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.
Take, 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
Dr. 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)
In 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.
One 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).