The pending changes at the North Broward Hospital District have been advertised as a way to make the hospitals more profitable and adaptable in the era after health-care reform. But a far more recent news event may have played a bigger role in the move: Florida's Republican primary for governor. (This gets a bit complicated, but bear with me.)
Had Bill McCollum won that August 24 primary, McCollum would have been a slight favorite to beat Democratic nominee Alex Sink in November's general election. Being a high-profile, traditional Republican, Gov. McCollum would likely have retained a majority of the seven commissioners who were appointed to the district board by past Republican governors.
But McCollum lost to Rick Scott, an untraditional Republican -- and one who has his own private-sector experience running a hospital.
Scott has no reason to be loyal to commissioners who had been appointed by Charlie Crist. But in a matchup with Sink, polls favor a Democrat victory in November, and Sink would be even less likely to retain Crist appointees at a hospital district with a history of scandal.
Considering that commissioners hire the hospital CEO, you can probably guess who Frank Nask was rooting for? (Hint: There are probably a few McCollum campaign signs in the Nask family garbage bin.)
So it's remarkable that less than three weeks after McCollum's defeat, on September 10, Nask approached the hospital board with a radical idea, one of questionable merit and dubious legality: Let's give the $1 billion taxpayer-supported hospital district's assets to a nonprofit board.
In an email Thursday morning, Nask told me that the topic of "management structure" was first broached at the July 2009 meeting -- and I remember it well. I wrote this blog post the same day.
The minutes from that meeting (see page 5 at this link) show that former Commissioner Robert Bernstein started the conversation, asking about the implications on the district of President Obama's health-care reform package. Nask said little on the subject, except that if coverage became universal, then the district would no longer receive tax dollars. Bernstein suggested a work group to consider transitioning to a new system, but there's no indication in the minutes that Nask expressed interest in the idea, and no motion was made by a commissioner.
Based on his email to me Thursday, Nask seems to be saying that this short conversation in July 2009 put the matter on his radar. But it wasn't till the commissioners' spring 2010 retreat, says Nask in the email, that the board instructed him "to conduct a formal assessment and provide a recommendation to the board."
My request for the audio of that meeting is pending. Considering that board retreats are held outside Broward County, it's an awfully poor setting for legislation that would have such far-ranging impact on the county's health consumers.
If Nask wanted to avoid questions about whether he had ulterior motives in recommending that the district lease its assets to a nonprofit, then he ought to have tried to make his recommendations before the August 24 gubernatorial elections. That way, he could have eased suspicions about whether he was reading the political tea leaves and devising a district plan that would spare him from the unemployment line.
It's still too early to tell exactly how the transition would occur, but it appears likely that the existing, lame-duck commissioners -- who overwhelmingly support Nask's leadership -- would appoint members of the nonprofit board that oversees that management of the district. Those appointees would then control Nask's fate, but considering the appointees' ties to the commissioners, Nask would seem to have excellent prospects for keeping his job. Or at least far, far better prospects than he would if the existing system stayed in place.
The upshot is that local health-care consumers have every reason to feel queasy about this transaction. I've sent another note to Nask to see whether he can offer assurances that his motives are pure. For starters, it seems like a good idea for the district to subject Nask's plan to an independent analysis and see if it passes the smell test.
I'll update when I hear back.
UPDATE: Here's what Nask had to say:
"This issue is not about my job security. It is about what is best for Broward Health going forward. The proposal responds to the issues raised by commissioners about how to best address the healthcare reform in order to put the system in a better position to face future challenges and opportunities, and possibly reduce the tax burden on the community.
The resolution approved by the commissioners allows us to move ahead with studies, consultation with outside experts regarding the ramifications and options for addressing the issues of pensions and malpractice protection, conducting a more detailed assessment of what a transition would entail, and evaluating what type of lease terms would make it viable, among others. This is a complex due diligence process and there is no date certain as to when a final lease agreement will come up for vote, or whether it will even be approved."
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It's comforting to know that there's a long way to go before this comes up for a vote. But it remains to be seen whether commissioners and the public will given a chance to consider proposals other than the one that Nask has offered.
I specifically asked Nask if he would allow an independent expert to take a look at his findings, then compare Nask's proposal with other possible restructuring plans. It appears Nask didn't address that part of the question.