Cardiac Cronies

The story of a cash-hemorrhaging public boondoggle begins, appropriately enough, with a massive heart attack. Seven years ago, a man woke up gasping for breath in his Fort Lauderdale mansion in the middle of the night. It was Dave Thomas, founder of the Wendy's hamburger chain. Cardiologist Michael Chizner helped...
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The story of a cash-hemorrhaging public boondoggle begins, appropriately enough, with a massive heart attack. Seven years ago, a man woke up gasping for breath in his Fort Lauderdale mansion in the middle of the night. It was Dave Thomas, founder of the Wendy's hamburger chain.

Cardiologist Michael Chizner helped stabilize the popular pitchman at Broward General Medical Center before Thomas was transported to Miami Beach for surgery. The fast-food mogul believed Chizner's work saved him from death that night in December 1996. They bonded, and a partnership was born.

Chizner and Thomas led an ambitious push by the North Broward Hospital District, which is supported by $174 million in property taxes and runs four public hospitals, to build a top-of-the-line heart care center at Broward General. The place was to be called "The Heart Center of Excellence." At the time, it wasn't meant to be ironic.

The district quickly began pouring money into the project. In 1997, NBHD hired heart surgeon Carl Gill for $1.2 million a year, an unprecedented salary that stunned other Broward physicians. But district officials insisted Gill was worth the money -- which amounts to three times the average heart surgeon's pay, according to a medical trade group. After signing the ten-year, $12 million contract, district CEO Wil Trower told the Miami Herald: "What we needed was that stellar cardiac surgeon to take us to that next level, and we feel Dr. Gill is that person."

A year later, NBHD signed another heart-stopping contract, this one with Chizner, who was awarded a ten-year, $10 million deal. Chizner was supposed to attract not only great heart surgeons to Broward General but also tens of millions of dollars in private donations. The cardiologist quickly signed up more local honchos to the project, including patients like former Marlins' owner John Henry, Wayne Huizenga-protégé and Gov. Jeb Bush-appointed NBHD commissioner Steven Berrard, and downtown developer Terry Stiles.

These men, along with Thomas, served as the anchors of a $50 million private donation drive, and their involvement helped justify the district's decision to undertake a $160 million Broward General expansion that includes a three-story heart center with cardiac intensive care units, labs, and surgical suites. Neither Chizner nor Gill returned repeated calls requesting comments.

In August 2000, the district issued a "Campus Master Plan" with "key assumptions" to further justify the expensive expansion. NBHD officials projected that, by 2002, the district would be doing 26 percent of the county's open-heart surgeries and 27 percent of cardiac catheterizations, common procedures that serve as chief measuring sticks of the heart medicine business.

But all the hype, big names, and rosy projections haven't done the project any good. It has proven to be, like so many district ventures, an abject failure. The numbers have plummeted. In 2000, 381 open-heart surgeries were performed at Broward General, according to Regional Health Planning Council statistics. That represented a sharp decrease from 500 in 1995. By 2002, the number was down all the way to 253 -- nearly a 50 percent drop in seven years. Catheterizations declined from 1,861 in 2000 to 1,196 in 2002, almost a 40 percent plunge.

And what about those projections that Broward General would have 26 and 27 percent of the Broward open-heart and catheterization markets by 2002? Well, the real numbers are 12 and 10 percent, respectively. So a key assumption in building the $160 million expansion is dead wrong. But that project, funded largely by a $100 million public bond issue, is still expected to be up and running in 2005, apparently for the benefit of paper patients.

The steep drop-off in heart business at Broward General represents a loss of tens of millions of dollars in annual revenues to the public health system. And that's not counting the bloated salaries and expenses of Chizner and Gill. In addition to the $2.2 million in pay they receive, the doctors get additional millions of dollars worth of office space, staff, and other perks. During the past five years, the entire expense package for the doctors has surpassed $20 million. And their leadership has been a disaster.

"There are other centers in Broward County which have expertise, volume, and successful outcomes that have earned a reputation as centers of excellence in cardiology," says Dr. Arthur Palamara, a past president of the Florida Board of Medicine. "I'm not aware of Broward General having that kind of reputation. And one reason for that is that other cardiologists feel miffed. The district hasn't done well on its projects and initiatives."

Unless you're in the medical industry or have a cardiac problem, you've probably never even heard about Gill, Chizner, and the Heart Center of Excellence debacle until now. It's just another example of waste, incompetence, and mismanagement on the part of CEO Trower that has slipped under the radar.

How did the district fail so miserably? It's largely the fault of those outrageous contracts, which alienated other surgeons, especially those from the Greater Fort Lauderdale Heart Group, the oldest and, with about 14 physicians, one of the largest bands of heart specialists in the county. For decades, the Greater Fort Lauderdale doctors built the heart program at Broward General. Chizner was a partner in the group until 1998, when he broke away to take his $10 million deal. At the same time, the district severed its indigent care contract with Greater Fort Lauderdale.

The remaining partners understandably viewed this as a betrayal by both Chizner and the district. So they took the bulk of their patients away from Broward General to nondistrict hospitals like Holy Cross and Northridge. Other heart surgeons, angry at the sheer dollar amount of the Chizner and Gill contracts, did the same.

Thus, the ghost town effect.

So why did the district give Chizner such a huge and exclusive contract? He's always courted district commissioners and used his rich and powerful patients like Stiles and Thomas, who died of cancer in 2002, as leverage. (As an example of how close he would become to his favored patients, he made house calls to Thomas and even delivered the Wendy's founder's eulogy.) Commissioner Steven Berrard, another Chizner patient, bears special blame for the fiasco. The more obvious it becomes that the Heart Center of Excellence project is failing, the harder he seems to push for it.

Chizner caters to the country club set, and the 54-year-old cardiologist doesn't seem to have a soft spot for those who can't afford health insurance -- i.e., the ones the public hospital system was formed to assist. In 1999, Trower and district general counsel William Scherer approved an addendum to his contract stipulating that he care only for "non-indigent patients." His hands, apparently, were meant only for captains of industry. At the same time that he's running the heart center into the ground and collecting the huge salary, Chizner has found time to publish a book titled Clinical Cardiology Made Ridiculously Simple. Too bad building a heart center isn't as easy as being a cardiac doctor. The book came out in January and is going for $34.95 a pop.

"They have to get rid of Chizner or the heart center will never succeed," says activist and long-time NBHD critic Jane Kreimer. "He is the key to all of the problems."

Gill, at least, handles some indigent cases. And he has a widespread reputation as a topnotch surgeon. But that doesn't change the undeniable fact that he's ridiculously overpaid. As part of his contract, he's supposed to do a minimum of 250 open-heart surgeries a year. Currently, Medicare and HMOs pay an average rate of about $2,200 apiece for those procedures, according to several heart surgeons. So even if Gill hit his quota, the services would be worth only about $550,000, as opposed to his $1.2 million salary. But numbers provided by the district show that Gill is averaging only about 210 surgeries annually during the past five years -- or 40 surgeries below the minimum.

If that kind of bloated pay sounds familiar, it's because I've already written about two other district contracts that are similarly inflated (see "All the Governor's Men," March 4). In all, the district pays at least $43.8 million a year in physician contracts, many of which seem to involve sweetheart deals. Houston, we have a pattern.

So what about that $50 million that Chizner and NBHD expected to raise from Thomas et al.? That goal, of course, was another huge failure. All those rich guys lent their names and faces to the cause, just not much of their money. According to the district's own numbers, the grand total raised to date is... $2.5 million. That amounts to one-twentieth of the goal -- almost enough to pay for a year's worth of the money wasted on Gill and Chizner.

The failed fundraising effort hasn't stopped the district from throwing away more money on more salaries. NBHD hired Linda Danoff in 2001 to lead the campaign. Danoff is an interesting choice; she's the ex-wife of Burton Danoff, another doctor who has a sweet, taxpayer-paid, $400,000-a-year deal to run the district's Rio Vista clinic in a tony part of Fort Lauderdale. She's also been employed by Linda Gill (no relation), the Republican hotelier and district booster who is a huge supporter of Gov. Bush, the ultimate overlord of NBHD. Lady Danoff is pulling in a cool $125,000 a year.

Which just goes to show that even when the project is losing the public tens of millions of dollars, there's always enough room for another cardiac crony.

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