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.

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.

 

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!