David DiPietro’s Raw Deal.

David-Di-PietroThere is no way to get around it, Florida’s Inspector General and Governor Scott got it wrong when they suspended David DiPietro from his position as Chair of Broward Health!

While DiPietro should be concerned about the unfolding Zimmerman Advertising scandal which embroils his wife, recently appointed as Judge and currently running for election, his close friend – Broward County Commissioner Chip Lamarca, and himself in troubling conduct – based on what I know, DiPietro was certainly not obstructing any investigations at Broward Health of which I am aware.

It is, however,  an overstatement in some public reports that DiPietro initiated the various investigations.  More to the truth of the matter is that DiPietro facilitated and enabled Dr. El Sanadi’s unfounded paranoia by recommending the highly respected corruption investigator Mr. Wayne Black.  We now know that Mr. Black’s first targets were none other than previous CEO Frank Nask, me (personally and as the author of this blog) as well as some of the information posted here.  Given my earlier allegations have since been born out; I believe that there was a reasonable basis for an independent investigation.  However, clearly Dr. El Sanadi’s personal paranoia had no basis in reality and should have been a warning signal to Mr. Chair DiPietro of things to come.  In gumshoe parlance, “Frank Nask and I turned up clean!” and there was reason to be concerned about many if not all of the matters I had previously raised.  Further, because investigation of this type generally expand over time – Mr. Black has also uncovered other concerns and matters.  Matters, unknown to me.

Chair DiPietro is correct to be concerned about the performance and problems with the Board’s ill-conceived choice for corporate council Lynn Barrett, But DiPietro must accept responsibility in orchestrating the ouster of highly respected previous Board Counsel Sam Goren and replacing him with someone with very limited governmental experience.

As to the suggestion that David DiPietro that DiPietro was acting or about to act in a retaliatory manor with respect to either interim CEO Fusco or Counsel Barrett, well – that notion is absurd.  Those are the two positions in which the Board, and by extension – the Board Chair have direct supervisory authority.  Both are “at will” employees of the Board.

I have written in the past about the retaliatory culture at Broward Health that must change, and in particular – for example, the circumstances around the ouster of the previous Broward Health corporate marketing director – Sara Howley, in which I believe DiPietro was directly involved.  See my article Board of Commissioners Rubber Stamp Shady Deals at Meeting – Very Tacky..        I know there are many, many examples of similar unfounded and retaliatory actions against Broward Health employees, physicians and vendors – but the allegations from the Florida Inspector General, in this case against David are just mistaken.

Finally, Chair DiPietro’s recent embrace of transparency and openness in the Board’s business with respect to his concerns relating to Counsel Lynn Barrett, Wayne Black and related matters was correct. Although I wish Chair DiPietro would carry his new found openness to public records and their the Board’s regular improper “strategic planning” shade meetings – those issues are for another day.

Summary

Readers of this blog know that I am no fan of Chair DiPietro’s tenure at Broward Health, but in my opinion – while there may be many other reasons to suspend and remove DiPietro from Broward Health’s Board, based on the Governor’s stated reasons, Governor Scott’s suspension of Chair David DiPietro was premature, improper and ill considered.   Further, I believe DiPietro’s concerns about the conduct of the current General Counsel of the District are both well founded and correct.  I applaud Chair DiPietro’s relatively new commitment to openness and transparency reflected with his proper instance on an open meeting to discuss the General Counsel issue.  Unless there are some facts not publically known, Florida’s Inspector General should recommend that DiPietro’s suspension be rescinded and he should be forthwith restored as chair of Broward Health’s Board of Commissioners.

I cannot say the same for Commissioner Darrell Wright’s suspension.

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.

 

 

 

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.