A Freestanding Fight

A hospital exec takes on the health care mafia and an ER deal involving an accused thief and a couple of insiders

The good doctor phoned me a couple of weeks ago after reading a column I wrote about the corrupt depths of a North Broward Hospital District building deal. He says he didn't want his name in print because district leaders would try to destroy him for saying his piece.

"I call the [district] the health care mafia," the doctor says. "It's one scam after another. Everything is a political contribution or a land deal."

Then he advised that I contact a few other physicians, including Dr. Benjamin Barnea, Coral Springs Medical Center's chief of staff. So I did, half expecting Barnea, who routinely reports to the Gov. Jeb Bush- appointed NBHD board, to ignore me. But he called me back. And he spoke. On the record.

"I don't understand how a public, tax-dollar-supported district that generates revenues of $800 million is totally unaccountable to the taxpayers," he says. "It's set up to support nefarious deals. I find this an aberration to the democratic process. It's taxation without representation."

Beautiful to hear: someone in power with some real courage. Check that. Barnea, who oversees the doctors at a 200-bed hospital and has spent 16 years practicing medicine in Broward County, should have some power in the district, but he doesn't. Political and business interests dominate the NBHD at the expense of actual health care. District leaders generally treat doctors as a nuisance. After all, they might let medical concerns or common sense get in the way of the high-stakes Monopoly game.

But Barnea says he's determined to change things, which some might see as a quixotic adventure at best. The district is a mammoth political and business machine, the fourth largest public hospital system in the United States, overseeing four public hospitals, several clinics, and a $720 million budget. Yet, even though it rakes in nearly $160 million in property taxes, it's in such bad financial shape that district officials are afraid it will lose its bond rating. And it's crooked from one end to the other, as was illustrated by the recent federal embezzlement conviction of its former CFO, Patricia Mahaney, and the aforementioned medical office building deal (see "Bad Operation," November 6, and "MOB Rules," November 27).

Though Barnea finds the office-building project to be "amazing," and not in a good way, he's most concerned about another NBHD venture, a freestanding emergency room planned for Sunrise on 14 acres of district-owned land at Pine Island Road and Commercial Boulevard. After commissioners approved the project, NBHD began final negotiations with a group called Strata Medical Services. The group's partners include two former district employees and a fellow who did five years' probation on a grand theft charge, but I'm saving that later in the article.

NBHD intends to sell the land to Strata for $5.5 million. One might question that price, especially since a bidder offered $5.7 million for it back in 2000, before a land boom raised most Broward land prices 50 to 100 percent. But hell, just to keep things moving, let's pretend it's a dandy deal.

After acquiring the land, Strata will build a medical complex that includes the emergency room. The district will pay the company $940,000 annually for the next 25 years to lease the facility. There will be no hospital attached, no intensive care units, no operating room, just a place where relatively minor injuries can be treated.

The district expects to lose money the first couple of years, then make a profit. But NBHD officials contend it won't lose more than a million dollars. If history tells us anything, that couldn't be further from the truth. Just remember Cambridge and Weston, two district clinics that recently lost millions.

But it's not so much the particulars of the deal as the big picture that bothers Barnea. For one thing, there is no real need for a glorified first-aid station in that area, which is serviced by two private hospitals; University Hospital is 2.67 miles away, and the Florida Medical Center, precisely five miles away. These hospitals aren't mentioned in the "justification" section of the district's staff prospectus on the deal that was given to the board in September. Nor is Westside Regional on Broward Boulevard, which also serves parts of Sunrise and is just over five miles from the planned new ER.

Of the expected 5,000 patients taken there each year, 20 percent -- or about 1,000 -- will need to be admitted to an actual hospital, according to the district. Those unfortunates will be sent to Barnea's facility in Coral Springs, which is 6.5 miles away and already burdened with too many patients for too few doctors, the chief of staff says.

"How do you serve citizens by dumping them in an ambulance and sending them to Coral Springs?" Barnea asks. "This project makes no medical sense."

Indeed, the concept itself is so controversial that such facilities are extremely rare. In California, they were outlawed by the legislature.

The district never briefed Barnea -- or any other medical leader -- about the project or its impact on his hospital. He just happened to find out about it at the September 24 board meeting. So he took the podium. "We need to think this through," he told the board. "How is it going to look that we are transporting people with a fleet of ambulances up to Coral Springs -- and bypassing other emergency rooms that are much closer because we wanted to bring them to our sister hospital -- and along the way the patient deteriorates and dies in the ambulance?"

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