It’s none of your business! Really?

Some Broward Health board members, and senior staff (in particular, clueless CEO – Dr. Nabil El Sanadi) ostensibly wants the public to think that what they do is none of anyone’s business and view the sunshine laws and transparency mandated by statute as simply an aggravation they must grudgingly and not happily endure.

When these few seemingly bad actors hang out their shingle announcing “Open for Business”, they aparently think it’s their business – not the public’s business.

Here is why they are wrong.

Broward Health is a public hospital system, created, established and funded by the community from a 45 bed hospital in 1938 to the massive public hospital system Broward Health is today.

Broward_Health_Medical_CenterThe early Broward community came together, volunteered their time, and raised money through Broward’s first “Hospital Fund” to convert the Granada apartments to a 45-bed hospital. In 1938, Broward Hospital admitted it first patient.  Fort Lauderdale paid for the new South Wing in 1942.  In 1948, the East Wing was built raising the Broward Hospital’s bed capacity to 142.  With donated land from the City of Fort Lauderdale and a legislative act approved by the voters in 1952 the North Broward Hospital District was created.  Broward Hospital was renamed Broward General and today it is known as Broward Medical Center.

From this community beginning, Broward General evolved from a 45 –bed hospital to Broward Health with over 50 health care facilities including 4 hospitals, close to 8,000 employees, and annual medical billings of close to 4 billion dollars with an annual budget of 1 billion dollars.  Today, Broward Health is one of 10 largest public hospital systems in the nation.

The most important purpose of Broward Health as one of the two public hospital systems in Broward is to provide for the health care needs of Broward.  The current leadership of Broward Health incorrectly understands this purpose as simply serving the indigent and proving a safety-net for those that cannot pay for healthcare services, but the health care needs of Broward are so much more.  It includes keeping health care costs down through competitive strategies, training our healthcare professionals (physicians, nurses, technicians, managers) for the future, creating healthcare employment opportunities for our citizens, providing required healthcare services to the county, municipalities and constitutional officers in Broward, and the list goes on.  The list does not include providing duplicative health services that are already being provided at similar price and quality levels by private and perhaps ‘competing’ healthcare providers.

Broward Health has become more than just a healthcare organization to Broward.  Broward health is a massive economic engine in the county because unlike private healthcare organizations that send its profit dollars to stock-holders and overpaid executives outside of Broward, most of Broward Health’s money is spent in Broward in the form of employee salaries, building projects and its associated job creation, and purchases of consumable supplies. As Frank Nask, Broward Health’s previous CEO, often said “Broward Health doesn’t have stockholders, we have patients and taxpayers.”

Broward Health is not a private hospital system that does some community benefit work, it is a public community hospital system that operates a health care system in Broward.  Broward does not provide community benefit work because it is tax based, and the removal of the tax base would not make Broward Health a private hospital system.  Everything Broward Health owns is owned by the public.  Everything Broward Health does is the public’s business.

It’s all our business, really!

Happy St. Patrick’s Day! Why this Blog exists.

I have received many anonymous tips during the first few days of going live and with some of these tips came questions as to my motives behind this blog.  It’s a fair question.

My simple goal is to make Broward Health, the system I have paid taxes to for over 20 years, and the likely place I will spend time in my advancing years – the finest public hospital system in the country.  Easier said than done.  There’s a lot of history to overcome, and many bad habits to change. To understand my commitment, I need to put it into context.

CaitlinCaitlin eventually made a full recovery but the lessons learned became the origin and reason for creating my attendance at most, if not all, of the Broward Health board meetings for the last four years, and this blog which was born out of bureaucratic frustration with and political misbehavior by Broward Health leadership.  Since coming to Broward in 1977 from New England, I have been active in public policy issues for the School Board, the County Government and served in an advisory position to many committees.  As a past elected official, chair of Broward’s Management and Efficiency Advisory Committee, chair of Broward’s Charter Review Committee, chair of Broward’s Growth Management Advisory Committee, and recognized public policy leader in Broward County by Gold Coast Magazine.  My family and I are long time taxpayers to and customers of Broward Health with deep and broad community roots in the Broward Health service area.  But back to Caitlin, my youngest of 4 children.

Caitlin, an otherwise healthy 19 year old Kodak and Nike fashion model arrived in Broward Health’s ICU after returning home to Fort Lauderdale for her spring break in 2011.  It was the second trip to the Emergency Room in two days that caused her admission to the Med/Surg floor.  The ER initially diagnosed a simple nerve pinch.  Less than 15 minutes after she arrived in her room at the Med/Surg floor, an alert physician noticed that she was experiencing organ failure – and she was taken to the ICU.  It was Saturday morning.

CaitlinICUFrom thereafter, event after event began to occur.  There was a failure of the “Rapid Response Team” to assemble.  There were problems with Caitlin’s medical records from the ER.  The “attending physician” asked for permission to insert a central line but “he had not done it in a while”.  Based on faulty blood work, the OB/GYN surgeons argued that she could be bleeding in her abdomen and they needed to do emergency laparoscopic surgery.  They successfully argued that, if they were right and the surgery was not done immediately, Caitlin could die.  There was no time to re-do any diagnostic tests.

The surgery was completed with no conclusions, but only exacerbated her condition.  In the recovery room, Caitlin woke up but could not breathe on her own and had to be sedated and reintubated.  To this day she has night terrors due to this incident.  Her condition was grave as she could no longer maintain blood pressure and her organs were failing.  The on-call ICU “intensivist” pulmonologist directed the nurses by phone and after refusing to come in to examine Caitlin said to another physician “you know how these cases go, it’s in God’s hands”.

For the next eight days, Caitlin was attended to by the heroic ICU nursing staff that all too often had to explain to the family that they were “waiting on Doctor’s orders”.  In spite of twenty-six (26) physicians on the case, it was not until the eighth day in the ICU that a diagnosis would be made.  Caitlin would be hospitalized for more than thirty days, with half of that time in the ICU.  Absent the heroic efforts of the extraordinary ICU nursing staff, Caitlin would not have survived.  But Caitlin did survive, and today she thrives.  So what happened?

Just before spring break, her college health clinic failed to treat her severe sore throat with antibiotics and this resulted in Lemierre’s syndrome.  If you are parents, and don’t know about it – click here.  It has a 97% mortality rate.  This condition and her symptoms were missed by the emergency room, in part by the failure of the emergency room to properly triage her condition, sloppy paperwork, etc. (and I put this mildly).   This was followed up by a circus in the ICU that nearly cost my daughter her life.

But my point – instead of suing everyone for malpractice, which we would likely win – my daughter and I decided that instead, we would commit to try to fix the problem so future families would not have to endure what we had to at the hands of Broward Health.  Besides, with medical bills approaching one million dollars, and Broward Health protected by sovereign immunity (capping recovery at $ 250,000) any recovery we could have made would likely be claimed by the insurance company.

Our ordeal started on St. Patrick’s Day, 2011 and we made our commitment in September of that same year.  I have been attending Broward Health Board committee and regular meetings ever since and up until the ouster of the CEO in December and the installation of a clueless CEO as a puppet to the political whims of an inexperienced Board Majority, progress was being made on many different fronts, slowly.

Now, much of the progress that was made is being trampled through arrogance, inexperience, and just plain carelessness.  This blog seeks to expose this conduct and by letting the sun shine in – make it difficult for back-room political deals to happen without consequence.

Stand by, it’s going to get bumpy!

BrwdHealth Blog hits 125,000 page views in record 13 days!

According to Google Analytic’s, this BrwdHealth Blog has had over 128,114 page views, from 63,000 sessions, and 58,396 users within the first 13 days of being live.

Analytics through 2015-03-15

(Notice the big spike down – the server was updated to better handle the web traffic and was temporarily down for maintenance.)

Coming soon (the titles may and probably will change..):

  • Strategic Planning, or How Broward Health Secretly Steers Public Money To Their Political Friends?
  • Dr. El Sanadi and the Di Pietro ConnectionThe Conspiracy begins!
  • South Florida Critical Care Network (SFCCN) – A Bold Experiment in cooperative Public Health,  Broward Health under El Sanadi works hard to snatch defeat from early success.
  • David Di Pietro’s process to “select” El Sanadi as CEO looks like the same process used by Governor Scott in choosing head of Florida’s Correction, was the Governor involved? – You decide.
  • The Deal to keep Broward Health Commissioner Nieland’s prostitution bust containedquid pro quo, The El Sanadi file.   El Sanadi’s contract – Guess who negotiated itYou won’t believe the contract terms!
  • When is a public record not a public record?  New Broward Health disclosures.  Shhh… It’s still a secret!

And many other developing stories…  Stay tuned (and keep the ‘Tips’ coming)!

 

Embattled Broward Health paid law firm $10.2 million; Tab included a lawyer’s M&Ms

Florida Bulldog has a great article published today; Embattled Broward Health paid law firm $10.2 million; Tab included a lawyer’s M&Ms  (click for the full story!!) written by Dan Christensen.  It’s a must read!

Here’s the first paragraph…

“Taxpayer-supported Broward Health has paid $10.2 million so far for legal advice about how to deal with an ongoing federal investigation into allegations that it colluded with doctors to submit tens of millions of dollars in bogus claims to Medicare and Medicaid.”

Shhhh… It’s a secret.

Since starting this site a few days ago, I have received many “tips” from “angry” people working at Broward Health about the recent “secret” doings at Broward Health.  Most of these tips are anonymous, but when I get the same tip from more than three people, I begin to wonder.  I hope to have the time to delve into some of these at greater depth, but in the meantime, here are some recent tidbits:

Shhhh its a secretEl Sanadi, who became Florida’s Broward Health’s new CEO after he and a handful of Board members orchestrated the ouster of the previous CEO, is apparently making a lot of changes behind closed doors, that should us all and which don’t seem good for Broward’s public Hospital.

After the herculean effort to certify Broward Health as a teaching hospital system through a decades  long and successful (although sometimes bumpy) collaboration with NOVA Southeastern (NSE),  El Sanadi and the Chair of the Board are scuttling the system’s relationship with Broward’s NOVA Southeastern and replacing it with Miami’s FIU.  According to one report, El Sanadi has given instructions not to hire any more Fellowship physicians or interns from NSE.  Apparently, El Sanadi has also made Dr. Kumar (a critical care physician who will be featured in a future article you won’t want to miss) the Medical Director in charge of the FIU program at Broward Health.  This policy change has never been presented to the Board publicly nor has Kumar’s new directorship contract.

In addition to the NSE change, El Sanadi with the Chair and another Board Member are believed to be pushing for a Request for Proposal (RFP)  for security services for their Republican friend ex-sheriff Lamberti.  This policy change also has never been presented to the Board publicly.

It is believed that El Sanadi with the Chair and a different Board Member are asking how they can get the Investment & Pension Committee to send out a new Request for Proposal (RFP) to change the professional finance adviser to Broward Health in favor of a “friend” of the Board member.  It should be noted that this is for an investment and pension portfolio of more than 800 million dollars.  This policy change also has never been presented to the Board publicly.

And if that’s not enough, El Sanadi and the Chair are seemingly working to establish a Kidney transplant center at Broward Health to attract patients from outside of Broward.  Not only is this capability duplicative in the area, but, at a cost of millions of dollars, it has very limited use for the public Broward Health purports to serve. You guessed it.  This policy change also has never been presented to the Board publicly.

One cannot help but wonder how long the other Board Members are going to allow this race to return to the dark days of Broward Health’s past, where Broward Health was little more than a cash register for insider dealing, to continue.  But, I guess the Board needs to be informed first, but shhhh… it’s a secret.

Broward Health Board Meeting – Part II Clueless!

(Part I – Board of Commissioners Rubber Stamp Shady Deals)

At the last Broward Health Board meeting (2/25/2015) in Florida a public speaker raised “process” concerns about a proposed million dollar sole-source lease for an orthopedic robotic surgery device for Broward Health North, the system’s Pompano Hospital.  The speaker represented a competing company and asserted that the robotic device should not be a sole source and called into question the apparent one-sided process that precipitated the agenda item.

BHRobotTo understand the importance of this otherwise benign item for a billion dollar Florida hospital system one must digress to context.  This unlikely hospital in Pompano established to address the health care needs of a predominantly minority and retirement community has over the last few years become one of Florida’s premier orthopedic centers for joint replacement.  This is very profitable for a hospital, especially this hospital that has been financially struggling.

The reason for this remarkable achievement is the hospital’s relationship with a prolific and highly respected orthopedic physicians group.  So when this group says it wants the hospital to get a particular robotic system or it will relocate to a hospital who has one – well, it doesn’t take an orthopedic surgeon to figure out what the hospital system will do.  Spend a million dollars over 4 years to keep millions of dollars of revenue/profit each yearDuh!

Pretty much of a straight forward deal that even makes sense for the taxpayers, so what am I writing about?   This item directly spotlights two issue: first, the Broward Health ridiculously convoluted and outdated procurement policy allows the subterfuge of insider dealings; and second, the very purpose of Broward Health as a public hospital system.

The robotic surgery system is less a sole source item and more a physician preference.  Medically, there is no objective basis to suggest that one type of joint replacement system is better than another, but with the complexity of orthopedic surgery – it is natural even foreseeable that a particular physician or physician’s group would become comfortable with one vendor over another.  It is also axiomatic that one of the operational functions of a hospital is to cater to the success (financially and medically) of its physicians.  So why did it take over six months to approve the lease?

The answer is that at Broward Health there apparently is a continuing massive effort in appearance over substance.  Rather than make the forthright and legitimate argument that the robotic lease was at the request of and for this particular successful physician’s group practice at Broward Health, staff was obligated to go through a convoluted and internal process to justify a procurement policy sole-source designation which this lease was not.  Two board members were uncomfortable with the apparent contradictions and a lengthy discussion ensued.  The new politically appointed CEO Dr. El Sanadi sat clueless.  In the end, the lease was approved which it should have been six months ago based on any reasonable financial analysis.

The second reason this particular agenda item was interesting is it exposes Broward Health’s understanding of its primary organizational purpose in Broward.  Rather than discuss whether it is appropriate for Broward Health to invest in the expansion of medical services to attract new patients from outside of Broward as opposed to investing in services which would serve and enhance the health care needs of its current patients, the seemingly primary supporting argument that was clear, but unsaid for the million dollar lease, was that the extraordinarily gifted and profitable orthopedic physician practice would leave Broward Health if the Board did not approve the lease.

The Board discussion should have been about the public policy of Broward Health’s responsibility to the health care needs of Broward County , Florida as opposed to the financial success of its physicians.  At the end, as a matter of Broward’s public interest, the lease should have been approved provided that the additional revenue it was predicted to produce would be applied to enhancing the health care needs of the community, and it came with an agreement that the requesting physician’s group would do their surgeries at Florida’s Broward Health North for the duration of the lease.  No such representations were made, and the lease was approved without any promises from the benefiting Physician’s group or the Board exercising is fiduciary responsibility to the public it “serves”.  No one should have approved the lease based on the disingenuous arguments made at the Board meeting.  It is sad and more than a little scary that neither the Board nor their CEO understood why the lease was good for the Broward Health system.

In this case, process mattered – and the layers of incompetence championed by a clue-less CEO smothered the pockets of excellence at Broward Health.  We should all be concerned!

Board of Commissioners Rubber Stamp Shady Deals at Meeting – Very Tacky.

Dateline:              February 25th, 2015 4:00pm
Broward Health North Conference Center

In Pompano Beach Florida, a windowless conference room decorated with chandeliers made out of tinsel, about 85 highly paid staffers, a few vendor representatives and as many as 3 people purportedly representing the public assembled for February’s public meeting of the Florida’s Broward Health Board of Commissioners.  On the dais the Board is flanked on one side by Sam Goren, its highly experienced and knowledgeable corporate counsel and on the other side by their recently appointed (see previous articles) CEO Dr. El Sanadi, CFO and Board Auditor.  And so the stage is set for a three hour meeting remarkable in its resemblance to Alice’s tea party (Disney– Alice in Wonderland (1951)) and more for what is not said than what was.

Meeting20150225After appropriately recognizing employee contributions with the obligatory distribution of plaques with pictures, the public was offered an opportunity to speak guaranteed by state statute.  (It is important to note that the public also has an opportunity to speak on each and every item on the Board agenda – guaranteed by state statute but that opportunity has only once been acknowledged by the Board in this writer’s more than three years attending meetings, and that was only by this writer’s insistence.)

The second of three speakers to address the Board came with carefully prepared notes to address the ENT physician contract approval that was appearing later on the agenda.  The speaker was a physician himself and he had serious questions wrapped in what the CEO and the Board asserted were misconceptions.  The contract was for on-call services for an Ear-Nose & Throat (ENT) specialist required under federal licensure for trauma hospitals.  The speaker asked how a new contract could be negotiated for 1 doctor (yes, one doctor) to replace a contract for 7 doctors (yes, seven doctors) for what was essentially $100.00 saving per day.  The speaker also raised issues relating to abnormalities in credentialing, e.g. rushed process, objection by the surgery staff, etc..  Notably, the Board Chair jumped in and said “no fair” (I’m paraphrasing), credentialing comments are confidential (he would know – he routinely represents physicians legally and “recuses” himself from votes regularly).  And the speaker raised even more concerns – that of the obvious coverage issue for one doctor to cover 4 hospitals that was covered by 7 doctors in the old contract.  The clear subtext of the speaker’s comments was the belief that the renewal of the old contract was not negotiated in good faith and the new contract was inadequate for the needs of the hospital system.  As a result of this speaker’s comments, the contract item was removed from the consent agenda to the discussion agenda which meant that there would be more conversation on the board for this item.

The final public speaker raised similar “process” concerns about a proposed million dollar sole-source lease for an orthopedic robotic surgery device for Broward Health North.  The speaker represented a competing company and asserted that the robotic device should not be a sole source and called into question the apparent one-sided process that precipitated the agenda item.  As this item was already on the discussion agenda, we were all assured a later conversation would ensue.

Because I want to delve a little deeper into the matters raised by the public speakers before I run out of space, I will skip some of the other agenda items that will be the subject of future articles.

The ENT Contract

To understand what happened with the ENT contract, there has to be an understanding of both the politics and personalities involved.  The previous ENT contract with Dr. Callari expired naturally on January 30th and was by any measure a bad contract that was grossly overpaid.  So why did Dr. El Sanadi fail to renew the agreement when after some tough negotiations, when the difference between renewing the contract with Dr. Callari who provided  7 physicians versus a new contract with Dr. DuMornay as a single physician was only somewhere around $100.00 per day?  For the answer, one needs to look to past presidential politics, petty jealousies, and abrasive personalities which serves as a micro-study for the management problems at Broward Health amplified by the ouster and replacement of the previous CEO.

There is a generally believed story that a dispute between Broward Health’s current chair and Sara Howley, the wife of Dr. Callari, started over a purported “lost” invitation to a Romney fundraiser in which Mrs. Romney was scheduled to appear.  The result was that the chair missed the event and Mrs. Romney.  It appears the Chair thought the “lost” invitation was intentional rather than an email foul-up, and a minor political dust-up ensued.  But here is where it gets interesting.   Sara Howley is the wife of the Dr. Callari and also the well-respected vice president of Corporate Communications at Broward Health.  At the same time that the ENT negotiations between Dr. El Sanadi and Dr. Callari were getting contentious, Sara Howley abruptly resigns her position (late January 2015).  It is generally believed that she was forced out with a resign or be fired mandate from Dr. El Sanadi on “instructions” from the Chair.  Very tacky.

But the ENT contract story gets even better and more curiousDr. DuMornay, the new contractor Dr. El Sanadi “recruited” actually previously worked with Dr. Callari’s ENT group until they had a falling out and because Dr. Callari enforced a non-compete clause, Dr. DuMornay moved to Georgia to work. But wait, it gets better.  In 2012 after the Dr. Calari’s original ENT contract was extended to provide time to negotiate a smooth transition to in-house (Broward Health employed physicians), Broward Health recruited Dr. DuMornay from Georgia to come and work for Broward Health.  The plan was for Dr. Callari to be on call for two weeks, and Dr. DuMornay together with other ENT physicians Broward Health intended to hire to work for a few weeks as a transition to the complete elimination of the ENT contract that had been so troublesome.  Dr. DuMornay agreed to and signed a contract – but then, just didn’t show up.  No notice, he just didn’t show up.   Apparently he later gave the reason that he wasn’t going to be paid enough. Surfacing just in time for Dr. El Sanadi to “recruit” and give him a new ENT contract, but not in time to go through the normal burdensome credentialing process at Broward General.

Now you know the rest of the story.

It should be noted that all these ENT physicians are experienced and perhaps even exceptional clinicians, but the extraordinarily unprofessional manner in which this contract was negotiated and eventually approved at this meeting is a throwback to the dark days at Broward Health where politics ruled.

As taxpayers, we should all be worried – and the Inspector General’s Office should take note.

I’m out of space for this article so In Meeting – part 2, I will add some additional tidbits you might find interesting about this meeting.  Look for it in the next few days.

To be continued…

Broward Health – Deja Vu, all over again!

Historically, Florida’s Broward Health was used a cash register for the politically connected where everything from lucrative land deals, insider supply & service procurement’s, to outrageous physician contracts given to cliques of gate-keeping physicians were the rule and not the exception for our public hospital.   Typified by a revolving door of politically appointed CEO’s more interested in their next position than in the mission of Broward Health as one of Broward’s 2 public health care systems, Broward Health thrived as a financial political base for the political aspirations of Florida’s governor’s office.

Then a few years ago, almost by accident, a politically naive chief financial officer was suddenly elevated to the position of CEO (see my previous article).  Not knowing any better, this professional CEO began to put the district on a firm financial footing for the first time in the hospital system’s history.  But because this financial CEO never could master the politics of the system, he failed to correct the legacy of the past misconduct quickly enough, and did not address the dangerous politics of the well connected physician contracts.  This was, in part, due to pressure from the politically appointed Board of Commissioners and the historically absent public oversight.  Instead, this CEO focused on financially strengthening the system and investing in quality health care system initiatives, again largely ignored by absent public oversight.

MoneySuckThe result was a whistle-blower complained to Medicare (OIG – Office of the Inspector General) about the excessive physician contracts at the system, and a federal investigation ensued.  The financial CEO was named in the complaint because he did not confront the improper direction from his political board, and failed to address the problems quickly enough.  In fairness, he was between the proverbial rock and hard place.  Soon you will hear about this OIG investigation because it is widely believed that it is coming to an end with a significant financial penalty in the tens of millions of dollars, against our public hospital for the misdeeds of past politically appointed boards and CEO’s.  A fine, we as taxpayers, must and will pay.

Recall that Broward Health was established many years ago as a tax supported public hospital system to serve the health care needs of Broward residents living north of Griffin Road.  Over the years, with substantial tax support, the system has grown to 4 hospitals, over 50 facilities including urgent care neighborhood centers, close to 8,000 employees and annual billings of close to 4 billion dollars (with a budget of over 1 billion dollars). From every perspective, it has become a substantial economic engine in our county.  Simply put, the money that goes to Broward Health generally stays in Broward – and that’s good.

But because of the governance structure of the hospital system, it essentially operates without effective oversight from those it serves, or the public that owns the system.  Its Board of Commissioners are appointed by the Governor, and so it is no surprise that the Board of Commissioners are either political operatives or simply the unapologetic result of political patronage with little or no relevant experience.

For much of the past year, Broward Health’s 7 member Board of Commissioners operated with only 4 and 5 members because the Governor’s office failed to timely fill vacancies.  3 of these members effectively orchestrated the financial CEO’s ouster and replaced him with a well-connected politically active physician through a sham recruitment and interview process.  2 of the 3 are political operatives, only recent Broward residents, and have no business or public policy experience.  In contrast, the leader of the 3, has an extensive but recent political pedigree – but no previous business or health-care experience.  It is noteworthy that this new CEO – has given tens of thousands of dollars to political candidates, committees and PAC’s in recent years.  It is not a coincidence that the current chair of the Board of Commissioners and the purported architect of the ouster is known as a prolific political fund raiser who maintains a number of political committees and PACs, which have benefited from the largess of the newly appointed CEO. Why else would the Board hire a person with no administrative experience running a hospital system?  It is déjà vu all over again!

We should all be nervous.

Innovative CEO NASK Forced Out, Politics Wins – We Loose!

BH_2C

In September 2014, I began my Florida Broward Health series with my “Path to Professional Competent Leadership” article.  My “It’s Our Hospital” article followed in October as the second of a planned three article series.  My final series planned for December promised to discuss why Florida’s Broward Health protects physician’s income at the expense of providing health care – but then events in November and December turned Broward Health on its head. The CEO was forced out after an embarrassing and remarkably unprofessional public circus, insiders on the Board forced a physician contract that was privately opposed by the medical staff, two new political appointments were made to the board by the re-elected governor, and in what appeared to be a slick political maneuver, a new CEO was hired with no previous experience managing a hospital let alone one of the largest public hospital system in the country. Each is a story that needs to be told. One of my first resolutions this year is to do my best to tell these important stories.  The result will be a regular monthly Broward Health article, beginning with how and why Frank Nask was forced out as CEO.

In hindsight, it was perhaps inevitable that Frank Nask would be forced out.  His obvious competence as a financial manager of a 4 billion dollar hospital system was ultimately defeated by his inability to understand and cope with a politically appointed board in a public hospital system fraught with pockets of excellence and smothered by layers of incompetence. Although the board approved all of Mr. Nask’s proposals and recommendations throughout his tenure as CEO, his decision making was too often frozen by board level gossip, innuendo, and his irrational fear of denial.  While it was clear he had a vision for Broward Health’s future based on world class health care and real quality metrics far exceeding the requirements of Medicare, it was equally clear that he was unable to communicate that vision successfully to his board members in a decisive manner. As a result, a number of critical innovations and programs that he started will no doubt be put aside for wont of an advocate or uncomfortably delayed while the new CEO learns his job.

It was the inexperience of the board and the lack of vision of its members that failed to take the opportunity during the final year of Nask’s contract (expires on March 31st 2015)  to negotiate in good faith an extension together with an appropriate succession plan that would maintain organizational stability, programmatic continuity and a smooth transition. Instead they chose to advertise, interview, negotiate and hire the CEO of a 4 billion dollar hospital system in 30 days.  Nask successfully negotiated a severance package and on December 20th, 2014, the old boss was out, and the new boss was in.  Meanwhile, the organization is in shock – as well it should be.

As a backdrop and perhaps even as a contributing factor to the CEO change, a notable physician’s contract was in controversy.  No one could debate that Dr. Michael Chizner had received an overly generous contract several years ago which was, in part, due to pressure put on the board of commissioners by notable people like Wayne Huizenga.  And it was no surprise that it was one of the contracts that had to be renegotiated on the basis of fair market value.  What was a surprise was the Dr. Chizner apparently refused to negotiate and/or agree to a fair market contract and as a result was given notice of contract termination.  Chizner hired republican powerhouse Senator George LeMieux as his attorney and before you knew it – many members of the high-powered Broward Workshop turned up at the November Broward Health board meeting, telling the board how Dr. Chizner saved their lives (in the back of the room, the testimonies were being coordinated by an associate of Senator LeMieux).

While it is clear that Dr. Chizner is a gifted physician, many in attendance at the meeting shared with me their disgust and embarrassment at one of their fellow physicians parading his patients in front of the board to force a contract.  After all, saving people and getting them healthy is the job description of all physicians at Broward Health – and they do it every day.

Dr. Chizner’s circus was successful in that the board pressured Nask into re-offering a contract to him – essentially the same one Dr. Chizner refused to sign previously, but which now he accepted.  The new (old) contract based on fair market value reportedly reduced Dr. Chizner’s annual payments by over $600,000.  Certainly with three highly partisan republican appointees controlling the Broward Health board and the very republican Broward workshop behind Chizner, It was apparent that Nask’s severance package was tied to the re-offer of the Chizner contract.

With Governor Scott’s reelection came two new board appointments, both with impeccable republican political credentials and with little or no real-world business experience.  Is this and are they a harbinger of bad things to come?  I’m not so sure.  These new board appointments are interesting and a subject of a future article.

As usual, I’m out of space well before I am out of story.  I’ll revisit some of this and focus on the new board appointments in my next article.  So, until then – Happy New Year!

Broward Health – It’s Our Hospital

Florida’s Broward Health is about the numbers:  4 Hospitals, 2 trauma centers; over 30 health care and support facilities; 7,000-8,000 employees including close to 1,200 new hires annually; 1,930 physicians in more than 104 medical specialties; and a billion dollar budget (4 billion gross charges).  This article will focus on the Broward Health physicians.

BHMC-homeI thought Florida’s Broward Health’s well-earned reputation for corruption was overstated and based on outside political and moneyed interests.  I was wrong.  If anything, its history is understated, based on a small group of insider politically active physicians and what was in the past a placid administration installed to do little more than facilitate and guarantee physician payments and lucrative real-estate deals.  Those physicians mantra “It’s our hospital!”

Historically, any attempt to change this culture was met with swift political action from the Board of Commissioners for the District after a deluge of “insider” calls demanding that they get the administration back in line.  In fact, the by-laws of the District require the CEO to get board approval before many administrative actions – like the hiring or firing of some senior executives.  After all, the Board wouldn’t want one of their “friends” fired.

So it was remarkable that in June, the Board supported a standard fair market physician contract for the top grossing physicians which, in some case, substantially reduced the physician’s compensation.  Before you shed a tear for these physicians, many of these physicians still make close to a million dollars a year.  Imagine what it was before the adjustment.  Here’s how it happened.

Historically, when the administration wanted to renegotiate a physician’s contract – the physician immediately appealed to both the Board (typically through politically connected intermediaries and lawyers) and insulated and “friendly” senior staff (who would want to stay on the Board’s good side).  Thus too often, the administration representing the public’s interest would be on one side with everyone else on the other.

But this time, because of the unusual independence of most of the current board members, and the regulatory pressure to reduce health care costs, Frank Nask (CEO of Broward Health) brought a blanket physician contract to the Board for approval first which required all contracts to be paid at the 50th percentile regional fair market price for physician services based on an independent evaluation.  Some Board members, having been called by their “friends” rebelled, but in a long and somewhat bizarre board meeting, they ultimately agreed so the policy was set – and the fair market value contract was adopted even though a number of physician’s and physician groups threatened to leave the hospital system if the fair market value contract was imposed on them. In the end, the contract was imposed and no one has, as yet, left.

It is important that what could be perceived as the misbehavior of some Broward Health physicians is the unfortunate exception for a profession undergoing dramatic change.  On August 29th, the Wall Street Journal reported that “physicians are increasingly unhappy with their once-vaulted profession, and that malaise is bad for their patients”. Dr. Jauhar says in his book “Doctored” that many of his colleagues are struggling with the loss of their professional ideals becoming “impatient, occasionally indifferent, at times dismissive or paternalistic”.  “Today medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future”.

In a 2008 survey of 12,000 physicians, only 6% described their morale as positive.  Eighty-four percent said that their incomes were constant or decreasing. Most said they didn’t have enough time to spend with patients because of paperwork, and nearly half said they planned to reduce the number of patients they would see in the next three years or stop practicing altogether.

Mr. Nask and Broward Health are keenly aware of the importance of and committed to both physician and patient satisfaction as a measure of the quality of health care to the community with a renewed system emphasis on surveys, analytic scores, and data mining.   Notably, Mr. Nask is modelling a modification of his fair market physician contract to include a committed level of service expressed in independently tracked physician minutes with the patient guarantees and non-clinical “paper-work” assistance.  If successful, such a model for health care delivery could serve the dual purpose of improving physician morale in their profession as well as the quality of health care being delivered to the patients of Broward Health.  We’ll see.

The next article in my Broward Health series will discuss why Broward Health protects physician’s income at the expense of providing health care?”  You’ll be surprised and perhaps more than a little angry at the answer.  Hint: it’s about the “Benjamin’s”!

Broward Health Sets New Path to Professional And Competent Leadership

This the first of three feature articles about Florida’s Broward Health, our safety-net hospital, the role it plays in our community from its leadership, its bumpy history, its 8,000 employees, its 4 billion dollar budget, its health care decisions, its physicians and of course the taxes we pay to it and what we get in return. It is a story of pockets of excellence and layers of incompetence seasoned with moneyed “sub-rosa” political intrigue, greed and some remarkable acts of courage and character. An insider’s story told from the outside where the good news is that Broward Health could be entering a time of great challenge and opportunity with exactly the right leadership and resources to become one of the finest public hospital systems in the country. A public health care system of which we can all be proud – provided it can avoid its colorful past missteps.

Nask

I begin with an introductory profile of Frank Nask, the chief executive officer of Broward Health. You might see him around town, but you would not know him if you did. He is quiet, unassuming and politically shy. He does not like nor crave the spotlight. His personality belies his sharp mind and quick wit. Supremely competent, he was recruited to the position of chief financial officer in 2008 from senior leadership in a lucrative nationally recognized turnaround healthcare crisis management firm to address serious financial problems at Broward Health.

Over his 35 year healthcare career, Mr. Nask has managed hospitals and groups of hospitals (mainly in the Northeast) always working for and with senior health care business leaders and hospital system boards where important strategic decisions were made through collaboration. But none of that experience prepared him for the experience of dealing with a politically appointed public hospital board whose primary role is to provide community policy oversight, and not strategic support to senior leadership.

Broward Health’s board of commissioners are appointed by the Governor typically based on political criteria more for their fund raising abilities and party affiliation then health care or business experience. While most appointees certainly want to do a good job and are motivated to represent the community faithfully, too many act as though their appointment to the hospital board magically vested them with experience, knowledge and perspective they previously lacked. The completely predictable result was that Broward Health’s previous boards too often made critical and important business based on political considerations.

The selection of the Hospital’s chief executive officer was generally an example of political as opposed to business calculations. So in 2010, when upon the sudden departure of the previous chief executive officer under unusual circumstances, the position was offered to Mr. Nask – he was justifiably skeptical. He wasn’t comfortable in politics and the position was political – but board members insisted he accept an interim position because of his remarkable success at stabilizing the system’s financial condition – and who better to be in charge during a transition period then the man watching the money? He accepted, and soon after he was asked to accept the position on a permanent basis.

It’s easy to overlook the growth and accomplishments of Mr. Nask’s stewardship because of his low key style and tendency to generously credit his team for the accomplishments, but the successes speak for themselves and could not have occurred without leadership. Among these successes are (but not limited to):

  • Increased the net assets of Broward Health by over 300 million dollars
  • Increased employment by over 250 full time positions
  • Handled more than 50 thousand more ER visits
  • Invested more than 276 million dollars in capital improvements in four hospitals
  • Retooled the non-profit Broward Health Foundation which then raised more than 12 million dollars of charitable giving since 2011 and is projected to receive an additional 9 million dollars in 2015.
  • Created the Broward Health Quality division to monitor and improve the quality of health care provided to patients which has resulted in improvements in all quality core measure scores.
  • Increased the intern and fellowship programs establishing Broward Health as a full teaching hospital system training the healthcare professionals and physicians for our community’s future.

The awards and accomplishments that have piled up for Broward Health in the last few years are too many to list here, but the reason they have is a new attitude at Broward Health that puts the patient and community first. As Mr. Nask is often quoted “Broward Health doesn’t have stockholders, we have patients!”

Well, as usual, I’m out of space. The next feature will talk about how the Broward Health cash register for well- connected insiders has been shut down and replaced with fair market value rules. What a concept for the fifth largest health care system in the country!