Broward Health Gawkers!

Too often too many of us carefully stand on the sidelines hurling criticisms at the players (in this case usually the Board Members) without offering any constructive solutions to the problems presented.

I would like to dedicate this post to some suggestions and perhaps, some superficial arguments on their behalf.  However, do not judge the suggestions merely on my supporting superficial arguments that by necessity must be uncharacteristically short.  Each suggestion could be a post entirely in itself.

poop-was-thereGovernmental Representation

However well intentioned, the Board of Commissioners – lacking any intuitional memory, should never have replaced their governmental counsel with compliance counsel.  Moreover, based on past District history, inside counsel versus a multi-disciplined outside firm has never worked for Broward Health.

Currently, Broward Health is misusing the highly respected Berger-Singerman governmental law firm.  Contrary to the current arrangements with the ‘Audit’ committee, Berger-Singerman should be retained by the Board through their general counsel to provide governmental advice to the Board.  Florida’s Attorney General has demanded 5 million from the District, which means the public – and we need to be both defended and protected.  Discussions in anticipation of litigation are generally and appropriately held in the shade.

The Board of Commissioners need the advice of a Governmental Lawyer – Like Sam Goren, Mitchell Burger is one of the best.  Let him continue to help the District, but elevate his assistance to the Board level.

Fog of War

The district is awash in rumors, allegations, name-calling, and conspiracies around every corner creating a “fog of war” condition over Board discussions and decisions.  This must be addressed.  Here is how it can be done.

  1. The Board should unilaterally revoke all current non-disparaging clauses in all severance agreements. This revocation should be noticed to every ex-employee currently receiving any kind of severance.
  2. The Board should unilaterally revoke all non-disparaging clauses in all vendor and/or service agreements currently active. This revocation should be noticed to every party to an agreement having a non-disparaging clause.
  3. The Board should establish a policy that no future agreements of any kind will contain any non-disparaging clauses, sections or prohibitions.
  4. Take your chief internal affairs or compliance person and establish them in the Florida Inspector General’s office for at least the next 12 months.  Have them establish a confidential reporting function for any Broward Health employee, vendor, physician or other who wants to confidentially report criminality, corruption, or policy (non-medical) violations at the District.  Have this person conduct exit interviews of every fired, work-place reduction, resigned, or retired employee of Broward Health.  Insure anonymity and confidentiality for all contacts to the office.  This office should forward allegations to the appropriate investigative agencies or departments. Once this process is established, no more internal investigations, no more rumor hunts – all allegations, etc. will be referred to the Broward Health office of the Inspector General.  (It is noteworthy that the Berger-Singerman firm has experience in setting this process up for the Water District.)

Governance

Interim CEO

The finances of the District have been mauled by incompetence, the District’s Bond Rating is in peril, and although the recent month of financial good news is welcome – the District is still on a perilous financial path as a result of weak leadership.  Even if the District accelerates the recruitment of a strong outside CEO – it will be months, if not years before a new person can be hired and transitioned into the unique problems at Broward Health.

If only there were someone with the requisite experience, knowledge and financial ability who could step in and start work day one!  But wait, there is.

Both CEO Frank Nask and Memorial’s CEO Frank Sacco are available and might be willing under the right circumstances to become an interim Broward Health CEO until such time as a new CEO can be hired and properly transitioned.  Both know the District, both enjoy the confidence of the Bond Markets, and both are strong leaders who could begin to sort out the problems on day one.  And neither would be interested in a long term assignment.

The Board should ask Commissioner Gustafson to make contact and see under what conditions either Nask or Sacco would be willing to briefly come out of retirement and become Broward Health’s interim CEO.  Maybe they wouldn’t, but maybe one of them might! Commissioner Gustafson has a good relationship with both men and would be an ideal Board advocate in this matter.  Worst case scenario is they both would say no.  Swallow your pride and think of the public you serve.

Purchasing Policy

MeetingNeverHappenedThe Board needs to address the very sad state of affairs in its weak purchasing policies.  Before Dr. El Sanadi, the Board with its then governmental counsel Sam Goren was working on a comprehensive review and rewrite of these policies.  I saw a draft of this effort and shared some ideas from my time a chair of the County’s management and efficiency study and Charter Review commissions.  It was a good beginning step, but it needed some work.  At the time and to his credit, Commissioner DiPietro was leading the effort. It is time to resurrect this effort and finish the job.

Centralized Credentialing

Centralized credentialing was supposed to be effective at the time of corporate’s move from Broward General’s historical location to the new facility at the Spectrum Center.  It was an important first step to address the negative influence of rampant physician silos at each of Broward Health’s hospitals.  Here how it was to work.

  1. All physician credentialing paperwork centralized at the new Corporate Headquarters.
  2. A new credentialing committee essentially comprised of the medical chief of staff of each hospital, and various other medical and compliance members.
  3. Physicians credentialed at one Broward Health Hospital would be at all Broward Health hospitals.

This strategy based on physician convenience would help drive and maintain patient admissions across the system while providing corporate with the ability to recruit needed area specialty physicians easily. Moreover, recognizing that the part of the credentialing fees that go to the various hospital medical staffs for their discretionary use would be lost or significantly reduced under this plan, it was important that an alternative method of funding the hospital medical staff’s discretionary budgets be found.  Not an impossible task. Finish this initiative.

Let me finish …

This is directly to the Board.  Knock it off, and get to work!  Stop chasing rumors, allegations, or conspiracies.  Start doing your job building for the future.  Ignore but cooperate fully with any investigations.  They will either materialize into something or disappear into nothingness.  Have a real vision for building Broward Health into the finest public health system in the nation and let nothing distract you from that mission.  Value your public, your physicians, your employees and the sacrifices of so many that put you in the position to do some good.  There are smart people who are standing by to help you succeed.  Seek them out and listen.  Eyes forward.

Doctor’s lounge at Broward Health an unhappy place these days – Sun Sentinel

Let me begin by stating that in no way do I speak for an entire medical staff of any particular hospital or hospital district. I can, however, offer the sentiments that have been shared with me by employees and physicians on an almost daily basis lately. In short, we are collectively frustrated, concerned and some of us are angry at the recent events and decisions within Broward Health.

Source: Doctor’s lounge at Broward Health an unhappy place these days – Sun Sentinel

David DiPietro’s Raw Deal.

David-Di-PietroThere is no way to get around it, Florida’s Inspector General and Governor Scott got it wrong when they suspended David DiPietro from his position as Chair of Broward Health!

While DiPietro should be concerned about the unfolding Zimmerman Advertising scandal which embroils his wife, recently appointed as Judge and currently running for election, his close friend – Broward County Commissioner Chip Lamarca, and himself in troubling conduct – based on what I know, DiPietro was certainly not obstructing any investigations at Broward Health of which I am aware.

It is, however,  an overstatement in some public reports that DiPietro initiated the various investigations.  More to the truth of the matter is that DiPietro facilitated and enabled Dr. El Sanadi’s unfounded paranoia by recommending the highly respected corruption investigator Mr. Wayne Black.  We now know that Mr. Black’s first targets were none other than previous CEO Frank Nask, me (personally and as the author of this blog) as well as some of the information posted here.  Given my earlier allegations have since been born out; I believe that there was a reasonable basis for an independent investigation.  However, clearly Dr. El Sanadi’s personal paranoia had no basis in reality and should have been a warning signal to Mr. Chair DiPietro of things to come.  In gumshoe parlance, “Frank Nask and I turned up clean!” and there was reason to be concerned about many if not all of the matters I had previously raised.  Further, because investigation of this type generally expand over time – Mr. Black has also uncovered other concerns and matters.  Matters, unknown to me.

Chair DiPietro is correct to be concerned about the performance and problems with the Board’s ill-conceived choice for corporate council Lynn Barrett, But DiPietro must accept responsibility in orchestrating the ouster of highly respected previous Board Counsel Sam Goren and replacing him with someone with very limited governmental experience.

As to the suggestion that David DiPietro that DiPietro was acting or about to act in a retaliatory manor with respect to either interim CEO Fusco or Counsel Barrett, well – that notion is absurd.  Those are the two positions in which the Board, and by extension – the Board Chair have direct supervisory authority.  Both are “at will” employees of the Board.

I have written in the past about the retaliatory culture at Broward Health that must change, and in particular – for example, the circumstances around the ouster of the previous Broward Health corporate marketing director – Sara Howley, in which I believe DiPietro was directly involved.  See my article Board of Commissioners Rubber Stamp Shady Deals at Meeting – Very Tacky..        I know there are many, many examples of similar unfounded and retaliatory actions against Broward Health employees, physicians and vendors – but the allegations from the Florida Inspector General, in this case against David are just mistaken.

Finally, Chair DiPietro’s recent embrace of transparency and openness in the Board’s business with respect to his concerns relating to Counsel Lynn Barrett, Wayne Black and related matters was correct. Although I wish Chair DiPietro would carry his new found openness to public records and their the Board’s regular improper “strategic planning” shade meetings – those issues are for another day.

Summary

Readers of this blog know that I am no fan of Chair DiPietro’s tenure at Broward Health, but in my opinion – while there may be many other reasons to suspend and remove DiPietro from Broward Health’s Board, based on the Governor’s stated reasons, Governor Scott’s suspension of Chair David DiPietro was premature, improper and ill considered.   Further, I believe DiPietro’s concerns about the conduct of the current General Counsel of the District are both well founded and correct.  I applaud Chair DiPietro’s relatively new commitment to openness and transparency reflected with his proper instance on an open meeting to discuss the General Counsel issue.  Unless there are some facts not publically known, Florida’s Inspector General should recommend that DiPietro’s suspension be rescinded and he should be forthwith restored as chair of Broward Health’s Board of Commissioners.

I cannot say the same for Commissioner Darrell Wright’s suspension.

Governor Scott’s Board Appointed Incompetent Political Hacks Killing Broward Health!

Govenor ScottGovernor Scott’s Board appointed incompetent political hacks are killing Broward Health through corrupt and incompetent improper interference with the management of Broward Health.  It was the root cause of the disastrous ouster of previous CEO Frank Nask, the hurried crowning of Dr. Nabil El Sanadi (perhaps the worst Broward Health CEO in its sordid history), the ouster of an exceptional governmental attorney Sam Goren, and the furious replacement of senior staff competency with remarkable mediocrity.   Over the last year and a half, senior staff competency has either been fired, or “retired”, or “work force reduced” and replaced with inexperience and incompetency.

Broward Health today is a textbook case in how an incompetent Board with dubious “agendas” can transform a thriving, growing and remarkable organization into a morass in 13 easy months.  250px-Brain_DrainWhile Broward Health’s leadership vacuum continues (no CEO, no COO, no CFO, and a general counsel that apparently hasn’t a clue) the “peter principle” established a trio of mid-level staffers (Donna Lewis, Doris Peek and Deon Wong Dr. El Sanadi’s “brain trust”) as those in charge in the back room of Broward Health’s retaliatory system of incompetence.  Doctors and professional staff leaving in droves as a result.

Amid literally too many specific examples of corruption and incompetence in the Broward Health leadership, Florida’s Inspector General Miguel deadpans, “There are also suspicions about pressure being applied by certain Board members on staff of Broward Health to steer contracts to various entities”.   Really?  Wow!  It’s almost like she has read any one of my original posts on the blog dating back to late 2014, or spoken to literally anyone at Broward Health.  Inspector General Miguel’s investigation is important, and I encourage anyone with specific information to contact her office privately and confidentially.  (You should not contact anyone at Broward Health until the Board adopts the federal whistleblower protections, a formal and very public policy against retaliatory employment and purchasing practices and there is an independent, secure and private method at Broward Health to make reports.  Until then, contact Wayne Black at 305-372-3748 with confidence who will continue to investigate corruption at Broward Health.)

David-Di-PietroThe man most responsible for this mess is David DiPietro, chair of the Broward Health Board, and by extension Governor Scott who accommodated DiPietro by providing Board appointments so DiPietro would control a majority of the Board in an acrid nougat of good intentions and greed, dipped in a creamy candy coating of rationalized “principles” and incompetence.

At last, on March 18th – the Governor correctly suspended DiPietro and his board political shadow Darryl WrightThe Governor did not go far enough and should have removed them both replacing them with better appointments.  Neither DiPietro nor Wright have any requisite experience to be serving as fiduciaries of the Broward Health system and both have conducted themselves in corrupt and/or incompetent ways that will continue to embarrass the Governor as events unfold.

A quick review:

Broward Health

BH_2CRecall that Broward Health is much more than simply a “last resort” health care system for Broward’s indigent population.  It is a 8,000 employee economic juggernaut for the county producing an impact of billions of dollars.  It is a vast training facility for our future doctors, nurses, medical technicians, healthcare administrators, and a multitude of other career paths.  It was started by inspired past leaders of Broward County using public properties, public monies and public treasure.  It was then and is now an investment in Broward’s future that small-minded appointed political hacks want to steal from our children’s future through privatization strategies and by characterizing Broward Health as a “private hospital system”, that does some public charity.  In fact, Broward Health is a public hospital system through and through.   See some of my past articles Broward Health – It’s Our Hospital and It’s none of your business! Really?,   for more on this topic.

CEO

A little over a year ago, DiPietro successfully orchestrated the ouster of then CEO Frank Nask and replaced him with his friend and surrogate Dr. El Sanadi, a republican political player with a history of significant contributions to the republican party and Governor Scott.  Not co-incidentally, David DiPitro’s wife – before being recently appointed judge by this Governor, was appointed to Florida’s Medical Board chaired by, you guessed it, Dr. El Sanadi.  Some, more cynical than me, thought that David DiPietro’s wife’s appointment to Florida’s Medical Board was to enhance David DiPietro’s growing medical legal practice enabling him to more easily continue and grow his ability as a reliable republican political fundraiser.    See some of my past articles Innovative CEO NASK Forced Out, Politics Wins – We Loose!, and The Best Broward Health CEO contract politics can buy!, and  Has the Office of Inspector General seen Dr. El Sanadi’s CEO Contract with Broward Health? and OMG – Nabil El Sanadi’s First 5 Months! for more on this topic.

Simon & Garfunkel captured the essence of Dr. El Sanadi’s tenure at Broward Health perfectly in their prophetic song “Richard Cory”Listen to it:

They say that Richard Cory owns one half of this whole town, With political connections to spread his wealth around. Born into society, a banker’s only child,
He had everything a man could want: power, grace, and style.

The papers print his picture almost everywhere he goes:
Richard Cory at the opera, Richard Cory at a show.
And the rumor of his parties and the orgies on his yacht!
Oh, he surely must be happy with everything he’s got.

He freely gave to charity, he had the common touch,
And they were grateful for his patronage and thanked him very much, So my mind was filled with wonder when the evening headlines read: “Richard Cory went home last night and put a bullet through his head.”

Frank Nask

NaskAccording to sources, Board Chair David DiPietro replaced CEO Frank Nask as Broward Health’s CEO simply because Nask refused to allow Board interference in Broward Health’s administration.   This did not sit well with DiPietro who, coincidentally has built a considerable health care legal practice since appointed on to Broward Health’s Board.

And why not replace Nask as CEO of Broward Health with someone who had no experience managing a hospital let alone one of the largest health care systems in the country?  After all, before coming to Broward Health, Nask was only a nationally respected health care consultant specializing in saving and managing troubled health care systems.

Not only was Frank Nask CEO at Broward Health during an unprecedented period of stability where the tax rate reduced from 2.5 to 1.6 mills and cash increased from 350 to 800 million dollars, but during one of our nation’s worst recessions – Broward Health actually increased staff with no system wide layoffs.  With the Governor’s emphasis on employment, one would think Frank Nask’s experience would be helpful increasing jobs in Broward!  Notably, during Nask’s tenure, capital spending increased to maintain plant and equipment while maintaining Broward Health’s bond ratings and covenants.

Frank Nask’s emphasis on Broward Health as a teaching hospital was realized through careful relationships with Nova Southeastern University, the University of Miami, and others.  Relationships that have been intentionally severely damaged in favor of a singular relationship with Florida International University over, among other more seedy financial issues, the pyric debate between MD’s and DO’s.  Again, David DiPietro is at the root of this disaster and the status of Broward Health as a teaching institution is now at risk and hanging by a thread.

Here’s the truth.  I imagine that 50 bad actors are embarrassing the remaining 7,950 Broward Health Employees.   There is another group of Broward Health employees that perhaps take the lead from these bad actors thinking “if they can do it, why can’t I”.  The vast majority of Broward Health employees come to work every day dedicated to both their profession and the public they serve.   It is important that we put the problems at Broward Health in perspective and take a collective deep breath.  As in any organization of Broward Health’s size and complexity – there is bound to be some discoverable criminality.  In these cases, Broward Health and the public are the victim.  Then there is non-criminal corruption.  A wink, a nod, a smile and someone benefits unfairly over the organization or colleague, patient or vendor.   Then there is incompetence.  The greatest threat to Broward Health today is the Board and management’s incompetence as Broward Health navigates through complex public and health care challenges.

MoneySuckIt’s simple – without a competent Broward Health Board, Broward Health’s problems and the talent & Brain drain will continue to grow geometrically to the certain embarrassment of the Governor.