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.

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

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

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

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

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

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

A quick review:

Broward Health

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

CEO

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

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

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

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

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

Frank Nask

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

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

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

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

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

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