Broward Health Gawkers!

Too often too many of us carefully stand on the sidelines hurling criticisms at the players (in this case usually the Board Members) without offering any constructive solutions to the problems presented.

I would like to dedicate this post to some suggestions and perhaps, some superficial arguments on their behalf.  However, do not judge the suggestions merely on my supporting superficial arguments that by necessity must be uncharacteristically short.  Each suggestion could be a post entirely in itself.

poop-was-thereGovernmental Representation

However well intentioned, the Board of Commissioners – lacking any intuitional memory, should never have replaced their governmental counsel with compliance counsel.  Moreover, based on past District history, inside counsel versus a multi-disciplined outside firm has never worked for Broward Health.

Currently, Broward Health is misusing the highly respected Berger-Singerman governmental law firm.  Contrary to the current arrangements with the ‘Audit’ committee, Berger-Singerman should be retained by the Board through their general counsel to provide governmental advice to the Board.  Florida’s Attorney General has demanded 5 million from the District, which means the public – and we need to be both defended and protected.  Discussions in anticipation of litigation are generally and appropriately held in the shade.

The Board of Commissioners need the advice of a Governmental Lawyer – Like Sam Goren, Mitchell Burger is one of the best.  Let him continue to help the District, but elevate his assistance to the Board level.

Fog of War

The district is awash in rumors, allegations, name-calling, and conspiracies around every corner creating a “fog of war” condition over Board discussions and decisions.  This must be addressed.  Here is how it can be done.

  1. The Board should unilaterally revoke all current non-disparaging clauses in all severance agreements. This revocation should be noticed to every ex-employee currently receiving any kind of severance.
  2. The Board should unilaterally revoke all non-disparaging clauses in all vendor and/or service agreements currently active. This revocation should be noticed to every party to an agreement having a non-disparaging clause.
  3. The Board should establish a policy that no future agreements of any kind will contain any non-disparaging clauses, sections or prohibitions.
  4. Take your chief internal affairs or compliance person and establish them in the Florida Inspector General’s office for at least the next 12 months.  Have them establish a confidential reporting function for any Broward Health employee, vendor, physician or other who wants to confidentially report criminality, corruption, or policy (non-medical) violations at the District.  Have this person conduct exit interviews of every fired, work-place reduction, resigned, or retired employee of Broward Health.  Insure anonymity and confidentiality for all contacts to the office.  This office should forward allegations to the appropriate investigative agencies or departments. Once this process is established, no more internal investigations, no more rumor hunts – all allegations, etc. will be referred to the Broward Health office of the Inspector General.  (It is noteworthy that the Berger-Singerman firm has experience in setting this process up for the Water District.)

Governance

Interim CEO

The finances of the District have been mauled by incompetence, the District’s Bond Rating is in peril, and although the recent month of financial good news is welcome – the District is still on a perilous financial path as a result of weak leadership.  Even if the District accelerates the recruitment of a strong outside CEO – it will be months, if not years before a new person can be hired and transitioned into the unique problems at Broward Health.

If only there were someone with the requisite experience, knowledge and financial ability who could step in and start work day one!  But wait, there is.

Both CEO Frank Nask and Memorial’s CEO Frank Sacco are available and might be willing under the right circumstances to become an interim Broward Health CEO until such time as a new CEO can be hired and properly transitioned.  Both know the District, both enjoy the confidence of the Bond Markets, and both are strong leaders who could begin to sort out the problems on day one.  And neither would be interested in a long term assignment.

The Board should ask Commissioner Gustafson to make contact and see under what conditions either Nask or Sacco would be willing to briefly come out of retirement and become Broward Health’s interim CEO.  Maybe they wouldn’t, but maybe one of them might! Commissioner Gustafson has a good relationship with both men and would be an ideal Board advocate in this matter.  Worst case scenario is they both would say no.  Swallow your pride and think of the public you serve.

Purchasing Policy

MeetingNeverHappenedThe Board needs to address the very sad state of affairs in its weak purchasing policies.  Before Dr. El Sanadi, the Board with its then governmental counsel Sam Goren was working on a comprehensive review and rewrite of these policies.  I saw a draft of this effort and shared some ideas from my time a chair of the County’s management and efficiency study and Charter Review commissions.  It was a good beginning step, but it needed some work.  At the time and to his credit, Commissioner DiPietro was leading the effort. It is time to resurrect this effort and finish the job.

Centralized Credentialing

Centralized credentialing was supposed to be effective at the time of corporate’s move from Broward General’s historical location to the new facility at the Spectrum Center.  It was an important first step to address the negative influence of rampant physician silos at each of Broward Health’s hospitals.  Here how it was to work.

  1. All physician credentialing paperwork centralized at the new Corporate Headquarters.
  2. A new credentialing committee essentially comprised of the medical chief of staff of each hospital, and various other medical and compliance members.
  3. Physicians credentialed at one Broward Health Hospital would be at all Broward Health hospitals.

This strategy based on physician convenience would help drive and maintain patient admissions across the system while providing corporate with the ability to recruit needed area specialty physicians easily. Moreover, recognizing that the part of the credentialing fees that go to the various hospital medical staffs for their discretionary use would be lost or significantly reduced under this plan, it was important that an alternative method of funding the hospital medical staff’s discretionary budgets be found.  Not an impossible task. Finish this initiative.

Let me finish …

This is directly to the Board.  Knock it off, and get to work!  Stop chasing rumors, allegations, or conspiracies.  Start doing your job building for the future.  Ignore but cooperate fully with any investigations.  They will either materialize into something or disappear into nothingness.  Have a real vision for building Broward Health into the finest public health system in the nation and let nothing distract you from that mission.  Value your public, your physicians, your employees and the sacrifices of so many that put you in the position to do some good.  There are smart people who are standing by to help you succeed.  Seek them out and listen.  Eyes forward.

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

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

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

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

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

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

A quick review:

Broward Health

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

CEO

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

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

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

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

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

Frank Nask

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

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

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

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

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

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

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.

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!

Broward Health – Deja Vu, all over again!

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

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

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

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

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

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

We should all be nervous.

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

BH_2C

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

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

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

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

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

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

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

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

Broward Health – It’s Our Hospital

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

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

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

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

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

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

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

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

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

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

Broward Health Sets New Path to Professional And Competent Leadership

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

Nask

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

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

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

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

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

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

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

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