By Dan Christensen, FloridaBulldog.org
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.
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 DEATH OF DR. EL SANADI
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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