappenedAs is my practice, I attended the Broward Health Board meeting yesterday, and, except for a predictable push back and sad ad hominem attack on this successful blog through a weak attempt at character assassination, apparently orchestrated by Chairman David Di Pietro through John Degroot,  the meeting was remarkably professional and well run.

Absent from the meeting were the smug insider winks and nods of obscured agendas so characteristic of recent meetings, and discussions from the Board and CEO Nabil El Sanandi were both direct and on point.

Holy transformation – I kept looking around making sure I was at the right meeting.

The only clever gotcha that occurred was a carefully choreographed “walk on” item to restore the Pediatric Neonatal ICU at Coral Springs that was closed in 2013 for “fiscal” reasons, but not medical reasons.  Since this item was a walk on, and emotionally argued, the full reasons for the closure in 2013 were never presented by Dr. El Sanadi even though he certainly had the full report that served as the basis for the closure in 2013.  Nevertheless, if one separated out the emotional arguments, what was left was persuasive, and had I been on the board, I would have gone along with the unanimous vote to reopen the unit at Coral Springs.

This is a good segue way into an important discussion about this blog as a continuation of its purpose (Happy St. Patrick’s Day! Why this Blog exists) and scope (It’s none of your business! Really?).  Certainly, I intend this blog to have “red meat” posts that will open up insider double dealing, fast talking and clever maneuvers designed to obfuscate Broward Health’s true purpose.  Some of the posts will deal with the seemingly bad actors on the Board and CEO Dr. Nabil El Sanadi in direct and revealing terms, but whether it be criticism or praise – it is always about their official action or inaction.  The Broward Health Board members, and the officers they specifically appoint are public officials under Florida Law.  Only these public officials will be identified by name in posts.  Even further, their private lives are not relevant in posts on this blog, except to the extent that they involve the public actions and duties of their positions with Broward Health.

OuttaHereAs an example, Dr. El Sanadi is, by reputation, a fine physician and clinician.  His appointment as CEO and his actions as CEO, including potential conflicts with his other personal businesses, are relevant to this blog.  Any criticism of Dr. El Sanadi in this blog is directed to him as a CEO, a public official.

Another example, David Di Pietro, the current chair of the Broward Health Board is also an attorney.  I have witnessed his abilities as a lawyer, and can easily commend his legal services.  But, as is evident from many of my posts, I have a real concerns with his stewardship as a Broward Health board member, let alone as chair of the board.

This blog will continue expose how the “sausage” is made at Broward Health, and continue to stimulate a robust conversation on the purpose and practices of our Broward health public hospital.  Along the way, you should expect some really good “red meat” posts, and being human, from time to time, I will swerve off my path and address actions like the ad hominem attack on me by Mr. Degroot, even though his actions are less than a whisper in a wind storm.

Stay tuned.  Next week, a multi-part series of stories will be posted – likely one each day.  You won’t want to miss it. Lots of “red meat”!

It’s none of your business! Really?

Some Broward Health board members, and senior staff (in particular, clueless CEO – Dr. Nabil El Sanadi) ostensibly wants the public to think that what they do is none of anyone’s business and view the sunshine laws and transparency mandated by statute as simply an aggravation they must grudgingly and not happily endure.

When these few seemingly bad actors hang out their shingle announcing “Open for Business”, they aparently think it’s their business – not the public’s business.

Here is why they are wrong.

Broward Health is a public hospital system, created, established and funded by the community from a 45 bed hospital in 1938 to the massive public hospital system Broward Health is today.

Broward_Health_Medical_CenterThe early Broward community came together, volunteered their time, and raised money through Broward’s first “Hospital Fund” to convert the Granada apartments to a 45-bed hospital. In 1938, Broward Hospital admitted it first patient.  Fort Lauderdale paid for the new South Wing in 1942.  In 1948, the East Wing was built raising the Broward Hospital’s bed capacity to 142.  With donated land from the City of Fort Lauderdale and a legislative act approved by the voters in 1952 the North Broward Hospital District was created.  Broward Hospital was renamed Broward General and today it is known as Broward Medical Center.

From this community beginning, Broward General evolved from a 45 –bed hospital to Broward Health with over 50 health care facilities including 4 hospitals, close to 8,000 employees, and annual medical billings of close to 4 billion dollars with an annual budget of 1 billion dollars.  Today, Broward Health is one of 10 largest public hospital systems in the nation.

The most important purpose of Broward Health as one of the two public hospital systems in Broward is to provide for the health care needs of Broward.  The current leadership of Broward Health incorrectly understands this purpose as simply serving the indigent and proving a safety-net for those that cannot pay for healthcare services, but the health care needs of Broward are so much more.  It includes keeping health care costs down through competitive strategies, training our healthcare professionals (physicians, nurses, technicians, managers) for the future, creating healthcare employment opportunities for our citizens, providing required healthcare services to the county, municipalities and constitutional officers in Broward, and the list goes on.  The list does not include providing duplicative health services that are already being provided at similar price and quality levels by private and perhaps ‘competing’ healthcare providers.

Broward Health has become more than just a healthcare organization to Broward.  Broward health is a massive economic engine in the county because unlike private healthcare organizations that send its profit dollars to stock-holders and overpaid executives outside of Broward, most of Broward Health’s money is spent in Broward in the form of employee salaries, building projects and its associated job creation, and purchases of consumable supplies. As Frank Nask, Broward Health’s previous CEO, often said “Broward Health doesn’t have stockholders, we have patients and taxpayers.”

Broward Health is not a private hospital system that does some community benefit work, it is a public community hospital system that operates a health care system in Broward.  Broward does not provide community benefit work because it is tax based, and the removal of the tax base would not make Broward Health a private hospital system.  Everything Broward Health owns is owned by the public.  Everything Broward Health does is the public’s business.

It’s all our business, really!

Happy St. Patrick’s Day! Why this Blog exists.

I have received many anonymous tips during the first few days of going live and with some of these tips came questions as to my motives behind this blog.  It’s a fair question.

My simple goal is to make Broward Health, the system I have paid taxes to for over 20 years, and the likely place I will spend time in my advancing years – the finest public hospital system in the country.  Easier said than done.  There’s a lot of history to overcome, and many bad habits to change. To understand my commitment, I need to put it into context.

CaitlinCaitlin eventually made a full recovery but the lessons learned became the origin and reason for creating my attendance at most, if not all, of the Broward Health board meetings for the last four years, and this blog which was born out of bureaucratic frustration with and political misbehavior by Broward Health leadership.  Since coming to Broward in 1977 from New England, I have been active in public policy issues for the School Board, the County Government and served in an advisory position to many committees.  As a past elected official, chair of Broward’s Management and Efficiency Advisory Committee, chair of Broward’s Charter Review Committee, chair of Broward’s Growth Management Advisory Committee, and recognized public policy leader in Broward County by Gold Coast Magazine.  My family and I are long time taxpayers to and customers of Broward Health with deep and broad community roots in the Broward Health service area.  But back to Caitlin, my youngest of 4 children.

Caitlin, an otherwise healthy 19 year old Kodak and Nike fashion model arrived in Broward Health’s ICU after returning home to Fort Lauderdale for her spring break in 2011.  It was the second trip to the Emergency Room in two days that caused her admission to the Med/Surg floor.  The ER initially diagnosed a simple nerve pinch.  Less than 15 minutes after she arrived in her room at the Med/Surg floor, an alert physician noticed that she was experiencing organ failure – and she was taken to the ICU.  It was Saturday morning.

CaitlinICUFrom thereafter, event after event began to occur.  There was a failure of the “Rapid Response Team” to assemble.  There were problems with Caitlin’s medical records from the ER.  The “attending physician” asked for permission to insert a central line but “he had not done it in a while”.  Based on faulty blood work, the OB/GYN surgeons argued that she could be bleeding in her abdomen and they needed to do emergency laparoscopic surgery.  They successfully argued that, if they were right and the surgery was not done immediately, Caitlin could die.  There was no time to re-do any diagnostic tests.

The surgery was completed with no conclusions, but only exacerbated her condition.  In the recovery room, Caitlin woke up but could not breathe on her own and had to be sedated and reintubated.  To this day she has night terrors due to this incident.  Her condition was grave as she could no longer maintain blood pressure and her organs were failing.  The on-call ICU “intensivist” pulmonologist directed the nurses by phone and after refusing to come in to examine Caitlin said to another physician “you know how these cases go, it’s in God’s hands”.

For the next eight days, Caitlin was attended to by the heroic ICU nursing staff that all too often had to explain to the family that they were “waiting on Doctor’s orders”.  In spite of twenty-six (26) physicians on the case, it was not until the eighth day in the ICU that a diagnosis would be made.  Caitlin would be hospitalized for more than thirty days, with half of that time in the ICU.  Absent the heroic efforts of the extraordinary ICU nursing staff, Caitlin would not have survived.  But Caitlin did survive, and today she thrives.  So what happened?

Just before spring break, her college health clinic failed to treat her severe sore throat with antibiotics and this resulted in Lemierre’s syndrome.  If you are parents, and don’t know about it – click here.  It has a 97% mortality rate.  This condition and her symptoms were missed by the emergency room, in part by the failure of the emergency room to properly triage her condition, sloppy paperwork, etc. (and I put this mildly).   This was followed up by a circus in the ICU that nearly cost my daughter her life.

But my point – instead of suing everyone for malpractice, which we would likely win – my daughter and I decided that instead, we would commit to try to fix the problem so future families would not have to endure what we had to at the hands of Broward Health.  Besides, with medical bills approaching one million dollars, and Broward Health protected by sovereign immunity (capping recovery at $ 250,000) any recovery we could have made would likely be claimed by the insurance company.

Our ordeal started on St. Patrick’s Day, 2011 and we made our commitment in September of that same year.  I have been attending Broward Health Board committee and regular meetings ever since and up until the ouster of the CEO in December and the installation of a clueless CEO as a puppet to the political whims of an inexperienced Board Majority, progress was being made on many different fronts, slowly.

Now, much of the progress that was made is being trampled through arrogance, inexperience, and just plain carelessness.  This blog seeks to expose this conduct and by letting the sun shine in – make it difficult for back-room political deals to happen without consequence.

Stand by, it’s going to get bumpy!

BrwdHealth Blog hits 125,000 page views in record 13 days!

According to Google Analytic’s, this BrwdHealth Blog has had over 128,114 page views, from 63,000 sessions, and 58,396 users within the first 13 days of being live.

Analytics through 2015-03-15

(Notice the big spike down – the server was updated to better handle the web traffic and was temporarily down for maintenance.)

Coming soon (the titles may and probably will change..):

  • Strategic Planning, or How Broward Health Secretly Steers Public Money To Their Political Friends?
  • Dr. El Sanadi and the Di Pietro ConnectionThe Conspiracy begins!
  • South Florida Critical Care Network (SFCCN) – A Bold Experiment in cooperative Public Health,  Broward Health under El Sanadi works hard to snatch defeat from early success.
  • David Di Pietro’s process to “select” El Sanadi as CEO looks like the same process used by Governor Scott in choosing head of Florida’s Correction, was the Governor involved? – You decide.
  • The Deal to keep Broward Health Commissioner Nieland’s prostitution bust containedquid pro quo, The El Sanadi file.   El Sanadi’s contract – Guess who negotiated itYou won’t believe the contract terms!
  • When is a public record not a public record?  New Broward Health disclosures.  Shhh… It’s still a secret!

And many other developing stories…  Stay tuned (and keep the ‘Tips’ coming)!

 

Embattled Broward Health paid law firm $10.2 million; Tab included a lawyer’s M&Ms

Florida Bulldog has a great article published today; Embattled Broward Health paid law firm $10.2 million; Tab included a lawyer’s M&Ms  (click for the full story!!) written by Dan Christensen.  It’s a must read!

Here’s the first paragraph…

“Taxpayer-supported Broward Health has paid $10.2 million so far for legal advice about how to deal with an ongoing federal investigation into allegations that it colluded with doctors to submit tens of millions of dollars in bogus claims to Medicare and Medicaid.”

Shhhh… It’s a secret.

Since starting this site a few days ago, I have received many “tips” from “angry” people working at Broward Health about the recent “secret” doings at Broward Health.  Most of these tips are anonymous, but when I get the same tip from more than three people, I begin to wonder.  I hope to have the time to delve into some of these at greater depth, but in the meantime, here are some recent tidbits:

Shhhh its a secretEl Sanadi, who became Florida’s Broward Health’s new CEO after he and a handful of Board members orchestrated the ouster of the previous CEO, is apparently making a lot of changes behind closed doors, that should us all and which don’t seem good for Broward’s public Hospital.

After the herculean effort to certify Broward Health as a teaching hospital system through a decades  long and successful (although sometimes bumpy) collaboration with NOVA Southeastern (NSE),  El Sanadi and the Chair of the Board are scuttling the system’s relationship with Broward’s NOVA Southeastern and replacing it with Miami’s FIU.  According to one report, El Sanadi has given instructions not to hire any more Fellowship physicians or interns from NSE.  Apparently, El Sanadi has also made Dr. Kumar (a critical care physician who will be featured in a future article you won’t want to miss) the Medical Director in charge of the FIU program at Broward Health.  This policy change has never been presented to the Board publicly nor has Kumar’s new directorship contract.

In addition to the NSE change, El Sanadi with the Chair and another Board Member are believed to be pushing for a Request for Proposal (RFP)  for security services for their Republican friend ex-sheriff Lamberti.  This policy change also has never been presented to the Board publicly.

It is believed that El Sanadi with the Chair and a different Board Member are asking how they can get the Investment & Pension Committee to send out a new Request for Proposal (RFP) to change the professional finance adviser to Broward Health in favor of a “friend” of the Board member.  It should be noted that this is for an investment and pension portfolio of more than 800 million dollars.  This policy change also has never been presented to the Board publicly.

And if that’s not enough, El Sanadi and the Chair are seemingly working to establish a Kidney transplant center at Broward Health to attract patients from outside of Broward.  Not only is this capability duplicative in the area, but, at a cost of millions of dollars, it has very limited use for the public Broward Health purports to serve. You guessed it.  This policy change also has never been presented to the Board publicly.

One cannot help but wonder how long the other Board Members are going to allow this race to return to the dark days of Broward Health’s past, where Broward Health was little more than a cash register for insider dealing, to continue.  But, I guess the Board needs to be informed first, but shhhh… it’s a secret.

Broward Health Board Meeting – Part II Clueless!

(Part I – Board of Commissioners Rubber Stamp Shady Deals)

At the last Broward Health Board meeting (2/25/2015) in Florida a public speaker raised “process” concerns about a proposed million dollar sole-source lease for an orthopedic robotic surgery device for Broward Health North, the system’s Pompano Hospital.  The speaker represented a competing company and asserted that the robotic device should not be a sole source and called into question the apparent one-sided process that precipitated the agenda item.

BHRobotTo understand the importance of this otherwise benign item for a billion dollar Florida hospital system one must digress to context.  This unlikely hospital in Pompano established to address the health care needs of a predominantly minority and retirement community has over the last few years become one of Florida’s premier orthopedic centers for joint replacement.  This is very profitable for a hospital, especially this hospital that has been financially struggling.

The reason for this remarkable achievement is the hospital’s relationship with a prolific and highly respected orthopedic physicians group.  So when this group says it wants the hospital to get a particular robotic system or it will relocate to a hospital who has one – well, it doesn’t take an orthopedic surgeon to figure out what the hospital system will do.  Spend a million dollars over 4 years to keep millions of dollars of revenue/profit each yearDuh!

Pretty much of a straight forward deal that even makes sense for the taxpayers, so what am I writing about?   This item directly spotlights two issue: first, the Broward Health ridiculously convoluted and outdated procurement policy allows the subterfuge of insider dealings; and second, the very purpose of Broward Health as a public hospital system.

The robotic surgery system is less a sole source item and more a physician preference.  Medically, there is no objective basis to suggest that one type of joint replacement system is better than another, but with the complexity of orthopedic surgery – it is natural even foreseeable that a particular physician or physician’s group would become comfortable with one vendor over another.  It is also axiomatic that one of the operational functions of a hospital is to cater to the success (financially and medically) of its physicians.  So why did it take over six months to approve the lease?

The answer is that at Broward Health there apparently is a continuing massive effort in appearance over substance.  Rather than make the forthright and legitimate argument that the robotic lease was at the request of and for this particular successful physician’s group practice at Broward Health, staff was obligated to go through a convoluted and internal process to justify a procurement policy sole-source designation which this lease was not.  Two board members were uncomfortable with the apparent contradictions and a lengthy discussion ensued.  The new politically appointed CEO Dr. El Sanadi sat clueless.  In the end, the lease was approved which it should have been six months ago based on any reasonable financial analysis.

The second reason this particular agenda item was interesting is it exposes Broward Health’s understanding of its primary organizational purpose in Broward.  Rather than discuss whether it is appropriate for Broward Health to invest in the expansion of medical services to attract new patients from outside of Broward as opposed to investing in services which would serve and enhance the health care needs of its current patients, the seemingly primary supporting argument that was clear, but unsaid for the million dollar lease, was that the extraordinarily gifted and profitable orthopedic physician practice would leave Broward Health if the Board did not approve the lease.

The Board discussion should have been about the public policy of Broward Health’s responsibility to the health care needs of Broward County , Florida as opposed to the financial success of its physicians.  At the end, as a matter of Broward’s public interest, the lease should have been approved provided that the additional revenue it was predicted to produce would be applied to enhancing the health care needs of the community, and it came with an agreement that the requesting physician’s group would do their surgeries at Florida’s Broward Health North for the duration of the lease.  No such representations were made, and the lease was approved without any promises from the benefiting Physician’s group or the Board exercising is fiduciary responsibility to the public it “serves”.  No one should have approved the lease based on the disingenuous arguments made at the Board meeting.  It is sad and more than a little scary that neither the Board nor their CEO understood why the lease was good for the Broward Health system.

In this case, process mattered – and the layers of incompetence championed by a clue-less CEO smothered the pockets of excellence at Broward Health.  We should all be concerned!