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.
To 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 year. Duh!
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 This item directly spotlights two issue: first, the Broward Health ridiculously convoluted and outdated procurement policy allows the subterfuge of insider dealings; and second, the very purpose of Broward Health as a public hospital system.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!