Broward Health needs major reform
Broward Health finally lanced a festering boil Wednesday by dismissing its divisive general counsel, Lynn Barrett, more than two years after a prior board chairman sounded the alarm about the damage she was causing.
And as the board of the North Broward Hospital District prepared to take this much-needed step, an ooze of awfulness seeped out about current conditions at this vital public health care system.
It was shocking to hear about the district’s mass exodus of doctors (113 last year, 80 so far this year;) improper staffing in the trauma center; specialists unavailable to cover the emergency room; difficulty sterilizing equipment because of an unsigned vendor contract; an ICU patient shipped to Holy Cross Medical Center because of an unsigned lithotripsy machine contract; chiefs of staff working with unsigned contracts; administrators hamstrung by the legal department; bills left unpaid; millions of dollars squandered on outside law firms; lawyers charging as much as $1,000 an hour; legal investigations launched by who knows who; and a culture where “staff are treated as criminals.”
In the best of lights, the toxic work environment at Broward Health can be blamed on Barrett’s over-zealous interpretation of a federal Corporate Integrity Agreement (CIA) meant to prevent kickbacks for patient referrals and hospital services. The hospital district signed the agreement — and paid the federal government a $69.5 million fine three years ago — to settle allegations that it had improperly rewarded nine physicians in exchange for patient referrals. To continue participating in the Medicare and Medicaid programs, the agreement demands Broward Health’s contracts be on the up and up.
From the start, Barrett needed help reviewing the contracts. Armed with an unlimited checkbook, she began hiring outside law firms and spending millions of dollars as she saw fit, amassing unchecked power along the way.
Barrett is said to have “weaponized” the firm she recruited to be the Independent Review Organization, or IRO, whose job is to ensure the district complies with the CIA. It has launched investigations that appear motivated by personal grudges.
One such investigation targeted Pauline Grant, a popular former administrator of Broward Health North who, after serving the district well for more than 30 years, agreed to become its interim CEO in January 2016. Before long, she bumped heads with Barrett.
Months later, Grant stood accused of having a conflict of interest for volunteering on the board of John Knox Village, which provides assisted living. Then she was accused of taking kickbacks after a disgruntled doctor alleged she gave preference to trauma surgeons who refer patients to Broward Health, an allegation found to be unfounded by an internal investigation.
At the time, Grant said the doctor’s allegation was one of 84 complaints logged on a hotline — including several against Barrett
— but the only one targeted for review. She said a team of lawyers hired by Barrett suddenly showed up and asked questions for hours. Then, they advised the board to take action or risk violating the CIA. The board fired Grant. On the board at the time was Beverly Capasso, who was soon named interim CEO, but announced her surprise resignation four weeks ago.
To us — and a good many others — the charges against Grant looked trumped up.
It reminded us of the trumped-up charges made against David DiPietro, the former board chairman who first blew the whistle on Barrett’s poor performance. For encouraging the hiring of an independent law firm, Gov. Rick Scott suspended him, alleging misfeasance. Di Pietro successfully sued. After restoring his good name, he resigned. What volunteer board member needs such headaches?
Still, during the public comments portion of Wednesday’s meeting, we were surprised by the comments of a rabbi, who took the microphone to bear witness to the integrity of today’s chairman, Andrew Klein, a Parkland attorney appointed to the board a little over a year ago.
Klein later dropped a bombshell of his own. He said there were good grounds to dismiss Barrett, including the targeting of individuals, “of which I am one.” (He didn’t elaborate and after the meeting, didn’t want to say much more.)
“We are spending millions and millions of dollars on lawyers,” Klein continued. “There’s money flowing unaccounted for. We’re well over $12 million a year in legal fees … Some of those firms have been used against our own employees, against our own board members … Attorneys who are supposed to represent us are acting adverse to our own interests.”
The biggest surprise came with Capasso’s turn to talk. She began her first public comments since announcing her resignation by summing up some successes, including a lowered tax rate and some topnotch hires. Then she addressed the elephant in the room.
“Broward Health has for several years been permeated by a level of intimidation and fear that creates an abusive work environment for the staff at many levels,” she said.
“When investigations can be initiated without anyone willing to admit they were the parent, when employees are subject to unexpectedly being interrogated by ex-FBI agents in an aggressive style, when executive management with the audacity to point out errors and inconsistencies in an IRO report at the request of the board are targeted for secondary investigations, it sends a chilling message to the rest of the organization: ‘No one can help you, so don’t cross the person with the checkbook controlling a Pandora’s box of unlimited and unchecked investigation power.’
“Recently, ten or more of my staff were interviewed by a D.C. law firm. For several, this meant five to seven hours of being gang interviewed by a tag team of three to five attorneys without any representation of their
own.
“No one in this audience — no matter how innocent — could possibly be expected in seven hours of aggressive questioning not to make some statement which could later be taken out of context by a cunning attorney and used against them. This is unfair. This is intimidation. This is harassment.”
Capasso sounded nothing like she did when she first came on the board and quickly voted to fire Grant, whose story sounds remarkably similar.
Neither did Christopher Ure, who in one of his first acts on the board, stood in Di Pietro’s way of firing Barrett. Now the longest serving board member, Ure voted for her dismissal on Wednesday.
It was disappointing, but not surprising, to see the governor’s newest appointment, Stacy Angier, sworn in just that day, vote to keep Barrett. A lot of doctors had risked the lawyer’s wrath by publicly calling for her dismissal. Apparently, Angier didn’t believe them or trust her more-experienced colleagues. It seemed she’d been quickly appointed to help save Barrett’s job.
Joining her in opposition was Steven Wellins, who said that when he was in the hospital, Barrett had spent four hours at his bedside.
It was clear that a number of commissioners feel personal affection for Barrett. Given that, we want to thank Commissioners Klein, Ure, Ray Berry and Nancy Gregoire for putting public service first.
Now, how do we keep such excess from ever happening again?
First, Broward’s legislative delegation should file a bill to change the board appointment process. Broward Health’s five public hospitals and network of indigent clinics are wholly owned by the people of Broward County. The governor should not get to appoint all board members. Gov. Scott has appointed no African-Americans or Hispanics to this board. The process needs to change.
Second, the board should amend the charter to limit how much money the general counsel can spend without board approval. While they’re at it, they should mirror the state ethics code and set a minimum two-year cooling off period between the time a general counsel leaves the district and can go to work for an outside law firm.
Third, they should audit the legal fees paid in recent years. Chairman Klein showed us hourly bills submitted by Foley and Lardner LLP for January and February. To explain the services provided, the same four words filled line after line on eight pages: “attend to legal matters.” You wouldn’t accept such a lack of detail from your attorney. Neither should Broward Health.
Fourth, they should seek a meeting with the federal U.S. Department of Health and Human Services, whose Office of Inspector General watchdogs compliance with the CIA. We wouldn’t be surprised if the OIG hears from the silk-stockinged lawyers who just lost their place at the public trough. If something is wrong at the district, let us hear it. After all, we’re their clients. And enlist the help of our congressional delegation.
Fifth, while Capasso appears to have hired well and interim CEO Gino Santorio is a popular choice among physicians, the board should look more broadly before naming a permanent CEO. And do a national search for a new general counsel.
Sixth, settle the lawsuit with Pauline Grant. Pay her attorney fees. Pay her severance. If there’d been any truth to the allegations, the federal government would have acted by now.
Seventh, stop signing confidentiality agreements with people who are asked to leave. Public dollars are being spent here. Be transparent.
Eighth, encourage Broward State Attorney Mike Satz to convene a grand jury that would review management procedures at Broward Health, as his Miami-Dade counterpart once did to address the disarray at Jackson Memorial Hospital. The governance review, as opposed to a criminal review, led to changes that have well served Jackson.
Ninth, stop charging the public and the media so much for public records. Sure, state law says you can, but that doesn’t mean you have to. Dan Lewis, who operates Broward Health Blog, was told he’d have to pay $1,400 to review invoices from law firms. Similarly, an attorney representing the medical staff was told she’d have to pay $5,000 to review legal invoices and retainer agreements, Broward Bulldog has reported.
Tenth, improve relations with the medical staff, the community and the media. Find a quality attorney who can say yes to contracts that pass federal muster. Reach out to community leaders tired of showing up to address problems during public comments. And improve relations with the media, who can help advocate for needed change and help people see their stake in the district’s success.
We all care about Broward Health. For everyone’s sake, we need it to prosper and thrive.
Despite the ugliness revealed when the boil was lanced, it feels like a new day could dawn at Broward Health. While it’s got a long history of political shenanigans, today’s board has the chance to turn the page.
A board majority did the right thing Wednesday. We got the feeling they will keep it up.