I’m Back With Tidbits!

   My last post was two months ago, and a lot has happened since then!

                Apart from vacation and family time, after my last post I wanted to step back a little and contemplate my end game with this blog.  I never intended this blog to be without purpose and to simply dissolve into article after article highlighting the inexcusable and indefensible conduct of Dr. El Sanadi and his board.  After over 35 years of public policy experience, it was my naïve hope that by exposing their outrageous conduct they would somehow modify and change their conduct.  That didn’t happen in spite of over 40 articles (although I don’t hear as many “if I may” or the hypocritical miss-use of “transparency” at meetings anymore).

                I needed to search for some measure of accountability to which Dr. El Sanadi and the board of commissioners could be held.  If the board were elected, the accountability would come from voters.  Those are people with whom I have some experience.  But the Broward Health board is appointed by the Governor who seems completely insensitive to the incompetence of his appointments so long as that are loyal to him politically.  I needed someone to hold responsible for the indefensible conduct of Dr. El Sanadi and the Broward Health Board.               strategy Noting that Broward is a Democratic island surrounded by a sea of Republican money, I had an “ah ha” moment.  The accountability comes from the money.  The money the Governor receives from Broward patrons, chief among these is the uber lobbyist and former chief of staff to Governor Scott – Billy Rubin whose office is on Las Olas in downtown Fort Lauderdale.  Way down the list is Chip La Marca currently a Broward County Commissioner.  Between them are a number of prominent distinguished community leaders who, by virtue of their relationship with the Governor and their citizenship of Broward need to be held accountable for Dr. El Sanadi’s and Broward Health Commissioner’s conduct.  Going forward, I will name as many of these people behind the people and challenge them to be accountable for their family’s, neighbor’s, and friend’s sake.  The Governor won’t listen to us, but perhaps he will listen to them. I had my answer!  Let the sun shine in!

                The second problem I needed to consider during my break was notion of Broward Health’s identity, and how it fit into the Broward community.  It has appeared to me that the overriding view Dr. El Sanadi and the Broward Health Board has of itself is that it is some kind of hybrid private organization competing with other Health care providers that, by virtue of its tax support – has some obligation as a “safety-net” hospital.  This is a republican, revisionist view in my opinion that does a disservice to both the sacrifice of the many who created, established and grew Broward Health to the massive organization it is today.  I have previously discussed the origins of Broward Health here, and here  – they are worth a reread.  The genesis of Broward Health is a story of public investment, volunteerism and tax support at its best.  Broward Health with 8,000 employees is not only a health care system but an economic juggernaut for Broward.  Both the health and success of Broward Health must be a priority of Broward’s leaders as well as clearly in the public interest.  Thus, there is a clear linkage between those moneyed interests who support the Governor and lobby the elected officials for their many clients and the conduct of Governor’s Scott’s appointments on the Hospital Board. 

                During my hiatus, I spoke with a number of board members.  I spoke with elected and political leaders throughout Broward and I spoke with experts in the delivery of medical services from here to Washington D.C…  I spoke with physicians both employed by and not employed by Broward Health.  I spoke privately with regional and senior management level Broward Health employees. Oh, and I filed a formal complaint to the Inspector General’s office about Dr. El Sanadi’s contract, under my own name (see my articles about Dr. El Sanadi’s contract here, here, and here).  In addition, I received many emails & tips from blog readers which I read and tried to correlate with other Broward Health information I was given.  Following are some resulting tidbits:

  1. Any El Sanadi shine that may have existed is now gone in the regions. Putting it nicely, there seems to be a universal consensus that Dr. El Sanadi is way out of his depth and hasn’t a clue. But thanks to El Sanadi’s unenviable reputation as a manager who takes any criticism personally as a sign of disloyalty, there isn’t much of a push back yet.  People understandably want to keep their jobs.
  2. A minority (3) board members are not “drinking El Sanadi’s cool-aide”. So far their disappointment has been expressed more through polite board questions, but underneath – they seem to be seething.
  3. MoneyMoneyThe liver & kidney transplant program is a text-book example of how much El Sanadi’s inexperience and arrogance can cost the system. Dr. El Sanadi has alienated the Jackson system, the University of Miami,   Nova Southeastern, and now is giving the Cleveland Clinic (ostensibly Broward Health’s competitor) over 2 million dollars just for Doctors.  Incredibly, word has it Dr. El Sanadi is also “lending” overworked and overextended Broward Health neurological physicians to the Cleveland Clinic for coverage as part of the deal.  If you add to the transplant deal the ongoing cost of the organ register and software, Dr. El Sanadi has dramatically increased the cost of the program which has yet to even fill an unmet need in Broward.
  4. 25insider1_span-articleLargeApparently, the highly praised Urology contract  Dr. El Sanadi negotiated, included some medical sleight of hand where changes of services made comparisons between the old contract and the new were like apples and oranges. The Board was delighted that El Sandi reduced the cost, but in reality – he apparently simply reduced the services being offered by Broward Health and increased the services offered by these physicians privately.  The result, the Urology physicians make more money – and that might be appropriate, but it certainly never was a conversation with the Board.
  5. Dr. El Sanadi has eliminated quality as a corporate responsibility by eliminating the corporate quality positions and people. Quality is now the responsibility of the regional hospital.  It bears notice that virtually all other health-care systems in the country have gone in the opposite direction and made quality a corporate, system wide responsibility.  Again, no apparent conversation with the Board of which I am aware or have been told.
  6. In the past, I have blogged that the reputation of Dr. El Sanadi as a clinician is excellent. Universally, comments from physicians working next to Dr. El Sanadi when he actually showed up to take a shift in the emergency room paints a very different picture.  Serious issues about his service with Phoenix and later with the successor to Phoenix suggests problems with both his performance and management.  I guess I believed his press.  I stand corrected.
  7. I have blogged that I didn’t think much of Dr. Chizner’s negotiating technique of bringing his patients to the Board meeting, but there is no denying his abilities as a physician. So when I begin to hear rumors that there are promises that were made to Dr. Chizner that apparently are not being kept by Broward Health, and that his duties as a Medical Director haven’t been paid – I am not surprised.  I hope this is untrue, but it seems to be entirely consistent with how Dr. El Sanadi operates.
  8. Many of the comments I hear speak to the lack of organization, lack of clear vision and the utter lack of any semblance of a chain of command at Broward Health under Dr. El Sanadi. The result is a culture of El Sanadi.  Multiple people are doing the same task assigned personally by Dr. El Sanadi because he seemingly doesn’t remember who he told to do what, one day from the next.
  9. In early June and July, I kept hearing persistent reports that Broward Health’s bond underwriters were calling for copies of the 2015/2016 budget which, although needing to begin on July 1st had not only not been prepared, but had also not been discussed with the Board.  Even more disturbing were rumors that Dr. El Sanadi had instructed some to simply duck the underwriter’s calls.  This apparently continued through most of July and then very late in the month – the budget first began to be discussed with Board members.    Contrast this to the normal budget review process in past years when the proposed budget was fully vetted with the Board in May and June, with changes from the collective Board in June finishing with the Trim meeting at the end of July and the Tax meeting in September.last-resort-customer-service The proposed 2015/2016 budget apparently shows a shortfall of $12 million dollars.  I am reliably told that this is somewhere around an $80 million dollar reversal from the previous year which showed a surplus of $70 million.  This seems consistent with Dr. El Sanadi’s stand not to run the system as a bank in favor of apparently running the system into the ground.  Taxes at the trim meeting were set to collect exactly the same tax amount as last year, and at the final tax hearing in September – the Board will again reduce this amount by $5 million with is about 3.2% less than the trim notice tax rate. The budgetary shortfall will be made up from the considerable reserves built up by El Sanadi’s predecessor to close to $750 million, but $250 million is already dedicated to capital projects and an annual reductions of State funding will create recurring charge against the reserves over the next few years of from $5 to $75 million dollars per year.  All this and the potential “false claims” justice department settlement estimated at over $69 million will make surprisingly short work of Broward Health’s reserves. Etc., etc., etc.

    You can be sure that the bond markets and underwriters will not be happy with Dr. El Sanadi’s uncontrolled and undisciplined fiscal policies at Broward Health.  Good republicans everywhere will have increasing difficulty explaining the reduction and lack of quality and medical services in the face of such rampant ineffective spending. Notably, for the first time since I have been attending Board Meetings, the July Board meeting did not have a finance report. 

There are about 8,000 employees at Broward Health.  Most do a wonderful job and all are deserving of a professional workplace.  Dr. El Sanadi and the current majority on Broward Health’s Board are putting that workplace and Broward Health at risk.  The people responsible for Dr. El Sanadi’s mess begins with the Governor Rick Scott, followed by Broward lobbyist Billy Rubin, followed by Board chairman David DiPietro and his proxies on the Board, followed by Broward Commissioner Chip LaMarca.  Keep those names in mind as you learn more about what’s going on at Broward Health and remember to hold them responsible at every opportunity you can until they take notice and step up.

Stay tuned for my next post which I promise with be soon & more regular. Thanks for your patience.

 

 

 

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

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

Last April 2015, I wrote two posts about Dr. El Sanadi’s appointment and contract as Broward Health’s CEO.  SeeThe Best Broward Health CEO contract politics can buy! “ and “Has the Office of Inspector General seen Dr. El Sanadi’s CEO Contract with Broward Health?”.

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

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

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

El Sanadi-Medical Director Contracts

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

OMG – Nabil El Sanadi’s First 5 Months!

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

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

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

Dear Dr. El Sanadi,

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

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

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

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

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

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

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

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

Sincerely,
Dan Lewis

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

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

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

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

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

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

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

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

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

Their response was:

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

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

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

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

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

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

Exemptions

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

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

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

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

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

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

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

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

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

Re: Public Records Request

Dear Dr. Sanadi,

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

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

Section I. Subject of the Communications

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sincerely,
Dan Lewis

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

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

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

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

Bumbling Inexperience of Dr. Nabil El Sanadi at Committee Meeting

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

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

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

Funding For Coral Springs Expansion

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

Approval of Clinical Trial Management System

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

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

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

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

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

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

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

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

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

The Promise

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

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

No Obligation

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

illusion_of_progress

A Pocket of Excellence

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

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

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

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

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

Mr. Lewis,

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

Nabil El Sanadi MD

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

Subject: RE: Appointment with Dr. El Sanadi

Dr. El Sanadi,

Purpose, intent & agenda;

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

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

Informal Agenda:

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

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

Dan Lewis

The Phone Message

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

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

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

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

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

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

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

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

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

As always, thank you!
Dan Lewis

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

How hard is it to just say no?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

trust

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

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

The Best Broward Health CEO contract politics can buy!

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

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

Tens of Thousands of Dollars

More detailed contribution report:

Detailed Conributions

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

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

    South Florida Fire Rescue Medical Directors’ Association, LLC

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

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

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

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

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

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

Salary

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

Full-Time?

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

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

Compete with Broward Health

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

Clinical Services

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

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

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

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

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

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

 

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

Broward Health March Board meeting, was I at the right meeting?

MeetingNeverHappenedAs is my practice, I attended the Broward Health Board meeting yesterday, and, except for a predictable push back and sad ad hominem attack on this successful blog through a weak attempt at character assassination, apparently orchestrated by Chairman David Di Pietro through John Degroot,  the meeting was remarkably professional and well run.

Absent from the meeting were the smug insider winks and nods of obscured agendas so characteristic of recent meetings, and discussions from the Board and CEO Nabil El Sanandi were both direct and on point.

Holy transformation – I kept looking around making sure I was at the right meeting.

The only clever gotcha that occurred was a carefully choreographed “walk on” item to restore the Pediatric Neonatal ICU at Coral Springs that was closed in 2013 for “fiscal” reasons, but not medical reasons.  Since this item was a walk on, and emotionally argued, the full reasons for the closure in 2013 were never presented by Dr. El Sanadi even though he certainly had the full report that served as the basis for the closure in 2013.  Nevertheless, if one separated out the emotional arguments, what was left was persuasive, and had I been on the board, I would have gone along with the unanimous vote to reopen the unit at Coral Springs.

This is a good segue way into an important discussion about this blog as a continuation of its purpose (Happy St. Patrick’s Day! Why this Blog exists) and scope (It’s none of your business! Really?).  Certainly, I intend this blog to have “red meat” posts that will open up insider double dealing, fast talking and clever maneuvers designed to obfuscate Broward Health’s true purpose.  Some of the posts will deal with the seemingly bad actors on the Board and CEO Dr. Nabil El Sanadi in direct and revealing terms, but whether it be criticism or praise – it is always about their official action or inaction.  The Broward Health Board members, and the officers they specifically appoint are public officials under Florida Law.  Only these public officials will be identified by name in posts.  Even further, their private lives are not relevant in posts on this blog, except to the extent that they involve the public actions and duties of their positions with Broward Health.

OuttaHereAs an example, Dr. El Sanadi is, by reputation, a fine physician and clinician.  His appointment as CEO and his actions as CEO, including potential conflicts with his other personal businesses, are relevant to this blog.  Any criticism of Dr. El Sanadi in this blog is directed to him as a CEO, a public official.

Another example, David Di Pietro, the current chair of the Broward Health Board is also an attorney.  I have witnessed his abilities as a lawyer, and can easily commend his legal services.  But, as is evident from many of my posts, I have a real concerns with his stewardship as a Broward Health board member, let alone as chair of the board.

This blog will continue expose how the “sausage” is made at Broward Health, and continue to stimulate a robust conversation on the purpose and practices of our Broward health public hospital.  Along the way, you should expect some really good “red meat” posts, and being human, from time to time, I will swerve off my path and address actions like the ad hominem attack on me by Mr. Degroot, even though his actions are less than a whisper in a wind storm.

Stay tuned.  Next week, a multi-part series of stories will be posted – likely one each day.  You won’t want to miss it. Lots of “red meat”!

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.

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”!