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OMG!

  Political Heresy?

    The six politically-appointed, devoutly-Republican governing Commissioners of the tax-funded North Broward Hospital District were left briefly speechless during their regular monthly meeting yesterday (April 31).
    Even Commissioner Rocky Rodriguez, long-afflicted with TV (Terminal Verbiage), was struck dumb when District CEO Frank Nask announced the GOP-dreaded Obamacare appeared to be having a an amazingly positive (gasp) impact on the number of uninsured patients being admitted to the giant tax-funded health care system.
   Like, Nask concluded, after only a few months, the Health Care Reform Act numbers suggest Obamacare's working far better than anyone* expected. (*At least here in Florida's Republican-controlled giant public health care system.)
   Which left some of the District's all-Republican board members seemingly more stunned than if FDR himself, the Liberal demonic ghost of all decent American Conservatives, came rolling into the main auditorium of the District's flagship Broward Health -- formerly known as Broward General Medical Center.
   Anyhow....
   Ponder the following:

           NORTH BROWARD HOSPITAL DISTRICT
                            (dba Broward Health)
                 Average Daily Inpatient Census

Payer 2000 2007 2014**
Medicare Traditional 232 262 201
Medicare HMO/PPO 110 95 157
Medicaid Traditional 112 141 182
Medicaid HMO/PPO 18 41 56
PSN Insured NA 27 59
Other Insured 43 23 NA
Commercial Insurance 125 160 176
Uninsured 145 178 133
Total  876 927 965
*first nine months of the current fiscal year
Source: North Broward Hospital District          

Dem bones

   What we have here* is a metaphor of the values that define America's health care system. JKdeG.
   *Five year trends for the cost Orthopedic physicians employed by the the North Broward Hospital District (dba Broward Health)

Orthopedist 2008 2013
Sports Medicine $1,810,488 $714,438
Visits                           6,428 0
Dr. George Caldwell $1,026,839 $2,114,531
Visits                          2,987 5,119
$ per visit $344 $413
Dr. Erol Yoldas $1,010,566 $2,315,698
Visits                          3,359 6,527
$ per visit $301 $355
Dr. Daniel Kanell $812,520 $1,486,311
Visits                          2,948 4,565
$ per visit $276 $326
Dr. Dominic Carreira $299,579 $1,136,013
Visits                          1,205 4,469
$249 $254
TOTAL
COSTS $4,959,992 $7,766,991
VISITS 16,927 20,680
PER VISIT $293 $376

Source: North Broward Hospital District



Question:

  So.....
What drives America's health care system?

   Patients 
        or 
    Profit?
  
  Socrates asked the same question four centuries before the birth of Jesus:
  "Is the physician a healer of the sick or a maker of money?" 
  That was then.
  And now...
  At Broward General Medical Center, the average charge for a potentially life-saving Diagnostic Cardiac Catheterization is $10,152 ...  with an average cost of $1,546.
  At Broward's Coral Springs Medical Center, the average charge for a CT and CTA without Contrast Composite is $6,372 ... with an average cost of $250.
 At Broward's Imperial Point Medical Center, the average charge for a Level I Arthoscopy is $2,434 ... with an average cost of $779.
 At Broward's North Broward Medical Center, the average charge for a Lower GI Endoscopy is $1,587... with an average cost of $319.
        Source: American Hospital Directory

Where's the Grand Jury?

  $260,000     
      Average salary of hospital-employed physician
    in the southeastern United States
                                                   Medscape 2013 

    $462,600
     Average salary of physician employed by the  
    North 
Broward Hospital District
                                            Broward Health 2013  

   $10 million 
    Legal fees the District has paid to defend itself 
    in an on-going Federal anti-trust suit alleging 
    Stark Law violations resulting from an historic 
    pattern of excessive payments to physicians 
    employed by Broward Health

     Average US Physician  District Physician 
     Compensation - 2013   Payment - 2013
     
Orthopedist- $405,000  District Orthopedist
                                         Dr. Yoldas - $2.3 million
                                         Dr. Caldwell - $2.1 million
                                         Dr. Burke - $1.5 million
                                         Dr. Kanell - $1.4 million
                                         Dr. Carreira - $1.1 million
     Cardiologist - $357,000  District Cardiologist
                                         Dr. Sharma - $1.6 million
                                         Dr. Chizner - $1.5 million
                                         Dr. Landau - $1.5 million
                                         Dr. Gellman - $1.4 million
                                         Dr. McCormack -$1.3 mill.
                                         Dr. El Sayed - $1.1 million
                                         Dr. Aueron - $1 million

   Losses* generated by private Physician employees working for the North Broward Hospital District under contracts negotiated by Broward Health CEO Frank Nask's administration:

    FY 2008 ($12,946,554)
    FY 2009 ($17,479,732)
    FY 2010 ($20,763,236)
    FY 2011 ($22,772,282)
    FY 2012 ($23,829,665)
    FY 2013 ($21,053,103)
    TOTAL ($118,844,572)

                   
              
"*It ain't my money!"

Source: Medscape.com
               Browardhealth.org

NOTE: Now a senior citizen eligible for AARP, Broward State Attorney Mike "Sitz" Satz doesn't do special grand juries any more. JKdeG

  

LeMieux or LePieux?

         
    Health Careless!
  Speaking of the Florida Bar, we'll have whatever the ex-short-term US Senator George LeMieux is drinking as head of Florida's mega law firm Gunster-Yoakley..
    Consider, gentle reader, the $173,800 in legal fees the North Broward Hospital District paid LeMieux to negotiate a decade-long exclusive contract with Florida's 21st Century oncology to provide radiation therapy for cancer patients at Broward General and North Broward hospitals -- using the same exotic equipment the District had purchased for $14 million a few years before.
   Talk about deal in need of vomit bags.
   Based on the contract Broward's Little Frenchman negotiated with 21st Century Oncology on alleged behalf of the tax-funded District:
   - 21st Century is paying Broward Health some $964,500 a year for the use of two linear accelerators, one cyber knife robotic surgery system and one Nucletron Digital HDR -- plus the use of outpatient facilities at Broward General and North Broward....
  - However, Broward Health's contract with 21st Century is generating annual losses of more than $900,000 for the District.
 - Plus the District is paying 21st Century an additional $2 million for uninsured patient care..
  - At the same time, 21st Century Oncology's CFO* is claiming  profits of $9.2 million from the first year of the cancer therapy company's remarkable contract with the District. (*Bryan J. Carey). 
  All of which suggests you might not want Gunster-Jokely's LeMieux to help buy your next car.
  Then there's the bizarre anomaly generated by two women named Hines.
  Like...
 Tracy Hines of Fort Myers who serves as the Manager of Clinical Systems and Infrastructure for 21st Century Oncology.
  Sarah Hines of Fort Myers who served as the Southwest Florida Regional Director for then Florida Senator George LeMieux from 2008 to 2011.
   Which certainly raises a few eyebrows -- if not ethical questions for the Florida bar. 
   Naturally, we've emailed Senator LeMeiux at his Gunster -Jokely office to determine if the two women as related in anyway.
   But, as of this date, all we've heard from LeMieux is the proverbial sound of silence.
   Oh yes.
   Further smarmy facts are, the folks at Broward Health and former Senator LeMiew go way back.
   Consider again the healthy campaign dollars the friendly folks at Broward Health contributed to the Little Frenchman's failed bid to retain his brief seat in the US Senator.
   Like:
   $5,500 from Orthopedic Surgeon Dr. George Yodlas.
   $2,500 from Orthopidic Surgeon Dr. William Burke
   $1,500 from Othopedic Surgeon Dr. Daniel Kannell
   $1,500 from Cadiologist Dr. William Cioci
   $750 from Frank Nask, CEO Broward Health
   $750 from Calvin Glidewell, CEO Broward General
   Not that this would have influenced* the contract the District hired Gunster-Jokely's LeMieux to negotiate with 21st Century Oncology (*sarcasm alert).
   Addendumb:
   In most communities, the above sordid facts would generate a special Grand Jury.
   However, here in Broward, the aging State Attorney** responsible creating a special Grand Jury to probe any dark issues in local government suffers
 from a chronic lack of prosecutorial testosterone. **Mike "Sits" Satz.
   Stay tuned. JKdeG


    
 
  

Tomorrow

         
LeMieux or LePieux?
         

Metaphor #2,779,349


That was then...and so is this!
   Metaphors speak volumes when it comes to revealing the nature of a culture, or its individual members -- as any student of of human behavior well knows.
    For example:
    Close by the uniformed guard in the lobby of the North Broward Hospital District's Administrative Headquarters vistors will encounter a stack of professionally crafted brochures extolling the virtues of the nation's tenth largest public health care system.
  Printed on quality stock featuring numerous full-color photos,  the 30 page brochure is modestly titled "Staying True to Our Mission."
  Page 4 of the brochure features full-color portrait of District CEO Frank Nask promising:
  "As we move into the uncharted waters of healthcare reform, we stand ready, prepared (sic) and focused on imporving patient outcomes while efficiently managing health care costs.
  However...
  On pages 6-7, the brochure offers "A few highlights" for 2012 -- followed by a detailed financial analysis of the District's community benefits, again for FY 2012.
  Which, as a two-year-old institutional metaphor of the giant tax-funded health care system, suggests a certain cultural disconnect with the nature of time. JKdeG
                   
                                 But it's 2014!!!

Powerful Metaphors


$53,000
Yearly rent McDonald's pays to sell
Big Macs, fries  and other fat-laden 
junk food in the lobby of Broward
General Medical Center
$1,100,000
Average salary of 8 staff cardiologists
paid to treat heart patients at
Broward General Medical Center
Source:North Broward Hospital District
      

Due Dilligence - NOT!

                          
                    Ignorantia juris neminem excusat!
                             
        Appointed by Florida's Governor for their
active membership in Broward's Republican
party, Commissioners responsible for governing the North Broward Hospital District have
established an unfortunate history of  dubious 
accountability and due dilligence.
JKdeG

#1 Although paid more than $600,000 as the CEO of Broward Health, nation's tenth largest public health care system, Frank Nask lacks a bachelor's degree from a fully accredited college, or university.
      Further, while Nask's resume lists a bachelor's degree in business administration from either Fort Lauderdale Metropolitan University and/or Drake College -- neither institution was fully accredited at the time Nask graduated, nor is either school in business today.
     However...
     The official Broward Health job description for the CEO of the billion dollar a year system requires Nask to show proof of "a Master's Degree and ten years of executive health care experience."

#2 Prior to joining the Broward Health as CFO in 2007, Nask's resume lists his status as a self-employed consultant -- this after losing his fulltime position as CFO of the jointly-operated* non profit St. Mary's and Good Samaritan hospitals in Palm Beach County. (*As Intracoastal Health Systems)
     It was during Nask's tenure as CFO that St. Mary's and Good Samaritan suffered a fatal financial meltdown that led to their court-ordered sale to the for profit Tenet Health Care.
                                                The Nask Years 
 
                               1997            1998            1999                    2000
St Mary's
Surplus (Loss)        $6.9 million    $3.2 million  ($24.5 million     ($42.8 million)
Good Samaritan
Surplus (Loss)        $3.5 million    $2.4 million   ($0.8 million)     ($29.1 million)
Combined                
Surplus (Loss         $10.4 million   $5.6 million  ($25.3 million)    ($71.9 million)
   
What happened?
    Doing business as Intracoastal Health Systems, the two hospitals had outsourced their entire business office operation to IPN Network, a Tennessee based company operated by Nask's former co-workers at HCA (the Hospital Corporation of America then owned by Florida's current Governor Rick Scott).
    "We are confident," Nask said at the time, "that our relationship with IPN will improve our receivables and bottom line."
     In addition, Nask said, "IPN can help us streamline our operations, resulting in better service for our patients and ultimately reducing our operating costs."
     However, an investigation by the Florida Attorney General's Office revealed that, in transferring their business office data to Network under Nask's direction, the two Palm Beach hospitals lost mega-millions in outstanding patient care billings -- this due to a catastrophic computer glinch.
    Thus, when connected, the IPN Network's computer and the computers at St. Mary's and Good Samaritan trashed each other.
    All of which endures as a cataclysmic metaphor of Nask's due diligence skills.
    Oh yes.
    When deposed by Florida Attorney General's Office lawyers, members of the hospitals governing board of trustees claimed they'd never been informed of  -- let alone approved -- the disastrous contract to outsource the two hospitals' business office systems.
#3 The North Broward Hospital District's governing Board of Commissioners first hired Nask as CFO of Broward Health and then as CEO of the giant tax funded health care system in each case without conducting a national search for other candidates for the key positions.
#4 In 2008, under Nask's leadership, the District retained and replaced three attorney's to serve as General Counsel for Broward Health: Laura Siedman, Troy Kishbaugh,  and Marc Goldstone -- in each case the attorney was interviewed and approved by Nask and DIstrict HR VP Dionne Wong, Esq., a member of the Florida bar. However, again in each case, District officials became disatisfied with their choices and replaced them.
    In a classic example of shooting the messenger, the District  fired two of the system's three General Counsel's after the attorney's had warned Broward Health Officials of potential anti-trust Stark Law violations in the generous paychecks enjoyed by the system's hired physicians.
    Note: During the past five years, the District has paid a Washington-based law firm more than $10 million to defend the District in the same Federal Anti-Trust Stark probe the District officials had been warned about. 
    Also...
    In a negotiated settlement in response to with damage actions filed by the last two District legal advisors hospital officials dumped, officials paid:
    - $175,000 in damages.
    - $297,000 in legal fees.
#5
Charging Nask lacked the qualifications to serve as the District's CEO, a majority of the District Commissioners sought to remove the top administration -- a move that was foiled when the then Governor Charlie Crist restricted the Commission to create a new majority in support of Nask.
#6  FY 2009 also saw the District's governing Board of Commissioners hire Goren, Cheroff, Doody & Ezrol  as the District's general counsel without issuing an RFP for more experienced law firms -- even though Goren et al lacked any experience in health care law. To date, Goren et all has been paid more than $4.7 million in tax dollars as the District's General Counsel.
#7 Following probable cause findings in response to an investigation of ethics violations by District Commssion Joseph Cobo, Goren's law firm authorized legal bills from an outside law firm the District's general counsel had retained to defend the Commissioner.
#8
Without issuing an RFP for other law firms experienced in representing health care systems in federal Stark Law violations, Goren, Cheroff, Doody & Ezrol has spent more than  $17.7 million in tax dollars for outside counsel during the last five years.
#9 Under instructions from Nask, the District's governing Board of Commissioners spent some $1 million on a Still River Systems Clinatron for cancer patients at North Broward General Hospital -- even though the exotic cancer-fighting device was never purchased.
#10 Without issuing an RFP for competitive bids, the District spent more than $12.4 on exotic cancer fighting equipment for North Broward and Broward General.
   Again, without seeking competitive bids from other physicians specializing in Oncology, Nask negotiated a contract with Broward Oncologist Dr. Anurag Agarwal to serve as director of the two cancer centers in 2009.
   Then, again without seeking competitive bids, Nask negotiated a multi-million dollar contract with 21st Century Oncology to operate the two cancer centers in 2011  - while awarding Agarawal a cash settlement to exit quietly.
#11 In May of 2009, Nask executed a contract to outsourced the Hospice Unit at North Broward Hospital  to Vitas Innovative Hospice Care, a for profit firm. This was done without issuing an RFP seeking competitive bids from other hospice firms, or obtaining approval from the District's governing Board of Trustees.
   To gauge the impact of Nask's move to outsource the Hospice Unit at North Broward Medical Center, we find:
Total                            2008       2013
District Hospice
Patient Encounters      21,339    12,422
    
       
#12 In a bold attempt to circumvent Florida's public records laws, Nask sought to "privatize" the tax-funded health care system under the guidance of the District's General Counsel Goren in 2010. However, after months of controversy and heated opposition from Broward's minority community, Nask's efforts were stymied by the then governing Board of Commissioners. 
#13 Despite Nask's failed attempt to free Broward Health  from Sunshine Law scrutiny, the District General Counsel routinely redacts key details -- including dollar amounts -- from multi-million contracts with outside firms requested under Florida's Sunshine Laws.  
#14 Without issuing RFP's for competitive bids from other providers, or formal approval from the District's governing board of Commissioners, Nask annually negotiates contracts (currently totaling some $63.3 million) with an unknown number of private physicians hired to provide uninsured patient care at Broward Health.
#15 Mandated by Florida's legislature, an independent audit found that -- minus the North Broward Hospital District's tax revenue -- the health care system's assets were well below fair market value.  
#16  Broward Health faces potential fines and penalties in excess of $100 million as the target of a still on-going Federal anti-trust investigation launched some five years ago.   
#17 After seven controversial years under Nask's leadership, the North Broward Hospital District has experienced a major decrease in health system revenue coupled with an increased dependence on revenue from interests and investments. Not that any of the District's governing Board of Commissioners are aware of these negative trends -- or their long range significance.      
    
Fiscal Year                 2007                   2013                   %
    Adjusted Admissions   105,810              119,223             13%
    Health Care
    System Revenue          $75,758,608*     $17,580,974
    Per Adj. Admission       $716                   $147                (79%)
    Interest & Investment
    Revenue                      $24,654,257*      $32,995,547
    Per Adj. Admission      $233                    $277                 19%
    Broward Health
    Surplus (Loss)             $100,412,865*    $50,576,521
     Per Adj. Admission     $949                   $424                 (55%)
    *2013 dollars                            
Bottom Line:
Where's a Grand Jury when you need one?

Sam's Club

               Sam
     The Power of Patronage
     

   As General Counsel for the nation's tenth largest health care system, attorney Sam Goren rules as the power behind CEO Frank Nask's dysfunctional throne at the North Broward Hospital District (dba Broward Health),
  Small wonder Goren takes pride in observing that -- from his sister and father to Sam himself --- a Gorens been collecting a paycheck from the District for decades.
  Only in Sam's case...
   Last year, Broward taxpayers paid Goren's law firm more than a million bucks as the District's  legal counsel -- a role that included negotiating mega-millions of dollars sans competitive bids, or the required approval from Broward Health's governing board of commissioners.
   Which, as far as the Power of Patronage goes, represents political muscle on steroids.
  
 As an immigrant from New York some four decades ago and a life-long Democrat, Goren represents all that made Broward an epi-center of Northeast liberal politics in Florida -- and one of the few Florida counties to back Florida Republican Governor Rick Scott's Democrat opponent in 2010.
  Not that the District's staunchly Republican governing Board of Commissioners appointed by Rick Scott seems to care - irony-wise.
  No matter. 
  Cleverly avoiding any scrutiny from Florida's public records laws, Sam Goren and his law partners play a major in the back room negotiations involving at least $300 million in outside contracts with various vendors and agencies every year.
   Which, as they say in the borough's of Sam's native Northeast, ain't chopped liver -- patronage-wise.
   Trouble is...
   We're still left with a very vexing sort of turd-in-the-punch-bowl puzzle worthy of the Florida Bar, the Ethics Commission, or the Attorney General's Office.
   As General Counsel for the North Broward Hospital District, the law firm of Goren Cheroff, Doody and Ezrol is paid millions to represent the interests of two clients at the same time
  One - The District Administration 
  Two - The District's governing Board of Commissioners.

  But...
  Which “client” is the law firm obligated to represent if and when -- as often happens -- there is a conflict in the diverse interests of the District's Administration and its governing Board of Commissioners?
   Let's say, for example, District policies mandate competitive bids and Board of Commission approval for all contracts over X amount.
   Let's further say District CEO Frank Nask -- with Goren's assistance and approval as General Counsel -- cuts deals in excess of X without informing the District's governing Board of Commissioners. 
   Further, let's say Goren regularly assists Nask in engineering these non-kosher deals behind the fiduciary backs of the District's governing Commissioners.
   And finally, given how all of the above disingenuous tap dancing is too often true...    
         
            Maybe if Pam isn't busy
         with her dog...?

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Recent Posts

  1. OMG!
    Thursday, May 01, 2014
  2. Dem bones
    Tuesday, April 29, 2014
  3. Question:
    Friday, April 25, 2014
  4. Where's the Grand Jury?
    Monday, April 14, 2014
  5. LeMieux or LePieux?
    Thursday, April 10, 2014
  6. Tomorrow
    Wednesday, April 09, 2014
  7. Metaphor #2,779,349
    Sunday, March 23, 2014
  8. Powerful Metaphors
    Saturday, March 15, 2014
  9. Due Dilligence - NOT!
    Tuesday, March 04, 2014
  10. Sam's Club
    Sunday, March 02, 2014

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