Dr. Agwunobi Sighting

I got tipped off to this article out of Spokane.

Providence Sacred Heart Medical Center may add 75 patient beds after reaching a proposed settlement with state health officials.

Such an expansion would make Sacred Heart a 719-bed hospital, but at a cost to sister hospital Holy Family, which would surrender 25 of its beds under the terms of the agreement announced Wednesday afternoon.

The deal will have to withstand a 30-day comment period and then receive final approval by the hospital and the Washington State Department of Health, which licenses and regulates the number of beds allowed in a community.

This continues the bizarre and inexplicable behavior of Providence Health Care under the leadership of Dr. Andrew Agwunobi. Upon taking over at the beginning of 2009, he announced that he would need to make cuts to staff.

This was in and of itself peculiar because as of December 2008, the hospital system had near $2 billion IN CASH. Then, last fall, their proposed buy out of Rockwood fell through.

Providence Sacred Heart Medical Center’s chief executive charged Rockwood Clinic’s leaders with bad-faith dealings and ethical lapses the day after Rockwood stunned Spokane’s medical community by announcing it would align with Sacred Heart’s main rival.

“It is clear to us that the interim leadership of Rockwood is leading the Rockwood physicians down a very dangerous path fueled purely by profit motive,” said Sacred Heart CEO Dr. Andrew Agwunobi.

This was also curious. After all, if the hospital is in such dire straits that it needed to cut staff, why was it involved in a buyout. With that buyout falling through, Agwunobi was able to secure this deal for expansion.

Providence is a non profit hospital. It pays no taxes. I've recently written a piece about non profits. Most watch dogs I've spoken with including one that watches over Providence itself agree that non profits acting like for profits while paying no taxes is a huge and under reported problem.

The Merger that Wasn't

In the Spokane area, there appears to be a very high stakes confrontation between CEO's of two competing local hospitals.

Providence Sacred Heart Medical Center’s chief executive charged Rockwood Clinic’s leaders with bad-faith dealings and ethical lapses the day after Rockwood stunned Spokane’s medical community by announcing it would align with Sacred Heart’s main rival.

“It is clear to us that the interim leadership of Rockwood is leading the Rockwood physicians down a very dangerous path fueled purely by profit motive,” said Sacred Heart CEO Dr. Andrew Agwunobi.

Rockwood will be purchased by Community Health Systems Inc., which bought Sacred Heart rival Deaconess Medical Center last year. Agwunobi accused Rockwood interim president Dr. Craig Whiting and others of gaming Sacred Heart months ago when they initiated talks to “strengthen partnerships” – going to the point of having Sacred Heart officials sign confidentiality agreements to keep a lid on the discussions while Rockwood said it needed to finish leadership changes and complete an internal analysis

The salty language used by Providence CEO, Dr. Andrew Agwunobi (known as Dr. Andy) has gained him some notoriety, but what is much more curious is the set of events that lead to this broken deal. Dr. Agwunobi took over at Providence in the winter of 2009. Here's a piece of an email that he sent to the staff within weeks of his arrival.

Dear Providence employee,

I am writing to inform you about some difficult decisions that will be made
over the next two months to address current financial challenges and to ensure
that our Providence ministries in Spokane and Stevens counties can continue to
weather this serious economic recession. I know you are aware from previous
communications that the financial outlook is challenging.

We as a system have experienced significant investment losses; the state budget cuts to hospitals and health care will be drastic; and, in keeping with our Mission, it is inevitable that we will treat many more uninsured and underinsured individuals in the months ahead. What you may not be aware of is that Providence Health Care is already experiencing significant financial challenges year-to-date in 2009. At this point, we are $9 million behind budget and this gap is increasing monthly. The economic recession is part of the cause, but we also have some productivity and expense overruns that have contributed to our poor financial performance.

So, back in the winter of this year, the same hospital system that was now attempting multi hundred million dollar buyout of its competitor was telling its employees that their financial situation was so dire that there would need to be employment cuts.



In June, the same system was denied its plan to expand its beds by 152.

State officials have rejected Providence Sacred Heart Medical Center’s plans to add 152 patient beds.

The decision by the Washington state Department of Health puts an end to a $175 million construction project that was expected to span several years and employ as many as 700 people.

“We’re surprised, disappointed and, quite frankly, saddened at this decision,” said Dr. Andrew Agwunobi, chief executive of Providence Health Care, “because we know the Department of Health is very objective. We also know, of course, that we need the beds.”

So, at the beginning of 2009, the system was in such dire financial straits that they needed to lay people off. In June, the same system was trying to apply for an expansion that was going to cost them $175 million. Dr. Agwunobi, and management, explained this dichotomy by claiming that the money to be used for the expansion would come from long term bonds, which presumably they couldn't provide to keep people at work.

In fact, the whole thing is nonsense. As of December 2008, this system sat on just under $2 billion in investments and cash. Their financial position was just fine. In fact, in 2008, the system had operating profits of $288 million. The system lost significant amounts of money on investments however even after those losses they still had $1.94 billion in cash and investments. It's still unclear why the cuts were announced but to blame it on finance is disingenuous if not simply a flat out lie.

As for Dr. Agwunobi, it's fair to characterize his term, now near one year, as a total disaster. Multiple sources within the hospital have characterized the environment at the hospital since he arrived as much more stressful, full of fear, and and a hospital divided. In fact, management took great pains to remove my own articles about Dr. Agwunobi and some hospitals in the system went so far but to block access for google searches of Dr. Agwunobi.

This latest episode is the latest in a string of embarrassments. The incident in June "surprised, disappointed, and saddened" Dr. Agwunobi. Now, a major merger was pulled out from underneath Dr. Agwunobi and he went into an irate rage to a member of the media.



It's important to review Dr. Agwunobi's history prior to arriving at Sacred Heart. I first tracked him to South Fulton Hospital in Atlanta, Georgia. He was the CEO there. He arrived there in 2001. At the time, South Fulton had recently finished a review by JCAHO (Joint Commission for the Accreditation of Hospitals Organization). That review was equivalent to roughly a C. He left South Fulton about two years later. Right after he left, JCAHO finished another review and failed South Fulton and put them on probation. They have since turned themselves around. He then went to Grady Hospital, one of the largest hospitals in the world. He left Grady about a year later following the release of an investigation by the Center for Medicare and Medicaid Services that concluded

Grady presents an immediate and serious threat to the health and safety of the patients

He then moved across country to St. Joseph's medical system and became its COO. He left there about a year later for reasons that are still unclear. He moved to Florida and served on the board of WellCare. About six months later, he cashed out about a million dollars worth of stock options and moved to the Florida's Association for Health Care Administration, within the Florida Department of Health. His first official move as head of AHCA was to investigate his former employer, WellCare. Following a raid lead by AHCA along with nearly a dozen other agencies, the stock price of WellCare tanked. Wellcare eventually went under, but Dr. Agwunobi had long cashed out. Within a year, he left AHCA and moved to the Spokane area. As such, he's had six high level jobs on both coasts in the last eight years. He always seems to leave under suspicious circumstances. Frankly, it's not entirely clear why he continues to get work.

Dr. Andrew Agwunobi Strikes Again IV

It appears that Dr. Agwunobi's cancer has spread. Dr. Agwunobi has, within the last year, take over as the CEO for the Eastern Washington region of Providence Health Systems. Dr. Agwunobi's first official act as CEO was to announce that cuts would need to be made. This pronouncement was met with fear and trepidation. A few months ago, I described the situation at Sacred Heart Hospital in the Providence Health Systems. (part of Dr. Agwunobi's region)

Following my initial report, this was posted the hospital board of Sacred Heart Hospital, (hit download attachment) one of the hospitals Dr. Agwunobi is responsible for. It addressed my previous post as well as my reporting on Dr. Agwunobi in general. The posting in the hospital refers to my reporting as "untrue" and refers to me as a "disgruntled former medical student". I am of course not now nor have I ever been a medical student. (I would agree with the characterization of disgruntled
but I would call that a lucky guess) While they characterize my reporting as untrue, the post never refutes any of the specifics in any of my pieces on Dr. Agwunobi. Let's put that to the side for a minute.

Dr. Agwunobi characterizes the region of Providence Health Care that he controls as being in dire financial straits and that's why he will have to make significant staff cuts. According to the financial statements filed by Providence Health Care system itself, the hospital had an operating profit of $288 million year ended December 2008. They carried a net loss but that came mostly from losses on investments (almost exclusively bonds and stocks). Given how poor the equity markets performed in 2008, that was to be expected. Furthermore, the hospital was still sitting on $1.95 BILLION in investments as of December 31, 2008. (page 21 of the financial statement) Does this sound like a hospital in dire financial straits?

I spoke with two medical professionals at Sacred Heart and they each described the same environment. It's a non profit hospital acting like a for profit. That's the worst of both worlds. What I mean is that the bottom line comes first. As such, staff is cut and everyone is pushed to the limit. Because everyone there is pushed beyond what is safe, patient care ultimately suffers. As such, the bottom line becomes the most important and only factor in all decisions.That's not merely a semantical point. Sacred Heart is part of the network of hospitals called Providence Health Care. Providence is a non profit hospital. Because it doesn't pay taxes the hospital is supposed to give the tax savings back to the community. That's not what's happening at Sacred Heart Hospital. Instead, the hospital is pocketing massive profits, cutting hospital resources, and forcing doctors to treat more patients than is safe. That is threatening patient care. That's the strategy that Dr. Agwunobi has implemented at the network.

Now, I can confirm from multiple different sources that, at Mt. Carmel in Colville, Wa., describe a similar situation. The administrators there are also being mistreated. There, they're being forced to take pay cuts and mandatory time off without pay and at the same time they also have added duties. On top of this, their IT department has blocked employees from using a google search of Agwunobi from work computers. Most of the staff is afraid for their collective jobs.

It wasn't even a year ago that Dr. Andrew Agwunobi took over as the CEO of the Eastern Washington region of the Providence Health Care System. This is a hospital system that has just under $2 billion in INVESTMENTS as of its last financial statement. Yet, he claims that it's struggling so much that he needs to make budget cuts. That's what he's doing and it's clear that all over every hospital that he controls, the employees are near panic. They're afraid for their jobs. Everyone is made to work twice as hard with fewer staff, less hours, and less money. All because you are being lied to and told the hospital is struggling when it's really flush with cash.

At the same time, the employees are clearly doing searches of his name and winding up at my site. That's how I've found out almost everything there. I've been tracking Dr. Agwunobi's career since 2001. That's when he took over as CEO of South Fulton Hospital. That's a small Atlanta hospital that serves most the poor. In two years, that hospital went from passing to failing JCAHO (a hospital governing body) reviews. Though, they didn't do that before Dr. Agwunobi was able to leave South Fulton and move to Grady Hospital. As such he left, and months later the next report came in as a failure.

He moved to Grady Hospital and a year later, HHS issued a report that concluded.

the conditions at Grady Hospital pose an immediate threat to the health and safety of the patients.

That stunning conclusion cost Dr. Agwunobi his job. To be more accurate, it caused him to take the fall for much bigger corruption that he was only one part of. In fact, he was told to take the fall in return for a cushy job as COO of St. Joseph's Hospital System in California that was arranged by then Grady Hospital board chairman, Robert Brown.

He spent a year at St. Joseph's and then moved to the board of Wellcare. He spent about six months there, cashed in his options of about $1 million. Then, he moved to the Florida AHCA (Agency for Health Care Administration), part of Florida's Department of Health. His first significant act not more than months into his job was being among ten state and federal agencies to raid WellCare. The stock dropped off a cliff after the raid. Of course, Dr. Agwunobi had already cashed out his options. He only survived about a year in part from the controversy surrounding this set of events. Now, he's spent nearly a year at the Eastern part of Washington of Providence Health Systems.

Things have gotten so bad that recruiters have set their eyes on the hospital and part of their pitch is to ask in shock.

What's happening at Providence?!

Of course, the most important thing is that this sort of mismanagement also becomes a time bomb or a cancer even. It's only a matter of time before every part of the hospital that he controls becomes infected with working conditions that are unbearable for everyone there. Right now, the upper management, which hired him despite having to know everything I recounted (r at least they should have), is calling anyone that leaves a "Rat." It's only a matter of time before people start dying in these conditions. Dr. Andrew Agwunobi is a menace and he must be stopped.

Dr. Agwunobi Then and Now

This story appeared in the Atlanta Journal Constitution.

In a “body blow” to efforts to save the cash-strapped Grady Health System, the facility must pay $20 million to the state due to Medicaid overpayments made to the center years ago, officials said.

Grady CEO Michael Young said the hospital is paying for desperate decisions made by his predecessors. He said Grady officials in 2004 and 2005 aggressively maximized the amount of Medicaid they received, leaving the current regime to pay back the extra millions.

“They were kind of robbing Peter to pay Paul,” Young said. “They took their money when they could ... and now it’s become someone else’s challenge.

This article is talking about Medicare billing and manipulation at Grady Hospital. Back in 2004-2005, the powers that be at the hospital maximized the billing on Medicare. This was all done within the confines of the law. In fact, all the hospital did was take too much up front with the agreement to pay later. Later is now.

This may seem harmless but it's actually a very effective way to pervert the current financial condition of a hospital and then leave before its true nature is realized. That's exactly what current Grady CEO Michael Young was complaining about. He was complaining that his predecessors had created this scheme leaving him with the bill. In fact, the CEO running Grady Hospital in 2004-2005 was perverting the financial health of the hospital. He was charging Medicare the maximum which created inflated earnings. The credit back from the hospital wouldn't happen for years. As such, the budget could look good during their term and they could high tail out of there before the bill came due. In a sense, that's what the CEO during this period did.

Who was that CEO? It was Dr. Andrew Agwunobi. I've recently tracked Dr. Agwunobi to Providence Health Care in Eastern Washington State. His first official act as CEO of that region was to send an organization wide email that warned staff that cuts were imminent.

We as a system have experienced significant investment losses; the state budget cuts to hospitals and health care will be drastic; and, in keeping with our Mission, it is inevitable that we will treat many more uninsured and under insured individuals in the months ahead. What you may not be aware of is that Providence Health Care is already experiencing significant financial challenges year-to-date in 2009. At this point, we are $9 million behind budget and this gap is increasing monthly. The economic recession is part of the cause, but we also have some productivity and expense overruns that have contributed to our poor financial performance.

As such, in addition to curtailing as many non-mission critical expenses as possible, we have made the difficult decision to implement some level of staff reductions in the Spokane hospitals during the months of April and May. As a faith-based organization, we consider any action that impacts our employees as an extremely serious step and, therefore, a great deal of work is being done to ensure that we minimize the number of people who will be directly affected. At this point we do not know how many staff will be impacted, but we will keep you informed as our internal analysis and that of the Wellspring consultants continues.

He's proclaiming the hospital is strapped for cash and unable to afford the current staff load despite the fact that the hospital system sits on nearly $2 billion worth of bonds. Dr. Agwunobi's tenure at Grady Hospital ended when an HHS report concluded that

Grady presents an immediate and serious threat to the health and safety of the patients

Now, we find out that on top of that he was also essentially cooking the books to make Grady appear more strong. About two and a half years after he left, Grady Hospital required a bailout of $200 million from the Woodruff Foundation. As such, one could say that Dr. Agwunobi was cooking the books to avoid the inevitable and make sure he was no longer there when it does happen.

Dr. Agwunobi has made it a career, you see, of finding high profile positions and then over staying his welcome very quickly, sometimes a year and less. In between, Grady Hospital and his current role at Providence, he spent a year as COO of St. Joseph's in California, six months on the board of Wellcare, about a year as Secretary of the Florida Agency for Health Care Administration. His first act as Secretary was to sign onto a raid on his former employer at Well Care. That raid just happened to be a couple months AFTER Agwunobi cashed out a million dollars worth of WellCare options that were part of his package when he left. Those same options were worthless after the raid.

Now, Agwunobi is attempting significant job cuts at a hospital that is financially healthy. Their latest financial statement showed that the system has nearly $2 billion in bonds. They made an operating profit of just more than $300 million last year. There's no logical reason for a hospital to say they need to impose job cuts when they sit on so much in bonds. Keep in mind that Providence is a non profit hospital and so they pay no taxes on any of this money. If a non profit hospital cut staff, even though they were financially viable, and these staff cuts lead to poor patient care, that would violate both the spirit and letter of their commitments in keeping their non profit status.

So, the same CEO that inflated his hospital's revenue in a shameless attempt to mislead the financial health of that hospital five years ago is now cutting staff on a financially viable hospital. Worse yet, the administration at his new hospital, Providence, knows all this, doesn't care, and supports Dr. Agwunobi 100% in his attempt to cut staff now.

Dr. Andrew Agwunobi Strikes Again III

This news story was published in a local Spokane newspaper the other day.

State officials have rejected Providence Sacred Heart Medical Center’s plans to add 152 patient beds.

The decision by the Washington state Department of Health puts an end to a $175 million construction project that was expected to span several years and employ as many as 700 people.

“We’re surprised, disappointed and, quite frankly, saddened at this decision,” said Dr. Andrew Agwunobi, chief executive of Providence Health Care, “because we know the Department of Health is very objective. We also know, of course, that we need the beds.”

Now, to put things into perspective, South Fulton Hospital in Atlanta has just over 300 beds total. As such, this addition would have been rather extensive if it had been approved. If you've been following my reporting on Providence Medical Center, you maybe scratching your head.

Let me catch everyone up. On March 27th, Dr. Agwunobi sent an email to the entire staff at Providence Hospital system in Eastern Washington, the area he is currently the Chief Executive Officer of. In the email, Dr. Agwunobi pronounced that because of difficult financial times some staff cuts would be coming. He cited a tough 2008 in the stock market and the hospital underperforming their budget projections as two reasons for the cuts.

Then, a couple weeks back, I followed up by analyzing the financials of this hospital system. Last year, their operating income was $288 million. The year previous they made just over $300 million. In fact, $300 million is about where they end up on any given year. Their so called financial problems stem mainly from having a bad year in the market in 2008. Despite significant losses in 2008, the hospital system continues to sit on just under $2 billion as of December 31, 2008. Furthermore, while the hospital system may not be meeting their budget projections, that doesn't necessarily mean the hospital is in dire financial straits. This is all very significant given that Providence enjoys non profit tax status and thus pays no income taxes on any of their profits. As such, if a financially health non profit hospital cut staff, that would put their non profit status in jeopardy.

Now, you maybe asking how a hospital that is supposed to be struggling so much that it needs to cut staff is able to move forward with a major expansion that would cost just south of $200 million. Furthermore, if the system is cutting staff, how were they going to find doctors and nurses to take care of the patients in this new addition? More than that, now that they are unable to move forward with the massive costs of this expansion, will the hospital still cut staff? After all, if they had enough in the budget for a nearly $200 million expansion, I can only assume they now still have enough money to pay all the staff they currently have. According to hospital officials, the short term cuts are "separate from the the capital spending projects." They planned to pay for the expansion by selling long term bonds. This would seem reasonable except that they are currently sitting on nearly $2 billion in investments. It sounds to me as though the system have enough for both short term and long term projects, including keeping their current staff.

Here's is the full dossier on Dr. Andrew Agwunobi. Here is my first and second piece in this series.

Dr. Andrew Agwunobi Strikes Again II

Nearly two months ago, I featured a story about Dr. Andrew Agwunobi. I have been tracking Dr. Agwunobi for nearly two years and much of it has not been flattering. He's trekked through the medical system and he's recently wound up as the CEO of the Eastern Washington region of the Providence Health Care System. The Providence health care system is a non profit hospital system. That means it enjoys tax exempt status. It also means that there are no shareholders. To earn this tax exempt status the hospital must provide a benefit for the community. Here the law becomes murky because that's something that's difficult to define.



Dr. Agwunobi wasted no time in settling into his new role. Within months, he announced that there would be staff cuts within his portion of the system.

We as a system have experienced significant investment losses; the state budget cuts to hospitals and health care will be drastic; and, in keeping with our Mission, it is inevitable that we will treat many more uninsured and under insured individuals in the months ahead. What you may not be aware of is that Providence Health Care is already experiencing significant financial challenges year-to-date in 2009. At this point, we are $9 million behind budget and this gap is increasing monthly. The economic recession is part of the cause, but we also have some productivity and expense overruns that have contributed to our poor financial performance.

As such, in addition to curtailing as many non-mission critical expenses as possible, we have made the difficult decision to implement some level of staff reductions in the Spokane hospitals during the months of April and May. As a faith-based organization, we consider any action that impacts our employees as an extremely serious step and, therefore, a great deal of work is being done to ensure that we minimize the number of people who will be directly affected. At this point we do not know how many staff will be impacted, but we will keep you informed as our internal analysis and that of the Wellspring consultants continues.

Following my initial report, this was posted the hospital board of Sacred Heart Hospital, (hit download attachment) one of the hospitals Dr. Agwunobi is responsible for. It addressed my previous post as well as my reporting on Dr. Agwunobi in general. The posting in the hospital refers to my reporting as "untrue" and refers to me as a "disgruntled former medical student". I am of course not now nor have I ever been a medical student. (I would agree with the characterization of disgruntled but I would call that a lucky guess) While they characterize my reporting as untrue, the post never refutes any of the specifics in any of my pieces on Dr. Agwunobi. Let's put that to the side for a minute.



Dr. Agwunobi characterizes the region of Providence Health Care that he controls as being in dire financial straits and that's why he will have to make significant staff cuts. According to the financial statements filed by Providence Health Care system itself, the hospital had an operating profit of $288 million year ended December 2008. They carried a net loss but that came mostly from losses on investments (almost exclusively bonds and stocks). Given how poor the equity markets performed in 2008, that was to be expected. Furthermore, the hospital was still sitting on $1.95 BILLION in investments as of December 31, 2008. (page 21 of the financial statement) Does this sound like a hospital in dire financial straits?



This is all not merely semantics. While they were able to carry a loss, exclusively from investments, in 2008, in 2007 they made just over $305 million in net operating profits. Had they been classified as a for profit hospital their tax bill would have been just south of $100 million.



So, the question much be asked. Why is a hospital system that made $288 million in operating profits last year and sitting on just south of $2 billion in investments, in need of cutting staff anywhere. Furthermore, Dr. Agwunobi is playing word games when he proclaims that Providence Health Care is "$9 million behind budget" year to date in his email. While that maybe true, all that means is that they are $9 million behind their projections. It certainly doesn't necessarily mean that they are in dire financial straits. Furthermore, if administration wanted to justify making budget cuts, they could easily set budget projections that couldn't be made in order to use the eventual shortfall as a reason to justify those very cuts.



So, why is a non profit hospital that just made under $300 million on their operations and sitting just under $2 billion just in investments in need of cutting staff? Only those making the cuts can say that. This brings me back to Dr. Agwunobi. This article refers to Dr. Agwunobi as "well travelled". I would say so. Here's a quick rundown of his work history. From 2001 through mid 2003, he was CEO of South Fulton Hospital, a fairly small hospital in Atlanta that treats mostly the poor. He left Fulton to become the CEO of Grady Hospital also in Atlanta. Grady Hospital is one of the largest hospitals in the world and also primarily serves the poor. He stayed there for about a year when he also left. He moved to St. Joseph's in California, a conglomerate of 14 hospitals, and became it's COO. He stayed there for about a year and then left to serve on the board of WellCare. He stayed at WellCare for about six months. He then moved on to head Florida's Agency for Health Care Administration (AHCA). The department within Florida's Department of Health that is primarily responsible for providing health care for the poor. He stayed there for about a year when he moved into his current position at the beginning of 2009. If you're keeping track, that's six high profile jobs on both coasts in about eight years.



There's more. When Dr. Agwunobi first took over at South Fulton, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued this report. The report gave South Fulton marginal but passing grades. The first report issued following Dr. Agwunobi's in 2004, however, denied South Fulton its JCAHO accreditation. Following about a year at Grady Hospital , the Department of Health and Human Services also issued a report that concluded that

there is a serious and immediate threat to the health and safety of the patients

at Grady Hospital. Dr. Agwunobi was terminated following this report. He moved to the West Coast to stay as COO of St. Joseph's. He left for reasons not known to me. He moved onto be on the board of WellCare. He stayed on the board for only about six months. He cashed out about a million dollars worth of stock options. Then, he moved onto AHCA where his first move was being one of several state agencies and the FBI to raid his former employer WellCare. Following the raid the price of the stock tanked and made the very same options that Dr. Agwunobi cashed in months earlier then nearly worthless. He stayed on at AHCA for about a year more before arriving at Providence.


Now, he's determined that a NON PROFIT hospital system that routinely makes somewhere in the neighborhood of $300 million yearly in operating profits, is sitting on nearly $2 billion in investment, is now in such dire financial straits that it needs to cut staff.

Dr. Andrew Agwunobi Strikes Again

Providence Health Care is a medical conglomerate that serves states including Washington, Idaho, and Montana. It's system includes about 2500 employees. Last month, the staff received this troubling email.

March 27, 2009

Dear Providence employee,

I am writing to inform you about some difficult decisions that will be made over the next two months to address current financial challenges and to ensure that our Providence ministries in Spokane and Stevens counties can continue to weather this serious economic recession. I know you are aware from previous communications that the financial outlook is challenging.

We as a system have experienced significant investment losses; the state budget cuts to hospitals and health care will be drastic; and, in keeping with our Mission, it is inevitable that we will treat many more uninsured and underinsured individuals in the months ahead. What you may not be aware of is that Providence Health Care is already experiencing significant financial challenges year-to-date in 2009. At this point, we are $9 million behind budget and this gap is increasing monthly. The economic recession is part of the cause, but we also have some productivity and expense overruns that have contributed to our poor financial performance.

As such, in addition to curtailing as many non-mission critical expenses as possible, we have made the difficult decision to implement some level of staff reductions in the Spokane hospitals during the months of April and May. As a faith-based organization, we consider any action that impacts our employees as an extremely serious step and, therefore, a great deal of work is being done to ensure that we minimize the number of people who will be directly affected. At this point we do not know how many staff will be impacted, but we will keep you informed as our internal analysis and that of the Wellspring consultants continues.

We know this news is unsettling for you and your families. Our commitment is to ensure that these changes occur with the deepest concern and compassion for employees. And where possible, we will work diligently to find opportunities within our own or other Providence ministries for those who are affected.

We are also committed to ensuring that throughout this challenging time, we continue to provide the high level of quality and service for which we are known to patients and their families.Through it all, Providence is committed to making the right decisions based on our values of respect, compassion, justice, excellence and stewardship. Our Catholic ministry has been in existence for over 123 years. Throughout our history, we have triumphed over many adversities. We are absolutely confident that we will emerge from these difficult times and will continue to fulfill our Mission for many generations to come.

Respectfully,
Andy Agwunobi

Future correspondence said that staff reductions would number about one tenth of the overall staff. Now, this announcement of dire financial straits would come to surprise to many on the staff for several reasons. First, not but weeks earlier, Elaine Cuture, COO of Providence Sacred Heart Hospital, told a meeting upper staff that the system was making $8 billion yearly and expenses of 9 million dollars weekly (or about half a billion in expenses)

Furthermore, according to their latest financial statement, the Providence system has just over $1.7 billion in investments, including more than $200 million in cash. (page 21) So, it appears that the system shouldn't have any trouble paying their staff. Furthermore, when Agwunobi says that Providence is "$9 million behind budget" all this means is that they are $9 million behind the estimates they set. That certainly doesn't necessarily mean the system is in such dire straits that they need to cut staff.

Now, while lay offs have been announced only a handful of upper managers have actually been laid off. As such, the bulk of nearly 300 people yet to be laid off still haven't been identified. As such, staff morale is low. There is bickering and some back stabbing. Finally, while lay offs have been announced, the system has not yet announced that any services will be cut back. As such, it is entirely possible that the layoffs will create a situation in which the system will simply not have enough staff for all the services. You simply can't have any other situation if you cut staff but not services. Such a situation will put all the patients in danger.

Now, you might be asking why you should care. Unless you work at Providence or are a patient, these events are not that important. What is important is that the person, Dr. Andrew Agwunobi, is allowed to orchestrate these lay offs at all. About a year and a half ago, I wrote a piece about Agwunobi (Dr. Andy as he likes to be called) entitled Why is this Man Working? That was two jobs ago. Since 20001, he has had no less than six jobs on both coasts in four different cities. Make no mistake, Dr. Agwunobi wasn't just upwardly mobile. He has been in a position of CEO or board director in each of these positions.

In 20001, he took over as CEO of South Fulton Hospital in Atlanta. This is a 75 bed hospital that primarily serves the poor. When he took over, JCAHO, the organization that oversees hospitals, gave a marginal but passing grade to South Fulton. Dr. Agwunobi left South Fulton in 2003 and a couple months later JCAHO failed South Fulton and placed it on probation. Of course, it was up to successors to clean up the mess he started. He then moved onto Grady Hospital. About a year later, CMS, a division of Health and Human Services, issued a report on Grady Hospital and its conclusion was

Grady presents an immediate and serious threat to the health and safety of the patients

In the aftermath of this report, he was removed as CEO. He then became the COO of St. Joseph's medical center in California. He lasted there about a year, and then moved to Florida to become a board member of Wellcare. (another health care system and this was located in Florida) He stayed at Wellcare for six months, cashed out about a million dollars worth of stock options, and moved onto head the AHCA (a government agency in Florida's Department of Health). His first move as head of AHCA was to investigate none other than Well Care. His department partnered with about ten government agencies to raid the offices of Well Care. Immediately following the raids, the stock of Well Care plummetted. He stayed head of AHCA for about a year until the heat of the clear conflict of interest of raiding his former employer finally caused him to resign (though local news claimed he was looking to spend more time with his family) Now, he has spent the last six months as CEO of Providence.

Now, try and connect the dots. We have an incompetent and a corrupt individual. Everywhere he has been has ended in disaster. South Fulton took several years to get out from under the probation slapped on it in the aftermath of Agwunobi's reign. Grady was nearly shut down at the end of 2007 by JCAHO. Wellcare no longer exists in nearly any form. What do you think will happen to Providence Health Systems. We have an indivdual claiming that the system is in dire financial straits even though all the evidence says otherwise. There's no way to verify what he is saying. Unless he augments his plan, he will create an understaffed hospital that will simply be a danger to the patients, much like the situation he lead at Grady Hospital.

The real story is NOT the situation materializing at Providence. Anyone who has followed his career could predict this. Furthermore, the over under is another nine months before he moves onto continue his reign of terror elsewhere, likely the East coast since that's the pattern forming now. The real story is how the board of Providence could hire this guy in the face of such overwhelming evidence that he is nothing less than a menace to any entity that gets near him. Isn't it their fiduciary duty to conduct the sort of research I just did? I asked how he could still be working and since two more employers gave him employment. How much more damage will he do to the nation's health care system before people finally say enough is enough.

Dr. Andy and the Media: Corruption Meets Incompetence Meets Corruption (Updated)

(Updated with the photo following a perceptive comment by a reader)

Introduction

Dr. Andrew Agwunobi, or Dr. Andy as colleagues called him, has traveled a long and winding road. He has frankly commited an obscene amount of corruption and worse yet, he has done it in all parts of the country. Agwunobi came to Atlanta's South Fulton Hospital as CEO immediately before a JCAHO report that gave the hospital passing but marginal grades. He left that hospital about two years later three months prior to another JCAHO report that failed it, suspended the hospital, and forced a total restructuring. He moved on to Grady Hospital, one of the largest hospitals in the world and the largest in America targeting the poor. A year after he arrived the Department of Health and Human Services issued a report that concluded

Grady presents an immediate and serious threat to the health and safety of the
patients

He was removed as CEO of Grady in the aftermath of the report only to wind up as COO at St. Joseph's, a network of hospitals across the country in California. He only managed to stay at St. Joseph's for just over year before he moved back to Florida to serve on the board of WellCare. He only managed to stay at WellCare for six months before cashing out one million dollars worth of stock options and moving on to become the head of the Florida Agency for Health Care Administration. His first order of business was investigating his most recent employer. Nine months into his tenure his agency was one of several that raided WellCare and the stock plummeted in aftermath. He was eventually investigated for his dubious maneuvers at WellCare and AHCA, and has recently resigned. He didn't resign without a new gig though, as he has already been offered a position as the COO of Providence Health and Services, another network of hospitals in Seattle.

If you just read the introduction, you are probably wondering just how he could have gotten away with so much corruption in so many places, and why he is still able to continue to get a job despite all of this overwhelming evidence of his own incompetence and corruption. The most obscene part is that it took me about thirty minutes of searching Google, the JCAHO website, and around the rest of the internet to determine and verify all of this information. If I am able to easily pin point so much corruption from one individual, why was he able to get away with it for so long in so many places and furthermore why is he continuing on his path? Whenever there is this much corruption, anywhere, it is with the tacit or even active approval of the media around it. In other words, Agwunobi was able to commit all of this corruption because the media around him refused, for whatever reason, to report on what should have been obvious.

A google search of Agwunobi's departure from South Fulton nets only 83 articles. Many of them come years later, and none of them mention the JCAHO report that was filed in the immediate aftermath of his departure. What that means is this. Even though the findings of JCAHO were a matter of public record and could be located with a quick search of their website (the way I found them) no one in the Atlanta area media bothered to investigate this guy, and ask a very simple question...if he ran a fairly small hospital into the ground why is he offered the top job at a very large hospital? Because no one asked no one knew.

To this day, much of the press relating to his time at Grady Hospital is largely positive. Here is one piece published in the immediate aftermath of his departure.

Agwunobi joined Grady on June 1, 2003. Dr. Andy, as he has become affectionately known, has been on the forefront of change for the health system during a very difficult period faced with financial challenges."We have been fortunate to have had the leadership, energy and skills of this remarkably talented individual at the helm of Grady during this sensitive period in the history of the health system," Brown said. "He will leave a legacy to be remembered and admired."

During his short tenure, Agwunobi negotiated the potential merger of Hughes Spalding Children's Hospital with Children's Healthcare of Atlanta, launched a public information and transparency campaign to raise awareness and brand the health system, oversaw a portfolio analysis with KPMG to identify financial strengths and weaknesses in all service areas in Grady, created a plan to grow revenues within the profitable service areas to help fund the mission of Grady Health System, created a plan to eliminate services to the uninsured who live outside DeKalb and Fulton counties, served as a catalyst for philanthropic support, improved pharmacy operations and won much recognition and praise.Grady's new interim chief also has a list of accomplishments and awards that are numerous. They include being the past chairman of the board of the Georgia Hospital Association, past regent of the American College of Healthcare Executives, service on the regional policy board of the American Hospital Association, the board of the Atlanta Chamber of Commerce and the board of the Georgia Chamber of Commerce.

Now, what you aren't going to find in this piece is any reference to the scathing HHS report that ultimately cost him his job. The reason for this is even more sinister. This report got almost no media attention in the Atlanta area when it was released. The people didn't know that Agwunobi was responsible as CEO for conditions that lead to this conclusion

the conditions at Grady Hospital pose a serious and immediate threat to the health and safety of the patients

That's because the people of Atlanta largely didn't know about the report at all. The HHS report received nothing more than a byline at the Atlanta Journal Constitution. In fact, the AJC never asked for or published the actual contents of the report. The AJC mentioned the conclusions in a by line and never bothered to explain any of the specifics of the report. Agwunobi wasn't held responsible for the contents of this report because the media didn't even bother to report on the report in the first place.

Given that Agwunobi had now managed to successively run two hospitals into the ground it might have made sense for someone to ask how it was that he got a promotion. After all, it couldn't possibly have been performance. Why exactly did St. Joseph's hire given his track record? Now, I have seen the contents of the HHS report and Agwunobi is only one of several people to be held responsible for its scathing conclusion. In fact, his responsibility is less than several people that stayed on at Grady. Yet, he was the only one to leave. If I had to speculate, I would say there was a quid pro quo, however I can only speculate because no one bothered to investigate how it all went down.

In fact, the media portrayed Agwunobi's tenure at Grady Hospital as largely positive. Here is an example.

Orange-based St. Joseph Health System, which runs three of the largest hospitals in the county, has hired a 40-year-old pediatrician and healthcare administrator as its new chief operating officer.

Andrew Agwunobi, who goes by "Dr. Andy," replaces Jeffery FIocken, who left St. Joseph in June. Agwunobi comes to St. Joseph from Grady Health System in Atlanta, where he oversaw a turnaround of hospital and clinic operator as chief executive since 2003.

Again, let's keep in mind that this so called turnaround climaxed with this conclusion...

the conditions at Grady Hospital present a serious and immediate threat to the health and safety of the patients.

Neither these conclusions or his contribution to them were ever explored by this article or frankly any of the media in California. Agwunobi was able to arrive at St. Joseph's and run a network of hospitals despite a track record that included running a small hospital into the ground and then a large one. Not only was his record never disected, but frankly, articles like this painted his record as positive.

He moved on the St. Joseph's and stayed largely under the radar there as well. He stayed so under the radar that to this day it is unclear why he stayed for such a short time and what made him leave. Agwunobi moved his family cross country to take a very lucrative position. Why in the world would he leave only about a year later and move his family cross country again. To this day no one knows the answer to that.

His move from St. Joseph's to WellCare and his subsequent departure from there also stayed largely under the radar. In fact, my one and only source for his malfeasance at WellCare is Pharma Fraud. (If anyone else reported on these facts, I can't find them). While I consider the author of Pharma Fraud to be a hero on this story, it is a sad commentary when a blogger is breaking news this big. In fact, while both Pharma Fraud and I were reporting Agwunobi's role in WellCare as well as his sordid history, the Florida media stayed largely silent. Again, a Google search of articles of Dr. Andrew Agwunobi and WellCare largely finds things that Pharma Fraud and I published and anything else has only been published since he re signed. The Florida media stayed nearly silent while this obvious corruption was right in front of them. You won't find any articles from any of their newspapers asking the questions Pharma Fraud and I were asking months ago.

This brings me to the present. Even after all of this has now come to light, the media continues to act with a naked corruption that leaves me scratching my head. Let's take a look at two articles as an example.

Agwunobi's resignation comes as the feds look into WellCare Health Plans. Agwunobi served for six months on the WellCare board and when he went to work for Crist, the Wall Street Journal reported that he cashed in $1 million worth of stock options and netted between $400,000 and $500,000. The CEO of WellCare, Todd Farha, announced his resignation in late January.

Here is the other one.

The current AHCA Secretary, pediatrician Andrew Agwunobi, will become regional CEO of Providence Health and Services, a Catholic hospital system in Washington State. AHCA spokesman Doc Kokol said Agwunobi had been unable to unite his family in Tallahassee and tired of commuting to Atlanta each weekend to see his wife, also a physician, and two young daughters. The entire family will be reunited in the move to Washington state, Kokol said. Crist praised Agwunobi’s work during his 13 months at AHCA. “He’s done a tremendous job opening windows to health care for a lot of people ...," Crist said. "I am very grateful for that.”

In other words, it is concurrently a matter of public record that Agwunobi is not only stepping down to spend more time with his family but also then moving that same family cross country to take another job. Maybe, I am the one that is obtuse, but that just makes no sense.

Given all of the corruption that this man has committed that is a matter of public record, you would also expect the Seattle Post Intelligencer and other Seattle media to ask how and why he got hired at all. Of course, those expectation would be giving those organizations too much credit. As of yet, the Intelligencer hasn't published anything about Agwunobi. This will be the fifth high level job for Agwunobi in five years, and the Intelligencer has no interest in investigating how that happened. He is about to be unleashed on the health care system of Washington, after already leaving a trail corruption in Georgia, California, and Florida, and no one in the media there is bothering to do the five minutes of leg work it would take to expose him before he gets there.

If you want to know why Agwunobi has been able to commit so much malfeasance and stay under the radar, there is your answer.

An Update on Dr. Andrew Agwunobi

It appears that the rest of the media has finally caught up to what I broke, along with Pharma Fraud, months ago. Dr. Andrew Agwunobi appears to be knee deep in the scandal at Well Care. I first heard of Dr. Andrew Agwunobi (here is the original) as the one time CEO of Grady Hospital during the years 2003-2004. In fact, Dr. Andrew Agwunobi has travelled quite the road.





He first popped up on the radar as the CEO of South Fulton, a relatively small Atlanta Hospital for the poor. When he walked into South Fulton, they were receiving marginal but passing grades from JCAHO. He walked out three months prior to a JCAHO report that failed the hospital and put them on probation. He then moved on to become the CEO of Grady Hospital, one of the largets hospitals in the country (and certainly the largest to serve the poor) Just over a year after he began his tenure at Grady, HHS issued a report that concluded this,

there is a serious and immediate danger to the health and safety of the patients.

So after running two separate hospitals into the ground, Dr. Agwunobi moved onto the next logical step in any such career path: he was given the job of COO of a network of hospitals at St. Joseph's in California. Here the story gets murky. He moved his family cross country and took what had to be a well paying job. For reasons that are still unclear he only stayed there for about a year before he moved his family back across country to Florida. This time he became a member of the board of WellCare. He only stayed at this job for about six months. He did cash out for a million bucks before he left though. Here is how Pharm Fraud described it...

Over the course of the past year, WellCare has lost both its chief medical officer and its top executive in Florida - the company's largest market - without offering any clear explanation for their exits. Yet, with the company under intense government scrutiny, a third departure has started looking even more telling to some.



Upon leaving WellCare, Agwunobi cashed out options and stocks for a $1 Million profit.



WellCare seemed to appreciate Agwunobi more than the board member he replaced. That director, Glen Johnson, had to forfeit his own unvested equity awards upon vacating his board seat.

Upon leaving WellCare, he took a job with the Florida Agency for Health Care Administration. His first order of business was to investigate his former employer, WellCare. His agency was one of ten that lead a raid on WellCare about eight months after he left the company. Things worked out for Agwunobi's stock options because in the immediate aftermath of the raid the stock plummetted.









The whole thing seemed fishy to me. Not only was he changing jobs constantly, not something you expect from a high level manager, but he seemed to always be leaving a mess behind him. He moved cross country twice in about a year and half and wound up nearly right where he started from. To top it off, he leaves WellCare with a parachute and then investigates the company and watches their stock plummet.

The story remained stagnant despite overwhelming proof of serious malfeasance. That was until just recently. Here is the latest.

The governor says the departure of Dr. Andrew Agwunobi from the Agency for Health Care Administration has nothing to do with a federal investigation.

Agwunobi's resignation comes as the feds look into WellCare Health Plans. Agwunobi served for six months on the WellCare board and when he went to work for Crist, the Wall Street Journal reported that he cashed in $1 million worth of stock options and netted between $400,000 and $500,000. The CEO of WellCare, Todd Farha, announced his resignation in late January.

I won't pretend to get into anyone's head, however Agwunobi's family situation is the same as it always was. What isn't the same is that the folks in Florida are finally paying attention to things I had been pointing out months ago.

The Changing Political Dynamic Surrounding Grady Hospital

From a purely political junkie level the current dynamics surrounding Grady Hospital are absolutely fascinating. Here is a quick run down. Late last month, the board at Grady Hospital approved a plan to go quasi private and asked, or demanded depending on your perspective, for roughly half a billion dollars in order to stay solvent. Then, not two weeks later, the JCAHO threatened to cut off Grady's national accreditation. Now, let's take each one at a time and then look at them together.

I believe the board is playing a huge political game of chicken with the Georgia legislature. I believe this plan does NOT have the best interest of the hospital in mind whatsoever. While that is certainly important, it is unfortunately a side issue in this political battle. As a friend of mine once put it

Grady can't shut down because who would take care of all the poor folks then

Without the money called for in this plan, Grady WILL shut down. The powers that be know this, and I have said as much. While Grady Hospital has had a long history of corruption and mismanagement, much of the power structure has continued to boldly and brazenly manage it in much the same way that has landed it in its current state. The reason for this is of course quite complicated, however it is due in no small part to Grady's vital role in Georgia health care system and society at large. Remember, Grady Hospital is among the largest in the world and is overwhelmingly responsible for taking care of most Georgia's poor folks. Without it all of the many "nice" hospitals in the area would have to take care of those folks.

I have fallen in love with the Latin phrase, Res Ipsa Loquitur. (The facts speak for themselves) Given Grady's long and sordid history with corruption and mismanagement, the fact that most of the power structure in Georgia never tried to really stop it tells me that most people don't much care as long as some other entity was taking care of those that no one else wanted to take care of, THE POOR. I believe the powers that be are counting on the exact same dynamic now. I believe the only thing most of the power players in Georgia want to avoid is for the poor folks to be dropped on the rest of the health care system. As long as they are Grady's problem, in my opinion, most everyone else turns a blind eye.

Thus, we have this game of chicken. The legislature doesn't want to hand Grady Hospital anymore money. They must know that the systemic problems currently going on at Grady aren't going to be solved with this plan, however without an infusion of cash, Grady shuts down. The powers that be at Grady are counting on the legislature blinking first. The legislature meets again in January so, for now, that part of the story is on hold.Enter the JCAHO. Just last week they publicly threatened to revoke the accreditation of Grady Hospital. To put this move in perspective only one hospital, King Hospital in California, has ever actually lost their accreditation. Many of allies on this story have extolled this move as pivotal. I am a lot more skeptical. There must have been the same kind of excitement when State Senator Charles Walker was convicted of 127 felonies at Grady and beyond. Yet, he, along with his daughter and the companies they ran, were the only ones that were convicted, and of course he got the absurd sentence of ten years. In 2004, the department of Health and Human Services conducted an investigation that concluded this...

the conditions at Grady Hospital pose a serious and immediate threat to the
health and safety of the patients

That was pretty damning however besides the then CEO, Dr. Andrew Agwunobi, no one lost their job as a result of this report and the power structure stayed in place despite its damning findings.Even in the late 1990's, Georgia Attorney General found Grady Hospital guilty of Medicare fraud. All of these were opportunities lost to clean up the corruption at Grady Hospital. The reason it didn't happen is also quite complicated, however I believe much of the blame goes to the media in Atlanta, headed by the Atlanta Journal Constitution.

In each of these stories, the truth is quite complicated and it was never fully explained to the citizens of Georgia. For instance, in the case of the HHS report, the report itself was damning, however how many people know the specifics of the report? Four departments were singled out: oncology, cardiology, General Surgery, and obgyn, in the report. Each of these departments had heads. None of these people lost their jobs because the specifics of the report weren't ever reported properly in the media. Furthermore, the heads of these departments had one boss, the Chief Medical Officer. His name is William Casarella and he has since been promoted within Emory University. This also happened because the media didn't properly report the specifics of the case. All people knew, if anything, about the investigation was the conclusion. While that was damning enough blame was impossible for a layman to determine without understanding the specifics as I now explain them.

In the case of Medicare fraud in the late 1990's, three departments were also identified: cardiology, obgyn, and oncology. Again, these departments have heads and a Chief Medical Officer above them. All of them including the CMO should have been and would have been fired if the media had properly exposed that case. As you can see the same departments are now coming up in multiple reports. No one outside the Grady structure knows this because the media, either through incompetence or worse, doesn't report the specifics of each case.There is one other case that the media did an atrocious job of reporting. That is the case of Dr. Sam Newcom. He was for about a year, the head of Oncology at Grady Hospital and Emory University Professor. He tried to speak out about the corruption and poor patient care at Grady Hospital and he was fired and ultimately paid off and silenced, but before that he wrote an article entitled Fighting Class Cleansing at Grady Memorial Hospital. You won't find this article in any mainstream Atlanta publication. As head of Oncology, you would be right in concluding that much of his indictment centered on his own department. In other words, oncology is the subject of a great deal of indictment from people of varying motivations and knowledge.

Nothing much has happened to clean up the oncology department and that is because the media has been asleep in reporting the specifics of what is going on at Grady.Then, there is Emory University. When the heat gets hot on Grady, Emory does a great job of distancing itself. In fact, they are doing their own disappearing act now. The truth is that they are for all intents and purposes one and the same. Each of these departments indicted by several different groups was run and almost fully staffed by staff at Emory University. The Chief Medical Officer, Dr. William Casarella, during much of this malfeasance has since been promoted within Emory. In other words, when there is sytemic problems at Grady Hospital, the blame must be laid at Emory University since it is staffed overwhelmingly by Emory professors and students. When Dr. Newcom indicted oncology, he was indicting his own colleagues since oncology is overwhelmingly staffed, like most of Grady Hospital, by Emory University personnel.

Now, what about the JCAHO findings? We know they are threatening to cut off accreditation however why? That, we don't know because for reasons unknown (I plan on calling the JCAHO on Monday for further explanation) the specifics of the findings aren't known. We can assume that multiple specific departments are the cause of it. It might be oncology, General Surgery, obgyn, cardiology, etc. The heads of any of the departments involved must be removed. If your department contributed to an investigation that ultimately lead to the accreditation of your hospital being threatened, THAT IS GROUNDS FOR REMOVAL, in my opinion at least. The current chief medical officer, Curtis Lewis, must be removed. If you are overseeing a hospital and the hospital is threatened with the removal of its accreditation, THAT IS GROUNDS FOR REMOVAL. The Current CEO of Grady Hospital is Otis Story, Sr. He must be removed for the same reasons. In fact, the entire board ought to be removed, however the board is overseen by Vernon Jones, and anyone that knows anything about Jones knows not to expect that to happen. Of course, how many Georgia folks know the real story behind Vernon Jones? That would require the media in Georgia to actually competently report the whole truth.

This whole case proves why the first amendment, the free press, is first not second or tenth. I hope everyone sees what happens when the media itself cedes its own freedoms and doesn't bother to report the whole truth. In order for this cycle to stop, the whole truth of the JCAHO findings must be reported by the media in Georgia. The media must keep the pressure on until all parties are held responsible. That is what has to happen.

Here is what will probably happen. There will be no more then a few more articles in the AJC about this report. Anymore reporting will be on the eventual deal made between Grady and the JCAHO, a deal that will no doubt be made in some back room. The major media in Georgia will NOT reveal the specific departments responsible for this latest investigation. They won't name names and they won't demand for heads to roll. Finally, they won't call Emory out when they distance themselves. Emory University will throw its significant weight around the Georgia Legislature and no one will report it. Grady will be given a golden parachute and none of the obvious systemic problems I have pointed out will ever be reported on or addressed. I hope I am wrong and I will be watching.

For more information on this case, please read this article. Also, please read the recommendations that my colleagues have come up with and compare them to the current plan.

My Recommendations for Fixing Grady Hospital

Introduction: If you haven't been following the plight of Grady Hospital in Atlanta, Georgia, here is a quick run down. Grady is one of the biggest hospitals not only in the Southeast but frankly in the entire country and the world. It has also been the scene to a great deal of corruption throughout the years. It has faced a series of financial crises throughout the years, however none are as critical as its current. Grady Hospital faces being closed down unless it is infused with cash to the tune of an estimated half a billion dollars according to some reports. Since Grady Hospital is the main hospital for the poor of Dekalb, Fulton and other area counties, this has become the subject of great debate and controversy. Because hospitals that cater to poor folks have limited profit potential, Grady is also naturally a public hospital. Thus, in the end, the taxpayers own it.

Enter the Grady Task Force which is a sort of consulting firm created by the Metro Atlanta Chamber of Commerce which has recommended a series of steps to save Grady. If you look at the link, you will see that for the most part the report is quite technical, however there is one recommendation which has become quite controversial. That is a plan to make the board quasi private. It should also be noted that Grady has paid four separate consulting firms about eight digits just in the last two to three years already. They have already hired another consulting firm even after the so called recommendations of the Grady Task Force.

I believe this plan, like the force itself, is nothing more than a sham and I wanted to offer my own alternative plan.

I want to point out that almost none of the ideas are actually my own, but rather those of folks that I have spoken with since I began tracking this story nearly two months ago. None of these folks ever saw any power at Grady, and I believe that after you read my plan you will see that there is no doubt that the wrong people are in charge. You will also see what it would actually take to turn Grady around.

The first thing Grady Hospital needs is some serious improvements in its infrastructure. For instance, its HVAC system is totally shot. Doctors have told me that sometimes it gets so bad at Grady that they themselves can't breathe. Now, imagine if you are a patient that has a breathing problem, what would such a state do to you. There is asbestos in the wall. The elevators are old and they breakdown all the time. There are patients that are in critical condition and time is of the essence. If they need to be moved from floor to floor, you simply cannot have the elevators broken. Doctors tell that this can be a regular occurrence. The computer system for tracking their medical records is old, from the seventies people tell me. Many times patients history can't easily be looked up, and thus allergies and other ailments may not be known. The building simply must be brought up to code.

If this is shocking to you, and you think this couldn't happen because the patients would talk, keep in mind the patients are the poorest folks in the area. They simply have no alternative and many times they don't know any better.One of the tragedies at Grady is that they recently had a giant addition added. That's right, while their infrastructure was falling apart they added a huge addition about five years ago. If you want to know why, you maybe interested in knowing that powerful board member Robert Brown also owns an architecture firm and while the firm is equipped to add on to hospitals they can't fix elevators. (He is also a prominent member of the Grady Task Force and one main reason why the force is in my opinion a total sham)

Grady also needs to be held accountable, so money will be given in tiers. The state legislature will choose a committee to oversee upgrades in infrastructure, and money will only be given if standards are met.The Grady Board, currently chosen by the Dekalb County CEO (currently Vernon Jones), needs to be elected and it must be split up by districts so that it evenly represents the folks currently treated by Grady Hospital. This board, which would serve four year terms, would be in charge of hiring and firing the Grady CEO.

Instead of paying Emory University and Morehouse (the two schools that supply the bulk of Grady staff) a flat fee for their services, the Grady Board would institute a tiered sort of grading system (based on JCOHA grades, patient feedback and whatever other measurements they chose). Keep in mind that as representatives of the people, the board would be giving Emory and Morehouse the people's money. This means they would be more inclined to grade the two schools harsher than softer. This would give the two schools that much more incentive to perform better.

Also, the two schools would be responsible for their own malpractice insurance. Unbelievably, at least at Emory, Grady pays for the malpractice insurance of Emory professors and medical students. Essentially, this means that Emory, a private institution, has it so the public, through a public hospital, covers its malpractice insurance. Not only is this an obscene misuse of public funds, but obviously can lead to all sorts of abuse. Obviously, if you aren't responsible for your own malpractice insurance, you are more likely to act a lot more recklessly. I believe that is exactly what Emory has done to tragic results. This will remove that motivation.

The state legislature would set up a committee that would be in charge of funding Grady. They would set their own set of benchmarks for receiving funding and would also be in charge of deciding how much Grady Hospital got. Since the legislators are also spending the people's, or their constituents, money, they would also be disinclined to grade easily. This would give the board more motivation to make sure performance is up to par. We saw just how tragic it could be in the case of State Senator Charles Walker when funds are determined by corrupt reasons rather than performance.

Grady would develop a new position called the Office of Conflict Interest. Each transaction, each finance, each so called deal, would be scoured by this office to make sure that say a board member's architecture firm isn't getting the deal because the owner is on the board. I believe there are many such deals like the one I refer to with Robert Brown and the addition his company got, and that can't happen. This hospital didn't just find itself in financial crisis for no reason. It got there because its financial dealings were corrupted. This office would be in charge of making sure every deal was on the level.

Grady would need to update its by laws. First, it would no longer be allowed to have retaliatory behavior against whistleblowers. People must be able to report malfeasance without the threat of losing their job. Joyce Harris lost her job when she blew the whistle on State Senator Charles Walker. I also firmly believe that Kevin Kuritzky was expelled for blowing the whistle on serious corruption as well. These are jus two examples and I believe there are many more. There needs to be a truly anonymous tip line so that malfeasance can be reported without threat of retaliation.

Grady Hospital can no longer be allowed to stall in providing financial records to outside sources. I have been told by more than one person that getting records can be maddeningly time consuming. In fact, I was told that by the time records were received the incident or incidents in question were so far in the past that most didn't care. For instance, it took my sources several years to finally figure out that Brown's company received the lucrative contract. Grady Hospital would now be the subject of stiff fines if records aren't turned over in a timely manner. Furthermore, an outside party, a judge or a lawyer, would act as a mediator, in disputes over records requests. Finally, the by laws would declare that Grady would from now on follow due process.

Grady Hospital would no longer be allowed to settle any lawsuits under seal. I have counted four Emory professors that I believe have been paid off. The case of Dr. Jim Murtaugh is the only one that has been unsealed so far and it provides a glimpse into just how far some will go to keep malfeasance quiet. This can't go on, and it will have to be outlawed.From now on, meetings held on the finances of Grady Hospital would be open to the public and the media. Currently, those meetings, like many others, are held in secret. Secrecy is a bedrock of corruption. By turning Grady over to a private board, it would make it even easier to maintain secrecy, and it is this diarists contention that secrecy is the end goal of the private board plan. In order to fix Grady, we need the opposite of secrecy. We need everything to be open. Keep in mind that Grady is a public hospital. It uses public funds. The public has every right to know where those funds are going. Open finance meetings are one way to assure that.

With these recommendations Grady would actually have a chance to thrive long term. While I am sure there will be those that will poke holes in it, I would dare anyone to compare my plan, less than two pages, to the plan by the Grady Task Force.

The Definitive Dossier on Dr. Andrew Agwunobi (Updated)

I stumbled upon the character of Dr. Andrew Ogwunobi in researching the overall crisis going on at Emory University and Grady Hospital. At first, he appeared to be an important player however a supporting actor in the overall scheme of Grady Hospital. While that remains true, he is also an individual that needs attention paid to in his own right.Dr. Agwunobi's story is picked up in 2001 when he became CEO of South Fulton Hospital in Atlanta, Georgia. South Fulton is a relatively small hospital that specializes in providing health care mostly to the poor of Atlanta.



Several months after he took over the hospital received its report card from the governing body the JCAHO. The report was not altogether great, however if we compare it to school, the hospital received the equivalent of a C or C-. There was plenty that the JCOHA found to be lacking at South Fulton, however they ultimately passed the hospital. He left in mid 2003 to take on a similar role at Grady Hospital, the largest hospital in Georgia and one of the largest in the country. Grady also specializes in providing health care for poor folks. Another JCAHO report was issued immediately after he left and this one failed South Fulton. At this point, the hospital was forced to institute a number of measures just to get back to JCAHO standards. Not to worry for Dr. Agwunobi, because South Fulton's mess was left for another to clean up since he had already moved on.



He was initially lauded for several cost cutting measures as well as other steps he took to streamline much of their technology and administration. Grady was also the subject of another investigation while Agwunobi was the CEO there. This one was done by the HHS. This report was issued about a year after he arrived and here are the conclusions.

an immediate and serious threat to the health and safety of the patients

It is really no worse than that if you are running a hospital. While the details of the report are complicated, ultimately Agwunobi lost his job in the aftermath. Furthermore, as CEO, he was ultimately responsible for everything at the hospital and this report clearly states he failed in the most insidious way.



At this point, his story turns from incompetence and possibly corruption to one of murkiness and peculiarity. Most people would think that after running two hospitals into the ground, Agwunobi's career would be over. It wasn't. In fact, he received a position as COO at St. Joseph's Hospital, a network of hospitals in California. This is in effect a promotion. This means that upon running two hospitals into the ground he received a promotion.



His move cross country was short lived. He only held his position at St. Joseph's for some more than a year when he moved cross country to Florida to serve on the board of WelCare, another chain of hospitals. This is rather peculiar. Agwunobi has a family including a small child and it doesn't make sense that he would make two cross country trips to change jobs in such a short period of time. I suppose that being on the board paid more. It may even pay a lot more, however being COO of a hospital chain pays plenty well. He would have to be extemely greedy if he did it simply for the money.



His stay at Welcare is even more peculiar. He only stayed there for about six months. He left last Decemeber after only six months. He was able to manage to cash out about a million dollars worth of options upon leaving.








As you can see from the chart, he cashed out just in the nick of time because only about eight months later the stock tumbled. Now, if we are keeping score, this makes four jobs in five years. Certainly, this couldn't be impressive for his next employer could it? Only the powers that be know because his next employer was the Dept. of Health in the state of Florida. He ran a department called the AHCA which specliazes in providing quality health care to poor folks. That is interesting because in my, admittedly non professional opinion, he failed miserably twice previously in that endeavor.

Of course, the story turns from bizarre to unbelievable. That is because WellCare's stock tumbled because it was targeted for investigation by several state and federal agencies including the AHCA. That's right, Agwunobi came to WellCare, stayed six months, cashed out for about a million bucks, and then went to an agency that is now targeting Wellcare.There are more questions than answers when it comes to Agwunobi, however the citizens of Florida currently pay his salary. They are the ones that need to ask how this guy, with a history of failure and no job longevity, winds up with such a prominent role in their government. They need to be the ones that get answers and I hope they will.

For all links to back up my statements please go here and here. Please go here to contact the Florida Department of Health, and here to contact the Florida Governor. Finally, go here to contact Dr. Agwunobi himself. Please be respectful and polite however everyone needs to demand answers.

UPDATE:I believe that this particular piece speaks for itself, and I firmly believe that at a minimum Dr. Agwunobi has some explaining to do regarding his dealings at WellCare. That said, Dr. Agwunobi has become a sort of tentacle in a larger story that I have been following. It is the story surrounding the crisis currently going on at Grady Hospital. I think that everyone should understand how Dr. Agwunobi fit into that crisis. Thus, I have put together a summary of the entire fiasco that tries to put all of its moving parts together in one piece. Please read it for guidance. See how Dr. Agwunobi fits in.

Epilogue: Since this story has written, there has been movement in the case of Agwunobi and WellCare and here is the latest update. Also, here is my analysis in the media's complicit role in overlooking Agwunobi's cross country terror of corruption.

Dr. Andy: The Follow Up

I will give a very big hat tip to Pharma Fraud. Last week, I published a piece on Dr. Andrew Agwunobi. Dr. Agwunobi has had quite a wild professional ride in the last few years. He took over a subpar hospital in Atlanta called South Fulton and two years later, under his leadership, the hospital went from being merely subpar to failing the standards of the governing board. He then moved onto Grady Hospital, the biggest hospital in Georgia and one of the biggest in the Southeast, and within about a year the HHS finished an investigation of that hospital. The findings concluded this,

an immediate and serious risk to the health and safety of the patients.

Despite a pattern of incompetence or corruption or both, Dr. Andy moved on cross country to run a chain of hospitals in California called St. Joseph's. Despite moving cross country to California, his stint there was short, only about a year, though it is unclear why he left such a lucrative position.

I picked up the story with Dr. Andy now in charge of the AHCA in Florida, which is a government bureau who's job it is to provide quality health care to the poor.

Pharma Fraud found another employer in between St. Joseph's and the AHCA. They pick it up here.

Last December, Andrew Agwunobi ended a brief stint on WellCare's board to become the top healthcare regulator in the company's home state of Florida . Agwunobi now leads the Florida Agency for Health Care Administration, which has partnered with the state's Medicaid Fraud Control Unit - a participant in last week's raid on WellCare - in an effort to stamp out corporate wrongdoing.

Agwunobi foreshadowed things to come, when on Friday October 19, just 5 days before the WellCare raid, he said in a Miami press conference that he commissioned a tough new look at fraud when he took over as secretary for the Agency for Health Care Administration. ''We targeted South Florida,'' he said, "the area with the single largest amount of Medicaid fraud in the country.''

Agwunobi declared that it was now ''open-season'' on anyone committing Medicaid fraud in South Florida. (More Medicaid fraud suspected in S. Fla.)

Here is the most interesting part from Pharma,

Upon leaving WellCare, Agwunobi cashed out options and stocks for a $1 Million profit.Let's review what Pharma has uncovered. Dr. Andy left a fairly short stint at St. Joseph's to take on another fairly short stint at WelCare. After six months, he leaves and simultaneously cashes out about a million dollars in options. He moves to a position in the state government, and promptly turns around and begins an investigation of the very organization he just left.

There are three words and phrases that come to mind when reading this: conflict of interest, appearance of impropriety, and in spades. This makes five employers in under six years for Agwunobi and the circumstances of his departures from all of them is well peculiar. Maybe someone in Florida can start asking some questions about his fitness for his job.