How Healthy Is Broward Health?

Broward Health is no stranger to controversy: the chain of hospitals has a long history of questionable behavior and suspect happenings including FBI investigations, embezzlement and fraud charges, no-bid contracts with advertising firms and the January 2016 suicide of Broward Health’s CEO Dr. Nabil El Sanadi (see timeline below for details).

Most recently, a series of leadership decisions, including the abrupt public firing of interim CEO Pauline Grant on accusations of violating anti-kickback policies (allegations she denies), has raised questions about the direction Broward Health and their board is headed. Those skeptical of these decisions — people like former Broward Health board member and Lighthouse Point native Maureen Canada (who chose not to renew her board seat in the heat of such controversy but was, untraditionally, squeezed out without a replacement by Governor Rick Scott), are suspicious, suspecting a power play may be in progress.

“Somebody wants to make Broward Health look bad,” Canada said, getting right to the point as we sat down to lunch at the Nauti Dawg in Lighthouse Point. Her empathetic demeanor and passion for the topic was obvious, as was her confusion. This confusion is at the heart of dozens of media reports including a recent editorial in the Sun Sentinel, which criticized the board’s firing of Grant.

Many believe Grant, who has worked in the hospital system for decades and was months from retirement, was fired in clear violation of the Sunshine Law (which prohibits government officials from making decisions behind closed doors, then announcing them in public). Grant and many at the board meeting at which Grant was fired, were blindsided by her abrupt termination, which was led by Broward Health General Counsel Lynn Barrett. Barrett had hired two outside law firms to conduct an investigation, which alleged that Grant had helped a physician who wanted to get on the on-call schedule in 2015 while she had been CEO of Broward Health North. The allegation was that the hospital, not Grant herself, profited. No specifics were given whatsoever at the board meeting in which Grant was fired in a four-to-one vote. Grant insisted there was no substance to the completely out-of-the-blue allegation and has filed a law suit for what she claims as a wrongful termination, violation of the Sunshine Law and damage to her reputation.

Canada was the only commissioner (out of five) at the meeting to vote against Grant’s dismissal.

“I don’t think this board should prosecute or condemn or be hasty to make decisions or judgments about our CEO who has been employed by this district for many, many years, is a woman of integrity, professionalism and someone that I have admired and have had the pleasure to work with for the past two years,” Canada said in an interview the Sun Sentinel.

Canada said hospital staff was heartbroken by the decision.

“Not at the allegations,” she said, “because no one gives them any merit. They are heartbroken that Pauline is the victim of corruption.”

Though Canada was the only dissenting member on the board at the time of the termination vote, another board member who was not in attendance, Sheela VanHoose, immediately led an effort to reverse the decision. Approximately 350 people showed up to support the reversal. That effort failed.

“This board is pretty set in how they are going to run the district,” said VanHoose in an interview with the Sun Sentinel in January 2017. “They do everything Lynn Barett says. Even the pomp and circumstance of flying in an outside lawyer from Alabama just to read the law to them. That to me shows it’s just about spinning the story. They had no intention of listening to the public.”

Following her failed effort, VanHoose resigned from the board by letter to Governor Rick Scott on December 23. In the letter she writes:

“As I look back on my short tenure, the time has been marked by both proud moments and tumultuous strife…This board has been impulsive at times, holding last minute meetings and receiving contracts before votes. We have approved contracts with questionable metrics and have made decisions that have led to a Corporate Integrity Agreement (CIA). Our board meetings have been tainted by self-serving and political agendas coated with infighting and grandstanding. These problems at Broward Health are not isolated to any one point in time. The issues at Broward Health historically have stemmed from the top, either due to an overtly political board or poor advisement. I am not the first Commissioner to publicly talk about these problems and I will not be the last. Our community deserves better.”

Postponing the Search for CEO

Since October, the board seems to have temporarily aborted, postponed or kept quiet their search for a permanent CEO. The board had paid an outside recruiting agency roughly $300,000 to conduct a search for the permanent CEO. According to Canada, the board had narrowed down the search to three promising final candidates after interviewing six semi-finalists in the September/October timeframe.

“Two of those three got four votes from the five board members,” she said. “I would have been thrilled to have either of those top two as the district CEO.”

But when the date for the final decision came around (which was set for October 31) , Canada recalls board member Christopher Ure saying “I was really hoping we would have had more candidates.” Then Rocky Rodriquez, the chairman, wanted to interview someone he’d heard about. Canada was baffled. She couldn’t make sense of the stall.

The search now seems to be up-in-the-air as after Grant was terminated the board re-appointed interim CEO Kevin Fusco who had already served as interim CEO immediately following El Sanadi’s suicide but was let go after complaints that he ruled with a culture of fear. He was replaced by Grant.

The back-and-forth has raised many questions. Canada has her suspicions about people involved behind the scenes. Although she has never met him, Canada added “Billy Rubin’s name keeps coming up as someone very interested in the district.”

Billy Rubin is a lobbyist currently registered to represent 62 clients before Governor Scott and executive branch agencies including health care heavyweights Aetna, Humana, Coventry Healthcare and Governor Rick Scott’s own former company, Columbia/HCA Healthcare. Before becoming governor, Rick Scott was known for having made a fortune in the healthcare industry. He founded Columbia at age 34 in 1987 and acquired HCA in 1989. He left in 1997 when Columbia/HCA admitted to fourteen felonies including false billing and fraudulent Medicare billing practices and agreed to pay the federal government a $600 million settlement, which was the largest fraud settlement in U.S. history.

Columbia/HCA currently operates over 40 hospitals throughout Florida including local facilities Westside Regional Medical Center in Plantation, JFK Medical Center in West Palm and Northwest Medical Center in Margate.

Rubin was one of the first supporters of Governor Scott and his candidacy for election.

“I got to know Rick in 1991 when he started his hospital company and we’ve stayed close ever since. I love him,” Rubin said in an article in the Miami Herald in November 2010. “He’s a very good friend. We’ve stayed in touch ever since.”

Neither Scott nor Rubin have been shy about their friendship. The relationship has, however, raised public speculation.

Ultimately Canada has no conclusion on what exactly is taking place at Broward Health, but she hopes to help advocate for the district residents in whatever capacity she can. The well-connected Broward Workshop organization of business and civic leaders has recently approached her to discuss strategies to help the besieged hospital district.

“I’m hoping to be on the other side of the podium now that my work on the board is done,” she said.

Broward Health Timeline

1952

The hospital district is born

A legislative act for the creation of the North Broward Hospital District (now called Broward Health) was approved by referendum and a District Board was appointed by the Florida governor. The independent special taxing district is funded largely by property tax revenues, which in 2015 amounted to about $140 million.

1961

The beginning of the Forman era

Power-wielding land baron Hamilton Forman was appointed to North Broward Hospital District’s seven-member board of commissioners, serving in numerous capacities until 1990. He was accused of turning the district into a political machine that handed out contracts only to doctors and vendors who made campaign contributions to whichever governor was in power.

1997

Public Clinic opened at Century Village shuts down, $500K loan to pay

A public clinic subsidized by tax dollars was opened inside the walls of the gated Century Village of Deerfield Beach because one of the district’s commissioners lived there. The project eventually failed, and the district was left with a $500,000 loan to repay.

2002

FBI investigates Broward Health $170 million building deal

The Federal Bureau of Investigation and U.S. Attorney’s Office began investigating a $170 million deal approved by the hospital district’s governing board for the construction a seven-story medical office building across from Broward General Medical Center. The case involved determining whether developers with political connections to hospital officials were given illegal advance notice of the where the building was to be constructed, and whether the price tag for the project was inflated.

2003

CFO jailed for embezzlement

The hospital district’s chief financial officer Patricia Mahaney was sentenced to 14 months in federal prison for embezzling $55,000 from the district. Mahaney’s embezzlement case led to the criminal investigation of the $170 million medical office building deal.

2004

Federal grand jury investigation of insider dealing

A federal grand jury investigating the hospital district’s $170 million medical office building deal questioned hospital officials, district board members and others involved in the project. In the end, no one was indicted, but the building plans were put on hold for years.

March 2005

Gov. Jeb Bush cleans house

North Broward Hospital District scandals prompted Gov. Jeb Bush to replace five of his seven appointees on the board. Five months later, the board fired general counsel William Scherer, who had been a political power at the district for 17 years, and was a Hamilton Forman protégé.

2012

Broward Health renames its hospitals

Five years after the North Broward Hospital District rebranded itself as Broward Health, it renamed its hospitals, including Broward Health Medical Center, Broward Health North, Broward Health Imperial Point and Broward Health Coral Springs. Broward Health officials said the business conversion, which cost about $750,000 over four years, was intended to create a brand that sounded less like public hospitals for uninsured patients, and would enable the hospital system to conduct more effective marketing campaigns in an extremely competitive environment.

2012

Company tied to Gov. Rick Scott gets Broward Health contract, gives $400K to his campaign

Although Broward Health adopted a lobbyist registration policy in 2004, it ignored it for over a decade, during which time lobbyists were able to operate freely behind the scenes, and many multi-million dollar contracts were awarded. One of the biggest was an unprecedented 25-year, no-bid deal in 2012 that outsourced the district’s radiation oncology services to 21st Century Oncology, a Fort Myers-based cancer care company, of which Gov. Rick Scott had an indirect ownership interest through his $210,000 investment in Vestar Capital Partners, the private equity firm that owns 21st Century. Scott’s good friend, lobbyist Billy Rubin, lobbied at the district and counted 21st Century Oncology among his clients. 21st Century Oncology later donated almost $400,000 to Gov. Scott’s re-election campaign.

October 2013

Broward Health commissioner quits amid governor’s inquiry into immunized testimony

Attorney Kimberly Kisslan resigned from the district’s board of commissioners just three months after being appointed by Gov. Rick Scott. It was revealed that Kisslan had testified under a grant of immunity to the federal grand jury that investigated the 2007 corruption case of former Broward Sheriff Ken Jenne, for whom Kisslan served as general counsel. The governor’s office, which began an inquiry into the matter, said it was not aware of this information when it announced Kisslan’s appointment, which raised questions as to why it did not come to light during a background check.

May 2015

Broward Health signs $2.1 million-a-year no-bid contract with Zimmerman Advertising

Broward Health entered into a $2.1 million-a-year advertising contract, renewable for three years, with Fort Lauderdale-based Zimmerman Advertising, without first seeking proposals or bids from other firms. Broward Health CEO Dr. Nabil El Sanadi, who signed the contract on behalf of Broward Health, apparently exceeded his signing authority of $250,000, and the contract was never brought to the district’s governing board for its approval. Just seven weeks after the contract was signed, advertising executive Jordan Zimmerman threw a political fundraiser for Broward County Court Judge Nina Di Pietro, the wife of Broward Health’s chairman, David Di Pietro.

September 2015

U.S. Justice Department settles a $69.5 million fraud case against Broward Health

The civil settlement ended an investigation that began in 2010 after a Fort Lauderdale orthopedic surgeon filed a whistleblower lawsuit alleging that from 2000 to 2014 Broward Health had participated in an illegal scheme to defraud Medicare and Medicaid by paying kickbacks to doctors who referred patients to its hospitals. In addition to paying the financial penalty, the settlement required that Broward Health accept the imposition of tough new ethics rules over five years.

January 2016

Broward Health CEO Dr. Nabil El Sanadi commits suicide; New state and federal probes announced

On Jan. 23, Dr. Nabil El Sanadi, who became president and CEO of Broward Health in December 2014, fatally shot himself in a lobby restroom of his Lauderdale-by-the-Sea condo building. On Jan. 29, the day of his memorial service, Florida’s Chief Inspector General Melinda M. Miguel, informed Broward Health that her office would review every contract the district has awarded since July 2012, with full support from Gov. Rick Scott. Soon after, it was confirmed that the FBI was conducting a separate, but possibly overlapping, investigation into allegations of corruption in Broward Health’s purchasing department.

January 2016

Plans for $71.4 million advertising contract fade after Broward Health CEO’s suicide

A proposed $71.4 million no-bid contract with Zimmerman Advertising, which Broward Health CEO Dr. Nabil El Sanadi and a majority of the board supported, was set for approval at the district’s January board meeting, but was put on hold after El Sanadi’s suicide on Jan. 23. Broward Health Chief Financial Officer Robert K. Martin opposed the deal at the Dec. 17 board meeting, and was fired on Jan. 7.

February 2016

Records involving former purchasing officer subpoenaed

As part of an FBI corruption investigation, a Fort Lauderdale federal grand jury subpoenaed records related to Broward Health’s former purchasing director Brian Bravo and 16 companies that do business with the district. The records requested dated back 10 years.

February 2016

Broward Health CEO pays hush money to fired execs, exceeds signing authority

Even though his signing authority was limited to $250,000, Broward Health acting CEO Kevin Fusco signed a separation agreement with $400,000 in hush money to the district’s former chief financial officer Robert K. Martin, who was fired after publicly criticizing the proposed $71.4 million no-bid deal with Zimmerman Advertising. On the same day, Fusco signed a second deal which paid $537,000 in hush money to Calvin Glidewell, the fired chief executive of Broward Health Medical Center.

March 2016

Florida’s Chief Inspector General Broadens Its Broward Health Inquiry

The office of Florida’s Chief Inspector General expanded the scope of its investigation of the hospital district, instructing Broward Health to turn over more than six types of records, including documents relating to “potential or actual” conflicts of interest disclosed by its commissioners or administrators since 2012, behind-the-scenes lobbying practices and copies of termination agreements signed in February with two former Broward Health executives who were paid a total of $937,000 in hush money authorized by then interim CEO Kevin Fusco.

March 2016

Broward Health’s acting CEO Kevin Fusco is replaced by Pauline Grant

Kevin Fusco was voted out as Broward Health’s interim CEO and returned to his job as chief operating officer, while Pauline Grant, who had been CEO of Broward Health North, was named the district’s new interim CEO. The change came amid criticism from senior management that a leadership crisis was threatening Broward Health’s ability to provide basic services to its patients. The district’s governing board also voted to put its controversial general counsel, Lynn Barrett, on a 30-day review plan following complaints that her mishandling of physicians’ contracts caused a backlog that could affect patient care.

March 2016

Florida Attorney General demands Broward Health pay $5.3 million for Medicaid fraud

In a letter dated March 10, Florida Attorney General Pam Bondi’s office demanded that Broward Health pay $5,325,671 to settle state Medicaid fraud claims uncovered during a federal whistleblower investigation that Broward Health paid $69.5 million to settle in Sept. 2015. Bondi’s office threatened to pursue Florida False Claims Act litigation “seeking treble damage and civil penalties” for each false claim submitted if the matter wasn’t resolved through settlement.

September 2016

Broward Health resurrects its long-lost lobbyist registration rules

For the first time, the hospital district began enforcing a lobbying policy it adopted 12 years ago, which requires lobbyists to publicly identify themselves and their clients, with sanctions for violators. Earlier in the year, the district’s Legal Affairs Committee spent months studying how to develop a lobbyist policy without being told by staff that a policy already existed.

October 2016

Broward Health board suspends its CEO search indefinitely

Broward Health’s governing board decided to postpose its selection of a new CEO after reading a report prepared by a law firm hired to assess the hospital system’s procedures, policies and operations. Earlier in the month, three finalists were interviewed for the permanent CEO position, and a decision was expected to be made by Oct. 31, but due to the significant deficiencies outlined in the report, board members decided to rethink hiring criteria and view more applicants.

December 2016

Broward Health Interim CEO Pauline Grant fired, replaced by COO Kevin Fusco

In a surprise move, the district’s board called a hasty meeting on Dec. 1 and voted 4-1 to fire interim CEO Pauline Grant over unspecified allegations of a kickback. Grant maintained there was no substance to the accusations and that the board wanted to replace her with someone more tractable on the system’s operations. Board member Maureen Canada cast the only dissenting vote, and later defended Grant’s character and her many years of service to the district. The board replaced Grant, just months before her retirement, with Chief Operating Officer Kevin Fusco, who had been removed as acting CEO nine months earlier after complaints from employees about administrative chaos and low morale.

December 2016

Board member Sheela VanHoose resigns

Broward Health board member Sheela VanHoose submitted a resignation letter to Gov. Rick Scott, to take effect Jan. 1, saying that she was frustrated by the actions of other board members and did not want to sign her name to an upcoming annual report to the federal government that she feared was inaccurate. VanHoose, who strongly opposed the firing of interim CEO Pauline Grant, but was absent for the vote, wrote in her letter that board meetings were tainted by “self-serving and political agendas” and the organization had “serious organizational and cultural problems” that prevented it from performing its basic functions.