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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...?

Coming soon...

         
        A Liberal's Lament
                                Or
          Why is a Uriah Heep double 
                        
                 Capo di Capo
                               of
              the nation's tenth larget
                    hospital system
*
           
     *aka Sam's Club
                
                             ?

Powerful Irony

               
   Sometimes cruel reality becomes way, way too up close and personal.
  Like last night, my 92-year-old mother-in-law lay paralyzed from the waist down in a pool of her own urine crying out for help while punching an impotent call button for absent care for more than an hour as a patient at the North Broward Hospital District's Imperial Point Medical Center.
  However...
  Thanks to the dramatic cost-cutting measures by District CEO Frank Nask's administrative team, the "bottom line" profits for the nation's tenth largest public health care system are up 67% over last year's.
  Which was cause for smiles all around at last month's meeting of the District's all-Republican governing Board of Commissioners appointed by Florida Governor Rick Scott himself..

On meaning and metaphor #1

                  
                        
.... all my means are sane, my motive and object mad.
                                                                             Captain Ahab
 
     The late Marshall McLuhan was wrong.
    The metaphor is the message -- not the media.
     For example:
     My last post served as a metaphor of our nation's grosslyt dysfunctional health care system.
     Just as today's...
     A life-long liberal Democrat from New York, Sam Goren became the third member of his family to work for the North Broward Hospital District (dba Broward Health) during the past four decades.
    In this case, Sam was hired as the District's General Counsel by the giant health care system's seven member governing board of Commissioners -- each appointed by Florida Governor Charlie Crist based on their active member in Broward's Republican party.
   For the record, neither Goren -- nor the other members of his law firm -- had any experience in health care law.
   Further, in seeking the services of a legal advisor for the billion dollar a year health care system, District officials hired Goren -- without any attempt to recruit the services of a lawyer (or law firm) experiences in health care law.
   Goren's solution to his lack experience in health care law?
   Hire outside law firms with the knowledge and training Goren lacked.
   However...
   Since his becoming general counsel to the nation's tenth largest public health care system, the tax-funded District has paid Goren, Cheroff, Doody & Ezrol more than $4.6 million in legal fees. 
   Further...
   Since the life-long liberal Democrat was hired as general counsel to the District's all-Republican governing Board of Commissioners, Goren has "farmed out" more than $17.7 million to other private law firms.
   Bottom line?
   Since Goren was hired to serve as the District's general counsel, Broward Health's legal costs have totaled some $23.9 million.
   Finally  ...
   Early last month, as a blog journalist, I made a 119 public records request to the District for copies of all Goren's legal bills to Broward Health.
  And now...
  Late yesterday, I received an email from the District informing me that some 3,700 pages of Goren's legal bills to the District are now available ... providing I pay the District $733.14 for copies of the invoice's from the attorney for his services.
  All of which serves as yet another public health care metaphor for the management style of the District's all-Republican governing Board of Commissioners appointed by Florida's Governor Rick Scott for the loyalty to the GOP.
                       
                       Sam Goren
                             --- attorney at law.

   
      

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Recent Posts

  1. Where's the Grand Jury?
    Monday, April 14, 2014
  2. LeMieux or LePieux?
    Thursday, April 10, 2014
  3. Tomorrow
    Wednesday, April 09, 2014
  4. Metaphor #2,779,349
    Sunday, March 23, 2014
  5. Powerful Metaphors
    Saturday, March 15, 2014
  6. Due Dilligence - NOT!
    Tuesday, March 04, 2014
  7. Sam's Club
    Sunday, March 02, 2014
  8. Coming soon...
    Sunday, February 23, 2014
  9. Powerful Irony
    Wednesday, February 12, 2014
  10. On meaning and metaphor #1
    Thursday, February 06, 2014

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