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Broward Health Commissioner Explains Reasons for Wanting to Terminate Hospital CEO

Later this month, when North Broward Hospital District Commissioner Robert Bernstein makes his case to the board for firing CEO Frank Nask, it'll be based on these grounds:

  • that Nask's lack of hospital operations experience has made him use poor judgment in deciding what district programs should be trimmed and which should be bolstered with new spending.
  • that Nask fostered an environment of secrecy, seeking to keep commissioners in the dark about issues that might cast him or his supporters in an unfavorable light, including two major internal investigations.
Through a hospital district spokesperson, Nask declined to comment for this article. Much more from Bernstein after the jump.

I asked Bernstein why he was bringing this to the board at this particular time. He said:

"As the hospital environment becomes more challenging, we don't have anyone in corporate that has direct experience at the hospital level as a CEO or COO. And the decisions that have been coming out of corporate are the sort of decisions you would expect from a CFO."

Chief financial officer is the position Nask occupied at the district before he was named CEO in early 2008. "Cuts are being made [to the hospital budget] without any idea for how they will affect hospital operation," Bernstein continued, speaking of Nask.

This critique will sound familiar to Nask -- and to anyone who read this Juice post from last month, which detailed some particularly hostile emails Bernstein wrote to Nask a year earlier. It's apparent, then, that Bernstein's frustration with Nask has been brewing for at least that long.

Which leads to questions about why he chose this month to make his move. It comes after one commissioner, Maureen Jaeger, has left the board to take a job in the Washington, D.C., office of Sen. George Lemieux and another commissioner, Rebecca Stoll, has accumulated a long streak of absences. She hasn't attended a board meeting since July. In August, her attorney husband, Steve Stoll, was furious about this Juice post, which contained allegations by a former hospital district lawyer that the Stolls had been using coercion as a way to gain collaborators in their effort to oust then-CEO Alan Levine.

But Bernstein denied that these were factors in his decision. He also said that he has not discussed Nask's performance with Gov. Charlie Crist's office, which appoints the board members, or with LeMieux, who has played a role as kingmaker in the district since Crist was sworn in as governor in 2007.

Bernstein declined to be more specific about exactly what budget cuts by Nask demonstrated the CEO's lack of wisdom for hospital operations. He says he'll wait for the January 27 meeting to get into those details.

Asked to elaborate on his other reason for going after Nask's job, the CEO's supposed secrecy, Bernstein told Juice: "Employees [of the district] have been wanting to pass information to board members, and they haven't been able to do that because they were intimidated by Mr. Nask."

The hospital charter calls for the CEO to be the sole conduit of information between district staff and its governor-appointed board of commissioners. In effect, commissioners have to trust that the CEO is telling them what they need to know in order to make informed decisions at the board level.

For instance, Bernstein says that since late 2007, he was anxious about whether the district's physician contracts and agreements for providing care to uninsured patients posed a problem for the federal Stark Statute and Anti-Kickback Statute. Then-CEO Levine made sure that an internal investigation was launched before he left the district in December of that year, but though the law firm Akerman Senterfitt was paid hundreds of thousands to work in conjunction with an auditing firm, Ernst & Young, to perform the compliance test, it appears that nothing ever came of it. Bernstein said he asked for a report on the investigation's findings on "numerous occasions" but that he never received it. (Juice has a pending records request with the district for the disposition of that investigation.)

"That's a very serious issue," Bernstein said of the fraud and abuse possibilities. "And yet we didn't hear a thing. Everybody knew there was a potential problem, and all the while, the clock was ticking."

Juice reported those fraud and abuse concerns in September. Last month, we reported that the district was in the midst of another fraud and abuse investigation -- with a new batch of attorneys, from Washington, D.C.-based Arent Fox.

The other communication breakdown that infuriated Bernstein was Nask's having failed to tell commissioners what happened in a late April meeting between board Chairman Mike Fernandez and Martin Goldberg, the attorney hired to investigate allegations of ethical misconduct by Commissioner Joseph Cobo.

According to Goldberg's investigative notes, Fernandez was angry about how thoroughly Goldberg was investigating the allegations against Cobo. He allegedly pressured Goldberg to write his report before he had a chance to finish his investigation. That whole sordid tale is here.

"None of the board members were privy to that meeting," says Bernstein. "But the board had authorized the investigation [of Cobo], and only the board had the authority to end the investigation." In Bernstein's opinion, Nask had an obligation to tell the other commissioners that one of them -- Fernandez -- was acting unilaterally. "What else was going on behind our backs?" he asks.

But it's fairly obvious why Nask didn't make that disclosure. Fernandez was one of the votes he needed to keep his employment at the district. And this is a problem -- executive decision-making by vote-counting -- that has plagued the CEO's position in recent years.

If Nask gets his walking papers, how can we guarantee that the next CEO won't be handcuffed in similar fashion? "Anybody in that position will be under that pressure," Bernstein acknowledged. "Which is why you need somebody with strong [hospital] operating experience. They need to tell us what they know as opposed to what they think we want to hear."

Bernstein is friendly with Shane Strum, a businessman with Broward roots who has served as a commissioner in the South Broward Hospital District and who was appointed chief of staff to Gov. Charlie Crist. Would he be a candidate for CEO at Broward Health? "No," said Bernstein. "He already has a job." Albeit a job that's uncertain, considering Crist will be leaving the governor's mansion and faces an uphill battle to recover momentum in his Senate primary race against Marco Rubio.

In the event of Nask's departure, Bernstein says he'd prefer to hire from among the district's existing group of hospital CEOs so that the next chief executive of the district has familiarity with the challenges of hospital operation.

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Thomas Francis

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