As Broward Health bleeds, doctors warn mismanagement is affecting health care

By Dan Christensen, FloridaBulldog.org 

Broward Health’s top doctors have warned the district’s leadership that the medical staff’s ability to function “is being compromised to the detriment of Broward Health as a viable health care system.”

A Jan. 19 letter from the Unified Medical Staff Committee obtained by Florida Bulldog also says that Broward Health is bleeding physicians due to mismanagement.

“The Medical Staff is critically concerned that the alienation of the physicians is affecting the delivery of health care,” the letter says. “Across the system there is physician attrition as physicians do not feel valued and necessary personnel and other support is delayed or denied, resulting in a continued downward spiral of [patient] volume and worsening morale of the non-physician staff as well.”

The North Broward Hospital District, as Broward Health is legally known, is the independent taxing district that serves as the safety net hospital system for the northern two-thirds of the county. It is led by a board of political appointees installed by Republican Gov. Rick Scott. It collects about $140 million in property taxes every year.

The doctor’s letter was given to Broward Health’s board of commissioners and its President/CEO Beverly Capasso. In December, Capasso, General Counsel Lynn Barrett, Chairman Rocky Rodriguez, Commissioner Christopher Ure and former Commissioner Linda Robison were indicted for violating Florida’s Government-in-the-Sunshine Law. All except Robison, who was not reappointed when her term expired late last year, remain in office.

“For many months the Medical Staff leadership has endeavored to address these concerns in a collaborative manner,” says the letter prepared by attorney Amy Galloway, who represents the medical staff. “Those efforts have largely been met by a lack of urgency to find practical, timely solutions to patient centered issues and shoulder shrugging reference to ‘corporate’ decision-making while Broward Health roils from one crisis and controversy to another.”

Compounding the problem

Broward Health’s leadership has compounded the problem, the doctors said, by taking actions and implementing policies “in violation of the medical staff’s bylaws” and the district’s “own corporate compliance program.” Broward Health established its compliance program in 2015 as part of its $70-million settlement of federal healthcare fraud charges. The physicians’ accusations could trigger a federal inquiry.

Through district spokesman Gary Bitner, Broward Health CEO Capasso declined to comment on the letter.

Dr. Gary Lehr, a Deerfield Beach surgeon who chairs the Unified Medical Staff Committee, and urologist Dr. Louis Yogel, chief of staff at the district’s Fort Lauderdale flagship Broward Health Medical Center, did not respond to requests for comment.

The physicians’ letter lists four “primary concerns:”

• Broward Health’s plan for the “unilateral adoption” of an on-call coverage policy for the emergency department “that strips the medical staff from meaningful participation in the process.”
• The “unilateral elimination” of Chief of Staff reports from the agenda of board meetings.
• A continuing “crisis” caused by significant delays in contract renewals routine primary care and specialist coverage, as well as contracting for non-clinical duties.
• The defunding of the physicians’ legal counsel. Until recently Broward Health paid that cost.

Traditionally, the chief medical officer at each of Broward Health’s four hospitals – Broward Health Medical Center, Imperial Point, Broward Health North and Coral Springs – provided the board with monthly reports about their hospitals, including grievances.

‘Smacks of censorship’

When the medical staff asked for the chiefs’ reports to be reinstated, however, it was “suggested the chiefs could request being placed on the agenda if and only if they submitted their comments to corporate in advance (and presumably for approval).  Such approval smacks of censorship,” the letter said.

The doctors’ most detailed complaint was about Broward Health’s draft policy to establish on-call emergency schedules without their input. Those schedules are now overseen by the department’s chair in consultation with the hospital’s chief of staff, and under ultimate oversight by the board.  “This process has been in place and when respected limits the ability of any one individual or group, physician or administrator, to use call as inducement for referrals…”

The federal Anti-Kickback Statute (AKS) forbids individuals or entities like hospitals from paying or receiving anything of value in exchange for referring patients whose care is paid for by government healthcare programs such as Medicare or Medicaid.

The physicians’ letter calls Broward Health’s draft on-call policy “seriously troubling” in light of the Dec. 1, 2016 termination of former district President/CEO Pauline Grant for alleged anti-kickback violations. The accusations arose after one orthopedic surgeon claimed that calls at Broward Health North, where Grant was then chief executive, were not being dispensed equally to doctors on the call panel.

“Independent of the veracity of those allegations, a safeguard against even the appearance of an AKS violation is the establishment (of) meaningful oversight and participation of the medical staff,” the letter says. Existing rules guard against “the quid quo pro grant of primary or specialist call” and ensure that “no administrative team has unilateral control over setting call.”

The termination of Grant is central to the criminal indictment against the four current and former commissioners and general counsel Barrett. Among other things, the charges say, the quintet conspired at unannounced meetings to oust Grant.

Grant sued Broward Health shortly after her ouster, leading the district to hire a number of private lawyers at high, yet undisclosed cost to taxpayers. The district’s legal costs rose significantly in December when more lawyers were retained to represent the five who were indicted.