My last post was two months ago, and a lot has happened since then!
Apart from vacation and family time, after my last post I wanted to step back a little and contemplate my end game with this blog. I never intended this blog to be without purpose and to simply dissolve into article after article highlighting the inexcusable and indefensible conduct of Dr. El Sanadi and his board. After over 35 years of public policy experience, it was my naïve hope that by exposing their outrageous conduct they would somehow modify and change their conduct. That didn’t happen in spite of over 40 articles (although I don’t hear as many “if I may” or the hypocritical miss-use of “transparency” at meetings anymore).
I needed to search for some measure of accountability to which Dr. El Sanadi and the board of commissioners could be held. If the board were elected, the accountability would come from voters. Those are people with whom I have some experience. But the Broward Health board is appointed by the Governor who seems completely insensitive to the incompetence of his appointments so long as that are loyal to him politically. I needed someone to hold responsible for the indefensible conduct of Dr. El Sanadi and the Broward Health Board. Noting that Broward is a Democratic island surrounded by a sea of Republican money, I had an “ah ha” moment. The accountability comes from the money. The money the Governor receives from Broward patrons, chief among these is the uber lobbyist and former chief of staff to Governor Scott – Billy Rubin whose office is on Las Olas in downtown Fort Lauderdale. Way down the list is Chip La Marca currently a Broward County Commissioner. Between them are a number of prominent distinguished community leaders who, by virtue of their relationship with the Governor and their citizenship of Broward need to be held accountable for Dr. El Sanadi’s and Broward Health Commissioner’s conduct. Going forward, I will name as many of these people behind the people and challenge them to be accountable for their family’s, neighbor’s, and friend’s sake. The Governor won’t listen to us, but perhaps he will listen to them. I had my answer! Let the sun shine in!
The second problem I needed to consider during my break was notion of Broward Health’s identity, and how it fit into the Broward community. It has appeared to me that the overriding view Dr. El Sanadi and the Broward Health Board has of itself is that it is some kind of hybrid private organization competing with other Health care providers that, by virtue of its tax support – has some obligation as a “safety-net” hospital. This is a republican, revisionist view in my opinion that does a disservice to both the sacrifice of the many who created, established and grew Broward Health to the massive organization it is today. I have previously discussed the origins of Broward Health here, and here – they are worth a reread. The genesis of Broward Health is a story of public investment, volunteerism and tax support at its best. Broward Health with 8,000 employees is not only a health care system but an economic juggernaut for Broward. Both the health and success of Broward Health must be a priority of Broward’s leaders as well as clearly in the public interest. Thus, there is a clear linkage between those moneyed interests who support the Governor and lobby the elected officials for their many clients and the conduct of Governor’s Scott’s appointments on the Hospital Board.
During my hiatus, I spoke with a number of board members. I spoke with elected and political leaders throughout Broward and I spoke with experts in the delivery of medical services from here to Washington D.C… I spoke with physicians both employed by and not employed by Broward Health. I spoke privately with regional and senior management level Broward Health employees. Oh, and I filed a formal complaint to the Inspector General’s office about Dr. El Sanadi’s contract, under my own name (see my articles about Dr. El Sanadi’s contract here, here, and here). In addition, I received many emails & tips from blog readers which I read and tried to correlate with other Broward Health information I was given. Following are some resulting tidbits:
- Any El Sanadi shine that may have existed is now gone in the regions. Putting it nicely, there seems to be a universal consensus that Dr. El Sanadi is way out of his depth and hasn’t a clue. But thanks to El Sanadi’s unenviable reputation as a manager who takes any criticism personally as a sign of disloyalty, there isn’t much of a push back yet. People understandably want to keep their jobs.
- A minority (3) board members are not “drinking El Sanadi’s cool-aide”. So far their disappointment has been expressed more through polite board questions, but underneath – they seem to be seething.
- The liver & kidney transplant program is a text-book example of how much El Sanadi’s inexperience and arrogance can cost the system. Dr. El Sanadi has alienated the Jackson system, the University of Miami, Nova Southeastern, and now is giving the Cleveland Clinic (ostensibly Broward Health’s competitor) over 2 million dollars just for Doctors. Incredibly, word has it Dr. El Sanadi is also “lending” overworked and overextended Broward Health neurological physicians to the Cleveland Clinic for coverage as part of the deal. If you add to the transplant deal the ongoing cost of the organ register and software, Dr. El Sanadi has dramatically increased the cost of the program which has yet to even fill an unmet need in Broward.
- Apparently, the highly praised Urology contract Dr. El Sanadi negotiated, included some medical sleight of hand where changes of services made comparisons between the old contract and the new were like apples and oranges. The Board was delighted that El Sandi reduced the cost, but in reality – he apparently simply reduced the services being offered by Broward Health and increased the services offered by these physicians privately. The result, the Urology physicians make more money – and that might be appropriate, but it certainly never was a conversation with the Board.
- Dr. El Sanadi has eliminated quality as a corporate responsibility by eliminating the corporate quality positions and people. Quality is now the responsibility of the regional hospital. It bears notice that virtually all other health-care systems in the country have gone in the opposite direction and made quality a corporate, system wide responsibility. Again, no apparent conversation with the Board of which I am aware or have been told.
- In the past, I have blogged that the reputation of Dr. El Sanadi as a clinician is excellent. Universally, comments from physicians working next to Dr. El Sanadi when he actually showed up to take a shift in the emergency room paints a very different picture. Serious issues about his service with Phoenix and later with the successor to Phoenix suggests problems with both his performance and management. I guess I believed his press. I stand corrected.
- I have blogged that I didn’t think much of Dr. Chizner’s negotiating technique of bringing his patients to the Board meeting, but there is no denying his abilities as a physician. So when I begin to hear rumors that there are promises that were made to Dr. Chizner that apparently are not being kept by Broward Health, and that his duties as a Medical Director haven’t been paid – I am not surprised. I hope this is untrue, but it seems to be entirely consistent with how Dr. El Sanadi operates.
- Many of the comments I hear speak to the lack of organization, lack of clear vision and the utter lack of any semblance of a chain of command at Broward Health under Dr. El Sanadi. The result is a culture of El Sanadi. Multiple people are doing the same task assigned personally by Dr. El Sanadi because he seemingly doesn’t remember who he told to do what, one day from the next.
- In early June and July, I kept hearing persistent reports that Broward Health’s bond underwriters were calling for copies of the 2015/2016 budget which, although needing to begin on July 1st – had not only not been prepared, but had also not been discussed with the Board. Even more disturbing were rumors that Dr. El Sanadi had instructed some to simply duck the underwriter’s calls. This apparently continued through most of July and then very late in the month – the budget first began to be discussed with Board members. Contrast this to the normal budget review process in past years when the proposed budget was fully vetted with the Board in May and June, with changes from the collective Board in June finishing with the Trim meeting at the end of July and the Tax meeting in September. The proposed 2015/2016 budget apparently shows a shortfall of $12 million dollars. I am reliably told that this is somewhere around an $80 million dollar reversal from the previous year which showed a surplus of $70 million. This seems consistent with Dr. El Sanadi’s stand not to run the system as a bank in favor of apparently running the system into the ground. Taxes at the trim meeting were set to collect exactly the same tax amount as last year, and at the final tax hearing in September – the Board will again reduce this amount by $5 million with is about 3.2% less than the trim notice tax rate. The budgetary shortfall will be made up from the considerable reserves built up by El Sanadi’s predecessor to close to $750 million, but $250 million is already dedicated to capital projects and an annual reductions of State funding will create recurring charge against the reserves over the next few years of from $5 to $75 million dollars per year. All this and the potential “false claims” justice department settlement estimated at over $69 million will make surprisingly short work of Broward Health’s reserves. Etc., etc., etc.
You can be sure that the bond markets and underwriters will not be happy with Dr. El Sanadi’s uncontrolled and undisciplined fiscal policies at Broward Health. Good republicans everywhere will have increasing difficulty explaining the reduction and lack of quality and medical services in the face of such rampant ineffective spending. Notably, for the first time since I have been attending Board Meetings, the July Board meeting did not have a finance report.
There are about 8,000 employees at Broward Health. Most do a wonderful job and all are deserving of a professional workplace. Dr. El Sanadi and the current majority on Broward Health’s Board are putting that workplace and Broward Health at risk. The people responsible for Dr. El Sanadi’s mess begins with the Governor Rick Scott, followed by Broward lobbyist Billy Rubin, followed by Board chairman David DiPietro and his proxies on the Board, followed by Broward Commissioner Chip LaMarca. Keep those names in mind as you learn more about what’s going on at Broward Health and remember to hold them responsible at every opportunity you can until they take notice and step up.
Stay tuned for my next post which I promise with be soon & more regular. Thanks for your patience.