Be afraid, be very afraid!

A Recent Broward Health Board Meeting

As seen in the City News, a group of 10 neighborhood newsletters that go to about 60,000 affluent homeowners in, and around, Ft. Lauderdale, Wilton Manors and Oakland Park each month. Author Dan Lewis’ articles are regularly published in the City News publications. Contact them at citynews@bellsouth.net or call (954) 564-1308.

The Broward Health chairperson begins the board meeting in broken English with a call to order, followed by an unintelligible instruction to call the roll: Chair Rocky Rodreguez, “here”; Vice-Chair Christopher Ure, “here”; Beverly Capasso, “here”; Linda Robinson, “here”. So, begins the meeting in a nondescript room at the unimpressive west-central “Spectrum” headquarters of the 2+ billion-dollar tax-supported safety-net hospital system responsible for the healthcare of the majority of Broward County.

By law, there are supposed to be 7 board members for Broward Health, all appointed by the Governor. But for more than a year the Governor has not appointed members to fill all the board vacancies. Recently, after one Board Member refused to be re-appointed, and another resigned because of alleged misconduct by her fellow Board Members, the board only has 4 active members – the exact number required for a quorum to conduct the business of the 2+ billion-dollar health-care enterprise.

Rocky Rodriquez
Rocky Rodriquez
Linda Robison
Linda Robison
Beverly Capasso
Beverly Capasso
Christopher Ure
Christopher Ure

Because the number of board members equals the board quorum requirement, depending on whose legal opinion the board chooses to follow – either the board requires a unanimous vote (a majority of the Board legal argument), or three of the four active members to vote (a majority of the quorum legal argument) for an agenda item for approval. Remarkably, the board’s legal counsel advised that on a particular agenda item where one board member recused themselves due to a conflict (an all too common occurrence), only 2 out of the remaining 3 votes would be required to approve the item. Not surprisingly,  no experienced or past Broward Health legal counsel agrees with this board’s legal counsel’s advice here. Consider the ramifications of a hypothetical agenda item to privatize the system where one ethical board member wisely recuses themselves. According to the current board counsel, only 2 affirmative votes would be required to flush the system down the toilette.

The Governor needs to do all that he can do to appoint members to fill all the vacancies on the Broward Health Board. The voting uncertainty alone argues for urgency.

But I digress, back to the meeting.

The meeting room is filled with senior and mid-level staff, district employees and physicians who have come to watch the board spectacle but have little other purpose in attending. Each has way better things to do, but here they are anyway. By my count, the only other people at the meeting are a few vendors interested in specific agenda items, some low-level employees who have rightly been singled out for monthly honors, and, of course, John DeGroot – a self-styled curmudgeon who should have listened to the advice “Better to Remain Silent and Be Thought a Fool than to Speak and Remove All Doubt”.  Unfortunately for John, there is little doubt left.

I bring up Degroot because what happens next illustrates the point that even the relatively simple task of managing public comment appears to be beyond the abilities of this Board.

The Chair calls for “Public Comment” (an agenda item that gives anyone the opportunity to address the board on any relevant matter) and DeGroot swaggers to the podium, as if fulfilling some anointed obligation to harangue the board. A security guard quietly takes his post about 20 feet back. Degroot begins, as he usually does, with a factually unsupported assumption to which no one agrees, and then demands that a particular board member give a response to an angry question born out of an unhappy life.

meeting cartoon

What happens next, or rather what doesn’t happen next is the point. Silence. Silence, while board members check their phones for calls, emails, texts – and waits, the chair shuffles, uneasy in his seat and waits – refusing to look up. Degroot waits in silence holding the podium hostage. And waits, and waits. Finally, I could take it no longer, I said out loud what everyone in the room was thinking “Are we waiting for the 3 Minutes to expire? This is ridiculous!”. The Chairman looked up and I shrugged my shoulders and used my best hand gestures to signal “WTF”. Thankfully, just then, the very able Maryanne Wing – clerk to the board, announced that 3 minutes had expired and Degroot sat down with his pyric victory and petulant smirk!

The context to this incident is this. There is typically a 3-minute rule for public comments at most public meetings, and Broward Health is no exception. Except, the 3 minutes is not a grant of time. Rather the 3 minutes is a limit. In addition, well run meetings prohibit the back and forth debate between the public and board members as a slippery slope to meeting chaos. Again, Broward Health meetings are no exception. Degroot knew full well that meeting decorum rules prohibit any conversation or response to his question by the Board.

Here’s what should have happened, but didn’t. After Degroot asked his absurd question – the Chair should have immediately reminded him that the board would not respond, and ask if there were anything else – and if not, instruct him to take his seat or be removed.

I use this incident as a microcosm illustrating a fundamental problem at Broward Health with its current 4-member board. The board doesn’t understand the basics of why they’re there, what they’re doing, or who’s interests they represent.

Another example in this same meeting, was the item addressing the suspension of the CEO search efforts. Here’s what happened. At a Board Member’s recommendation and after paying more than $300,000 to recruit a new CEO to replace more than a year of “interim” CEO’s, and after interviews culled the candidate list to 2the board abruptly cancelled their CEO replacement activities to hire, instead,  a management company to tell them (the board) what, if anything, is wrong with the management organization at Broward Health.  Likely, after spending hundreds of thousands more of our tax dollars – the management company will report what everyone knows, that the root of the management problems at Broward Health is the board itself.

By common sense, relevant Florida Statutes, Broward Health’s charter, and specific prohibitions – the Broward Health board is not to interfere with the management or operations of the health system. The board’s job is to make policy, and supervise the CEO, Corporate Counsel as well as a compliance officer – not manage Broward Health!

It is specifically the CEO’s job to manage the organization (please see every text book about the function of CEO’s versus its Boards!).

Here’s what should have happened. The board should hire a CEO, give that CEO the support necessary to address all the management issues of the District. The board should remove itself from any involvement in the hiring and firing of district employees. The Board should support the CEO if he or she believes that he or she should hire a management company for areas in which the CEO may designates and that management company, if hired, should be responsive to the CEO – not the Board.

Instead, the board using a board member’s convoluted argument hired a management company to advise “the board” on the management of Broward Health. This advice demonstrates a complete lack of understanding about a public organization, its management, processes, functions, or this member’s role as a public fiduciary. What is both disappointing and a little unnerving is that the resume of this board member asserts his experience as a management consultant and wealth manager. Based on his Board actions, he’s the consultant who borrows your watch to tell you the time.

self-inflicted-woundThe current 4-member board doesn’t understand the basics of why they’re there, what they’re doing, or who’s interests they represent.

The active board members are a realtor, and insurance salesman, a nurse and a lawyer connected with a local lobbying firm known for its government practice.  Most observers and those “in the know” believe this board is being bullied by an out-of-control corporate counsel who’s conduct appears to be remarkably self-serving and designed to strengthen her political control of the organization. Supporting this group of misfits is the weakest senior staff in the history of Broward Health due to the ill-conceived political “purges” begun under the chairmanship of disgraced David DiPietro and continuing under CEO Dr. El Sanadi (who, you recall, committed suicide while under a cloud of investigations). (You can read my many articles published at the time – see the archives ). This menagerie is running a 2+-billion-dollar healthcare enterprise into the ground with (and I’m being charitable here) their best intentions.

A conspiracy type would consider all this through the lens of deliberate destabilization for the purpose of satisfying the Governor’s stated intentions to privatize public hospitals in Florida. Publicity shy, consummate lobbyist, Broward resident and close friend of the Governor – “Billy” Rubin’s name is often mentioned as the puppet-master.

I know and have great respect for Rubin and his abilities. While he certainly has clients with interest in Broward Health, I am not convinced by the conspiracy arguments or Rubin’s alleged part in that scenario. So what is driving this train wreck?

After going to the last few meetings, I am struck by the overt incompetence of the board and their complete failure to understand their role in the governance of Broward Health. I think the damage is largely self-inflicted.

Pick your cliché: deliberate destabilization, paralysis by analysis, stagnation by allegation – each is apropos and from any perspective, Broward Health’s Board conduct and actions seem to defy reasonable explanations and is an embarrassment to every taxpayer in its district.

The problem is most acute in the system’s governance – the Board, it’s hires and senior staff. Less problematic are thankfully the thousands of health care workers who daily deliver high quality service to the community. But the organization, at its most granular critical levels are not immune from the irresponsibility of the board and senior management. The longer that the board dysfunction and the Governor’s failure to appoint qualified people to a full board continues, the more avoidable and inexcusable damage will be done to the organization and Broward’s healthcare needs.

Anonymous Letter to the Broward Health Board.

The following letter was received from an anonymous source and I thought that I would pass it along in it’s entirety as an article.

I want to remind all the readers of this blog – that the mission here has always been and will continue to be an effort to make Broward Health the finest public hospital system in the country.  To that end, fast talking & slick dealing whether lawful or merely ethical breaches must be stopped and exposed.  It is an embarrassment to the fine men and women comprising the nearly 8,000 employees of the system.

Thank you to the anonymous writer of this letter.  I quote without comment:

“To the Commissioners of the North Broward Hospital District

I urge you to read the following in its entirety. I implore you to honor your responsibility in performing appropriate oversight and making reasonable inquiry into the allegations contained in this letter.

I must relay this message anonymously, due to the increasing culture of fear, intimidation and retaliation at Broward Health. Despite what you may have heard, Broward Health’s “anonymous” internal reporting system is anything but. I will explain in more detail below. 

I assure you that I am not writing for political, personal or private gain. My sole purpose is to put you on notice, and create a record of impropriety and unethical behavior that has yet to be addressed in any meaningful way. Your lack of action has encouraged this behavior. 

The most egregious occurrence took place after the Board Meeting of 04/27/16. I cannot wait until the next meeting to speak. I cannot participate in betraying the trust of the entire workforce and the taxpaying public.

  1. The General Counsel is permitted to engage in deceptive behavior and is collecting all “anonymous” employee complaints and reports

Before discussing the issue at hand, please review the below Broward Health Policy, created by General Counsel with assistance of External Counsel (Foley & Lardner):

Broward Health Policy GA-004-242 – Response and Prevention of Offenses – Sections D.7 and E.7 state:
“No Broward Health Workforce Member, with the exception of the General Counsel or his or her designee, or any person or entity retained by Broward Health to assist it in conducting a Preliminary Review or Focused Investigation will engage in any deceptive or pre-textual conduct”.

Compare this with the Florida Bar’s Rulesof Professional Conduct 4-8.4 (c), which states:

“A lawyer shall not engage in conduct involving dishonesty, fraud, deceit, or misrepresentation, except that it shall not be professional misconduct for a lawyer for a criminal law enforcement agency or regulatory agency to advise others about or to supervise another in an undercover investigation, unless prohibited by law or rule, and it shall not be professional misconduct for a lawyer employed in a capacity other than as a lawyer by a criminal law enforcement agency or regulatory agency to participate in an undercover investigation, unless prohibited by law or rule”.

Policy GA-004-242, drafted at least partially by the General Counsel, allows her to engage in deceptive conduct, despite the Florida Bar’s prohibition to the contrary. 

You may ask yourself, why would “any person or entity retained by Broward Health to assist in conducting a Preliminary Review of Focused Investigation” be allowed to engage in deceptive conduct, if their goal is truth-finding? That’s a good question. 

Under El-Sanadi’s leadership, the role of General Counsel was greatly expanded, and many other departments were re-aligned off the record to be subordinate to her office. As before, you may ask yourself, why would the employee (the General Counsel, due to her expanded oversight) be allowed to engage in deceptive conduct? There is no good answer. 

This has allowed the General Counsel’s power to expand without any meaningful oversight, after all, she is allowed to engage in deceptive conduct. Many wasteful, inefficient and even unethical policies, procedures and processes have been created and implemented since.

  1. Deceptive CIA Compliance under the General Counsel

The Management Certification and Sub-Certification Process (the “Process”) is required by the Corporate Integrity Agreement (“CIA”), which impacts 100 employees. The Process is a way of having employees attest that their area of responsibility is in compliance with policies, procedures, and laws. The forms used as part of the Process were changed by the General Counsel and Foley & Lardner to literally remove the ability of the attesting employee to certify that their area of responsibility was not in compliance. This was done intentionally- meetings occurred with Dr. El Sanadi, General Counsel, and Foley & Lardner to discuss the need for “clean certifications”- meaning not only that there was no way to indicate that the employee’s area was not in compliance, but also no way for the employee to hand-write in further details regarding their area’s compliance. Further, instruction was given by General Counsel and Foley & Lardner to remove written examples of compliance issues for employees to report, leaving the workforce in a position to blindly guess over which sorts of problems should have been reported in the first place. The General Counsel, who is allowed to be deceptive, has now created a shadow over any employee who wants to accurately fill out their Process forms. 

This has created endless red tape, and has turned what was supposed to be a regulated compliance process into another egregious example of misconduct. 

What will happen when the CIA annual reporting period ends and employees are required to provide the annual Management Certification? Questions will arise as to why were they certifying compliance on a monthly basis (due to the ethically massaged forms discussed above) but cannot provide an annual certification, due to the lack of the ability to state that they’re not in compliance. Could one reasonably say these monthly certifications were crafted to be deceptive by the employee who is empowered to engage in deceptive conduct? The CIA has stipulated penalties of $50,000 per occurrence of a falsified Management Certification. I urge you to ask employees what they think of this process and prepare for what will happen in six months.
Why else is it important for employees to have the ability to say, “no, I cannot certify” that they are in compliance and be allowed to provide an explanation?

On or about December 31, 2015, Bob Martin, Chief Financial Officer (“CFO”), was asked to complete the CFO Certification. The CFO Certification included an attestation that Unallowable Costs related to legal fees in defending Broward Health in United States of America ex rel. Michael Reilly, M.D. vs. North Broward Hospital District were removed from the Cost Report. Although the action of removing Unallowable Costs had to be performed within 90 days according to the Settlement Agreement, the CFO Certification was not required to be signed until the First Annual Report was due later in 2016 per the CIA (page 28). Upon being asked to complete the CFO Certification, Mr. Martin specifically asked that his CFO Certification form be revised to include the ability to say “no” regarding compliance. Mr. Martin was explained that under the direction of General Counsel and Foley & Lardner, the lack of ability to say “no” or to include reasons why were removed from various CIA certification forms. Mr. Martin then asked for the form to be changed, so that he could certify (with regard to whether he was in compliance) to say, “yes, with exceptions”. Did Mr. Martin have something important to convey?

Below is Mr. Martin’s attestation that Unallowable Costs were removed from the Cost Report.

Yes, with the following exceptions:

“This Certification only covers the period up to and including December 31, 2015. Based on advice and direction from Broward Health’s Internal General Counsel, Only External costs were to be considered non-allowable and removed from the Cost Reports. All Internal Costs were considered allowable and were not removed from the Cost Reports. Also, due to lack of adequate record keeping by Broward Health’s previous External General Counsel Firm, an estimate of 20% was used to determine the portion of the Firm’s fees from 2011 through 2015 that were considered non-allowable (as defined in the Settlement Agreement) based on the advice and direction from Broward Health’s Internal General Counsel.”

Why could Mr. Martin not simply state, “Yes – the requirement was met”? Was there doubt in guidance given by General Counsel (who is allowed to be deceptive)? Did the Office of Inspector General and Department of Justice intend on an estimate being calculated rather than precise accounting practices? Do we have documentation that this estimate was appropriate and met our CIA obligation? Mr. Martin’s certification sounds unsure. Mr. Martin was terminated soon thereafter.

III. Aggressive Threats toward Medical Staff

There were Board Meetings spent discussing physicians not signing the initial Code of Conduct and hospital Policies. Any layman can read pages 8-9 of the CIA and see that the requirement actually mandated distribution of the Code and Policies to all Covered Persons (which included physicians), not signatures. Other organizations with the exact same CIA language have done just that – distributed and succeeded – without damaging their reputation with the medical staff. How much time, staff hours and money was wasted conducting witch hunts and putting doctors on trial at Board Meetings with threats of medical staff revocation because of a signature requirement that was unnecessary? This is one of many overzealous, wasteful responses to what should have been an easy implementation with appropriate foresight and interpretation. Who made the decision to carry out such a simple requirement in this manner while spending millions of dollars on legal advice that was at best, inefficient, and at worst, misinterpretation – all unmonitored and unquestioned?

IV.

Finally, there is the engagement of Baker Donelson, and the most recent development associated with them that necessitated writing this letter today. Broward Health was required per CIA (pages 40-42) to engage an Independent Review Organization (“IRO”) to perform a Systems and Transactions Review related to Focus Arrangements. The requirements regarding qualifications, responsibilities and independence/objectivity of the IRO are all listed on pages 40-42 of CIA, yet they have been ignored.

  1. General Counsel has stated that the IRO was unilaterally selected by Dr. El Sanadi – an all too common response and excuse these days for scenarios that should have involved legal guidance and/or review.
  2. Scott Newton of Baker Donelson expressed to a Broward Heath employee that he was actually contacted on his cell phone by Myla Reizen of Foley & Lardner, the law firm that Broward Health continues to pay unquestioned and unnecessary legal fees to. Ms. Reizen also has a prior relationship with General Counsel. How exactly was this IRO chosen? Are they truly independent? Are they allowed to be deceptive under the Broward Health policy discussed above?
  3. There is question as to whether Baker Donelson has the necessary experience and qualifications to be an IRO. Interviews and billable hours thus far have demonstrated lack of experience including the billing to Broward Health for tasks and work product that an IRO should already be knowledgeable in and possess. The IRO should not be charging Broward Health for a learning experience. Where is documentation of the due diligence for such an important obligation?
  4. Broward Health has already been charged in excess of $200,000 for work not substantive or related to an actual Systems or Transactions Review related to Focus Arrangements. In fact, a Systems and Transaction Review cannot even be performed yet according to the OIG monitor. What are we (and the taxpayers) paying for? Are we being double or triple billed for attorney attendance at meeting and interviews? Are we paying for necessary services? Do charges billed line up with the contractual scope of representation?
  5. One employee interview with Baker Donelson (that I have personal knowledge of) went completely off scope including a line of questioning regarding personal relationships between executives. There is no reason for an outside, supposedly independent organization to be asking these questions unless they are being instructed by other Broward Health employees to do so. There would have been no knowledge on the part of Baker Donelson to ask these questions unless prompted by other Broward Health employees. The interview that occurred with Baker Donelson immediately prior to this occurrence of inappropriate questioning was that of the General Counsel. Is the General Counsel and the IRO using their ability to be deceptive to ferret out dissent? Are we paying vendors to perform a witch hunt? Does this sound like an independent review?
  6. As a result of the runaway billing (outside course and scope), an estimate of hours and expenses was requested from Baker Donelson by the Corporate Compliance Department to keep expenses reasonable. Soon after this request, Baker Donelson requested to be transferred under and report to the General Counsel’s office citing inference. Does this re-alignment under the oversight of General Counsel allow them to be deceptive?
  7. MOST IMPORTANTLY: On May 4, 2016, Baker Donelson made a formal request to General Counsel to provide them with ALL documents relating to the Corporate Compliance Disclosure Logs, database, interviews, reports summaries, reporter identities, including all documents related to anonymous and confidential reports made by employees.Immediately after this request, General Counsel forwarded it to the Corporate Compliance Department with the expectation that this confidential document turnover occur immediately. Baker Donelson has not been retained to ferret out anonymous employee complaints. A Systems and Transaction Review related to Focus Arrangements DOES NOT include provision of confidential and anonymous reporting maintained in the Disclosure Log for the entire Broward Health workforce. This is a complete betrayal of (previously encouraged) employee confidentiality and trust. It is the right of every employee to know that this behavior would be encouraged on the watch of General Counsel. This action will chill the ability of any employee to anonymously report actual or suspected compliance issues without retaliation or improper provision of confidential information to undeserving third parties. This action WILL undermine the entire mechanism in which the workforce is expected to report actual or suspected issues. I will leave it to the reader to imagine what the true motive for this inappropriate attempt at accessing information was for. I will not stand by as a silent witness while this behavior occurs. This is unacceptable.

A formal complaint with documentation will be submitted to the OIG Monitor whom was previously assured the independence of Baker Donelson.

All employees have the right to know that this confidential reporting mechanism is in jeopardy. The anonymous complaints have been requested by persons inside and outside of Broward Health. All Certifying and Sub-Certifying employees have the right to know as they are included in these policies and processes and their employment is affected when these behaviors occur.

The appropriate next steps are not to figure out who is writing this e-mail, or how to retaliate against them. Communications from Kevin Fusco and Commissioner Di Pietro on 3/2/16 and Commissioner Rodriguez on 3/22/16 assure that retaliatory behavior is not condoned. Will the first steps be to identify and retaliate or will it be to address the actual message and demonstrate accountability?

The appropriate next steps are to make reasonably inquiry into these matters including:

  1. Review of Policy GA-004-242 and the Florida Bar Rules of Professional Conduct.
  2. Review of ownership and decisions made during CIA implementation including working documents for Management Certification changes and other tasks.
  3. Review of Mr. Martin’s Chief Financial Officer Certification history.
  4. Review of the relationship with Baker Donelson including initial engagement, scope of work, actual work performed, expenses paid, and the relation to actual scope of engagement versus attempted scope. Objective review of whether they are truly “independent.”
  5. Review of the attempt by General Counsel on May 4, 2016 to provide entire, non-redacted Disclosure Logs, confidential employee reports and allegations to Baker Donelson. 
  6. Review allegedunilateral decisions made by Dr. El Sanadi including contract awarding, personnel hiring, role and oversight and departmental shifting, without review or approval. 
  7. Review of collateral damage including costs of bad decisions, loss of morale and ineffective policies, procedures and processes initiated by General Counsel (that are not simply accounted for in budgeted or unbudgeted legal costs in excel spreadsheets)
  8. Review of the continued absence of legal guidance in areas where actually needed.
  9. Re-review of legal guidance given regarding appropriateness of Shade Sessions at Special Board Meetings. Contrary to Commissioner Ure’s recollection, actual meeting minutes reflect that General Counsel stated a Shade Session to discuss ongoing investigations was appropriate. Commissioner Di Pietro is the one that requested a separate legal opinion be received.

Unfortunately, this is just scratching the surface. You have been given the appropriate starting point. Willful ignorance and naivete are no longer an option.

We are nearing the end of the road where employees will bring issues to the Board internally. If this is not addressed with swift and immediate action from the top down by the responsible governing body, this information will be handled from the bottom up. Further absence of appropriate oversight and inquiry can only be considered wanton disregard. Further absence of appropriate oversight and inquiry will leave no choice but for employees to communicate with any agency or stakeholder with whom Broward Health does business or is expected to provide outcomes to that will listen to their complaints, including but not limited to: Officer of Inspector General, Department of Justice, Officer of Inspector General Monitor, Laura Elis, Florida Bar, Agency for Health Care Administration, Joint Commission, State Attorney’s office, citizens, all employees, television stations, newspapers, bloggers, Health Care Compliance Associate, Society of Corporate Compliance and Ethics, qui tam attorneys, employment attorneys and other healthcare organizations in Florida. 

Others have stood and spoke at Board Meetings, stating that this corporate chaos has not affected healthcare services that we provide – I respectfully disagree. The continuum of healthcare includes all employees and departments within Broward Health. When one department struggles or fails, it will directly or indirectly impact all others. When one department cannot hire FTEs, has to flex down staffing or cannot order supplies as the result of corporate waste, it will directly or indirectly impact others. It may not be immediately apparent or easily measureable, but these behaviors including conflict of interest, lack of accountability and policy supported deception absolutely impact the overall function of this organization and services that we provide.

I urge all employees and the Board to ask questions and demand answers. Attend Board Meetings and demand answers as to why this is allowed at the corporate level. Demand answers as to why this is not addressed with the supposed transparency that is verbally touted at Board Meetings. Demand answers as to why a direct report to the Board is not held to the same standard as other Broward Health employees.

The mission of Broward Health is to provide quality health care to the people we serve and support the needs of all physicians and employees.”

Messy Divorce of Rick Scott and David DiPietro

This week, a judge struck down Florida Governor Rick Scott’s suspension of David DiPietro & Darrell Wright and in an ironic twist – the Judge was right. (Scott Wrong to Boot Appointee for Malfeasance-Judge Rules – Miami Herald, Judge-To-Scott-Reinstate-Suspended-Broward-Health-Chairman – Local 10, Di-Pietro-Reinstated – Sun Sentinel)  While any reader of the blog this past year would find ample grounds to not only suspend but even remove Mr. David DiPietro and Mr. Darrell Wright for improper conduct as board members, the singular stated reasons for the Governor’s actions were remarkably off the mark.   It’s like missing the fish in a barrel without water.

'They're nice, but do you really expect me to drink my imported Merlot from domestic Merlot glasses?'The hypocrisy is palatable, the irony is distasteful, and the lesson is dangerously evident.  Based on the Judge’s order, Broward Health appears to be an organization that is run by an incompetent board of political hacks, accountable to no one – not the public, not the voters, not the taxpayers, not its customers, not the 8,000 plus employees, not even the Governor.   The irony is that I was hoping for the Governor to win, knowing full well that in this case only – I felt the Governor’s actions were somewhat precipitous and not well thought out. See my article “David DiPietro’s Raw Deal”.  I was hoping that, at the very least – the Board would be accountable to someone – even if it were only the Governor.

Even more infuriating, is the “vindication” DiPietro claimed in the judge’s order.

“I am pleased and gratified at the judge’s ruling,” Di Pietro said in a statement. “The order is vindication of my service at Broward Health … I am proud of my record of fighting corruption at Broward Health, and with my reinstatement, I intend to continue to champion multiple transparency and accountability reforms.”  David DiPietro  4/11/16 Sun Sentinel  

Shhhh its a secretNotwithstanding the fact that DiPietro was correct to object to the most recent secret meeting on the dual issues of the performance of their corporate counsel and well-known corruption investigator Mr. Wayne Black’s allegation of administrative obstruction, David has been a willing participant in many secret  meetings at Broward HealthThese secret  meetings include among others, the highly controversial meetings on the Zimmerman Advertising proposals wherein David had no objection and was reportedly a strong proponent.  In his report, Even Mr. Berger (the attorney hired by the Board to do a limited internal investigation on behalf of the Board’s Audit committee), concluded that the Zimmerman meeting should not have been held behind closed doors in secret.  It appears that Mr. DiPietro only objects when his personal/political agenda dictates and not, as he would have us believe, when the public interests are at issue.

NotASecretAnymoreNot only has DiPietro not fought corruption, nor championed either transparency or accountability from his position as Chair of the Board – his orchestration of some of the most incompetent Board decisions has made his board and his tenure one of the worst, incompetent if not corrupt Boards in Broward Health’s sordid history.   And that is saying something!  It is not accidental nor an overstatement to hold him personally responsible for much of the dire straits in which Broward Health now finds itself.  I have spent a great many words on this and related topics in this blog, and I will not repeat them here.  Please see a short list of my past articles (“Dan Lewis’ Original Posts“– found on the lower right of the home page.)

Politics

David-Di-PietroI have to admit that I like David DiPietro, and I think he is a good attorney – but I hate the job he is doing as a Broward Health Board Member, particularly as its chair.  So it is appropriate to look at the politics of the matter which are really quite interesting.

Govenor ScottFrom the time of his original appointment to the Board by Governor Rick Scott in 2011 until mid-2014 when Governor Scott appointed additional board members to support DiPietro, David generally was on the short end of a 5-2 vote.  Governor Scott made his new appointments primarily on the recommendation of a rather small group of insider Broward republicans – including, of course, one of DiPietro’s best friend Broward County Commissioner Chip LeMarca who quite coincidentally later was able to parlay a failed construction background into a high paying community relations position with – wait for it … Zimmerman Advertising.

Notably in light of his strong recent support of the Zimmerman Advertising contract, one of DiPietro’s past 5-2 lost votes was to oppose the advertising expenditure for the re-branding of the systems individual hospitals in favor of a unified brand “Broward Health” hospital.   At that time, he did not feel that Broward Health money should be spent in advertising.

Back then, this same group of insider Broward republicans together with David helped to orchestrate the appointment of David’s wife, Nina to Florida’s Medical Board currently chaired by none other than Dr. Nabil El SanadiSmall world!

It was now clear in Broward’s hushed circles of political power that David DiPietro was the go-to person for any appointments by Governor Rick Scott in Broward including; the Judicial Nominating Commission for the 17th Judicial Circuit (JNC) and the Broward Health Board.

And so, three new Broward Health Board appointments gave DiPietro a majority (Rodriquez, Nieland and Wright).  

Go Back We Fucked Everything UpWith the help of the three new Scott appointments to the Board handpicked by David DiPietro, he now had a majority.  In short order, David was elected chair and with the threat of his new majority, ousted not only past CEO Frank Nask, but also corporate counsel Sam Goren and the marketing department headed by Sara Howley (which would pave the way for the Zimmerman contract that had already been approved by new CEO Dr. El Sanadi). (See my articles: Innovative CEO NASK Forced Out, Politics Wins – We Loose!,    Board of Commissioners Rubber Stamp Shady Deals at Meeting – Very Tacky).  After all, Dr. El Sanadi could be relied upon to play ball in return for a sweetheart contract (please see my previous posts “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 so, new appointments on the Judicial Nominating Commission (JNC), now chaired by the son of a prominent cardiac surgeon and significant Republican contributor and fundraiser, Dr. Zachariah Zachariah.  During this time frame,  Dr. El Sanadiin secret, purchased Dr. Zachariah’s medical practice on behalf of Broward Health in a multi-million-dollar deal currently under some intense regulatory review.  This deal could not have been done without the approval of DiPietro.  Coincidentally, the very same JNC chaired by the young Zachariah and other DiPietro recommended appointments, sent Nina DiPietro, David’s wife, name to the Governor for a judicial appointment!

In what had been panned as Florida’s most inexperienced judicial appointment ever, once again, as he had done so often before, the Governor accommodated David DiPietro with his wife’s appointment to the Broward County Bench.

MoneyMoneyJudge Nina DiPietro now has to stand for election in Broward on August 30th, 2016, a republican Scott appointee in a democratic Broward County.  It would take money, and lots of it.  No problem for David DiPietro.  As of today, she is currently running unopposed and has raised more money than any other Broward judicial candidate through mid-March with $267,000.

A quarter of her donations through January came from health care-related sources.  Zimmerman and his collection of companies gave Nina’s campaign approximately $50,000.  Broward Health vendors and physician contractors ponied up another $100,000.   Then David made up another $100,000 in loans made possible by the explosive growth of his law practice during his Broward Health tenure – and they say this position does not pay!

Judge Nina DiPietro, however, was not always running unopposed.  For a brief time, she had an opponent – then, inexplicitly, her opponent switched to a different judicial race and according to people he apparently told, Zimmerman was helping design his campaign material.  Wow, small world.

All this success for David DiPietro primarily due to the Governor’s largess makes his lawsuit and his public statements against his benefactor baffling.

vvGZZguIf David had asked me, and he did not, I would have advised him to tell the governor that because of the Governor’s commitment to serve the public; his actions were understandable but miss-informed.  David should have said that he stands ready to serve as soon as the Governor can confirm he was misinformed and re-instates him.  Instead, in a very public way – David called the Governor out, embarrassed his office and went to court with an action that now serves to undermine the Governor’s office, authority and reputation.  As a lifelong Democrat, politically – I am delighted.  However, right, wrong or indifferent – it was the wrong political move.  Loyalty is an important part of politics and I would have advised David to stand by his Governor, his benefactor.  If I were in David’s position, that is what I would have done, even as a Democrat.

The Governor must be thinking a lot about the word “ingrate”;  n. “ungrateful person,” 1670s, from earlier adjective meaning “unfriendly”(late 14c.) also “ungrateful, unthankful,” from Latin ingratus “unpleasant,” also “ungrateful,” from in- “not” (see in- (1)) + gratus “pleasing, beloved, dear, agreeable” (see grace ). The noun meaning “ungrateful person” dates from 1670s.

It’s fair to say that David’s relationship with the Governor’s office has been irreparably broken as has is close circle of friends.  As a vocal Trump supporter, now David can only dream of a Trump presidency.

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.

Dr. Nabil El Sanadi – Rest in Peace!

Dr. Nabil El Sanadi died unexpectedly this past weekend in what the police reported was an apparent suicide.  It is likely that the official cause of death will be consistent with conclusions by the police.  Dr. El Sanadi recently underwent a triple bypass surgery and some notable cardiac physicians told me that patients going through this procedure sometimes experience depression. Beyond these facts, it is not appropriate to speculate.

Whenever death surprises us, it is natural for those closest to the deceased to feel a profound sense of personal loss as they seek closure.  When the deceased is a public official, organizations and institutions feel a similar loss as they try to regain their balance.  When the cause of death confuses us, getting closure and regaining balance become particularly challenging.

I attended the January 27th 2016 Broward Health Board meeting last night, and was moved by the many personal stories of those who knew Dr. El Sanadi differently than I did.  I did not know the personal side of Dr. Nabil El Sanadi, but I respect the feelings of those that did and they have my sincere condolences.

After hearing about Dr. Nabil El Sanadi’s apparent suicide, I was quoted correctly saying,

“He [Dr. El Sanadi] has decimated the professional and competent senior staff and put in place people that will give him the answers that he wanted… While I’m sensitive and sorry for people’s loss, the damage he [Dr. El Sanadi] has done to Broward Health is almost incalculable.”

I stand by that quote.  My position has not changed, see my articles “I’m Back with Tidbits” and OMG – Nabil El Sanadi’s First 5 Months!”

Even the most stalwart defender of Dr. El Sanadi’s tenure as CEO must be troubled by his apparent suicide and the possibility, no matter how remote, that something at Broward Health contributed to his state of mind and death.  Surely, a physician of his stature would recognize post-operative depression and know that there are successful treatments and help readily available.  Suicide is a serious matter and I would refer you to and encourage you to support the great work of NAMI .

It should be noted that though my last real post was in October 2015, there have since been rampant rumors of ongoing investigations at Broward Health, including the apparent seizure of computers by the FBI.  Further, based on Broward Health’s’ financials, the loss from operations for the six-month period ending December 31, 2015 is $87.4 million compared to the same period 2014 was $37.6 million. Under Dr. El Sanadi’s management, 2015 is worse by $49.8 million. 2014 was low due to the implementation of the health exchanges whereby more people were insured and revenues and operating results improved. That program continued in 2015 and should have produced the same or better results. Instead, revenues decline $20.4 million and expenses increased $29.4 million.  Serious CEO candidates will want to know what caused this dismal financial performance.  Of course, there is the whole matter of the Zimmerman Advertising contract, which probably illustrates Dr. El Sanadi’s financial mismanagement best and in part provides at least a partial answer to the question of what is going wrong financially at Broward Health.

During Dr. El Sanadi’s tenure, long-term relations with Nova Southeastern University, and the University of Miami were overtly severed, and Broward Health entered into an ill-conceived expensive multi-million dollar agreement with The Cleveland Clinic, a direct competitor, to provide transplant services when Broward Health failed to receive a certificate of need for this duplicative and apparently unnecessary service.

Corporate senior staff in marketing, quality assurance finance, purchasing, physician staffing and operations all “retired” or were part of “work-force reductions” shortly after expressing alarm or opposition to Dr. El Sanadi’s actions or the actions of his elevated “inner circle”.

The heart and soul of a hospital system are its physicians, nurses and healthcare professionals – and according to many, their relationship with Broward Health corporate leadership during  Dr. El Sanadi tenure have never been worse.

Under the existing circumstances, it is appropriate for the Board of Broward Health to take a sober and hard look at the last 13 months under Dr. El Sanadi and the lessons it teaches for the future of the organization.  This is particularly true if issues or conflicts at Broward Health contributed to his apparent suicide.

I have previously written about how the Broward Health Board politicized the appointment of Dr. El Sanadi, who was objectively unqualified without any previous experience running a hospital let alone one of the largest hospital systems in the country.  See my articles The Best Broward Health CEO contract politics can buy!,    “Bumbling Inexperience of Dr. Nabil El Sanadi at Committee Meeting”  and OMG – Nabil El Sanadi’s First 5 Months!” .

I have also previously written about just some of Dr. El Sanadi’s extra-curricular business dealings that appeared to be in direct conflict to his fiduciary responsibilities for Broward Health as CEO.  Business dealings that are ongoing and continue to this day.  It is noteworthy, that more of Dr. El Sanadi’s business dealings have come to light including some nasty business with a medical air transport firm, and medical directorships for cruise lines that, I am told, have been the subject of some litigation and ongoing investigations.  The lesson here is the necessity to vet potential future CEO candidates and any existing business investments or relationships they may have to avoid even the appearance of impropriety.  This important step was skipped for Dr. Sanadi’s selection. See my articles “Has the Office of Inspector General seen Dr. El Sanadi’s CEO Contract with Broward Health?”  and “Nabil El Sanadi – Broward Health’s Million Dollar CEO!” 

The Board gave new member Christopher Ure the task of recommending the process for the selection of the next CEO and I was immensely impressed with his professionalism and assurances that any process he recommended would be transparent, exhaustive and ethical.  I take him at his word and wish him success in this endeavor, but I’m not sure I’ll hold my breath just yet.

Two final points that it is impossible to over emphasize:

  1. Broward health is a public organization. It was born public, publically nurtured , and is publically ownedBroward Health is not a private hospital that does some public service in return for its taxing authority.  The public is the system’s strongest ally, its secret competitive weapon – not its burden. See my article.  “Broward Health – It’s Our Hospital”
  2. Dr. El Sanadi often spoke of transparency while taking every possible step to operate in secret, and behind closed doors. Consider the example of the Memorial system that conducts its strategic planning meetings in public, with public participation.  Contrast that with Broward Health that does so behind closed doors, and in secret, hidden from the public– yet has virtually every item on their Board agenda assert that its expenditure is consistent with the District’s “strategic Plan” the public never gets to see.  I wrote a few articles on this subject; “It’s none of your business!  Really?” , and “Bombshell – Broward Health Non-Agenda Item stinks of insider Double Dealing” 

I did know the official Dr. El Sanadi as CEO of Broward Health for 13 months and what I knew, I did not like. In fairness, I do not know whether his official conduct to which I objected was his or was in part orchestrated by meddling board members. We will never know.

The living must go on, and organizations must continue to serve.  Rest in peace Dr. El Sanadi.  Your burden is now squarely on the Board’s shoulders.   We will be watching, and hoping for their success.

Updated. Million Dollar Secret Attorney/Client Meeting Transcripts!

Broward Hospital District Shade Meeting Transcript – August 20, 2015

As the result of my public records request (click to see request), today I received a partial response in the form of the paper court reporter transcripts for a number of shade meetings in re:  Attorney/Client Meeting to discuss matters of litigation pending before the US District Court in which Broward Health is a Defendant in a False Claims Act Case. 

The transcripts were for the meetings held on:

  • June 4th, 2014
  • September 5th, 2014
  • October 22nd, 2014
  • December 15th, 2014
  • August 20th, 2015

Click here to download the first transcript (August 20th, 2015) here (9 megabyte PDF).

Click here to download the December 15th, 2014 transcript here (12 megabyte PDF)

Click here to download the October 22nd, 2014 transcript here (7 megabyte PDF)

Click here to download the September 5th, 2014 transcript here (8 megabyte PDF)

Click here to download the June 4th, 2014 transcript here (16 megabyte PDF)

I have not read the transcripts, nor have I confirmed what transcripts are missing but I wanted to post the first transcript as soon as possible.  All the transcripts that have been produced are now posted.

I am reliably told that the five transcripts represent all the shade meetings in this matter, however, there were apparently many one on one meetings between attorneys & Board members in a concerted effort to keep shade meeting comments to a minimum.  There are no minutes of these meetings and presumably the content of those meetings would be Broward Health attorney/client discussions thus not a subject for a public records request.

After I read & digest the content of the transcripts, I will post both my comments and analysis.

Stay tuned.

 

Public Records Request #4 – Reilly v. North Broward Hospital District, et al.,

Sent: Wednesday, September 16, 2015 9:02 AM
Subject: Public Records Request #4 – Reilly v. North Broward Hospital District, et al., Case No. 10-60590 (S.D. Fla.)

September 16, 2015

Lynn Barrett, General Counsel
North Broward Hospital District
Broward Health Spectrum Office
1700 NW 49 Street,
Fort Lauderdale, Florida

Re: Public Records Request #4 – Reilly v. North Broward Hospital District, et al., Case No. 10-60590 (S.D. Fla.)

Dear Ms. Barrett,

This letter is a public records request pursuant to the Public Records Act, Florida Statutes, Section 119 to allow the inspection and copying of public records. This request is also made pursuant to Art. 1, s. 24(a), Fla. Const. which establishes a constitutional right of access to any public record made or received in connection with the official business of any public body, officer, or employee of the state, or persons acting on their behalf.

YOU ARE CAUTIONED THAT THE FAILURE OF THE REQUESTEE TO FULLY COMPLY MAY RESULT, INTER ALIA, IN THE INSTITUTION OF LITIGATION, THE REQUEST FOR APPOINTMENT BY THE COURT OF AN INDEPENDENT REVIEW AND AN AWARD OF ATTORNEY’S FEES AND COSTS TO REQUESTOR’S LEGAL COUNSEL.

Please provide me electronic copies of the following records to Dan@BrwdHealth.com which as a result of the settlement of United States ex rel. Reilly v. North Broward Hospital District, et al., Case No. 10-60590 (S.D. Fla.) have now become public.

  1. The recorded and transcribed minutes of all shade meetings held in this matter by the Board of Broward Health.

As a corollary to the above matter and consistent with the public’s right to know and the public interest in the appropriate expenditure of their tax funds, please provide me electronic copies of the following records to Dan@BrwdHeath.com or alternatively, please let me know when the following records are available for my inspection.

  1. Copies of all invoices from Broward Health’s Fair Market Analysis contractor for 2014 through the date of this production.
  2. Copies of all Fair Market Value Analysis provided by Broward Health’s independent consultant to Broward Health for 2014 through the date of this production.

In previous public records requests, I have requested copies of physician service, employment and medical directorship contracts that have, in part, been produced with excluded scope of services and compensation sections.  These fundamental and basic elements of these contracts have been excluded by Broward Health asserting privilege for confidential and trade secret information.

I would argue that fair market value, by definition, cannot be a confidential or a trade secret and that the disclosure of the financial arrangements by contract for physician professional services by Broward Health is both necessary and in the public interest in light of the recent settlement.  It is noteworthy that this information is considered a public record by the Memorial system, as well as other public hospitals in Florida.  Therefore, please provide me electronic copies of the following records to Dan@BrwdHeath.com or alternatively, please let me know when the following records are available for my inspection.

  1. Complete copies of all executed contracts between Broward Health and physicians for professional or any other services for which a Fair Market Analysis was utilized for 2014 through the date of this production.

If you have a requested public record but claim a privilege which protects you from providing it pursuant to this public records request, A LOG SHOULD BE PROVIDED IDENTIFYING THE SPECIFIC DOCUMENT/ COMMUNICATION BEING WITHHELD, AND THE LEGAL BASIS FOR THE CLAIMED PRIVILEGE.

Please note that section 119.07(2)(a) of the Public Records Law provides that a person who has custody of a public record and who asserts that an exemption applies to a particular pubic record or part of such record shall delete or excise from the record only that portion of the record with respect to which an exemption has been asserted and validly applies, and such person shall produce the remainder of such record for inspection and examination.  This section further provides that if the person who has custody of a public record contends that the record or part of it is exempt from inspection, he shall state the basis of the exemption which he contends is applicable to the record, including the statutory citation to an exemption created or afforded by statute, and, if requested by the person seeking the right under this subsection to inspect, examine, or copy the record, he shall state in writing and with particularity the reasons for his conclusion that the record is exempt.

It is hereby requested that you do state in writing both the statutory citation to any exemption which you claim applicable to any requested record and the specific reasons for a conclusion that the requested record is exempt.

Also, please note that section 119.07(2)(C) prohibits the destruction of any of the requested records, including any which you claim are exempt, for a period of 30 days after the date on which you receive this written request.  If a civil action is instituted to enforce the Public Records Law with respect to the requested records within the 30-day period, you may not dispose of the records except by court order after notice to all affected parties.

As a matter of Florida law, unless the nature or volume of public records to be inspected or copied requires “extensive” use of information technology resources or “extensive” clerical or supervisory assistance, the special service charge is not authorized. If authorized due to the nature or volume of a request, the special service charge should not be routinely imposed, but should reflect the information technology resources or labor costs actually incurred by the agency. AGO 90-07. And see, AGOs 92-38, 86-69 and 84-81.  Moreover, the statute mandates that the special service charge be “reasonable.” See, Carden v. Chief of Police, 696 So. 2d 772, 773 (Fla. 2d DCA 1996), stating that an “excessive charge” under s. 119.07(1)(b), F.S., “could well serve to inhibit the pursuit of rights conferred by the Public Records Act.”

After inspection, I agree that I will compensate you for the actual cost of duplication of any of the records that I have requested.  If the nature or volume of the public records requested is such to require extensive use of information technology resources and/or extensive clerical and/or supervisory assistance by personnel of your office, I agree that I will compensate you for those costs that are reasonable as well, subject to the terms enumerated herein.  Before incurring any charges, please contact me and advise me of the actual cost basis of duplication and/or any necessary and reasonable staff research time.

I would appreciate confirmation that you have received this request and an estimated date of when I might receive and/or inspect the public records. Thank you in advance for your prompt consideration of my request. Please feel free to contact me if you have any questions.

Thank you for your kind attention to my request.

Florida Hospital District Agrees to Pay United States $69.5 Million to Settle False Claims Act Allegations

Justice News
Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE

Tuesday, September 15, 2015

Florida Hospital District Agrees to Pay United States $69.5 Million to Settle False Claims Act Allegations

North Broward Hospital District, a special taxing district of the state of Florida that operates hospitals and other health care facilities in the Broward County, Florida, area, has agreed to pay the United States $69.5 million to settle allegations that it violated the False Claims Act by engaging in improper financial relationships with referring physicians, the Justice Department announced today.

“The Department of Justice has long-standing concerns about improper financial relationships between health care providers and their referral sources, because those relationships can alter a physician’s judgment about the patient’s true health care needs and drive up health care costs for everybody,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.  “In addition to yielding a recovery for taxpayers, this settlement should deter similar conduct in the future and help make health care more affordable.”

“Our citizens deserve medical treatment uncorrupted by excessive salaries paid to physicians as a reward for the referral of business rather than the provision of the highest quality healthcare,” said U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida.  “This office will be steadfast in continuing to devote all necessary resources to ensure that anyone rendering medical care does so for the sole benefit of the patient and in compliance with the law.”

“Improper financial rewards  given to physicians in exchange for patient referrals corrupts medical decision making and inflates health care costs,” said Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG).  “Our agency will continue to root out such behavior from our health care system.”

The settlement announced today resolved allegations that the hospital district provided compensation to nine employed physicians that exceeded the fair market value of their services.  The United States contended that these agreements violated the Stark Statute and the False Claims Act.  The Stark Statute restricts the financial relationships that hospitals may have with doctors who refer patients to them.

The allegations settled today arose from a lawsuit filed by a whistleblower, Dr. Michael Reilly, under the qui tam provisions of the False Claims Act.  Under the act, private citizens can bring suit on behalf of the government for false claims and share in any recovery.  Dr. Reilly will receive $12,045,655.51 from the recovery announced today.

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $25 billion through False Claims Act cases, with more than $16 billion of that amount recovered in cases involving fraud against federal health care programs.

The case, United States ex rel. Reilly v. North Broward Hospital District, et al., Case No. 10-60590 (S.D. Fla.), was handled by the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office of the Southern District of Florida and the HHS-OIG.  The claims settled by this agreement are allegations only, and there has been no determination of liability.

I’m Back With Tidbits!

   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.               strategy 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:

  1. 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.
  2. 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.
  3. MoneyMoneyThe 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.
  4. 25insider1_span-articleLargeApparently, 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.last-resort-customer-service 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.

 

 

 

Nabil El Sanadi – Broward Health’s Million Dollar CEO!

Dr. Nabil El Sanadi, crying poverty, is Broward Health’s highest paid CEO in history with over one million dollars in “active” compensation by including his “part-time” work and his full-time position as CEO.  This for a person who has never managed a hospital let alone one of the largest public hospital systems in the nation.

Last April 2015, I wrote two posts about Dr. El Sanadi’s appointment and contract as Broward Health’s CEO.  SeeThe 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?”.

montoya3-transparencyDr. El Sanadi refused to produce his “Medical Director” contracts with the Broward Sheriff’s Office (BSO), or his contracts with the cities of Fort Lauderdale, Sunrise, and Tamarac as requested by my first public record’s request, which was, in part, the subject to my four-part post (see  Just say No – How Not to Cancel a Meeting – Part 3).  When Dr. El Sanadi refused to produce these contracts, I asked BSO and each city for a copy, and all the contracts were produced electronically and un-redacted to me within 48 hours! (see BSO contract, Fort Lauderdale contract, Sunrise contract, Tamarac contract) This is in contrast to the heavily redacted response from El Sanadi’s attorney, which was produced close to 60 days after requested at a cost to Broward Health of about $44,000.00.  Ostensibly this is El Sanadi’s version of transparency!

These “Medical Director” contracts were made important in section 6.3 of Dr. El Sanadi’s Broward Health contract because it allows Dr. El Sanadi to maintain his “Medical Director” agreements despite requiring him to be full time with Broward Health.  This contract provision effectively ignores the time El Sanadi contracted to the various other governmental entities, and even the basic indemnifications for either the time or money predictable legal proceedings of all types might require.  It puts the deep pockets of Broward Health squarely at risk for these outside activities, leaving the tax payers holding the bag!

But not to worry, Dr. El Sanadi is being well paid for his “part-time outside” work:

El Sanadi-Medical Director Contracts

bruce-eric-kaplan-right-now-i-m-dealing-with-all-this-spring-bullshit-new-yorker-cartoonWhat’s more, these four “Medical Director” contracts incorporate the EMS (Rescue and ambulance) services for 10 cities plus Port Everglades and the Airport.  The cities include Fort Lauderdale, Sunrise, Tamarac, Dania Beach, Deerfield Beach, Cooper City, Lauderdale Lakes, Pembroke Park, West Park and Weston.  Mutual Aid agreements extend this service to all adjoining cities.  As I discussed in my previous post “Has the Office of Inspector General seen Dr. El Sanadi’s CEO Contract with Broward Health?”, these agreements on their face present serious ethical problems for “King” El Sanadi as well as unacceptable exposure to Broward Health in potential direct and indirect liability.  This, not to mention likely increased scrutiny by the Justice Department.Add this “part-time outside” work fees to his annual salary of $675,000.00 as Broward Health’s CEO and Dr. El Sanadi’s is being paid over $947,340.00 annually this year.  Next year, all these amounts automatically escalate.  Adding insult to injury, these amounts do not include generous benefits and potential bonuses which would make his total annual salary and benefits value at the public tit well over one million dollars.

Here are some (but not all) of the duties for which “King” El Sanadi has contracted.  (Every one of Dr. El Sanadi’s part time contracts incorporate similar language to this language taken from the BSO agreement (Emphasis added)).

  1. [El Sanadi] shall serve as liaison between the [EMS Department] and the various community hospitals, other local emergency medical services agencies, and any other agency, physician, institution or organization affecting the [EMS Department] provision of emergency medical services.
  2. [El Sanadi] shall be available and on-call twenty-four (24) hours per day seven (7) days per week every day that this Agreement is in effect.
  3. [El Sanadi] shall make radio or ‘telephone contact with the [EMS Department] within fifteen (15) minutes of the Medical Director’s receipt of an electronic notification or page from the Fire Rescue operations center.
  4. [El Sanadi] shall issue standing orders and protocols to the [EMS Department] to ensure that the [EMS Department] transports each of its patients to facilities that offer a type and level of care appropriate to the patient’s medical condition if available within the service region.
  5. [El Sanadi] shall audit the performance of system personnel by use of a quality assurance program to include but not be limited to a prompt review of patient care records, direct observation, and comparison of performance standards for drugs, equipment, system protocols and procedures.
  6. [El Sanadi] shall assist, and make recommendations to, [EMS Department] regarding planning for emergency medical services, ambulance transportation policies, deployment of vehicles, distribution of resources, personnel matters, emergency medical technician training, paramedic training, utilization of medical facilities, hospital supplies, medical equipment, medications, narcotics, emergency medical services billing and reimbursement systems, and recovery of costs associated with the [EMS Department] emergency medical services system.
  7. [El Sanadi] shall perform at least forty-eight (48) hours per year, to wit: eight (8) hours every other calendar month, of in-the-field operations riding in rescue vehicles and/or EMS supervisor vehicles, reviewing the performance of Fire-Rescue Department’s emergency medical services personnel, and reviewing different incidents in which emergency medical services are rendered.
  8. [El Sanadi] shall participate in monthly and/or quarterly meetings with emergency medical services supervisors and/or field training officers, to last 1-4 hours.
  9. [El Sanadi] shall audit the performance of system personnel by use of a quality assurance program to include, but not be limited to, a prompt review of run reports, direct observation, and comparison of performance standards for drugs, equipment, system protocols and procedures.

Remember, multiply all these duties and time commitments by 4 – for BSO (and its contracted cities), Fort Lauderdale, Sunrise and Tamarac.

El Sanadi has a contractual obligation to direct patients being transported by BSO and the contracting cities emergency (EMS) to particular hospitals within a competitive hospital environment.  Another word for “direct” is “steer”?  When El Sanadi steers patients to any Broward Health facility – potentially, his annual bonus increases!  This arrangement would seem to be so facially offensive to the Justice Department, and so many anti-kick-back laws that it is curious why the Broward Health Board of Commissioners, or any of its attorneys wouldn’t have serious concerns.  How can the Broward Health Board reconcile the time El Sanadi, let alone the accompanying potential liability, will spend with his “part-time” work at the expense of Broward Health? Aren’t the taxpayers entitled to a full time CEO?  Aren’t we paying enough for a full time CEO?   Clearly, the Broward Health Board of Commissioners in their reputed inexperienced wisdom, who are putatively irresponsibly led by their Chair David DiPietro, and seemingly rushed by a sham process to coronate El Sanadi, didn’t think so.  Either that, or Dr. El Sanadi was less then candid about his outside obligations when he negotiated his CEO contract with Broward Health.

DoAsISaySo how has Broward Health been managed by its highest paid CEO?  Among cries of “Patient’s First”, and “Manage Broward Health as a Hospital, not as a bank”, “King” Nabil El Sanadi has been busy putatively running Broward Health as his kingdom.  Inside sources at Broward Health tell of rumors of a growing horrific working environment, lack of confidence votes, sweetheart deals, erratic behavior, and retaliatory tactics against any employees proximate to anyone articulating objections abound.

El Sanadi and his mirrorFor my part, it has been difficult to discern what measure of criticism is caused by necessary reforms that have been a long time in coming, or the product of El Sanadi’s personal administrative style that is seemingly characterized by these sources most often as two-faced, publicity craven narcissism.  “King” El Sanadi  has much in common with the Emperor with no clothes.  To some high ranking sources, “King El Sanadi is writing a new chapter in ineffective management and leading Broward Health backward into the bad ol’ days of rampant and corrupt insider double dealing starting with his contract.

Note:  Dr. El Sanadi’s apparent conflicts are not restricted to just his “Medical Director” contracts, which are all in his name, but they also likely include his ownership, control or participation in his or his wife’s companies all of which seem to be in competition with Broward Health (See: Has the Office of Inspector General seen Dr. El Sanadi’s CEO Contract with Broward Health?”):

  • South Florida Fire Rescue Medical Directors’ Association, LLC
  • N & L Services, Inc.
  • Total EMS, Inc.
  • El Sanadi Holdings, LLC
  • Green Harbor Company

I will post information on these companies as information is developed.

 

Bombshell Broward Health Non-Agenda Item stinks of insider Double Dealing

At Wednesday’s Broward Health Board Meeting (May 27/2015), it was announced that  corporate counsel Sam Goren, named partner of the highly respected governmental law firm of Goren, Cherof, Doody & Ezrol, P.A., , had given notice that he would resign as Broward Health’s corporate counsel.  No reason was given for this sudden resignation but it appeared to have been seemingly orchestrated by CEO Dr. El Sanadi and Board chairperson David DiPietro.

Following the ouster of Sam Goren,, a non-agenda item to replace the corporate counsel was walked on to the end of the Board of Commissioners formal meeting yesterday by Dr. El Sanadi.

'Now that we all agree on the agenda, a show of hands on how many want to keep it hidden.'

The non-agenda item was not noticed to the public, and it is unknown to what extent Dr. El Sanadi briefed individual commissioners of his plan to bring the General Counsel’s position inside (as opposed to an independent outside counsel) and to advertise, interview and hire Mr. Goren’s replacement within 30 days.   Some, but not all of the board members were apparently caught unawares of El Sanadi’s plan reminiscent of the putative sham “process” that was used to make him CEO (see post:  Innovative CEO NASK Forced Out, Politics Wins – We Loose!).

Sam Goren and his firm are a class act.  I know.  When I was chair of Broward County’s Management and Efficiency Study committee and later, the chair of Broward County Charter Review Commission, Sam worked as our independent counsel.  In four years, a collaborative effort with Sam’s learned guidance resulted in a completely re-written Broward county charter which now stands as a national model for county government.  Some of Sam’s innovations were the public’s bill of rights, and the mandated ethics code for all elected officials.  Sam would not and will not ever admit that he was forced to resign as corporate counsel, even when true, but he could not stay when his advice is neither solicited nor taken by a client.   His sincere request would be to “let it go”.  So I will respect his request with respect to his and his firm’s service.

bruce-eric-kaplan-right-now-i-m-dealing-with-all-this-spring-bullshit-new-yorker-cartoonHowever, the circumstances surrounding Sam Goren’s reputed ouster and the resulting actions of the Board and Dr. El Sanadi is another matter entirely. First the non-advertised, non-noticed walk on agenda item by Dr. El Sanadi absent a declaration of an emergency is indicative of the ostensible nonchalance disrespect El Sanadi holds the formality of the public meeting process and the public in general, let alone the Board Members themselves.  The agenda walk on item resulted in 4 actions by the Board seemingly carefully orchestrated by El Sanadi and DiPietro, each of which is an important public policy consideration that appeared to be considered in less than an offhand manner by the rest of the Board.

The First action was to revert back to the pre-outside corporate counsel model and move the corporate counsel’s position inside Broward Health.  As most past Board Members would remind the current board, having the corporate counsel inside Broward Health as opposed to being outside and free of undue administrative influence inherent with inside counsel was not only problematic but reputedly was one of the root causes of Broward Health’s current difficulties with the Justice Department.  Previous to the service of Sam Goren and his firm, the previous inside counsel was purportedly removed under a very dark cloud.  This should have been an important policy conversation for the Board, but as it was – not more than a few brief minutes was spent on it.

What should have occurred was a more thorough discussion and an agreement to advertise for proposals for both inside and outside Corporate Counsel for Broward Health.  Outside counsel proposals could identify firm resources and prices that could serve Broward Health.  Inside counsel proposals could identify the costs of establishing an internal Corporate Legal Counsel department.  The Board, armed with these proposals, could then evaluate the submittals and make a much more informed decision for the system.

Instead, no choices and no options were presented.  That’s what happens when there is little preparation or notice of an agenda item.

The second action was a determination of what the minimum qualifications for an inside corporate counsel should have.  Remarkably, even though Dr. El Sanadi has no experience hiring a corporate counsel for a large hospital system – he offered basic qualifications, which were not surprisingly quickly supported by DiPietro.  Together, El Sanadi and DiPietro Ying and Yanged the minimum qualifications on behalf of the Board – presumably matching a pre-determined but as yet unknown friend of theirs. The name I keep hearing is attorney Myla Ruth Reizen from Miami.

The third action was to establish a less than 30 day time period and process for the board to make this critical selection for the District beginning with advertising for the position today (Thursday, May 28th).

The fourth action was to establish a pre-selection process to determine who would be interviewed by the Board.  DiPietro offered to sacrifice himself for the greater good of the Board and agreed to select 5 semi-finalists apparently completely based only on his personal discretion.   Of course, it was conveyed that if any board member wanted to add a name to his 5 choices they could, but that would enlarge the scheduled interview time allotted past 7:00 pm on June 15th.   Wow!!

Workplace-CultureI wonder why they even go through a process when they (DiPietro and El Sanadi) seemingly already know who they want to hire.

Its yet another ostensible sham “process” from DiPietro and ElSanadi that stinks of insider dealing taking us closer and closer to the bad ole’ days of Broward Health corruption. How little they must think of the public they were appointed to serve!

OMG – Nabil El Sanadi’s First 5 Months!

I’ve taken a little time since my last post to talk with a few Broward Health Board members, some senior Broward Health physicians, and some notably well informed people who work for or with Broward Health.  The consensus picture they paint of Dr. Nabil El Sanadi’s first 5 months as CEO is peppered by his apparent arrogant administrative miss-steps, ‘discretionary’ spending seemingly more befitting a drunken sailor, a rumored lack of confidence vote by the medical staff, and ostensible team busting organizational paranoia that even by Broward Health standards is remarkable.  It appears that Dr. El Sanadi’s lack of experience as a CEO and possible narcissistic personality is threatening the very health of the Broward Health organization and its ability to overcome challenges and take advantage of unique opportunities to serve the health needs of Broward County.

DoAsISayAbsent transparency in Dr. El Sanadi’s actions, any public debate or even disclosure of his “strategic plan”, and the complete apparent absence of responsible oversight by Governor Scott’s appointed Broward Health board, we should all be concerned.

It is in this context that I decided to write Dr. El Sanadi the following open letter, and invite him to similarly respond.

Dear Dr. El Sanadi,

It is obvious that I have been openly critical of how you have appeared to have “bought” your appointment as CEO through your political connections and extensive political contributions as opposed to your experience and abilities to administer and manage one of the largest public hospital systems in America.  But regardless of how you arrived at your current position, here you are, and in spite of some putative initial missteps – you have the ability to change the criticisms to praise through your actions.

But first you have to lose your semblant paranoia, embrace the potential of the many diverse voices at Broward Health and have the personal strength of character to surround yourself with people who are smarter and more experienced then you are.   Learn to work with those that disagree with you.  Use their thoughts and energy to polish your ideas and vision.  Above all, make them feel secure in their candor.  Stop talking about being transparent.  Be transparent.  It’s ok to make some mistakes in the beginning.  It’s even expected.  Admit them quickly, bring people together and move on.  Be confident.  Embrace humility.

Understand that Broward Health is not a private hospital system that receives tax-assistance for indigent care, but rather an important public enterprise that not only exists to serve the public health needs of our community but also has grown to be an important Broward economic engine that must be protected.

last-resort-customer-serviceUnderstand that criticisms of you, your actions, and your conduct are not personal, but rather are job related, and goes with your public position.  Don’t be afraid to agree with your critics when they “accidently” get it right, and stop ostensibly promoting yourself and start promoting Broward Health, its 8,000 employees, and its future potential to more fully serve Broward County.  Your apparent self-promotion is becoming embarrassing, and way too political for a CEO.

That said, I would encourage you to complete some important initiatives that had started before you became CEO.  Two of more than 12 identified initiatives are:

  1. The establishment of an intensivist program at Broward Health Medical Center and Broward Health North ICUs. The previous 4 board of commissioners have supported this important standard of care for Broward Health and at the time of your appointment – there was ongoing, but incomplete negotiations for a program at Broward Medical Center. The intensivist program standard is, as you know, a board certified critical care physician on site (not on call) for every 15-24 occupied ICU beds.  It means that the highly qualified ICU nursing staff will never again have to tell a patient or family that they are waiting on doctor’s orders.  You should know that Broward Health will be among the last hospitals in Broward to adopt this standard of medical care for those most in need.  Further, every study on ICU care concludes that on-site intensivists saves lives.  The reverse is similarly true.  The absence of an ICU intensivist costs lives.
  2. Centralized credentialing of Physicians. Currently credentialing paperwork is centralized at the new Spectrum center.  That is only the first step.  The end game is that the credentialing committee should be comprised of the chief of Medical Staffs from each hospital, and once a physician is credentialed for any Broward Health hospital – they are credentialed at all Broward Health hospitals.  This will immediately create community viability for all of Broward Health, and address the seeming historic problems of particular specialty deficits at any given hospital at any given time.  As an accomplished clinician, this should be a no brainer for you.

Dr. El Sanadi, it been more than 5 months.  Ostensibly, it’s time to show more than your press clippings, and your political letters of support to the Governor.  Interviews and ribbon cutting just isn’t enough!  Do the job, and if you can’t – then go away.

If you wish to respond to this open letter, please remember that I published your vision unedited, and I will similarly publish your response unedited.

Sincerely,
Dan Lewis

poop-was-thereI’m trying to keep these posts a little shorter than some of my previous posts.  Here’s a peek about planned upcoming posts you won’t want to miss:

As Bette Davis said in “All about Eve”, “Fasten your seatbelts, it’s going to be a bumpy night. Stay tuned.

Just say No – How Not to Cancel a Meeting – Part 4

Dr. El Sanadi’s response to my public records request (see Part 3) flies in the face of his public claims of transparency as Broward Health’s CEO.  My El Sanadi public records request can be seen here.

Soon after I submitted my public records request to Dr. El Sanadi, Broward Health through their corporate counsel’s office hired a law firm to represent and respond on his behalf.  Although this is common, and given his position as CEO entirely appropriate, it did create a layer of delay and formality in the process.  The public records request response can be seen here (it is a very large PDF file -22 Megs).  Any redacted file or exempted record must be noted as specified by section 119 of the public records law.  This section states in part:

0317toon_ohmanCLRThis section further provides that if the person who has custody of a public record contends that the record or part of it is exempt from inspection, he shall state the basis of the exemption which he contends is applicable to the record, including the statutory citation to an exemption created or afforded by statute, and, if requested by the person seeking the right under this subsection to inspect, examine, or copy the record, he shall state in writing and with particularity the reasons for his conclusion that the record is exempt. 

Dr. El Sanadi’s exemption log can be seen here (PDF file – 42 KB).

To ensure that Dr. El Sanadi was given every opportunity to be transparent in his dealings with Broward Health, I sent his “Public Record’s” attorney the following request:

Let me know if you take the position on behalf of Dr. El Sanadi that his response to my public records request is complete, and that he has produced all the requested records in his possession and control, and/or asserted an exemption for their production in the exemption log.

Their response was:

Within the parameters of your request, there are no other records for which Dr. El Sanadi is an agency or custodian of public records. 

To the extent you are seeking his communications and other records with BSO, Fort Lauderdale, Sunrise and Tamarac in his capacity as medical director for those agencies, he is an independent contractor and not an agency or custodian of public records.  Each record you seek is in the possession of those agencies.  If you want those records, you can go to those agencies and request them.  Those agencies will exercise their prerogative to decide which records are exempt or exempt and confidential.  I urge you to review §§395.50 & 401.30, Florida Statutes.  With limited exceptions, none of which are applicable here, Art. I, §24 of the Constitution and Chapter 119 place the responsibility and burden of compliance on government agencies, not on individual citizens.   

sunshine-law-2The issue and the point of my public records request was to provide Dr. El Sanadi an opportunity to be transparent in his contractual dealings with Broward Health.  Specifically, Paragraph 6.3 of his employment agreement provides in part that he “agree[s] to refrain from any other service or employment which would restrict his ability to devote his full time to employment as President/CEO”.  Further his agreement allows him to be a board member of any organization that does not create a conflict prohibited by Chapter 112, Part III, Florida Statutes.   You will recall that, according to public corporate records, in addition to being the highly paid medical director for the Broward Sheriff’s office and the cities of Fort Lauderdale, Sunrise, and Tamarac, Dr. El Sanadi is an officer and/or board member of the following active corporations:

  • South Florida Fire Rescue Medical Directors’ Association, LLC
  • N & L Services, Inc.
  • Total EMS, Inc.
  • El Sanadi Holdings, LLC
  • Green Harbor Company

In addition to these outside duties, he is allowed to work in the emergency room for 4 hours per week.  Now, no one questions Dr. El Sanadi’s abilities as a distinguished emergency medicine clinician, but all these other non-Broward Health duties, responsibilities, and contracts raise the issue of Dr. El Sanadi’s ability to faithfully fulfill his contractual obligation to be a full time CEO for Broward Health.  Further, flying in the face of his constant assertion of transparency is Dr. El Sanadi’s refusal to produce the requested documents putatively knowing full well that, at the very least – in the case of the medical directorship contracts – they are certainly public records.

Finally, Dr. El Sanadi’s refusal to be transparent about his private businesses is troubling at best.  See my previous post “Has the Office of Inspector General seen Dr. El Sanadi’s CEO Contract with Broward Health? “. Perhaps what is more troubling is that the members of Broward Health’s Board of Commissioners are apparently not asking these questions!

Exemptions

wonthurtmeThrough his attorneys, Dr. El Sanadi has claimed many exemptions to the public records statutes.  He, through his attorneys,  has taken an over-broad position, which is ostensibly contrary to the mission of Broward Health and the public good, but completely consistent with the seeming attitude what happens at Broward Health is none of the public’s business (see my post – “It’s none of your business! Really?”).

Once again, instead of simply responding transparently, Dr. El Sanadi evidently plays games.  Perhaps if he had just provided the records, the issue would be closed, but instead he obfuscates the issue to the extent that it seems that he must be hiding somethingThere are people who walk the talk, then apparently there is Dr. El Sanadi.  He should not be allowed to even say the word “transparently”!

Clearly, thanks to Dr. El Sanadi’s ostensible evasionthe issue of his contract, his companies, and his outside employment is far from over.  Stay tuned!

Just say No – How Not to Cancel a Meeting – Part 3

DoAsISayIn “Just say No – How Not to Cancel a Meeting – Part 1” you learned that there were a number of initiatives underway to improve Broward Health’s services at the time David DiPietro, the Board Chair, seemingly orchestrated the ouster of Frank Nask followed by DiPietro’s apparently predetermined CEO choice and his wife’s fellow medical board member, Dr. Nabil El Sanadi as Broward Health’s new CEO.  See  “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?”.   In Part 1, you also saw a remarkable  paranoia of organizational transparency in an email chain that is a troubling indicator of how Dr. El Sanadi ostensibly sees his new public responsibilities.

In “Just say No – How Not to Cancel a Meeting – Part 2” Dr. Nabil El Sanadi decided to abandon any direct or simple response to my request for a meeting and instead seemingly chose to communicate through his Corporate Counsel Mr. Horowitz a veiled warning not to question him and Dr. El Sanadi’s apparent paranoia deepens.   This resulted in my detailed response to the Board of Commissioners through its chairman David DiPietro (see part 2) and my request for public records which is where this post begins.

open-govt-cartoon1Public organizations like Broward Health must operate transparently under the sunshine in Florida and every document, every piece of paper, and every computer data file is available for review and duplication by the public unless exempted from disclosure.  Further, every vendor and/or sub-contractor to a public organization must similarly maintain and when requested, disclose their public documents relating to their agreements and contracts with a public entity.  The penalties for the failure to do so can be harsh and a personal liability.  Click here for “The Reporter’s Handbook – Sunshine and Public Records Laws” which has more information about public records in Florida.

Because Dr. El Sanadi refused to meet privately, the following public records request was promulgated to him personally. (Click here to download a copy of the Public Records Request to Dr. El Sanadi.)

February 17, 2015
Dr. Nabil El Sanadi
5100 N Ocean Blvd #518
Ft Lauderdale, FL 33308

Re: Public Records Request

Dear Dr. Sanadi,

This letter is a public records request pursuant to the Public Records Act, Florida Statutes, Section 119 to allow the inspection and copying of public records. This request is also made pursuant to Art. 1, s. 24(a), Fla. Const. which establishes a constitutional right of access to any public record made or received in connection with the official business of any public body, officer, or employee of the state, or persons acting on their behalf.

 YOU ARE CAUTIONED THAT THE FAILURE OF THE REQUESTEE TO FULLY COMPLY MAY RESULT, INTER ALIA, IN THE INSTITUTION OF LITIGATION, THE REQUEST FOR APPOINTMENT BY THE COURT OF AN INDEPENDENT REVIEW AND AN AWARD OF ATTORNEY’S FEES AND COSTS TO REQUESTOR’S LEGAL COUNSEL.

Section I. Subject of the Communications

The subject of the “communications” and/or “records”[1] are limited to those created since December 20th, 2014 and include, but not limited to, correspondence, letters, e-mails, memoranda, notes, text messages, documents of any nature, and facsimiles in your possession by and between any of the individuals identified below, and/or any third party not previously identified which pertains to, relates to, or mentions in any manner the following individuals and/or entities, or the matters identified below:

  1. Any “communications” and/or “records” related to the transition from the previous CEO to your administration including but not limited to the formation of committees, the addition or elimination of budgeted employee positions, and/or the reassignment of officers of Broward Health and its related entities.
  2. Any “communications” and/or “records” related to new or previously unoccupied medical directorships.
  3. Any “communications” and/or “records” related to recruitment of fellowship and/or internship positions at Broward Health or any of its entities.
  4. Any “communications” and/or “records” related to the relationship between Broward Health and Nova Southeastern University.
  5. Any “communications” and/or “records” related to the relationship between Broward Health and FIU.
  6. Any “communications” and/or “records” related to physician credentialing at Broward Health.
  7. Any “communications” and/or “records” related to the Broward County Sherriff’s office.
  8. Any “communications” and/or “records” related to the City of Sunrise, Florida.
  9. Any “communications” and/or “records” related to the City of Tamarac, Florida.
  10. Any “communications” and/or “records” related to the City of Fort Lauderdale, Florida.
  11. Any “communications” and/or “records” related to Dr. Stephen Scott and or the entity commonly referred to as “The Phoenix Group” and/or its successor company MCare who currently provides Emergency Management services to Broward Health.
  12. Any “communications” and/or “records” related to your calendar.
  13. Any “communications” and/or “records” related to your Broward Health cellular phone.
  14. Any “communications” and/or “records” related to your use of Broward Health vehicles, mileage, per diem and/or travel expenses.
  15. Any “communications” and/or “records” related to your outside Medical Director Agreements.
  16. Any “communications” and/or “records” related to your clinical work performed pursuant to section 6.4 of your Broward Health employment agreement.
  17. Any “communications” and/or “records” related to payments from you to the Children’s Diagnostic & Treatment Center.
  18. A copy of any contracts including attachments signed by you on behalf of Broward Health which have not been presented to the Board of Commissioners at a regularly scheduled Board meeting.
  19. Any “communications” and/or “records” by and between[2] you and any past or current Broward Health Board member.

Paragraph 6.3 of your employment agreement provides in part that you “agree[s] to refrain from any other service or employment which would restrict his ability to devote his full time to employment as President/CEO”.  Further your agreement allows you to be a board member of any organization that does not create a conflict prohibited by Chapter 112, Part III, Florida Statutes.   According to public corporate records, you are an officer and/or board member of the following active corporations:

  • South Florida Fire Rescue Medical Directors’ Association, LLC
  • N & L Services, Inc.
  • Total EMS, Inc.
  • El Sanadi Holdings, LLC
  • Green Harbor Company

To identify any potential conflicts with your obligations under Florida’s code of ethics for Public Officials, please provide the following “communications” and/or “records” for each entity wherein you were or are a current officer, partner, principal and/or employee after December 20th, 2014;

  1. Any “communications” and/or “records” between any of the entities identified above and Broward Health and/or any of its entities.
  2. Any “communications” and/or “records” which identify clients/members/customers of any of the entities identified above.
  3. Any “communications” and/or “records” which show income & expense & profit distributions for any of the entities identified above.
  4. Any “communications” and/or “records” which reference or concern services offered and/or the job description, duties and/or time commitments for you outside of your Broward Health duties, including but not limited to a copy of any contracts between any of the entities identified above and any third party.

If you have a requested public record but claim a privilege which protects you from providing it pursuant to this public records request, A LOG SHOULD BE PROVIDED IDENTIFYING THE SPECIFIC DOCUMENT/ COMMUNICATION BEING WITHHELD, AND THE LEGAL BASIS FOR THE CLAIMED PRIVILEGE. 

Please note that section 119.07(2)(a) of the Public Records Law provides that a person who has custody of a public record and who asserts that an exemption applies to a particular pubic record or part of such record shall delete or excise from the record only that portion of the record with respect to which an exemption has been asserted and validly applies, and such person shall produce the remainder of such record for inspection and examination.  This section further provides that if the person who has custody of a public record contends that the record or part of it is exempt from inspection, he shall state the basis of the exemption which he contends is applicable to the record, including the statutory citation to an exemption created or afforded by statute, and, if requested by the person seeking the right under this subsection to inspect, examine, or copy the record, he shall state in writing and with particularity the reasons for his conclusion that the record is exempt. 

It is hereby requested that you do state in writing both the statutory citation to any exemption which you claim applicable to any requested record and the specific reasons for a conclusion that the requested record is exempt. 

Also, please note that section 119.07(2)(C) prohibits the destruction of any of the requested records, including any which you claim are exempt, for a period of 30 days after the date on which you receive this written request.  If a civil action is instituted to enforce the Public Records Law with respect to the requested records within the 30-day period, you may not dispose of the records except by court order after notice to all affected parties. 

As a matter of Florida law, unless the nature or volume of public records to be inspected or copied requires “extensive” use of information technology resources or “extensive” clerical or supervisory assistance, the special service charge is not authorized. If authorized due to the nature or volume of a request, the special service charge should not be routinely imposed, but should reflect the information technology resources or labor costs actually incurred by the agency. AGO 90-07. And see, AGOs 92-38, 86-69 and 84-81.  Moreover, the statute mandates that the special service charge be “reasonable.” See, Carden v. Chief of Police, 696 So. 2d 772, 773 (Fla. 2d DCA 1996), stating that an “excessive charge” under s. 119.07(1)(b), F.S., “could well serve to inhibit the pursuit of rights conferred by the Public Records Act.” 

After inspection, I agree that I will compensate you for the actual cost of duplication of any of the records that I have requested.  If the nature or volume of the public records requested is such to require extensive use of information technology resources and/or extensive clerical and/or supervisory assistance by personnel of your office, I agree that I will compensate you for those costs that are reasonable as well, subject to the terms enumerated herein.  Before incurring any charges, please contact me and advise me of the actual cost basis of duplication and/or any necessary and reasonable staff research time.  

If these public records can be provided electronically, please email them to me.  Alternatively, kindly let me know when and where I may inspect them. 

I would appreciate confirmation that you have received this request and an estimated date of when I might receive and/or inspect the public records. Thank you in advance for your prompt consideration of my request. Please feel free to contact me if you have any questions.

Sincerely,
Dan Lewis

Zambia-FOI-cartoon-559x440Dr. El Sanadi’s response was again through legal counsel.  This time, however, a special law firm was hired for the ostensibly sole purpose of fulfilling Dr. El Sanadi’s personal statutory requirement to respond and comply with this public records request.

In the final post in this series, Just say No – How Not to Cancel a Meeting – Part 4” you will see Dr. El Sanadi’s incomplete response which appears to be a hypocritical attempt to outsmart the law and duck both the letter and the spirit of transparency in spite of his publicly proclaiming to be a devoted acolyte of “complete transparency”.   It is a post you won’t want to miss.

Notes:
[1]     The term “records(s)” as used herein shall mean “all documents, papers, letters, maps, books, tapes, photographs, films, sound recordings, data processing software (including e-mail), or other material, regardless of the physical form, characteristics, or means of transmission, made or received pursuant to law or ordinance or in connection with the transaction of official business by any agency.”  “Records” also includes originals, drafts, revisions and other non-identical copies (together with all attachments thereto).

[2] By and between means any and all “communications” in which the persons identified either initiated, received, or was copied in any manner on the communication.

Bumbling Inexperience of Dr. Nabil El Sanadi at Committee Meeting

It is difficult to judge the actions of the Broward Health Board due to the well-intentioned but bumbling inexperience of Dr. Nabil El Sanadi as CEO evidenced in the Board Finance Committee meeting yesterday (April 23, 2015) attended by all the Board Members.  This meeting was open to the public, but besides me and two others representing the public, the audience was populated by a gaggle of highly compensated Broward Health staffers who have no apparent purpose in attending and who probably should be at their desks working.

Having spent his life becoming an extraordinary clinician, Dr. El Sanadi’s medical prowess is not in dispute.  His inexperience as an administrator and his apparent lack of understanding of the dynamics of a public institution is ostensibly, on the other hand, painfully evident.

steps-for-the-incompetentTake, for example, three agenda items discussed at the finance committee with all Board members present; funding for Coral Springs expansion, approval of clinical trial management system, and the ever volatile discussion about Broward Health’s partnership with the Memorial System in the Florida Critical Care Network (FLCCN).  Each of these items provided Dr. El Sanadi an opportunity to demonstrate true leadership and understanding.  Instead, apparently, in a flurry of disingenuous “if I may” and “prospectively” interruptions of even his own staff presenters – he barely bumbled through, and often debated with his own staff.  (Imagine how much fun these meetings would be if each time he says “if I may” or “prospectively” one has to drink a shot of …!) . Let me briefly discuss each item in turn.

Funding For Coral Springs Expansion

Amidst a backdrop of possible catastrophic governmental changes in the way some health services are funded at Broward Health (thanks to the ever putative dysfunctional State Legislature and Governor) – Broward Health may need to restructure it’s 2015-2016 budget downward by 10% (about 100 million dollars).  Now, no one really thinks this will be necessary – but professional and prudent management must certainly allow for the possibility.  Now comes a request for close to 9 million dollars to expand the facilities at Broward Health Coral Springs(click here).  While the need was not in dispute (that is to say, no one disputed the request), and the savings by committing the funds now during currently approved construction activities as opposed to later was arguably evident – the commission quite rightly balked at committing additional funds given the legislative climate in Tallahassee.  Even though arguably these funds should have been authorized when the original expansion was approved, the impromptu compromise offered by Dr. El Sanadi  – without much apparent thought, was that the construction contracts could be structured in a manner where they could be cancelled in whole or in part.  Now no one knows if this is either possible or prudent, but it nevertheless became a condition of approval.  Dr. El Sanadi’s seeming failure to know about, predict or anticipate the Board’s sensitivity to the authorization of additional funding speaks volumes about his experience.  Especially since at least one Board member knows something about the availability of public bonds to fund necessary health care capital projects.  It is unfathomable and telling that Dr. El Sanadi appeared not to have included incremental or alternative funding strategies in the original staff presentation to the Board.

Approval of Clinical Trial Management System

ReadBlogDr. El Sanadi’s proposal to establish a top down corporate infrastructure for clinical trials (click here) throughout the Broward Health system was within his “wheelhouse” as a clinician, well thought out and well justified to medically serve the needs of our community.  But administratively, the details of the program seemed sloppy and the funding request was confusing at best.  The funding request was for over 1 million dollars for software to manage the program, but the proforma and the executive summary provided to the Board also referenced 23 additional FTE’s (full time employees (equivalent)).  One could see some members of the board mentally trying to calculate the cost for 23 additional (?) employees (23 * 50K = 1,150,000/per year).   So was the authorization for the million dollars for the software, and another million dollars for the new (?) employees, asked one Board Member.  “If I may”, “proactively” we will make that a budget issue said the CEO.  Apparently, not knowing what that meant, a Board member asked – “ok, so we’ll take that up in the Budget?”  “Yes” said the CEO.  Then the staff presenter said “We already have 21 FTE’s”.  “So we only need 2 more” a Board Member asked?  “If I may”, said the CEO.  “Proactively, we will want to have ….”  and the discussion ostensibly went into oblivion surrendering to – “the budget process” without resolution.

In a seeming coup de grâce for the CEO’s visibly suffering administrative incompetence, the chief financial officer added that the program might involve some additional liability for Broward Health – an issue that, based on the surprised look on Dr. El Sanadi’s face, was apparently not expected.  The issue, properly raised was that if a trial goes wrong with a patient, there is a legitimate question about who is responsible for the potential and expensive resulting medical bills; is it the pharmaceutical company, the insurance company, Broward health, or the tax payers.  It appeared that this issue should have been professionally addressed with a responsible discussion at the board level regarding policies, for example, the possibility of only allowing Broward residents to participate in clinical trials at Broward Health.   Instead,   “If I may” interjected the CEO to his senior staff: “Broward Health already does clinical trials……”, which did not seem to address the very real possibility of some serious liability exposure.

Broward Health and Memorial System’s Partnership
– South Florida Community Care Network (SFCCN)

Press1In what should be a bold first step in the partnership of the two public hospital systems for the benefit of Broward, the SFCCN is apparently being reduced to what one could describe as a sophomoric and vitriolic measurement of penile girth between the systems.  Most of the blame for this is purportedly on Broward Health and its inability to successfully address legitimate administrative issues through its senior staff, particularly Dr. El Sanadi, as adults.

The underlying controversy seems to be about the division of profits in the partnership enterprise, coupled with the referral of patients to one or the other hospital systems.  A minor issue relates to the status of partnership internal advisory committees and whether they are governed by sunshine laws.  Here, there seems to be a difference of opinion among the attorneys advising the partnership and the members, which seemingly could be easily resolved by Broward Health asking for an opinion from the Attorney General (as opposed to the partnership asking for an opinion).

One would think that the revenue issue could be resolved simply through the mandatory public audit system, but Broward Health’s CFO, who is the chair of the partnership entity’s finance committee says no.  In my experience with both Broward County and School Board audits, one simply adds the issue to the auditor’s scope and the matter is investigated and independently reported upon.  Clearly, the members of the partnership (the CEO’s of Broward Health and the Memorial System) could agree to add that matter to the audit scope and thereby resolve the financial dispute.

As to the referral issue, the members could similarly agree on a specific policy relating to referrals to the appropriate medical facility closest to the patient with the need.  Certainly, this can also be audited by a third party at the direction of the members.  Instead, because of the apparent sophomoric distrust and seemingly complete lack of vision on the part Dr. El Sanadi and some members of the Broward Health Board, their solution seemingly is to change the governance of the partnership in a manner that would always benefit one partner at the expense of the other.  So strong is the appearance of distrust that Broward Health ostensibly even wants to fire the existing manager of the partnership even though the partnership has become a 100 million dollar business in just over 1 year producing reasonable profits to both systems while providing important health care services to Broward County.  Broward Health’s conduct in this partnership appears to be an embarrassment of inexperience under Dr. El Sanadi, a disservice to Broward Health and Broward County, and threatens this very important joint initiative.

ThinkOutOfBoxOne cannot help but wonder how much damage Dr. El Sanadi will do to Broward Health while he learns his job.   One lesson he needs to learn sooner than later is that criticism goes with the job, is not personal, but is in the public interest and for the public purpose.  Furthermore, It appears that he and his Board all need to learn that transparency is not just a word.
(Personal disclaimer: -the quotes herein are NOT VERBATIM but are based on my recollections, notes and impressions of the discussions). 

Just say No – How Not to Cancel a Meeting – Part 2

In “Just say No – How Not to Cancel a Meeting – Part 1” you learned that there were a number of initiatives underway to improve Broward Health’s services at the time David DiPietro, the Board Chair, seemingly orchestrated the ouster of Frank Nask followed by DiPietro’s apparently predetermined CEO choice and his wife’s fellow medical board member, Dr. Nabil El Sanadi as Broward Health’s new CEO.  See  “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?”.   In Part 1, you also saw a remarkable paranoia of organizational transparency in an email chain that is a troubling indicator of how Dr. El Sanadi ostensibly sees his new public responsibilities.

The Saga Continues

After Dr. El Sanadi unilaterally cancelled a planned conference call without explanation,  it appears that he directed Broward Health’s corporate attorney to send me the following correspondence:NotQuiteAsAdvertised

From: Jacob G. Horowitz
Sent: Tuesday, February 10, 2015 5:09 PM
To: Dan Lewis
Cc: ‘nelsanadi@browardhealth.org’ (nelsanadi@browardhealth.org); Sam Goren
Subject: Broward Health

Good afternoon. Attached please find a correspondence from the Broward Health General Counsel’s Office in response to your recent inquiry to Dr. El Sanadi.

Thank you.
Jacob G. Horowitz
GOREN, CHEROF, DOODY & EZROL, P.A.

The following letter was attached to the Mr. Horowitz’s email.

Horowitz_Page_1

Horowitz_Page_2As is my custom, I acknowledged receipt of the letter by email:

From: Dan Lewis
Sent: Tuesday, February 10, 2015 6:19 PM
To: ‘Jacob G. Horowitz’
Cc: ”nelsanadi@browardhealth.org’ (nelsanadi@browardhealth.org)’; ‘Sam Goren’; ‘David Di Pietro’
Subject: RE: Broward Health

Mr. Horowitz,

I am in receipt of your remarkable and disappointing “General Counsel’s Office” correspondence.  Certainly it calls for an equally remarkable response, which will be forth coming.

It seems to me that it may be a good time for a very public debate.

Let the sun shine in!

Best.
Dan Lewis

right to knowA few days later, I replied to Mr. Horowitz’s correspondence with my letter to Board Chair, David DiPietro (whom I felt responsible for this putative mess) and copied the entire Broward Health Board of Commissioners.

February 17, 2015

Mr. David Di Pietro,
North Broward Hospital District
Board of Commissioners
District 6 – At Large

Dear Mr. Di Pietro,

I have taken a few days to digest the district’s February 10th corporate counsel’s letter to me on behalf of Dr. El Sanadi in which you were copied. The letter was initially both infuriating and disappointing, then over time, just sad.

Some context

For the past three years I have attended virtually all of your open committee and Board meetings with the singular purpose of helping the system become the finest public hospital system in the country. This purpose emanated from a commitment I made after nearly losing my daughter to a rare medical syndrome and the systemic incompetence of both the emergency and ICU services at Broward Health. Instead of litigating these failures, I committed

to use my abilities and resources to be part of an effort to help the system leave its colorful past behind and improve the quality of health services it provides to the public it serves.

During this time, it should be noted that I have met with you, both past and current Board members, numerous senior staff, and most of the elected officials representing the city, county and state interests within the District boundaries multiple times on an evolving agenda focused on making the District one of the finest public hospital systems in the country. I have used my experience spanning over 30 years as a former elected official, past chair of multiple School Board advisory committees, past chair of the Growth Management Advisory Committee, the Management & Efficiency Study Committee and the past chair of both the Fort Lauderdale Charter review committee and Broward County Charter Review Committees.

Requested meeting

Imagine my surprise at receiving your Corporate Counsel’s letter which was in response to a simple request to meet with your new CEO. You will recall that you promised to facilitate this meeting which was first requested in December shortly after Dr. El Sanadi was appointed. In fact, Dr. El Sanadi himself promised to meet with me in March at a previous Board meeting.  So what happened?

First was my public objection to the Board’s position relating to the SFCCN, followed by my attendance at the SFCCN board meeting. At the SFCCN Board meeting, I spoke on the issue of public meetings, the impact of sunshine committees and public records in a misunderstood effort to help the District.

Then, following Dr. El Sanadi’s instructions – earlier this month, I called Mrs. Wing to set a time for a private meeting.  I was asked to propose a topic and agenda for this meeting which I did from my working notes. This resulted in a remarkable recorded message from Dr. El Sanadi which in raw terms foreshadowed your Corporate Counsel’s letter to me.

My proposed agenda“My purpose, and intent in meeting with you is to afford both of us the opportunity to get to know each other in a frank and useful exchange of ideas.  This exchange will help me understand the extent with which I will be able to work with him to fulfill what I hope is a shared commitment for excellence.Informal Agenda:

  1. Incomplete initiatives:
    1. Intensivist program
    2. Centralized credentialing
    3. Centralized EMR & CPOE training
    4. Multi-level alliance w/ the Memorial System for Health Care services to all public employees in the county including:
      1. County government
      2. Constitutional Officers
      3. Municipalities
      4. Taxing Districts
      5. Non Profits
      6. Unions
  2. Procurement Policy
  3. Board Liaison Position
  4. Broward Health as a Teaching & Research Hospital
  5. Internships
  6. The Nova strategy as extended to FIU
  7. The Ambassador’s Program
  8. Tri-County Physician Marketing
  9. Board Policies:
    1. Eliminate committees, conduct all business at meetings;
    2. All board questions through CEO to staff
    3. Audit Reports, like management reports, provided to staff for response before going to Board.
    4. Executive Officer liaison to Board to review all agenda items with individual board members prior to Board meetings.
    5. New procurement code.
    6. New policy on agenda items e.g. who can place items on the agenda, timelines for agenda items, etc..  All board members must be allowed to place items on the agenda.  Agenda items must be moved and seconded before discussion and motions.
  10. FLCCN

I hope that this agenda is sufficient for you to find time in your busy schedule to meet with me. I too have a busy schedule, but I will make the time to meet with you when it is convenient for you.”

Corporate Counsel’s Letter

“Strategic planning” as defined by Section 395.3035 F.S. and as applied is overly broad and in my opinion is being used to shield the District and Administration from important public oversight. While there is certainly instances where confidentiality is necessary, in most cases it is not.  This “behind closed door” mentality is significantly responsible for the misconduct of the past which is and has been the subject of numerous state and federal investigations into the District dealings.  For the Corporate Counsel to opine that “it would not be legally appropriate for Dr. El Sanadi” to discuss the matters on my proposed agenda is absurd and overly broad. Certainly a CEO of one to the nation’s largest public hospital system knows enough not to disclose sensitive or confidential information in the course of normal conversations. Persisting in this untenable position would beg judicial intervention and interpretation, and perhaps that would be a good thing.

Further, in what can only be taken as a threat on the basis of an intentional misinterpretation that I am a lobbyist, or that the Boards internal lobbying policy in anyway applies to me or my requested meeting.  The comment “We recognize that the policy may not apply to your current request” is akin to the admonition “with no disrespect” immediately followed by disrespect. It is what it is, it says what it says.

At this point, I am not convinced that Dr. El Sanadi shares my commitment, or has the ability to make Broward health the finest health care system in the country. From what I have seen thus far, he seems remarkable unprepared for such an effort.

Going forward

I believe that any meeting with Dr. El Sanadi would be unproductive at this point.  Instead, I will be making some comprehensive requests to Dr. El Sanadi pursuant to Art. 1, s. 24(a), Fla. Const. which establishes a constitutional right of access to any public record made or received in connection with the official business of any public body, officer, or employee of the state, or persons acting on his behalf.

In addition, shortly, you and some of your other Board Members will receive a comprehensive public records request from me on any correspondence, documents, and records you have or have received roughly consistent with the topics on my agenda above. Regrettably, because of the apparent secrecy in which your new CEO choses to operate, some of my 119 requests will be somewhat broader than the agenda.  (You will recall the requirement to respond to these requests are not only the responsibility of the organization, but also a personal obligations of holding office.)

I am doing my best not to prematurely draw conclusions from what I have seen and heard about the irresponsible damage being done to the Broward Health organization by what appears to be at best a well-intentioned but completely unprepared and inexperienced CEO.  I hope my fears are unjustified and that the records I will be requesting will show a very different picture. If my fears are justified then you should be very concerned.

Sincerely,
Dan Lewis

After I sent my letter, I had an opportunity to attend the February Board of Commissioner’s meeting.  Three commissioners came up to me, acknowledged my letter and asked that they be kept in the loop.  This was in stark contrast to the throng of staff members, who regularly attend board meetings for no apparent reason, uncharacteristically distancing themselves from me (likely for fear of being seen with me by Dr. El Sanadi). A sad expression of understandable organizational fear.

BeingWrong

Part 3 of this series “Just say No – How Not to Cancel a Meeting “ will focus on the public records request to Dr. El Sanadi and his curious response.  Stay tuned!

Just say No – How Not to Cancel a Meeting – Part 1

The Promise

December 20th, 2014 was Dr. Nabil El Sanadi’s first day as Broward Health’s new CEO.  Previous to his first day, I had been promised time to visit with Dr. El Sanadi by Dr. El Sanadi himself as well as members of his Board of Commissioners.  This promise was the result of four years of interaction between current and previous board members and senior staff on a number of initiatives with which there was both broad and strong support.  I was worried that, with the transition to a new CEO, some – if not all, the momentum for these initiatives would be lost.

I also wanted to take the measure of this new CEO, to look him in the eye and get a sense of his commitment to the public he was now to serve and to share with him some of the public efforts that had preceded his appointment.  I had been told that administratively, he was all smoke and no fire – I didn’t want to believe it at the time.

No Obligation

While there was no obligation for Dr. El Sanadi to meet with me as a member of the public, I do have a 30+ year history of civic activism and governmental public policy advisory experience, and I am a current member of the Broward County Health Planning Council.  And they promised.

illusion_of_progress

A Pocket of Excellence

At this point I need to introduce you to a truly magnificent lady who is a consummate professional.  A lady who has served a number of Broward Health CEO’s with both dignity and class.  That lady is Maryanne Wing and you will see her name in the emails below.  Apparently because of Dr. El Sanadi’s discomfort with technology, in particular emails, Ms. Wing has been given the responsibility to receive and on direction, respond to communications directed at Dr. El Sanadi.  This is not entirely uncommon and in public enterprises is normally used to preserve correspondence to and from the CEO as a public record.

Here’s what happened when I emailed Dr. El Sanadi’s office for an appointment, through Maryanne Wing.

From: Dan Lewis
Sent: Thursday, January 29, 2015 4:35 PM
To: Wing, Maryanne
Cc: ‘David Di Pietro’
Subject: Appointment with Dr. El Sanadi

Good afternoon Maryanne,Please let me know when it would be convenient for me to meet with Dr. El Sanadi on a variety of matters.  I would estimate that we will need an hour.Thank you.
Dan Lewis

From: Wing, Maryanne
Sent: Saturday, January 31, 2015 12:41 PM
To: Dan Lewis
Subject: RE: Appointment with Dr. El Sanadi

Mr. Lewis,

Can you please let me know what is the purpose, intent and the agenda for your requested meeting.

Nabil El Sanadi MD

From: Dan Lewis
Sent: Monday, February 2, 2015 10:09 AM
To: ‘Wing, Maryanne’
Cc: ‘David Di Pietro’

Subject: RE: Appointment with Dr. El Sanadi

Dr. El Sanadi,

Purpose, intent & agenda;

For reasons we can discuss, I have made a commitment to help make Broward Health the finest public health care system in the country.  Broward Health is a system with pockets of excellence and layers of incompetence.  To effectively meet the challenges of the organization, it must find bold and inventive strategies to grow its pockets of excellence and melt away its layers of incompetence. These strategies must be both internal and external to the organization and administrative and political in their nature.

My purpose, and intent in meeting with you is to afford both of us the opportunity to get to know each other in a frank and useful exchange of ideas.  This exchange will help me understand the extent with which I will be able to work with him to fulfill what I hope is a shared commitment for excellence.

Informal Agenda:

  1. Incomplete initiatives:
    1. Intensivist program
    2. Centralized credentialing
    3. Centralized EMR & CPOE training
    4. Multi-level alliance w/ the Memorial System for Health Care services to all public employees in the county including:
      1. County government
      2. Constitutional Officers
      3. Municipalities
      4. Taxing Districts
      5. Non Profits
      6. Unions
  2. Procurement Policy
  3. Board Liaison Position
  4. Broward Health as a Teaching & Research Hospital
  5. Internships
  6. The Nova strategy as extended to FIU
  7. The Ambassador’s Program
  8. Tri-County Physician Marketing
  9. Board Policies:
    1. Eliminate committees, conduct all business at meetings;
    2. All board questions through CEO to staff
    3. Audit Reports, like management reports, provided to staff for response before going to Board.
    4. Executive Officer liaison to Board to review all agenda items with individual board members prior to Board meetings.
    5. New procurement code.
    6. New policy on agenda items e.g. who can place items on the agenda, timelines for agenda items, etc..  All board members must be allowed to place items on the agenda.  Agenda items must be moved and seconded before discussion and motions.
  10. FLCCN

I hope that this agenda is sufficient for you to find time in your busy schedule to meet with me.  I too have a busy schedule, but I will make the time to meet with you when it is convenient for you.

Dan Lewis

The Phone Message

It is said that character is what you do when you think no one is looking.  After I sent my requested informal agenda to Dr. Sanadi, I received a remarkable phone message.  Listen to it here.

After I returned his call and left a message, I received a phone conference invitation below.  It was for Dr. El Sanadi plus unknown additional participants and me:

From: Wing, Maryanne
Sent: Monday, February 2, 2015 11:39 AM
To: Dan Lewis
Subject: Conference Call with Dan Lewis and Dr. El Sanadi

When: Wednesday, February 4, 2015 9:15 AM-9:45 AM (UTC-05:00) Eastern Time (US & Canada).
Where: 1-800-508-6095 passcode 7685335 moderator code 2836893

To resolve my confusion from Dr. El Sanadi’s curious response to my simple request for a convenient meeting time, I sent the following email.

From: Dan Lewis
Sent: Monday, February 2, 2015 10:09 AM
To: ‘Wing, Maryanne’
Cc: ‘David Di Pietro’
Subject: RE: Conference Call with Dan Lewis and Dr. El Sanadi

Good afternoon Maryanne,This morning, almost immediately after I sent my requested meeting purpose and proposed agenda, I received a curious voice message from Dr. Sanadi, and immediately returned his call.  He was not available so I left word that I returned his call.  Now you send me a notice of a conference call.

While I am delighted to be invited to participate in a conference call with Dr. El Sanadi – I am confused.  Is this call instead of my requested individual and private meeting with Dr. El Sanidi?

Therefore, could you please send me the agenda, and a list of the participants who will be on this call before I confirm my attendance?

As always, thank you!
Dan Lewis

Although I was out of the office at the time the conference call was to take place, I nevertheless excused myself from my meeting and signed on to the call anyway.  After waiting a few minutes, I signed off the call only to later find out that the call had been unilaterally canceled an hour before by Dr. El Sanadi.  What?

How hard is it to just say no?

In “Just say No – How Not to Cancel a Meeting – Part 2”  I received an ostensibly threatening letter from Broward Health’s corporate counsel just for asking for a convenient time for a promised meeting.  Look for Part 2 on Wednesday, April 22nd.

Has the Office of Inspector General seen Dr. El Sanadi’s CEO Contract with Broward Health?

“Oh what a tangled web we weave when first we practice to deceive.” – Sir Walter Scott

According to the Broward Health’s contract with Dr. El Sanadi as CEO, Broward Health recognizes him administratively as CEO, as a physician who works in the Emergency Room (4 hours per week), and as a Medical Director for the Cities of Fort Lauderdale, Sunrise, Tamarac and the Broward Sheriff’s Office.

Also according to Dr. El Sanadi’s contract, he will receive a substantial bonus based on the financial performance of Broward Health.

As a physician who works in the Emergency Room, he has the opportunity and sometimes the responsibility to admit a patient to inpatient or outpatient status with the hospital.  This is a referral to a health system with which he has a financial arrangement.

As the Medical Director for the cities and Broward Sheriff’s Office (BSO) – he is the physician for their EMS activities that can deliver patients to a variety of hospitals for emergency, inpatient and outpatient services.  This can result in a referral to a health system with which he has a financial arrangement.

Not referenced in Dr. El Sanadi’s contract, are his on-going businesses:

  • South Florida Fire Rescue Medical Directors’ Association, LLC
  • N & L Services, Inc.
  • Total EMS, Inc.
  • El Sanadi Holdings, LLC
  • Green Harbor Company

nobody_tells_meDepending on the business activities of his on-going businesses, they might also refer patients to a health system with which Dr. El Sanadi has a financial arrangement.  The nature of the activities for Dr. El Sanadi’s businesses is unknown not only because of the Board’s seemingly abject failure to adequately negotiate Dr. El Sanadi’s contract and protect the public, but also because of Dr. El Sanadi’s apparent failure to be forthcoming with the information.  After a public records request was made for this information, Broward Health’s attorneys asserted that information about Dr. El Sanadi’s ongoing businesses is not public, and therefore related documents are not public records. See the public records request here.  See Dr. El Sanadi’s  (through Broward Health’s attorney) response to the public records request here.  See Dr. El Sanadi’s asserted exemption log  here.

As is generally known, the Office of the Inspector General (OIG) has been investigating Broward Health for some time, and is in the process of finalizing a settlement with the Hospital System all about STARK federal anti-kickback law violations.  The Stark Act is implicated when a hospital or health system has a financial arrangement, which can be either an ownership or compensation arrangement, with a referring physician.  Fines to Broward Health as a result of this investigation are rumored to be in the 10’s of millions of dollars that we Taxpayers will have to pay.  If so, this is money that will not be spent for Broward County’s Health care needs.  A copy of the draft OIG settlement agreement is here.

It is surprising then that the Broward Health Board would enter into a contract, which on its face seems to create STARK violations.  Certainly few could argue that the actual terms of Dr. El Sanadi’s contract with Broward Health, at the very least, create the opportunities for STARK violations.

What is even more egregious is section 6.3 of Dr. El Sanadi’s contract with Broward Health that essentially says that even if his outside financial arrangements are somehow not ethical, not lawful, and/or not permitted that “the parties agree to negotiate in good faith to secure a compliant alternative that provides for EL SANADI’S continued functioning in a medical director capacity during the term of the Agreement.”  See Dr. El Sanadi’s Broward Health full contract here. (A future Post will get into the public records request, and its responses.  Stay tuned.)

It is a public disservice when an important contract with wide ranging implications is negotiated by a politically appointed board member with little or no previous experience in negotiating contracts that affect the taxpayers, and a public institution – created, and paid for by public money –who hides behind words like “strategic planning” and “Trade secrets” to shield them from public oversight.  See my article “The Best Broward Health CEO contract politics can buy!”.

trust

Dr. El Sanadi needs to decide whether he will be a practicing physician and medical director or Broward Health’s CEO.  Ostensibly, to do both is to do both jobs poorly, and puts the public at risk for additional STARK violations.  The Broward Health Board Board of Commissioners, particularly it’s current chairman David Di Pietro and Governor Scott will be held responsible for the irresponsible actions of this politically appointed board.

 “Oh what a tangled web we weave when first we practice to deceive.” – Sir Walter Scott

The Best Broward Health CEO contract politics can buy!

dejaVuThere is little doubt that Dr. Nabil El Sanadi is as ambitious as any Wall Street wolf.  Taking the political route for career advancement, it is believed that Dr. Nabil El Sanadi and his wife Lori have given tens of thousands of dollars in contributions to secure his very lucrative political appointments as “Medical Director” to Broward Sheriff’s Office, the City of Sunrise, the City of Tamarac and the City of Fort Lauderdale as Medical Director[i] and appointment to the State of Florida Medical Board where he serves as its current chair.  It has been estimated that these contracts pay Dr. El Sanadi over $300,000.00 in additional taxpayer funds while he receives his $675,000.00 (plus benefits) Broward Health “full-time” CEO pay.  It is noteworthy that the wife of David Di Pietro who is currently under consideration for a gubernatorial judicial appointment in Broward was also previously appointed to the Florida Medical Board in September 2012 and serves closely with Dr. El Sanadi prior to his CEO appointment.  This reputed close relationship between the Di Pietro’s and El Sanadi continues through today. Recall that David Di Pietro is the current chair of Broward Health and the alleged puppeteer behind El Sanadi’s CEO appointment as well as one of Governor Scott’s political fundraisers. Coincidence?

Based on public political contribution records, here’s how generous Dr. El Sanadi has been to his republican benefactors:

Tens of Thousands of Dollars

More detailed contribution report:

Detailed Conributions

But Dr. El Sanadi is not only an “emergency medicine” physician, he is also somewhat of a business conglomerate prior to becoming Broward Health’s CEO in that he and his wife either jointly or severally own and control a number of businesses including (according to SunBiz – http://www.sunbiz.com):

  • Shhhh its a secret
    Shhhh…. It’s a secret.

    South Florida Fire Rescue Medical Directors’ Association, LLC

  • N & L Services, Inc.
  • Total EMS, Inc.
  • El Sanadi Holdings, LLC
  • Green Harbor Company

It is also widely believed that David Di Pietro not only force the resignation of Frank Nask, Broward Health’s previous CEO, but also through his fund raising relationship with the Governor, packed the Broward Health board with political appointees and created a sham CEO search process to guarantee El Sanadi’s appointment as CEO of Broward Health.  What is unknown is the extent that Governor Scott played in El Sanadi’s selection as CEO and if so, what if anything was offered as a quid pro quo.

What is curious is that the script that the Governor used to unilaterally replace the state director of corrections in 2014 that drew so much public fire and the script Di Pietro used to appoint El Sanadi are remarkable similar.  See the Sun-Sentinel Editorial here. (I’m reminded that just because you are paranoid, it doesn’t mean you are wrong!)

This story continues with the contract negotiation between Broward Health and Dr. El Sanadi.  The negotiation responsibility fell to Di Pietro’s Board confidant and fellow political appointment David Nieland or as he is affectionately called “Country”.   You will recall that David Nieland was the Homeland investigator who implicated the Obama White House intern in the Secret Service prostitute scandal thereby becoming a darling of the Republican Party.   Allegedly,Nieland was also later implicated in his own prostitute scandal right here in Broward when he was ensnared in a BSO sting operation as a “John”.  Reportedly, Nieland said he was “undercover” in an “investigation” that later turned out not to be true and the matter was dropped through the efforts of political insiders. Mayo: Should hospital commissioner step down after prostitution reports?, Washington Post: Investigator of Secret Service prostitution scandal also linked to prostitutionNY Post: Investigator for Secret Service hjooker scandal quits after paying for sex

The Nieland Broward Health contract with Dr. El Sanadi can be found here)

The contract between Broward Health and Dr. Nabil El Sanadi makes El Sanadi a public official and his duties as CEO creates a fiduciary responsibility to the public.  He is bound by the State ethics, financial reporting, and other state requirements that are common to all public officials in Florida.  Following are some notable excerpts of his contract about which we should all be concerned:

Salary

“4.1 In consideration for his service as President/CEO the DISTRICT agrees to pay EL SANADI a salary of Six Hundred Seventy Five Thousand and 00100 Dollars $67500000 per annum or such higher figure as shall be determined by the Board of Commissioners at an annual review of his compensation and performance by the Board as provided in Article 5 or at such other times as determined by the Board of Commissioners”

Full-Time?

(Summary:  El Sanadi gets $675,000.00 for full time as CEO, and also seemingly works for the Broward Sheriff’s Office, the City of Sunrise, the City of Tamarac and the City of Fort Lauderdale as Medical Director making an unknown amount of money in competition to Broward Health and as a physician – with some unknown amount of the ‘outside’ income to be voluntarily paid to the Children’s Diagnostic Treatment Center. Talk about triple dipping potential on the taxpayers!)

“6.1 EL SANADI will render full time professional services to the DISTRICT in the capacity of President/Chief Executive Officer of the DISTRICT and any of its subsidiaries He will at all times faithfully industriously and to tie best of his ability perform all duties that may be required of him by virtue of his position as President/CEO and all duties set forth in law the DISTRICT Charter DISTRICT bylaws and in policy statements of the Board of Commissioners as may be created or amended from time to time It is  understood that these duties shall be substantially the same as those of a chief executive officer of a business corporation.”

Compete with Broward Health

“6.3 Except as provided herein with respect to existing Medical Director Agreements with the Broward Sheriff’s Office the City of Sunrise the City of Tamarac and the City of Fort Lauderdale Medical Director Agreements EL SANADI agrees to refrain from any other service or employment which would restrict his ability to devote his full time to employment as President/CEO to faithfully perform the duties and work of the Office of President/CEO and at all times to work in the interest and furtherance of the general business of the Charter of the DISTRICT EL SANADI shall be permitted to perform services required pursuant to the Medical Director Agreements up to a maximum of sixteen 16 hours per calendar month for the term of this Agreement Upon the expiration of each Medical Director Agreement EL SANADI shall be permitted to renew the Medical Director Agreements subject to the consent of the Board Commissioners of the DISTRICT such consent shall not be unreasonably Withheld In the event it becomes necessary to seek an informal opinion from the Florida Attorney General regarding the ability of EL SANADI to continue providing services pursuant to the Medical Director Agreements the DISTRICTs General Counsel shall make such a request to confirm that the Medical Director Agreements do not create a conflict for EL SANADI as prohibited by Chapter 112 Part III Florida Statutes Florida’s Code of Ethics for Public Officials If there is a conflict the parties agree to negotiate in good faith to secure a compliant alternative that provides for EL SANADI’S continued functioning in a medical director capacity during the term of the Agreement.  EL SANADI covenants and agrees to voluntarily contribute a portion of the income derived from the above referenced Medical Director Agreements on an annual basis to Broward Health with a specific destination to be the Children’s Diagnostic Treatment Center a direct support organization of Broward Health Further on request EL SANADI shall provide evidence of such contribution in writing.” 

Clinical Services

“6.4 EL SANADI shall be authorized to provide clinical services to the DISTRICT up to four 4 hours per week subject to the consent of the Board of Commissioners of the DISTRICT reviewed during the annual evaluation period such consent shall not be unreasonably withheld and shall be supportive of EL SANADI in maintenance of his specialty Board certification.  Any and all income derived by EL SANADI for clinical work performed hereunder shall be paid voluntarily and directly to Broward Health with an ultimate destination of all funds to be provided to the Children’s Diagnostic Treatment Center.” 

El Sanadi’s contributions to the Children’s Diagnostic Treatment Center so far:  2/4/15 – $930.00.

When the Nieland Broward Health contract with Dr. El Sanadi was approved by BrowardTheManOutside Health board, El Sanadi said “Nieland was a tough negotiator”.  What? Was El Sanadi serious or simply deflecting?  You decide.

What is not generally known is that previous to the appointment of El Sanadi as CEO of Broward Health is that there was an initiative from the previous CEO Frank Nask to offer medical directorship services to all municipalities and governmental entities within the North Broward Hospital District as a free service of Broward Health which would make the El Sanadi medical directorship agreements a direct as opposed to indirect competitor to the public interests of Broward Health.  It is not surprising that this initiative under El Sanadi can’t be found.

Essentially, this contract “negotiated” by “Country” David Nieland makes a mockery of the independence and fiduciary responsibilities of the Broward Health CEO where almost anything in the health care sector in Broward is in tacit competition with the public interests of Broward Health.  That is, apparently, unless you are part of the Governor’s republican fund-raising apparatus.

In a future post, the El Sanadi, Coventry, Phoenix Emergency Services, and the BSO incestuous relationship of insider double dealings will be examined.  My working title is “Bend Over and Smile – Broward style”.

 

[i] In order for Firefighter/EMS units to be allowed to perform certain medical protocols as non-physicians, the department needs to have a certifying physician a.k.a. “Medical Director” under contract.  Both the contract time requirements and demands for the Physician is limited so these very profitable contracts are highly competitive and political charged.

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”!