Company tied to Gov. Scott got Broward Health contract, gave $400K to his campaign

By Dan Christensen and Buddy Nevins, 

Gov. Rick Scott speaks about cancer research funding at 21st Century Oncology, April 10, 2014 Photo: Dania Maxwell/Political Fix Florida, the joint bureau of Naples Daily News / Tampa Tribune / Treasure Coast in Tallahassee.

Gov. Rick Scott speaks about cancer research funding at 21st Century Oncology, April 10, 2014
Photo: Dania Maxwell/Political Fix Florida, the joint bureau of Naples Daily News / Tampa Tribune / Treasure Coast in Tallahassee.

A cancer treatment company financially tied to Gov. Rick Scott that got a no-bid, 25-year contract from Broward Health in January 2012 later contributed nearly $400,000 to the governor’s re-election campaign, state records show.

21st Century Oncology’s political generosity went deeper. Since Republican Scott was first elected in November 2010, the Fort Myers-based company has contributed another $340,000 to the Republican Party of Florida. this week reported on Gov. Scott’s indirect ownership interest in 21st Century Oncology via his $210,000 investment in the company’s owner, the private equity firm Vestar Capital Partners. The story also reported that attorneys for Broward Health, a tax-supported public hospital system, had denied a public records request for a copy of the contract.

Hours after the story was published, however, the hospital district’s lawyers at the Foley Lardner law firm changed their minds and released a copy of the 42-page contract, exhibits and amendments.

The contract spells out the terms of an exclusive and lengthy arrangement in which Broward Health gave 21st Century Oncology LLC exclusive rights to supply radiation oncology services to Broward Health’s patients – and collect all the revenue those patients generate.

21st Century paid zero for access to patients

21st Century paid Broward Health nothing to obtain that access. Likewise, Broward Health did not pay 21st Century to assume a practice area that then-Broward Health president and chief executive Frank Nask told the district’s board of commissioners in 2012 was losing $3.5 million a year.

Broward Health Acting President/CEO Kevin Fusco isn't talking

Broward Health Acting President/CEO Kevin Fusco isn’t talking

Why would 21st Century want to take over a money-losing operation? How might it turn it into a profit maker? Kevin Fusco, who holds Nask’s job today, was asked by email to discuss the oncology radiation program’s performance under 21st Century. He did not respond.

The contract, however, says the parties executed a separate agreement that requires 21st Century to pay Broward Health unspecified fees for the right to use its space and equipment, such as CT scanners, located at Broward Health Medical Center in Fort Lauderdale and Broward Health North in Pompano Beach. That agreement is a public record, and a copy has been requested by

At the same time, the contract also specifically allows 21st Century to continue to operate radiation oncology facilities in Deerfield Beach, Plantation, Tamarac, Pembroke Pines, Coral Springs and Aventura “without being in violation of this agreement.”

The contract is for 10 years and automatically renews for three consecutive five-year periods unless 21st Century wants out earlier.

Broward Health also pays 21st Century a yearly fee of $120,000 to provide a medical director for the oncology program. The director sets physician schedules and monitors performance, and is paid based on 8 to 12 hours of work a week.

More significantly, the contract requires Broward Health to pay 21st Century Oncology to treat poor patients who don’t have the money for treatment. Money that comes from taxpayers.

Broward Health’s payments for indigent patients under the original contract were broken into three categories of rates: $21,000 for high level services (prostate, lung, head and neck); $14,000 for intermediate level services (breast, gastrointestinal [esophagus, pancreas, anal canal], brain; $8,000 for low level services (lymphoma, skin, palliative cases).

About a year later, the contract was amended to delete any reference to indigent patient fees. Broward Health’s payment schedule for indigent services was changed to now pay the radiation company 65 percent of the Medicare Part B allowable. No explanation for the change, or its cost to the public health system, was given.

One knowledgeable source, however, said it is his understanding that 21st Century Oncology’s contract with Broward Health is worth $20-30 million a year to the company, “multiplied by 25” years.

A reliable contributor to Scott

Throughout all this time, 21st Century was a reliable contributor to Gov. Scott, who appoints Broward Health’s governing Board of Commissioners.

21st Century Oncology has donated to Florida’s Republican Party since the late 1990s.

Its contributions increased noticeably, however, during Scott’s first campaign in 2010, including a $20,000 contribution by 21st Century CEO Dr. Daniel Dosoretz days before the vote.

The bulk of 21st Century’s political contributions have been to Gov. Scott’s Let’s Get to Work committee, which can accept unlimited donations. More than $360,000 over a half-dozen large donations were made to the committee between May 2012 and January 2014 when Scott faced a tough re-election challenge from former Gov. Charlie Crist. 21st Century Oncology gave an additional $30,000 last March to Let’s Get to Work after the governor won re-election.

Scott’s own campaign organization, which is limited under the law as to how much it can accept from each donor, also got money from 21st Century. Four corporations owned by the company gave the maximum $3,000 contribution each on Jan. 31, 2014. One of those corporations was 21st Century Oncology LLC, the entity that entered into the deal with Broward Health.

The firm’s giving also extended to the governor’s first inauguration. In 2011, 21st Century Oncology gave $25,000 to the governor’s inaugural committee.

Jackie Schutz, a spokesman for the governor, said this week that Gov. Scott wasn’t aware that 21st Century had sought the Broward Health contract prior to its award in 2012. She also said the governor keeps his assets in a blind trust and doesn’t know about or control what he owns.

“The governor and his staff have had no conversation or contact about Vestar or 21st Century Oncology with the North Broward Hospital District,” Schutz said.

Broward Health gave company with financial ties to Gov. Scott 25-year, no-bid contract

By Dan Christensen and Buddy Nevins, 

Gov. Rick Scott announces plans to seek new cancer research funds during an April 2014 visit to the Fort Myers headquarters of 21st Century Oncology, a company in which he owns an indirect financial interest. Company chief executive Dr. Daniel Dosoretz is at far right. Photo: NBC-2, WBBH Fort Myers

Gov. Rick Scott announces plans to seek new cancer research funds during an April 2014 visit to the Fort Myers headquarters of 21st Century Oncology, a company in which he owns an indirect financial interest. Company chief executive Dr. Daniel Dosoretz is at far right. Photo: NBC-2, WBBH Fort Myers

An oncology company financially connected to Gov. Rick Scott got a no-bid contract four years ago from taxpayer-supported Broward Health for as long as 25 years – an unprecedented term.

Scott was an investor in a private equity firm that owns 21st Century Oncology, state records show. The Fort Myers-based cancer care company got the contract in 2012 to supply radiation oncology services to Broward’s biggest public health system.

The value and language of the contract with 21st Century Oncology are not known. The hospital system’s lawyers denied a public records request by for a copy of the contract.

The North Broward Hospital District, Broward Health’s legal name, is and was at the time run by an all-Republican board of commissioners appointed by the governor. Gov. Scott, who took office in January 2011, is a Republican. He was re-elected in 2014.

“This is news to me,” said Commission Chairman David Di Pietro, who seemed stunned last week when told of the governor’s indirect ownership interest in 21st Century Oncology, a contract he voted to approve. “In 2012 I was unaware of that, and I have no further comment at this time.”

Broward Health awarded the contract, with an initial term of 10 years and three separate five-year renewal options, to 21st Century Oncology after deciding to outsource its day-to-day business of providing radiation treatment services for cancer patients.

“In all my years I’ve never heard of a contract for that duration, especially at a tax-supported system like Broward Health,” said Florida International University healthcare professor Sal Barbera, a former hospital CEO who blew the whistle on Medicare fraud by Tenet Healthcare Corp. in 1997.

Information about the contract is contained in publicly traded 21st Century’s filings with the U.S. Securities and Exchange Commission (SEC) and the minutes of a Jan. 30, 2012 board meeting when the deal was approved in a 5-1 vote.

Financial disclosure filings by Gov. Scott indicate that at that time he owned a $210,000 indirect interest in 21st Century Oncology. The governor’s stake came via his investment in Vestar Capital Partners, the private equity firm that owns 21st Century.

Spokeswoman: Scott didn’t contact district about 21st Century

“The governor and his staff have had no conversation or contact about Vestar Capital or 21st Century Oncology with the North Broward Hospital District,” Scott’s communications director Jackie Schutz said in a statement on Sunday.

Schutz also said Gov. Scott wasn’t aware 21st Century Oncology had sought the Broward Health contract prior to its award in January 2012. Likewise, she said no executives at Vestar or 21st Century asked the governor to try to influence the selection of 21st Century by the district.

21st Century co-founder and chief executive Dr. Daniel Dosoretz

21st Century co-founder and chief executive Dr. Daniel Dosoretz

Two of the commissioners who voted for the deal continue to serve on the board today, Di Pietro and Joel Gustafson. Gustafson, who was chairman the day of the vote, could not be reached for comment.

In April 2014 Gov. Scott publicly touted 21st Century Orthopedics and its chief executive and co-founder Dr. Daniel Dosoretz during a visit to the company’s Fort Myers office while pushing a 60 percent hike in state funding for cancer research, including $20 million in new state grants for companies like 21st Century Oncology. Scott signed the measure into law two months later.

“There’s something in this for us, and it’s not exactly the same as what’s in it for the University of Florida and other centers,” 21st Century Oncology Chief Medical Officer Constantine Mantz told the Naples Daily News. “But to his credit, (Scott) has thought about some of the little guys in the state…We really have not had any ability to access state funds for any of our research activities, and so this is important for us.”

Last March, Scott named 21st Century gynecologic oncologist Dr. James Orr of Bonita Springs to the Florida Board of Medicine. At the same time, the governor appointed to the board Dr. Nabil El Sanadi, the Broward Health chief executive whose Jan. 16 suicide sent shock waves through the district, and prominent Republican fundraiser and Fort Lauderdale cardiologist Dr. Zachariah Zachariah, who recently jumped to Broward Health from Holy Cross Hospital.

Details of Gov. Scott’s indirect ownership interest in 21st Century Oncology are contained in his 2010 and 2013 financial disclosure forms and documents filed by his lawyers with the Florida Commission on Ethics.

Dr. Nabil El Sanadi, Broward Health's late chief executive

Dr. Nabil El Sanadi, Broward Health’s late chief executive

Gov. Scott keeps his assets, which his most recent disclosure form valued at $146.8 million, in a blind trust. He has had two such trusts while in office and as such maintains he has no knowledge of his investments, and thus no conflicts of interest.

While establishing Scott’s first blind trust in April 2011, his attorneys identified for the ethics commission several “passive investments” in companies that do business in Florida and are subject to state regulation. They explained that to avoid conflicts Scott was putting those assets in a blind trust modeled after the model federal blind trust and under the control of an “independent” financial professional. They asked for the commission’s blessing and it was soon granted.

In 2014, however, reported that Scott’s blind trust deviated substantially from the U.S. model and that the independent trustee was a New York investment advisory firm whose chief executive was former Scott business crony Alan Lee Bazaar.

One investment, in which Gov. Scott was said by the lawyers to play no managerial or decision-making role, was Vestar Capital Partners, 21st Century Oncology’s owner. Vestar has raised about $8 billion in capital in six equity funds since the late 1980s.

Scott’s investment in Vestar Capital Partners

“Governor Scott owns, through limited partnerships, interests in private investment partnerships in New York operated by Vestar Capital Partners,” says an April 20, 2011 letter signed by Scott’s attorneys Richard E. Coates, of Tallahassee, and James T. Fuller of Washington’s Williams & Connolly. “Governor Scott owns a 1% or less limited partnership interest in one investment fund, Vestar Capital Partners V, that has approximately $43 million in equity capital.

“Among its other investments, in 2008 this investment fund acquired a controlling interest in Radiation Therapy Services Inc. The stock of this corporation is owned by the investment fund. This corporation, based in Fort Myers, Florida, operates more than 90 radiation therapy centers in over 15 states, including Florida, under the name 21st Century Oncology,” the letter says.

Radiation Therapy Services changed its name to 21st Century Oncology in 2013.

On July 1, 2011, less than three months after his lawyers wrote to the ethics commission, Gov. Scott reported on his financial disclosure form that his assets included a $210,000 investment in Vestar Executives V, LP. The governor didn’t publicly disclose his financial assets again for nearly four years until he decided to terminate his blind trust in order to qualify to run for a second term. He disclosed, then immediately placed his assets into a new blind trust that by law affords him immunity from prohibited conflicts of interest.

That financial disclosure form, filed in June 2014, revealed that Scott continued to own about $210,000 worth of Vestar Executives V, one of a number of interconnected Vestar Capital Partners V funds.

Both Vestar Capital Partners V and Vestar Executives V are organized in the Cayman Islands, according to paperwork filed with the SEC.

Broward Health’s board approved its 2012 deal with 21st Century Oncology with only then-Commissioner Clarence McKee dissenting.

McKee “questioned why it did not go out for bid,” the minutes say. “Also, assuming that everything else goes well and Broward Health does not terminate 21st Century within the 10-year period, Commissioner McKee said that 21st Century would be getting a 25-year contract. He felt that the contract is too long and it should have gone out for bid.”

Then-CEO Frank Nask replied, “There was no requirement to do the RFP (request for proposals),” the minutes say.

In its annual report filed with the SEC last March, 21st Century Oncology described itself as “the largest integrated network of cancer treatment centers and affiliated physicians in the world.” It has grown by gobbling up a number of other treatment providers, including last summer’s buyout of South Florida Radiation Oncology and its network of treatment centers stretching from Miami-Dade to Vero Beach.

21st Century Oncology’s huge debt

To do that, however, 21st Century Oncology took on $1 billion in debt through the end of September, and continues to suffer from hundreds of millions of dollars in operating losses.

21st Century Oncology’s problems intensified in December with a U.S. Justice Department announcement that it had agreed to pay $19.75 million to settle whistleblower allegations that it had violated the False Claims Act by billing Medicare and Tricare, the U.S. military health care program, for laboratory tests that were not medically necessary.

Benjamin C. Mizer, the head of the Justice Department’s civil division, said the settlement demonstrated the government’s commitment to oppose “unscrupulous providers” of healthcare services.

21st Century Oncology’s problems have continued in 2016. In January the company announced, without explanation, that it was withdrawing an initial public stock offering that it had hoped would raise about $100 million to pay off debt.

Today, 21st Century Oncology is again in the spotlight due to Gov. Scott’s indirect investment and its extraordinarily long, no-bid contract with Broward Health. Yet the public hospital system has refused to make public a copy of that contract, citing an exemption in Florida’s public records law that protects some hospital records from competitors.

Miami attorney Thomas Julin represents the Florida Bulldog. He disagrees with the district’s decision.

“The Legislature gave public hospitals a limited amount of secrecy for small contracts that their governing boards are not required to approve,” Julin said. “Contracts that must go before the board, the big ones, must be made public a month before the vote takes place.

“The public owns these hospitals and is entitled to know how they spend the public’s money,” he said. “We’re deciding now whether to challenge in court the withholding of these records.”

Fort Lauderdale federal grand jury subpoenas Broward Health’s purchasing records

By Dan Christensen and Buddy Nevins, gjpic

A Fort Lauderdale federal grand jury has slapped a subpoena on Broward Health, demanding records related to an ongoing FBI investigation focused on its purchasing practices, two knowledgeable sources have told

The subpoena, served earlier this month, is said to seek information about former hospital district procurement officer Brian Bravo and 16 companies that do business with Broward Health. They include MedAssets, a Georgia-based group purchasing organization for the Broward system and other hospitals (NASDAQ: MDAS) with a market capitalization of $1.87 billion.

The subpoena seeks those records going back 10 years. The name of veteran Assistant U.S. Attorney Neil Karadbil is on the subpoena.

“I’m told the (administrative) staff is on shutdown, spending hours finding all these documents,” one source said.

Broward Health’s attorneys declined to release a copy of the federal grand jury subpoena, saying it is exempt from disclosure under Florida’s public records law.

Fort Lauderdale Assistant U.S. Attorney Neil Karadbil

Fort Lauderdale Assistant U.S. Attorney Neil Karadbil

Commissioner Joel Gustafson, asked if he was aware of the grand jury’s subpoena, said, “I don’t know if I’m allowed to answer that question. We’ve been admonished not to talk about any alleged investigation. If I find that I can, I’ll call you back.”

At the same time, has learned that top Broward Health staff – chief executive Kevin Fusco, general counsel Lynn Barrett and security director and ethics officer Carlos Perez-Irizarry – have phoned board members to privately update them on the status of the criminal investigation. The move avoided a public discussion of those details.

Commissioners were told that district administrators, criticized in Miami-based investigator Wayne Black’s email for having blocked the FBI’s investigation, are cooperating and turning over requested records, although no time frame for compliance was given. They were also told that general counsel Barrett has waived a claim of privilege to certain documents, facilitating their production.

One of the items turned over: Bravo’s laptop.

The decision by Fusco and the others to brief commissioners individually, thus possibly outside the Sunshine Law, is problematic.

Sunshine law

Florida’s Government-in-the-Sunshine Manual, compiled by the attorney general’s office, cites a 1979 appeals court ruling that held a series of private meetings between a school board superintendent and individual members of the school board were subject to the Sunshine Law.

“While normally meetings between the school superintendent and an individual school board member would not be subject (to the Sunshine Law), these meetings were held in ‘rapid-fire succession’ in order to avoid a public airing of a controversial redistricting problem,” the manual says.

Joe Jacquot, a lawyer with the Foley Lardner law firm that represents Broward Health, said private updates for commissioners don’t violate the Sunshine Law. “As you say, staff appears to be updating individual board members in the normal course,” said Jacquot.

Broward Health officials have said Bravo was fired in December. On Sunday, hospital district board chairman David Di Pietro told This Week In South Florida that Bravo received an “unbelievable” severance package while he was under investigation by the FBI. The deal included a $17,000 payout for personal leave time, plus Bravo remains on Broward Health’s payroll until June.

Black, the private investigator hired last year to look into corruption allegations at Broward Health, told commissioners in a recent email that Bravo “was bragging about getting $75,000 BH (Broward Health) to pay his criminal defense attorney.”

Bravo did not respond to detailed requests for comment. Joel Hackney, chief executive officer of MedAssets, also did not respond to a detailed voicemail requesting comment.

Broward Health spends tens of millions of dollars on medical supplies every year. The district hired MedAssets in December 2007 in an effort to reduce the cost of supplies.

An undated company press release quotes Bravo: “MedAssets has been very effective in working with our leadership team, departments and physicians to review utilization and to implement strategies to reduce physician preference item supply costs while maintaining the quality of patient care.”

Supply costs can represent as much as 31 percent of a hospital’s cost per case, according to a 2006 academic study cited by the Milbank Quarterly, a healthcare journal.

“Gaining control of the hospital’s supply chain – the flow of products and associated services to meet the needs of the hospital and those who serve patients – presents special challenges,” the journal reported. “This is because the most expensive materials – up to 61 percent of the total supply expenditures – are for items about which physicians have a strong preference.”

Broward Health’s $71.4 million, no-bid advertising deal with Zimmerman delayed by suicide

By Buddy Nevins and Dan Christensen, 

Jordan Zimmerman, left, advertising firm founder and Dr. Nabil El Sanadi, late chief executive of Broward Health

Jordan Zimmerman, left, advertising firm founder and Dr. Nabil El Sanadi, late chief executive of Broward Health

Broward Health’s plan to award a no-bid advertising contract worth as much as $71.4 million over six years to a politically connected advertising firm was interrupted last month after hospital district chief executive Dr. Nabil El Sanadi killed himself.

The deal, negotiated in secret by El Sanadi and Broward Health’s board of commissioners without considering any firm but one run by a major Republican fundraiser, is so large that records say other planned projects might have to be delayed.

The records also show that El Sanadi pushed the deal despite a warning in December from Broward Health’s chief financial officer, Robert K. Martin, that the proposed agreement with Fort Lauderdale’s Zimmerman Advertising was based on phony statistics.

Within weeks of his warning, however, Martin was out of the job he’d held since 2010. A knowledgeable source told that Martin was fired because El Sanadi lost confidence in him, and that Martin was given a separation agreement with a substantial payout and a requirement that he keep his mouth shut.

Martin’s sudden departure caught some Broward Health commissioners off guard.

“It was very quick. I thought he was doing a good job,” said Joel Gustafson, one of seven commissioners appointed by Republican Gov. Rick Scott to oversee the public health system.

Broward Health interim chief executive Kevin Fusco declined to be interviewed about Martin’s departure following last week’s board meeting. He also did not respond to written questions sent to him via a spokeswoman on Thursday. Likewise, Broward Health’s lawyers did not respond to a Feb. 4 public records request for a copy of Martin’s separation agreement.

Interim Broward Health CEO Kevin Fusco, left, and former chief financial officer Robert K. Martin

Interim Broward Health CEO Kevin Fusco, left, and former chief financial officer Robert K. Martin

Martin could not be reached for comment.

The proposed Zimmerman contract is for the production and placement of Broward Health ads and promotions at an annual cost not to exceed $10 million for three years, with annual renewals for up to three more years. In addition, taxpayer-supported Broward Health would pay Zimmerman an annual agency retainer fee of $1.9 million, to be adjusted based on volume growth results.

The goal: “increasing in-patient and out-patient volume,” the minutes from the December board meeting say. The proposed contract itself, as well as details of the advertising plan, has not been made public.

In December, the commission approved spending an initial $5 million with Zimmerman from December thru next July, but the rest of the deal was postponed.

Commissioners were to vote Jan. 27 on authorizing El Sanadi to sign the full contract, but the vote was canceled after El Sanadi’s suicide four days earlier.

Contract on hold

Now the matter has been put on hold until a permanent new chief executive can be chosen, said board chairman David Di Pietro.

“I do support this. I think we have horrible branding issues. We need image control,” said Di Pietro. “What has gotten lost in all this is what is actually being done at our medical facilities.”

Zimmerman Advertising is a nationally known firm that’s part of Omnicon Group. Martin’s warning that the proposed contract with Zimmerman was badly flawed came at Broward Health’s regular board meeting Dec. 16 – the first time the matter surfaced publicly following months of private board planning meetings.

Zimmerman Advertising's Fort Lauderdale headquarters

Zimmerman Advertising’s Fort Lauderdale headquarters

According to minutes of that meeting, Zimmerman previously pitched the advertising campaign based on substantial projected benefits that Broward Health Chief Financial Officer Martin said relied on erroneous figures.

Sources said company founder Jordan Zimmerman made the presentation at the “shade” meeting the public was not allowed to attend. Accompanying Zimmerman at that time was Broward County Commissioner Chip LaMarca, a Zimmerman employee and former chair of the Republican Party of Broward County.

The minutes say Broward Health’s leadership agreed to the multi-million-dollar deal “based on a presentation by Zimmerman showing an ROI [return on investment] of 290 percent or an expected contribution margin of approximately $58 million by the end of year three for a $30 million spend.”

Martin, however, told commissioners that Zimmerman’s numbers were based on “hitting 74 percent occupancy level with no reasoning behind it just because that was the national occupancy level for hospitals with greater than 500 beds.”

While Zimmerman estimated its multi-million-dollar ad campaign would generate revenue as much as $4 for every dollar spent, Martin said the real figure was a loss of 10 cents on a dollar spent.

Martin explained that Zimmerman’s calculations were based on a profit of $800 per patient night instead of Broward Health’s actual profit of $400 per patient night. Likewise, Zimmerman used 1,750 Broward Health beds to calculate the 74 percent occupancy, but Broward Health actually operates 1,360 beds, Martin said. 

Using Broward Health’s actual figures lowers the projected return on investment “from 290 percent to seven percent,” Martin said. “After factoring in the $1.9 million annual retainer fee, the actual ROI for BH (Broward Health) is a negative 10 percent after spending $35 million.”

‘A fiduciary responsibility’

“Mr. Martin informed the board that he has a fiduciary responsibility and with that responsibility he must remind the board that at the strategic planning meeting it was agreed to spend the $10 million based on a 290 percent return which is not possible,” the minutes say.

“Given that BH is already $12.5 million behind budget for the year, Mr. Martin feels that for the board to spend (millions) without knowing what the expectations are and not to be able to hold Zimmerman to some benchmarks without knowing what BH is paying for, is something the board should not be doing,” the minutes say.

El Sanadi and a majority of the board shrugged off Martin’s concerns.

“It is critical and essential for Broward Health not to miss the opportunity to get its services out to the community as the (winter tourist) season begins,” El Sanadi said, according to the minutes.

The board voted 5-2 to spend $5 million with Zimmerman between Dec. 16 and July 1. A broader formal contract, to include a method of determining whether the advertising was working, would be hammered out later.

Voting no were Commissioners Gustafson and Sheela VanHoose. Gustafson called the Zimmerman deal “very expensive advertising” and said the cost was so high the board should spend more time debating it. VanHoose said, “There is no contract and that is a problem.”

Beset by competition from private and other public hospital systems, Broward Health has been struggling for years to fill its beds with patients paying for elective surgery.

El Sanadi, named CEO in December 2014, hired Zimmerman to provide marketing services for Broward Health in April 2015.

Former Florida Sen. George Lemieux introduced Jordan Zimmerman and Broward Health CEO Dr. Nabil El Sanadi

Former Florida Sen. George Lemieux introduced Jordan Zimmerman and Broward Health CEO Dr. Nabil El Sanadi

“Nabil contacted me on the recommendation of (one-time Republican U.S. Sen.) George LeMieux in November 2014. He believed Broward Health wasn’t performing like it should,” firm owner Jordan Zimmerman said in an interview last week. The contract was for $2 million, he said.

Broward Health Commissioner Gustafson remembered things differently. “I don’t recall us having a discussion of how we should promote our business … I believe Zimmerman brought the idea to us.  I believe he met with every commissioner,” Gustafson said.

There is no record of Zimmerman’s lobbying. State hospital districts are not required to register lobbyists.

A generous political donor

At the December meeting, Martin told commissioners he also was concerned at Zimmerman Advertising’s “lack of experience at the hospital level.” Still, Broward Health’s Republican commissioners knew Jordan Zimmerman as a generous political contributor to Republican causes.

Zimmerman and his wife, Denise, served on Republican presidential nominee Mitt Romney’s Florida finance committee. In October 2012, the couple and other GOP heavyweights hosted a $25,000-a-plate dinner for Romney in Boca Raton.

Last July, Zimmerman co-hosted a $10,800–a-ticket lunch reception for former Gov. Jeb Bush’s presidential bid.

In June, Gov. Scott reappointed Zimmerman, 59, to a four-year term on the board of trustees of his alma mater, the University of South Florida. Zimmerman donated a record $10 million to the school last March. The university later renamed its mass communications school the Zimmerman School of Advertising and Mass Communications.

With El Sanadi’s help, the idea of hiring Zimmerman’s ad firm got quick traction at Broward Health. Secret commission meetings to discuss the advertising proposal were held under a state exemption to the Sunshine Law that permits public hospitals to hold closed-door meetings for “strategic planning.”

Some details, however, emerged in December. The proposal cost so much that other planned projects would have to be delayed until the 2016-2017 fiscal year, according to interviews and Broward Health documents. Still, despite the multi-million-dollar size of the proposal, only Zimmerman Advertising was considered for the job.

Broward Health Chief Information Officer Doris Peek was assigned to privately negotiate a deal with Zimmerman. Peek conceded at the December commission meeting that “marketing is not her specialty” and she depended on Zimmerman Advertising “to use their expertise how best to spend the money.”

Peek is quoted in the minutes as telling commissioners, “The numbers being used were generated by Zimmerman.”

Zimmerman’s research found that Broward Health badly needed to step up its advertising.  According to the firm, Broward Health’s “brand awareness” in the tri-county area was 4 percent, while competitors had 96 percent “more exposure.”

El Sanadi told the board he’d “spent a lot of time with Zimmerman” and hoped the deal would begin in January.

Zimmerman said in an interview that his talks with El Sanadi about the competitive problems that Broward Health was facing convinced him to take on the advertising job.

“Even though it was a small contract, I thought this was valuable to do. “I’ve lived here 40 years. I felt an obligation to do something to help Broward Health to become top of mind. We have to build the brand so that it becomes a destination.”

Broward Health halts public meeting on alleged interference with FBI probe

By Buddy Nevins and Dan Christensen, bh

A   public meeting called to discuss whether the North Broward Hospital District’s top lawyer deliberately obstructed an FBI investigation was shut down shortly after it began Wednesday on her advice.

The allegations against general counsel Lynn Barrett will now be discussed in the future behind closed doors. The move to hold the meeting in private was made over the vigorous objections of two North Broward commissioners and the Sun-Sentinel.

“I totally disagree that we can go into the shade for something like this.  I don’t think its good public policy,” said Commissioner Chair David Di Pietro, an attorney.

Sun-Sentinel Editorial Board Editor Rosemary O’Hara told the commission that she had consulted with the newspaper’s attorney and was told that a private meeting on the allegations is “not allowed under the law.”

Most government meetings in Florida must be held in public under the state Sunshine Law.

Barrett ruled that the meeting could be held in private because it involved possible legal action as a result of the investigation.  The Sunshine Law has an exception for discussions of pending litigation.

The vote of the North Board commission was 5-2 to close the meeting. Voting to hold the meeting outside public view were Commissioners Joel K. Gustafson, Rocky Rodriguez, Maureen Canada, Sheela VanHoose and Christopher T. Ure, who attended via telephone. Chairman Di Pietro and Commissioner Darryl L. Wright voted to keep the meeting in the Sunshine.

Commissioners are appointed by Gov. Rick Scott to oversee the $1.2 billion public health system that includes four hospitals and numerous clinics.

The decision was made after an hour-long debate on whether the discussion of Barrett’s alleged actions would jeopardize an ongoing FBI investigation.

Law enforcement says don’t talk

Broward Health security director and ethics officer Carlos Perez-Irizarry, a former federal prosecutor, told commissioners that unspecified law enforcement officials have asked Broward Health not to discuss the probe.

“We have been asked not to disclose the extent and content of what we’ve been asked to do,” Perez-Irizzary said.

The allegations against Barrett came from noted Miami investigator Wayne Black, who was hired by the late North Broward chief executive Nabil El-Sanadi to uncover corruption at the health care system.

In an e-mail sent to the Commission last week, Black accused Barrett of hindering the FBI investigation by refusing to turn over evidence, including the laptop computer of a Broward Health executive under suspicion of wrongdoing. Broward Health is the district’s brand name.

Barrett didn’t talk about the accusations against her. “So how does one respond to allegations when one can’t confirm” to others that there is an FBI investigation, she said.

Instead, she told the commissioners that the meeting should take place with the public excluded so that any investigation not be jeopardized.

Di Pietro, a lawyer who was once a state prosecutor, clearly was upset with Barrett’s advice, which served to keep the discussion about her conduct private.  He said holding the meeting out of the Sunshine was “inappropriate” for a public agency and added, “I don’t want my name attached to it.”

Still, neither Di Pietro nor any other commissioner suggested it was a conflict of interest to close the meeting on the advice of Barrett, whose actions would be a subject of that same meeting.

At one point Di Pietro and lawyer Barrett got into a heated exchange, with Di Pietro insisting that he was never notified by Broward Health’s administration that the investigation was taking place.

“Show me on document, one piece of paper” that would show he was notified, he asked Barrett. She replied that he had heard about it in a discussion in a parking lot.

No date was set for the private board meeting to discuss the investigation.


Broward Health rattled by corruption probes, may seek a new way to govern itself

By Dan Christensen and Buddy Nevins, 

Fort Lauderdale's Broward Health Medical Center, flagship of the North Broward Hospital District.

Fort Lauderdale’s Broward Health Medical Center, flagship of the North Broward Hospital District.

“What a colossal mess!”

That’s the opening salvo from the Miami-Dade County Grand Jury’s August 2010 report on ailing Jackson Memorial Hospital.

The same could be said today of Broward Health.

Six years ago Jackson was plagued by financial mismanagement and deficits so large that it teetered near bankruptcy. Tax-assisted Broward Health’s problem isn’t a lack of money; it has more than $700 million in reserves. Broward Health’s problem is corruption.

Broward Health was rattled by last week’s news of investigations by both the FBI and the state chief inspector general. And while North Broward’s public hospital network has never faced a state or county grand jury’s scrutiny, some at the district and elsewhere are wondering whether it is time to find a better way for the $1.8-billion enterprise to govern itself, free of political influence and control.

Broward State Attorney Michael Satz has the authority to empanel a grand jury to look at how Broward Health could be reformed to operate more efficiently. On Tuesday he said the situation is not at the point where he would consider convening a grand jury, adding that he doesn’t want to duplicate or get in the way of an ongoing federal investigation.

“Sometimes it is an easy decision. With the pill mills (grand jury in 2009) it was easy. It was a problem that everybody was talking about. It was something that needed to be addressed,” Satz said. “The Feds and the Justice Department is all over there. They have been there a while. We don’t want to get in the way of the Feds.”

Broward Health is the brand name of the North Broward Hospital District, an independent special taxing district that operates under a state charter dating to the 1940s. The governor appoints the district’s seven volunteer commissioners to four-year terms. Last year the district collected about $140 million in property taxes.

The district, which operates four hospitals and dozens of clinics and outpatient centers, has long been plagued by periodic questions of mismanagement, cronyism and theft.

When Hamilton Forman was in charge

From the 1970s to today, the North Broward system has grappled with scandal. Powerbroker Hamilton Forman, who controlled the district for three decades through his position on the governing board of commissioners, was accused of building a political machine from the political contributions of physicians and vendors at the hospitals. Contracts were alleged to be handed out only to political supporters of whatever governor was in power.

In the 1980s, a $7-million nonprofit fund-raising arm of the district only brought in 100 new paying patients and lost money on much of its ventures, such as a new office building near Imperial Point.

In 1990, Forman left the hospital commission.  The controversial didn’t end.

A public clinic paid for with tax dollars was opened in 1997 behind the walls at the gated Century Village of Deerfield Beach because one of the district’s commissioners lived there. It ended up a losing proposition, and the district was stuck with a $500,000 loan to pay off.

In 2002, the district’s chief financial officer was jailed for embezzlement. Meanwhile, the hospital district was accused of a pattern of overpaying for physician practices and wasting tax money on non-health care related expenses. It spent lavishly on parties and gifts, such as roughly $32,000 in one year on flowers and $304,000 on taxis. It gave $28,000 to charter schools, including one owned by Forman.

The North Broward Hospital District also spent big on construction, like a $100-million-plus renovation of Broward General Medical Center that included a splashy, new multi-story-high new entrance. By 2003, a federal Grand Jury was investigating whether favored developers got illegal advanced word on where the district was going to build a $170-million office building. No one was indicted, and the building plans were put on hold for  years.

Broward Health’s scandals were supersized in September with the announcement that it had agreed to pay $69.5 million to settle a federal whistleblower lawsuit alleging it was part of a sprawling Medicare and Medicaid fraud scheme with doctors that went for more than a decade.

The settlement also imposed new duties on both commissioners and staff to monitor, report and certify that its financial arrangements with physicians and vendors meet federal requirements. Likewise, it required the establishment of a new Code of Ethics and new ethics training for board members, administrators and doctors.

“This is just a resolution of something that’s been on the table for the last four or five years and goes back as far as 2001,” Dr. Nabil El Sanadi, Broward Health’s chief executive, said at the time. “It’s always good to get things like this over with.”

Yet even as El Sanadi spoke, more scandal was bubbling beneath the surface at Broward Health.

Fate steps in

Fate stepped in last month when El Sanadi, cast 14 months ago to lead Broward Health’s turnaround, killed himself for reasons that remain unclear. The day of his funeral Florida’s Chief Inspector General Melinda M. Miguel, informed Broward Health her office would review every contract the district has awarded since July 2012. She cited unspecified “allegations.”

Bad turned to worse last week with confirmation that the FBI is investigating allegations of corruption in Broward Health’s purchasing department. The story exploded with additional allegations by a private investigator hired by El Sanadi to look into corruption that Broward Health general counsel Lynn Barrett had withheld evidence from the FBI.

The resulting turmoil at Broward Health has raised core questions about the district’s culture and how it governs itself. In the case of Jackson Memorial, the grand jury publicly addressed those questions.

The grand jury’s focus was evident in the title of its report: “Designed to Fail: A Redesign to Succeed.”

The grand jury took testimony about an array of operational problems at Jackson and concluded “sweeping change in all areas is needed” to protect what it called “our sainted jewel of an institution that we all rely on.”

The Public Health Trust runs Jackson Memorial Hospital and the Jackson Health System. The trust is an ostensibly independent governing body, but it is largely controlled by the Miami-Dade County Commission.

The grand jury found that the Public Health Trust, the county commission and county administrators had failed to properly oversee the Jackson Health System and that “the governance system must be changed.”

But grand juries merely recommend, and the suggested changes didn’t happen. Instead, Jackson Memorial experienced a financial turnaround under new management. Miami-Dade County continued its control, and the Public Health Trust shrank its board of trustees from 17 members to seven.

Jackson grand jury threw a spotlight

Still, the grand jury’s examination was useful.

Most importantly perhaps, it threw a spotlight on Jackson and made the case for needed structural change in a time of crisis.

It called for the appointment of a group of local experts in hospital finance, management and governance to study and recommend the best governance system for Jackson Memorial. In May 2011 a task force report of 41 Miami-Dade executives recommended that Jackson be converted to a nonprofit run by a small, independent board separated as much as possible from county politics, the Miami Herald reported.

The story by reporter John Dorschner said the group had noted that 90 percent of American public hospitals “have restructured their governance to be insulated from political pressure.”

Two examples were Tampa General and Atlanta’s Grady Health Systems, “both of which have nonprofit companies operating facilities that remain owned by local governments, with oversight groups making certain that the poor are well served and the tax dollars are spent appropriately,” the story said.

Again it didn’t happen. Entrenched county interests prevailed, just as they had in 2009 when Miami-Dade commissioners rejected a proposal to ask voters to approve a different system of government for Jackson that would have granted it greater autonomy.

As an independent special taxing district run by seven commissioners appointed by the governor and established under state law, Broward Health doesn’t face such control issues from Broward County. The county pays the district about $10 million annually to help provide for indigent care.

Despite its contribution, county government has no say on how Broward Health will be governed in the future.  That can only be decided by the Legislature, perhaps with a nudge from a Grand Jury.

Jack Nicklaus in hot water with Justice Department over filled wetlands at golf club

By Francisco Alvarado, 

The Bear's Club, co-developed by golf legend Jack Nicklaus.

The Bear’s Club, co-developed by golf legend Jack Nicklaus.

Golf legend Jack Nicklaus is in legal hot water with the U.S. Department of Justice over construction work his companies performed on environmentally protected wetlands at The Bear’s Club, a 369-acre private golf course community in Jupiter which the six-time Masters champion co-developed in 1999.

In a federal lawsuit filed to little notice in October, government attorneys allege four Nicklaus-owned entities filled close to an acre of wetlands in 2010 without permission from the U.S. Army Corps of Engineers in order to relocate a tee box, improve golfing conditions on the club’s 15th hole and make room for the development of five residential lots.

The lawsuit claims The Bear’s Club developers ignored the Corps’ denial to modify the original building permit, which included an easement agreement to set aside several acres as protected wetlands.

The Corps found out The Bear’s Club had filled the wetlands from the South Florida Water Management District on Oct. 27, 2010, the complaint states.

Federal prosecutors contend The Bear’s Club and its owners had “economic motive for seeking the modification.” The initiation fee for a golf membership at The Bear’s Club is $90,000 and the annual fee is $25,000, according to the complaint, which also named Nicklaus’ development partner Clarendon Properties Group and its owners, Ivan Charles Frederickson and Robert Whitley.

The government has asked the court to order the defendants to undertake, at their own expense and at the direction of the Army Corps, measures to mitigate the damages caused by their violations of the permit and the Clean Water Act.

Wyn Hornbuckle, a Justice spokesman, said the department doesn’t comment on pending litigation. Eugene Stearns, the Miami attorney for The Bear’s Club and its partners, said his clients deny the allegations.

Lawsuit ‘Puzzling’

“The lawsuit is puzzling for a number of reasons,” Stearns told “We believe it is a tempest in a teapot. We don’t believe we violated the agreement with the Corps.”

Last month Stearns filed a motion to dismiss the government’s complaint, alleging the Corps doesn’t have jurisdiction over the wetlands in dispute.

“The easement expressly provides that it can be altered or amended,” Stearns’ motion states. “It also expressly provides that the state and only the state and the South Florida Water Management District possesses the power to grant amendments. The appropriate state agency authorized the very work the Corps alleges was unlawfully undertaken.”

Nicklaus’ attorney also disputed the negative impact of filling the wetlands.

“The tee box required building a pad on a relatively small piece of wetlands,” Stearns said in an interview. “The change near the 15th hole was a result of people hitting balls into area that would get really muddy when it rained. If you go out there, you’ll see the wetland area is still very beautiful.”

In a response to Stearns’ motion, Justice Department lawyer Andrew James Doyle asserts the Corps does have jurisdiction over the wetlands under the Clean Water Act. The Bear’s Club violated the easement agreement by filling wetlands that were “not to be disturbed by any dredging, filling, land clearing, agricultural activities, or any other construction whatsoever,” Doyle wrote.

He added that wetlands “were to be preserved in perpetuity as a purely natural area.”

“Defendants filled the wetlands for the purpose of making the golf course easily playable for weaker players,” Doyle wrote.

FBI corruption probe at Broward Health allegedly blocked by hospital district’s lawyer

By Dan Christensen and Buddy Nevins, elsanadimemorial1

Broward’s Health’s general counsel failed to cooperate with the FBI, withheld evidence and protected an executive accused of attempting to rape several employees, according to an explosive e-mail sent last week by a private investigator hired by the late Dr. Nabil El Sanadi to look into alleged corruption at the public hospital system.

The email, obtained by, is from Wayne Black, a noted Miami-based investigator, and was received at Broward Health’s headquarters on Friday, just hours after El Sanadi’s memorial service. El Sanadi had been president and chief executive of taxpayer-supported Broward Health for 14 months.

Black’s email blasted Broward Health General Counsel Lynn Barrett.

“I can no longer sit quietly while needed evidence and information is being withheld from the corruption squad at the FBI,” Black told Barrett.

Black wrote that Barrett had shut him out of “various investigations” and accused her of wrongfully asserting a claim of legal privilege to block law-enforcement access to a laptop used by a suspect executive.

“I was complaining in writing that it may appear you were potentially obstructing justice and that the FBI needed to image and take a look at the suspect’s hard drive, owned by BH (Broward Health),” he said. “I understand that even today, the FBI does not have access to that laptop. This is outrageous and the public deserves better.”

Broward Health general counsel Lynn Barrett at last weeks' board meeting

Broward Health general counsel Lynn Barrett at last weeks’ board meeting

“I also hope that after all these months, that executive’s laptop didn’t get ‘lost’ or damaged or wiped. You know very well that there is no possible attorney/client privileged information on the laptop,” Black said. “Even if there was a privilege, the DOJ/FBI has experienced taint teams to deal with any issues.”

Barrett did not respond to requests for comment by phone and email. Black declined comment because the matter is pending.

Black’s scathing email was sent to Barrett, with copies to members of Broward Health’s board of commissioners. The day it arrived, Florida’s chief inspector general also informed Broward Health that she has opened an inquiry into millions of dollars in contracts that the hospital district has awarded since July 2012.

Special meeting expected next week

Broward Health’s board is expected to hold a special meeting next week to discuss the inspector general’s investigation. No date has been set.

Black’s email explains that El Sanadi hired him in April 2015 at the direction of board chairman David Di Pietro to investigate “information and allegations of corruption at Broward Health” given to him by El Sanadi.

“I discovered the irregularities in the security RFP [request for proposals] and Nabil put a hold on the RFP process at my request. There was obvious corruption and the matter is still not resolved to this day. I later developed witnesses regarding kickbacks and other crimes and immediately referred the matter to the FBI corruption squad,” Black wrote. “We (myself and FBI agents) promised witnesses that they would not be known unless they testified. We kept that promise and will continue to do so.”

El Sanadi was informed and told Black to keep working.

“Nabil and I met several times at his home or at a local restaurant to discuss my findings as he felt his office was bugged. We used Nabil’s wife’s email to communicate most of the time because we didn’t know who would have access to sensitive emails,” Black said.

Black’s frustrations with Barrett, who was hired last summer, began shortly after her arrival when “one of your outside attorneys demanded that I turn over the names of FBI witnesses in the ongoing federal investigation. I refused, of course.”

Miami investigator Wayne Black

Miami investigator Wayne Black

The two “bumped heads” again later, Black wrote. “You had no experience with evidence handling in ongoing criminal investigations and I wrote you about that several times. Rather than turning over potential evidence to me for the FBI, your outside law firm, under some privilege argument, made copies and did their ‘privilege research,’ which I am sure, resulted in huge billings to the taxpayers of Broward County. I then wrote you that long memo about obstructing justice appearances.”

Black and Ryan Stumphauzer, a former Miami federal prosecutor working with him, asked El Sanadi “to simply make a decision on who was doing the corruption investigation internally … us or you and your Tampa law firm” – identified by Broward Health officials as Foley Lardner. “He told me it was Ryan and me but that never materialized, even after I organized an off-site meeting with Nabil and the FBI.’’

El Sanadi’s change of heart?

The email suggests a possible change of heart by El Sanadi for the corruption investigations he’d initiated.

“What Nabil promised the FBI about evidence turnover at that meeting never happened. For months, I would call Nabil and ask why the FBI still didn’t get the laptop of the suspect – he would say that the attorneys were researching something,” Black wrote.

Black continued, “Recently, much to everyone’s surprise and after the FBI contacted one suspect employee, it was decided that BH would terminate the employee and give him six months severance pay.” Black said a witness who heard about it said, “it must have been hush money.”

The former executive, identified by Broward Health officials as former purchasing boss Brian Bravo, “was bragging about getting $75,000 from BH to pay his criminal defense attorney,” Black wrote to Barrett. “I texted you and you responded you knew nothing about it. This was untrue according to Nabil. I called him immediately thereafter and he told me that you and HR [human resources] had approved the ‘settlement’ and that there was some confidentiality agreement with the former executive, now suspect.”

Black continued, “The same executive (and you were briefed about this) who according to eyewitnesses drugged and attempted to rape several employees, had sex with female employees in his office at BH, took kickbacks from vendors, created companies to sell goods to BH, had relatives working at BH in violation of policy and was generally uncooperative with internal audit in the past. And there is more from witnesses about which you were not briefed. Imagine what our cooperating witnesses must think.”

Bravo could not be reached for comment.

Black indicated that he’s surprised the FBI has yet to serve subpoenas in the case. “If this were Miami and I was still at the Public Corruption Unit and someone dragged their feet for even days, let alone months, turning over critical evidence … I would long ago [have] served a search warrant. I pray that you will take my advice just this once and immediately give that suspect’s laptop” to the FBI.

In wake of El Sanadi suicide, Florida IG probes every Broward Health contract since 2012

By Dan Christensen, 

Dr. Nabil El Sanadi's casket leaves Friday's funeral service at First Baptist church in downtown Fort Lauderdale. Photo: Sun-Sentinel

Dr. Nabil El Sanadi’s casket leaves Friday’s funeral service at First Baptist church in downtown Fort Lauderdale. Photo: Sun-Sentinel

As Gov. Rick Scott and hundreds of others paid their final respects Friday to Dr. Nabil El Sanadi, Broward Health’s late president, Florida’s chief inspector general quietly opened a wide-ranging investigation into how the hospital district hands out millions of dollars in contracts.

“I have received Governor Scott’s full support to conduct a thorough review of every contract North Broward Hospital District/Broward Health has entered into since July 1, 2012 and all correspondence, in any form, related to these contracts,” Chief Inspector General Melinda M. Miguel said in a Jan. 29 letter to district chairman David Di Pietro.

“The purpose of the review is to determine any possible improprieties or inappropriate actions including any violation of law, rule, regulation, charter, bylaws or procedures associated with these contracts,” Miguel wrote.

The letter says the probe of taxpayer-supported Broward Health was begun based on “reported allegations,” but it does not elaborate. Miguel, who reports directly to Gov. Scott, did not respond to a request for comment Monday. also has confirmed the FBI is conducting a separate, though possibly overlapping criminal investigation into allegations of corruption in Broward Health’s purchasing department. Details were not immediately available.

“The FBI does not confirm/deny the existence of an investigation,” said Miami FBI spokesman James Marshall.

State, fed probes are newest blows to Broward Health

News of the state and federal probes are the latest blows to the county’s largest and most troubled safety-net hospital system. Last September, Broward Health paid more than $69.5 million to settle federal whistleblower allegations that for more than a decade its administrators and doctors had conspired in an illegal kickback scheme to defraud Medicare and Medicaid.

El Sanadi’s shocking death – he shot himself in a public restroom at his Lauderdale-by-the-Sea condominium on Jan. 23 – led to an immediate outpouring of affection for a man described as both a compassionate physician and a dedicated leader. Friends and acquaintances, however, have been unable to explain why the Egyptian-born El Sanadi would commit suicide.

Broward Health’s board – appointed by Republican Gov. Scott – hired El Sanadi 14 months ago to replace Frank Nask. El Sanadi had little executive experience, but he and his wife, Lori, were sizable contributors to Scott’s 2014 re-election – giving a total of $16,000 to the governor’s campaign and his Let’s Get to Work political action committee. El Sanadi gave another $36,529 to the Republican Party of Florida Over in 2014.

Dr. Nabil El Sanadi

Dr. Nabil El Sanadi

El Sanadi arrived amid what was then a mostly secret, yet intense whistleblower investigation that had surfaced in May 2011 when U.S. Department of Health and Human Services agents subpoenaed Broward Health records about its contracts with more than two dozen doctors. Broward Health ultimately produced millions of documents.

El Sanadi played a key role in negotiations that led to the settlement. Indeed, at last Wednesday’s board meeting a clearly emotional chairman Di Pietro told the audience that El Sanadi was responsible saving Broward Health millions by relentlessly chipping away at the government’s demands.

Last August, Broward Health’s seven-member board voted unanimously to bring an end to the embarrassing investigation by agreeing to pay the $69.5 million and accept the imposition of tough new ethics rules over five years. The payout was atop another $10.2 million paid to an out-of-state law firm for legal advice about how to deal with the probe.

The settlement was a relief to both the board and El Sanadi.

“This is just a resolution of something that’s been on the table for the last four or give years and goes back as far as 2001. It’s always good to get things like this over with,” El Sanadi told after the deal was made public on Sept. 15.

The inspector general’s letter to Di Pietro notes that state law imposes a duty to cooperate on every state officer and employee, agency and special district – Broward Health is an independent special taxing district that collected $140 million in property taxes in 2015.

Likewise, Broward Health was asked to identify a contact to act as a liaison. Broward Health’s internal auditor is Vinnette Hall.

Broward Health warns doctors: sign new ethics rules or lose privileges to practice

By Dan Christensen, 

Broward Health's urgent website message to doctors and staff over the weekend

Broward Health’s urgent website message to doctors and staff over the weekend

A doctors’ rebellion at Broward Health has prompted a stern warning from the hospital district’s board that their privileges to practice at its hospitals and clinics will be suspended if they don’t agree in writing to new ethics rules.

At its regular meeting on Wednesday, Broward Health board of commissioners unanimously approved sending warning letters to doctors informing them of the consequences of failing to sign. While the letters had not been received as of Saturday, physicians were nevertheless vocal about the matter.

Some doctors refused to comply citing concern that ill-defined paperwork they’re being asked sign undercuts existing administrative safeguards that protect their interests and assure due process in disputes. Many complied reluctantly.

Dr. Louis Yogel, chief of staff at Broward Health Medical Center in Fort Lauderdale, said in an interview that many physicians had expressed “reservations” about the various written certifications required of them, “but for the most part there is an understanding that this has been thrust upon us and we have to do it.”

At Wednesday’s meeting, Yogel told commissioners that a few intransigent doctors might even sue. “The last thing this place needs is lawsuits from doctors,” he said.

By Friday afternoon, however, Yogel said most, if not all, of Broward Health’s doctors had now signed.

Still, urgency about the situation persisted through the weekend on Broward Health’s website where physicians and non-physician practitioners were urged to print out and sign several “Mandatory – OVERDUE” certifications.

Broward Health surgeon Dr. Nicholas Tranakas, left, and Broward Health Medical Center Dr. Louis Yogel

Broward Health surgeon Dr. Nicholas Tranakas, left, and Broward Health Medical Center Dr. Louis Yogel

One doctor holdout who capitulated Friday is Dr. Nicholas Tranakas, Broward Health’s medical director for cancer services. He said his concerns remain, but he decided to sign the necessary certifications out of concern for his patients.

“I had to put my patients in front of my principles at this point,” Tranakas said on Saturday. “This week alone I have four ladies under 35 with diagnoses of breast cancer.” He did not rule out filing suit if Broward Health fails to address his continuing concerns.

In an interview Thursday, Tranakas discussed those concerns.

“I don’t have the exact numbers, but quite a few physicians are taken aback about how this was proposed. The main concern is … the statement that we accept the consequences for not following the policies and procedures. It’s vague,” Tranakas said.


The dispute erupted publicly at last week’s meeting of Broward Health’s board of commissioners – a session focused chiefly on mourning the Jan. 23 death of Broward Health president and CEO Dr. Nabil El Sanadi.

El Sanadi, 60, fatally shot himself in the chest in a lobby-floor bathroom at his Lauderdale-by-the-Sea condominium. Police said El Sanadi left no goodbye note, and bereaved friends and colleagues have been at a loss to explain the suicide of a dedicated physician and leader they said gave no hint of inner turmoil.

In September, El Sanadi helped negotiate a $69.5-million civil settlement of federal whistleblower allegations that for more than a decade Broward Health had participated in an illegal scheme to defraud Medicare and Medicaid by paying illegal kickbacks to doctors who referred patients to its hospitals.

As part of the deal, the U.S. Justice Department also required the North Broward Hospital District – Broward Health’s legal name – to sign a “Corporate Integrity Agreement” that imposed new duties to monitor and disclose the district’s financial arrangements with doctors and vendors, develop a new Code of Conduct and establish ethics training for board members, administrators and doctors.

The agreement requires individuals who attend training to certify in writing that they have done so. As part of the district’s compliance effort, Broward Health’s lawyers drew up several certifications doctors are being requiring to sign.

Dr. Tranakas’s specific problem continues to be a requirement that doctors certify that they are aware that failure to comply with the Code of Conduct or district policies and procedures “may result in a number of consequences including but not limited to termination.”

While Broward Health board chairman David Di Pietro, an attorney, likened signing off on such language to signing off on the conditions for an iTunes download, Tranakas saw it differently.

“The government said you have to educate the entire staff, including physicians, on what policy and conduct should be. I don’t think the government told them what punishment is going to be,” said Tranakas. “My point is who is going to dole out those consequences? There already is a process in place … What you are signing doesn’t give you any indication of what the consequences are and who will enforce them.”

On Saturday, Tranakas said what comes next will “depend on how much the board is willing to work with the medical staff attorney to make this right.”

The medical staff attorney, who represents physicians and others in internal matters, is Fort Lauderdale’s Amy Galloway. She declined to comment.

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