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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Latest comments

  • It seems odd that you are writing about a document the North Broward doctors are being forced to sign without disclosing the document.

  • Is this the same meeting where a now former Sun-Sentinel city editor — from ages ago — threw a Publix pie at another attendee over remarks about the deceased CEO?

  • Signing the documents is required by the DOJ/OIG CIA. Period. End of conversation. Don’t sign, don’t accept legal responsibility for being compliant with law, then get out! Good bye, good riddance! Oh, but after all that whining you don’t want to go? Why is that? How much are you being paid and for what services? Are the fees you are receiving commercially reasonable? And who was the attorney representing these hold-out, whining non-employed physician medical directors or PPUC providers, you know, the latter intended to care for poor? Is there any tie to the one of the King’s men?

  • I think the feds should look very carefully into Yogel’s and Tranakas’s contracts. I’ll bet their lucrative as all heck, perhaps even tangled up in all of this scandal, hence the hold back to sign on the dotted line, knowing if/when they are non-complaint with the law it is off to sing sing for them! Any comments, doctors?

  • Dan, have you checked on the progress of this? Has everyone signed all of the documents as required in the CIA? Months have gone by, and failure to comply will not only result in additional tax payer funded fines, but could also result in a new investigation and fines!

  • Thanks, Dan. No surprises there.

  • Let’s see if I have this correctly. A hospital and its administration, that is under criminal investigation for ethics violations, wants physicians to sign a document stating they will adhere to ethics rules or lose the ability to practice at the hospital? What nonsense! Arrogant organization! What about the patients? Are their interests considered?

  • It’s a requirement of the Feds since Browsrd Health and several of their physicians colluded in exchange of salaries and other financial perks that FAR EXCEDDED fair market value in e change for Medicare and Medicaid insured patient referrals for services that the physicians AND the executives knew were substandard. Additionally, these doctors colluded with the hospital not to refer indigent patients though Broward Health is a safety net system. If you want the sordid details, get a free account on PACER, the U.S. court systems records, and pull the final settlement. After you read it, then tell us all how sorry you feel for these physicians who violated their oath for greed. Tell us how you feel about medical directorships where the doctor thought his gym time was his obligation instead of reviewing and improving patient care. Sorry, no Kleenex for you, Tai, or the disgracefully behaved physicians. And trust me, BH got off easy as did many physicians

  • Wow. I did as qui tam suggested and was blown away! Loved the part about the medical directors being paid for their professional services by going to the gym, by doing their regular work, etc. What a sham, or as the government called it “boondoggling.” Yup, that’s pretty clear. I guess that’s why none of these high class docs have come forward to discuss the matter and explain their part. All I have left to say is beware if your BH doctor is too physically fit! ROFL!!

  • Since BH is on a 5-yr CIA with the DOJ why hasn’t the DOJ revisited BH and reconsidered whether they are complying? I heard rumors of additional fines being for noncompliance with the CIA and that there were many other problems besides the ones the DOJ addressed in the CIA.

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