IN THE CIRCUIT COURT OF THE 17Tx

JUDICIAL CIRCUIT, IN AND FORBROWARD COUNTY, FLORIDA

Pauline Grant, Case Number:

Plaintiff,

►•

North Broward Hospital District d/b/aBroward Health,

Defendant.

COMPLAINT

COMES NOW, the Plaintiff, PALTLINE GRANT, and sues the Defendant,

NORTH BROWARD HOSPITAL DISTRICT d/b/a BROWARD HEALTH ("Broward

Health"), and states the following:

Introduction

1. This is a whistleblower action brought by Pauline Grant, the former Interim

Chief Executive Officer of Broward Health and former CEO of Broward Health North.

2. Pauline Grant has been subjected to actions by Broward Health that are

prohibited by Florida's Whistleblower Statute, as set forth in § 112.3187 of the Florida

Statutes, in retaliation for actions she took in an attempt to investigate and remedy

misfeasance and malfeasance within the public agency.

1

Filing # 65173983 E-Filed 12/08/2017 03:41:17 PM

Jurisdiction and Venue

3. This Court has jurisdiction of this action as Ms. Grant seeks damages in

excess of $15,000, exclusive of interest, costs and attorneys' fees.

4. Venue is proper in Broward County, as Ms. Grant is a resident of Broward

County, Broward Health is a special taxing district and government agency operating its

business in Broward County and all of the events giving rise to this lawsuit took place

within Broward County.

5. Pauline Grant was, at all times material hereto, an "employee" of Broward

Health as defined by §112.3187(3)(b}, Fla. Stat.

6. Broward Health was, at all times material hereto, an "agency" as defined in

§ 112.31$7(3)(a), Fla. Stat.

Conditions Precedent

7. In January of 2017, Pauline Grant jointly filed a Charge of Discrimination

with the Florida Commission on Human Relations and the Equal Employment Opportunity

Commission which included, inter alia, allegations that she was wrongfully terminated

from her employment in retaliation for raising valid concerns protected by Florida's Public

Whistleblower Statute, § 112.3187, Fla. Stat. See Exhibit A.

8. Although not required for the filing of this lawsuit, in June of 2017, Pauline

Grant also placed Broward Health on notice of her intent to bring suit against it for injuries

and damages she suffered as a result of actions taken by its agents and employees. See

Exhibit B.

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9. On June 14, 2017, the Florida Commission on Human Relations issued a

determination of Ms. Grant's Charge. In a letter that made no reference whatsoever to the

whistleblower allegations, the Commission found no reasonable cause. See Exhibit C.

10. Accordingly, Ms. Grant has the right to bring suit in circuit court within 180

days of that letter. This complaint is within that time frame.

11. Ms. Grant has satisfied all conditions precedent to the filing of this lawsuit.

Factual Allegations

12. Pauline Grant has been employed by Broward Health since 1991.

13. From 2003 until 2016, Ms. Grant was employed as the Chief Executive

Officer of Broward Health North, one of four hospitals owned and controlled by Broward

Health.

14. In August of 2015, Broward Health paid approximately $70 million dollars

as part of a settlement with the federal government arising from a whistleblower claim that

involved allegations that it did not pay market value to physicians on its medical staff. The

CEO of Broward Health at the time was Dr. Nabil El Sanadi.

15. As part of that settlement, the federal government imposed afive-year

Corporate Integrity Agreement (CIA).

16. The CIA requires Broward Health to, among other things, establish a

compliance program and retain an independent review organization (IRO) to ensure that

Broward Health's "financial arrangements with physicians and vendors" satisfy federal

requirements.

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17. The Monitor from the Office of the Inspector General of the Department of

Health and Human Services assigned to oversee Broward Health's compliance with the

CIA is Laura Ellis.

18. The appointed IRO is J. Scott Newton and/or the Law Firm of Baker

Donelson who were approved and retained by the Board in December 2015.

19. According to guidelines from the Office of the Inspector General, an IRO is

required to be independent and objective with respect to the review that is being performed.

20. Similarly, the CIA at issue in this case includes specific language stating that

the IRO must perform its review in a "professionally independent and objective fashion,"

and provides a method for the removal or termination of the IRO if there is reason to

believe that the IRO is not qualified, independent, objective, or has failed to carry out its

responsibilities.

21. Shortly after the IRO was retained, questions began to arise about his/its

independence.

22. In January of 2016, then-CEO Dr. Nabil El Sanadi committed suicide.

Shortly thereafter, then-COO Kevin Fusco was named Interim CEO of Broward Health.

23. In March of 2016, the then-Chairman of the Board, David Di Pietro had

received widespread complaints both about the Interim CEO's leadership of Broward

Health and the General Counsel's incompetency. Accordingly, he placed two items on the

Board Agenda: the replacement of then Interim CEO, Kevin Fusco, and the termination of

General Counsel, Lynn Barrett.

0

24. At that March 2016 meeting, challenges were raised by Broward Health

employees as to the competence and qualifications of the Interim CEO, the General

Counsel and the IRO.

25. At the conclusion of the meeting, the Board voted to remove Kevin Fusco as

the Interim CEO, and put Pauline Grant in his place. Ms. Grant had no prior knowledge

that she was going to be asked to take on the role of Interim CEO at this meeting.

26. The Board also voted 4-3 to retain Lynn Barrett as the General Counsel,

subject to an upcoming review of her performance.

27. Just two weeks into her tenure as Interim CEO, on March 31, 2016, Ms.

Grant received a letter from the IRO praising her immediate and decisive response to

ongoing concerns of the IRO regarding document production.

28. In May of 2016, an anonymous email was sent to the Broward Health Board

of Commissioners and a number of Broward Health employees, which questioned, among

other things, actions being taken by General Counsel's office, and the qualifications and

scope of work of the IRO who was being compensated with taxpayer dollars. See Exhibit

D.

29. Ms. Grant contacted the OIG Monitor and was told that any investigation

into the complaints of the anonymous letter and the independence of the IRO would have

to be performed by independent, outside investigators.

30. Accordingly, Ms. Grant and others interviewed several law firms to

determine their qualifications to act as outside investigators for this purpose.

5

31. Ms. Grant advised the Board that she was in the process of retaining outside

investigators in May of 2016.

32. In an email dated June 3, 2016, following additional complaints about the

IRO and ongoing practices at Broward Health, Ms. Ellis again reiterated that they "should

be investigated by the independent party retained to investigate the previous May 2016

anonymous disclosure." See Exhibit E.

33. Soon after Ms. Grant brought these concerns to the Board and expressed her

intent to hire outside investigators, Broward Health, primarily through the General

Counsel's office, began a systematic effort to discredit Ms. Grant and remove her from the

position of Interim CEO in retaliation for her efforts to investigate and remedy these issues.

34. On June 13, 2016, without any explanation into her change of decision, the

OIG Monitor advised Broward Health, in writing, that she had spoken with the IRO, and

was satisfied that he was acting within the scope of his engagement and that she remained

satisfied that he possessed the necessary qualifications and independence to perform his

review. See Exhibit F.

35. Thereafter, at the urging of General Counsel, the Board revised its

procedures such that only General Counsel is pernutted to retain outside counsel.

36. Additionally, General Counsel caused and directed multiple investigations

into a complaint regarding allegations that Ms. Grant Pauline Grant, Judith Johnson, M.D.

(the Medical Director of Orthopedic Trauma), and Steven Naide, M.D. (the Medical

Director of Trauma) were receiving kickbacks and unfairly disbursing the orthopedic

trauma call schedule at Broward Health North.

:'i

37. Those allegations were made known to General Counsel when the

anonymous complaint was made in November of 2015, before Ms. Grant was appointed

Interim CEO.

38. General Counsel's efforts to investigate it, however, did not occur until after

Ms. Grant had advised General Counsel, and the Board, of her intention to retain outside

counsel to investigate the ongoing complaints regarding the General Counsel and the IRO.

39. Thereafter, internal investigations by both Compliance and the General

Counsel's Office concluded there was nothing to support the kickback allegations against

Ms. Grant.

40. In August of 2016, notwithstanding the conclusions of the internal

investigations, and without seeking approval from the Board Members, General Counsel,

then hired an outside law firm from Nashville, Tennessee (Waller Lansden) to conduct an

investigation in to the physician's "kickback" allegations.

41. In September and October of 2016, General Counsel arranged for those

lawyers to meet with various staff, including physicians from Broward Health North and

Pauline Grant, without advising those individuals of the purpose of the meetings, without

affording them an opportunity to prepare, and without offering or affording them an

opportunity to obtain or have counsel present.

42. In fact, during her own surprise meeting with those attorneys, Ms. Grant was

expressly advised by General Counsel that Ms. Grant was not under an investigation just

prior to General Counsel leaving Ms. Grant, the CEO, alone with these lawyers.

7

43. The individuals involved in approving physicians for the trauma call

schedule, as well as those who were contracted to participate in it, all denied any

wrongdoing at Braward Health North, including fraud, kickbacks or other misconduct on

the part of Ms. Grant or anyone else.

44. The outside lawyers were also informed that there were quality and

qualification issues with this particular physician and his partner.

45. General Counsel directed outside counsel to focus on the call lists even after

the investigators suggested preliminarily that the complaint appeared to lack merit, as it had

come from a disgruntled employee.

46. Unbeknownst to Ms. Grant, the outside investigators and the IRO continued

to target her over the next few months.

47. In late October of 2016, the IRO published its first report.

48. The report suddenly claimed that Ms. Grant was involved in a perceived

conspiracy to prevent document production to the IRO, despite the IRO's earlier letter

praising Ms. Grant for her assistance in that process.

49. The IRO further suggested that Ms. Grant and others were attempting to

conceal the alleged kickback complaint.

50. This allegation was baseless, as the alleged kickback complaint was

disclosed to Compliance, the General Counsel and others at the time it was made in

November of 2015.

~3

51. In November of 2016 the outside lawyers investigating the kickback

allegations advised General Counsel that they had concluded that there was a probable

violation of federal statutes.

52. Throughout November, General Counsel and outside lawyers at Foley &

Lardner, coordinated meetings with some of the Board Members who secretly met, or

spoke, with General Counsel, the outside lawyer from Tennessee, Mr. Westling, attorneys

from Foley & Lardner (including but perhaps not limited to Kevin Hyde and/or Myla

Reizen), as well as a third attorney, Jack Selden, from an Alabama law firm (Bradley).

53. Certain other Board Members were never afforded this opportunity.

54. While these meetings were occurring, a negative news article circulated in

Politico an November 23, 2016, containing information that appeared to have been leaked

by the General Counsel's office.

55. Ms. Grant found this leaked information to be particularly egregious since

the IRO report had just accused her, without evidence, of leaking information about

Broward Health to the press.

56. On November 30, 2016, Ms. Grant wrote to the Board Members at Broward

Health, to whom she directly reported, regarding these allegations that had been made

against her, many of which were false and unsubstantiated. See Exhibit G.

57. Ms. Grant's letter put the Board Members on notice that Ms. Grant believed

that she was being retaliated against since out of dozens of open complaints in the

confidential compliance disclosure log, the IRO had singled her out, notwithstanding the

fact that there were open complaints against the General Counsel, the Chief Ethics Officer,

and other Board Members and senior leaders within the agency.

58. Ms. Grant specifically advised the Board that the actions were "retaliatory"

and a "deliberate effort" to impact her ability to do her job, her credibility, and her

reputation.

59. The very next morning, December 1, 2016, less than 2 hours before the start

of a Special Board Meeting, General Counsel brought another unannounced lawyer to meet

with Ms. Grant.

60. The attorney, Jack Selden, who had already met with a number of the Board

Members, but not all of them, advised Ms. Grant that there was probable cause to suggest

that she had done something wrong and asked her if she had an attorney.

61. Mr. Selden advised Ms. Grant that they had brought her in to put her on

notice that this issue was going to be discussed at the special Board meeting scheduled for

11:00 a.m. that morning.

62. It was not until the 11:00 a.m. Board meeting that Ms. Grant first learned that

she had been investigated and implicated in a purported kickback scheme and that the

information was going to be submitted to the federal government.

63. The notice and agenda for the December 1St Board meeting had been drafted

by General Counsel with assistance of lawyers from the Foley Lardner firm, and in no way

indicated that Ms. Grant, or any allegations against her, were to be discussed.

64. No one from the law firm who conducted the investigation appeared at that

Board meeting.

10

65. Additionally, no written summary of the investigation, list of witnesses,

summary of statements, or documentary evidence was ever provided to anyone at Broward

Health before that meeting.

66. Rather, Jack Selden, whose firm was nat involved in the investigation,

simply reported about the allegations of kickbacks from the anonymous complaint, the

apparent conclusion that there appeared to have been a probable violation of federal anti-

kickback laws, and his opinion that it constituted a reportable event under the CIA.

67. Without proper notice to her or the public, or an opportunity to prepare a

response to the allegations against her, Ms. Grant was terminated by a 4-1 vote of the

Board at that meeting with one Board Member absent.

68. Since the wrongful termination on December 1, 2016, General Counsel,

through outside lawyers, and the IRO, has continued to raise false allegations impugning

Ms. Grant's character, which has resulted in the issuance of reports designed to disparage

Ms. Grant and an effort to initiate local, state and federal investigations.

69. These actions were taken in retaliation for Ms. Grant's efforts to investigate

the anonymous complaints against General Counsel and the IRO, and her attempts to bring

to the Board's attention issues of malfeasance and gross mismanagement within Broward

Health.

70. Ms. Grant has provided her own responses, all of which support a finding

that those reports have not been objective, and that factual information favorable to Ms.

Grant has been intentionally withheld or excluded, which again supports her contention

that she has been improperly targeted.

11

71. Ms. Grant has filed suit against Broward Health as follows:

a. Claim against Broward Health, the Board of Commissioners, andGeneral Counsel for violations of Florida's Sunshine Act (BrowardCircuit Case Number CACE-16-022981, Honorable Mily RodriguezPowell);

b. Claim against Broward Health for Breach of Contract (Severance)(Broward Circuit Case Number CACE-17-009406-08, HonorableDavid Haimes); and

c. Claim against Broward Health for violations of the Public RecordsAct (Broward Circuit Case Number: CACE-17-014710, HonorableMichael Robinson).

COUNTIVIOLATION OF §112.3187

72. Ms. Grant realleges paragraphs 1-71 as if completely set forth herein.

73. At all times material hereto, Pauline Grant was an "employee" of Broward

Health, which is an "agency" as defined by the Florida's Whistle-blower's Act, § 112.3187,

Fla. Stat.

74. In response to concerns raised in a 2016 anonymous e-mail and at certain

Board and other Committee meetings, which questioned the qualifications of General

Counsel and the IRO, among other things, and upon the advice and direction of the OIG

Monitor, Ms. Grant determined that an outside investigation into the allegations was

appropriate.

75. After advising the Board and General Counsel of her intent to investigate the

concerns raised in the anonymous email, outside counsel was hired by General Counsel for

what appears to be the sole purpose of investigating Ms. Grant, notwithstanding the fact

12

that a several internal investigations had already been completed, all of which suggested no

wrongdoing on her part.

76. Likewise, in response to the October 2016 IRO report and subsequent stories

in the press, Ms. Grant properly raised concerns with the Board, to whom she directly

reports, about how investigations were being handled within the agency and how she was

being improperly targeted and retaliated against.

77. During her tenure as the CEO of Broward Health-North and the Interim CEO

of Broward Health, Ms. Grant brought the following information to the attention of the

Board of Commissioners of Broward Health:

a. that she intended to investigate, with the assistance of outside counselat the direction of the OIG Monitor, complaints about the GeneralCounsel and questions about the independence of the IndependentReview Organization;

b. that inaccurate and untrue information about herself and others wasbeing communicated to the IRO and others;

c. that the IRO had issued a report including allegations against her, andothers, but had never interviewed her, personally, to discuss the issuesor concerns;

d. that the General Counsel and IRO had improperly accused theCompliance Officer of a cover up of allegations made against Ms.Grant (notwithstanding that the Compliance Officer and a SeniorAttorney had completed a fu11 investigation);

e. that many complaints against the General Counsel, the Chief EthicsOfficer, several Board Members, and other senior executives ofBroward Health had not been properly or timely investigated;

f. that she, as the CEO, was improperly "interviewed" by outsideattorneys without any notice of the purpose or subject matter of themeeting;

13

g. that she was being retaliated against;

h. that the IRO and other agents or employees of Broward Health weredeliberately attempting to damage her character and create suspicionand mistrust;

i. that internal Broward Health information was being shared by theGeneral Counsel's office with outside news sources without formalrecords requests; and

j. that she, as the Interim CEO, was not being timely and properlyinformed of ongoing investigations into Broward Health.

78. All of these allegations put the Board on notice of acts, or suspected acts, of

gross mismanagement, malfeasance, waste of public funds, gross neglect of duty, and

possible violations of state or local laws, rules or regulations by Broward Health's own

agents and independent contractors, including, but not limited to, the General Counsel, the

IRO, and outside investigators.

79. This information was properly disclosed to the Board, and the Florida

Commission on Human Relations, as well as the Equal Employment Opportunity

Commission.

80. This information was properly included in a written and signed letter to the

Board as Ms. Grant's supervisory officials, as required by the law.

81. Further, the acts taken in regard to interviewing outside counsel in

preparation for investigating the anonymous complaints were taken under the advice and

direction of the OIG Monitor.

82. As a result of her actions, Pauline Grant was wrongfully terminated from her

position as Interim CEO of Broward Health and CEO of Broward Health North.

14

83. The decision to single out Ms. Grant and subject her to multiple

investigations without notice or any opportunity to be heard or represented by counsel was

motivated by a retaliatory animus designed to punish her for objecting to ongoing

questionable practices within the agency, for her participation in attempting to investigate

various complaints, or for her perceived support of other employees who were challenging

ongoing practices within the agency.

84. Ms. Grant's attempts to investigate ongoing complaints and to bring those

issues to the attention of the Board was designed to improve the benefits provided to the

public by Broward Health and was not made in bad faith or with any improper purpose.

85. Ms. Grant's actions did not occur at a tune after the agency had initiated any

personnel action against her.

86. Pursuant to § 112.3187(4), it was unlawful for Broward Health to dismiss or

discipline Ms. Grant in retaliation for the attempted investigation and/or disclosure of

information.

87. As a direct and proximate result of Broward Health's prohibited and

retaliatory actions in terminating her from her employment, Ms. Grant has suffered

damages that are continuing in nature.

88. Pursuant to § 112.3187(9), Ms. Grant seeks the following relief:

a. Reinstatement of her position, with salary and benefits or,alternatively, front pay as alternative relief;

b. Compensation for lost wages, benefits and other remuneration causedby the improper adverse action;

15

c. Compensation for the impact to her reputation and future earningcapacity as a result of the improper allegations and adverseemployment action;

d. The payment of reasonable costs, including attorneys' fees, incurredby Ms. Grant for the undersigned's services; and

e. The issuance of an injunction prohibiting any other or futureretaliation.

WHEREFORE, PAULINE GRANT respectfully requests a judgment against the

NORTH BROWARD HOSPITAL DISTRICT cUb/a BROWARD HEALTH for the above-

mentioned relief and any other and further relief this Court deems appropriate under the

circumstances.

Demand for Jury Trial

Plaintiff demands a trial by jury on all issues so triable.

Respectfully submitted,

Haliczer Pettis & Schwamm, PAOne Financial Plaza100 SE Third Avenue, Seventh FloorFort Lauderdale, FL 33394Phone: (954)523-9922ser~jice(~~hpsleQal .cam

L~ ~ ?r~

EU NE K. PETTISFlorida Bar Number: 508454

i[~

Date Stamq (FCHR Use Onlv)

FLORIDA COMMISSION ON HUMAN RELATIONS2009 Apalachee Parkway, Suite 200

Tallahassee, Florida 32301

EMPLOYMENT CHARGE OF DISCRIMINATION FCHR No.Name (Indicate Mr. or Ms.) E-Mail Address Date of BirthMs. Pauline Grant P4rant5597(c~aol.com 7/12/1950

Street Address Home Telephone Number7981 NW 125th Terrace (with area code) 954-242-8955

City, State, and Zip Code Work (if possible to call you there)Parkland, FL 33076

List the employer, labor organization, employment agency, apprenticeship committee,overnment a enc , or other erson who discriminated a ainst ou.Name Number of Employees Telephone NumberNorth Broward Hospital District d/b/a Approximately 7,500Broward HealthStreet Address (Branch/Office in Florida) City, State and Zip Code County1800 NW 49th Street, Suite 110 Fort Lauderdale, FL 33309 Broward

CAUSE OF DISCRIMINATION BASED ON -Check appropriate boxes) DATE MOST RECENT DISCRIMINATION~ RACE ~ COLOR ❑SEX ❑RELIGION ❑DISABILITY TOOK PLACE (month, day, year)❑ NATIONAL ORIGIN ❑AGE ❑MARITAL STATUS RETALIATION

12/1/2016HAVE YOU FILED A CHARGE ON THIS MATTER WITH THE EEOC OR ANOTHER AGENCY? YES NOIF 50, PROVIDE THE NAME OF THE AGENCY AND THE DATE OF FILING:

The following is a statement of the facts, including pertinent dates, constituting the unlawfulemployment practice (If additional space is needed, attach extra sheets(s)):On December 1, 2016, the North Broward Hospital District Board of Commissioners voted to ternunate myemployment as Interim CEO of Broward Health and CEO of the Broward North Hospital. I believe thisternunation was in retaliation for my attempts to report and remedy gross mismanagement/malfeasance withinthe Broward Health system and violated the Florida Whistleblower statute. Broward Health is a special districtof the State of Florida.

I also believe that my ternunation may have been part of a pattern and practice of removing high-ranking black,female personnel at Broward Health. Multiple black, female senior-level administrators have been recentlyterminated or forced to resign under conditions that white female or male adnunistrators have not been subjectedto.

I believe that my ternunation was orchestrated in retaliation for engaging in activities that are protected underSection 112.3187, Florida Statutes. I further believe that my termination was part of a larger pattern and practiceof terminating black, female executives within the Broward Health system in violation of Section 760.10,Florida Statutes andlor Title VII of the Civil Rights Act. Please do not hesitate to contact me if you need anyfurther information.

verify that I have read the foregoing charge of discrimination and that the facts stated fn it are true.SIGNATURE OF COMPLAINANT DATE

/~~../~" / Z -~ / 7FCHR Charge Form -Revised 7/17/14

Haliczer Pettis Schwan~u~►ATTORNEYS AT LAW

JAMES 5. HALICZER

EUGENE K. PETTISH

RICHARD B. SCHWAMM

KENNETH J. MILLER

N EAL C. FALK

DEBRA POTTER KLAUBER

MICHAEL M. RIED HAMMER°

ALAN J, LANDERMAN

TRISHA 5. WIDOWFIELD

MISTI Z. BARNETT

RENEE L. GRANT

BRIAN D. MURRY

CAROLINE TABASH

ERIN DERNIS

HEATHER L. WEETER

PATRICK M. JOHNS

FRANKLIN H. SATO

NIKEISHA S.W. PRYOR

OF COUNSEL

RICHARD L. WAGENHEIM°

BARBARA B.WAGNER°

4HOAgD CERTIFIED IN EO UCA710N LAW

O BOARD CERTIFIED IN WORKERS COMPENSATION

Via Certified Mail

June 2, 2017

North Broward Hospital District d/b/a Broward Healthc/o Lynn Barrett, General Counsel and Registered Agent1800 N.W. 49~' Street, Suite 120Fort Lauderdale, FL 33309

Florida Department of Financial ServicesAttention: Jeff Atwater200 East Gaines StreetTallahassee, FL 32399

FORT LAUDERDALE

ONE FINANCIAL PLAZA •SEVENTH FLOOR

I00 S.E. THIRD AVENUE

FORT LAUDERDALE, FLORIDA 33394

TELEPHONE (x"34) 523-9922

FAX (984) 322-2512

ORLANDO

LANDMARK CENTER TWO • SUITE 478

226 E. ROBINSON STREET

ORLANDO, FLORIDA 32801

TELEPHONE (407) 841-9H66

FAX (407) 841-9916

REPLY TO:

Fort Lauderdale

Re: Our client: Pauline GrantDates of Incident: May 2016-presentLocation of Incident: 1800 N.W. 49"' St., Suite 120

Fort Lauderdale, FL 33309

Dear Ms. Barrett and Mr. Atwater:

Pursuant to section 768.28 of the Florida Statutes, notice is hereby given thatPauline Grant is making a claim against the North Broward Hospital District d/b/aBroward Health regarding injuries and losses she sustained in incidents which occurredbetween May 2016 and the present.

~T E F 1~

A PROFESSIONAL ASSOCIATION

It is hereby alleged that actions taken by the agents and employees of the NorthBroward Hospital District to defame Pauline Grant and impugn her professionalcharacter and reputation were the cause of injury and damages to Pauline Grant. Thoseagents and employees, whether negligently, recklessly, or maliciously, caused false anddefamatory statements and written submissions about Ms. Grant to be published atBroward Health Board meetings and in local and national publications, despite the factthat multiple investigations, both internal and through outside representatives, resultedin findings that there was no wrongdoing by Ms. Grant. Ms. Grant maintains that thesestatements were published for the purpose of impacting her employment, motivated bya desire to harm her reputation and designed to retaliate against her.

Please accept this as a formal notice of this claim against the North BrowardHospital District and its agents and employees, and have your legal representativecontact the undersigned within thirty (30) days so that we may discuss this matter.

In addition to the above information, please also accept the followinginformation regarding Ms. Grant as required by the applicable statutory provisions:

1. Date of Birth: 07/ 12/ 19502. Social Security Number: 263-87-14143. Place of Birth: Sav-La-Mar, Jamaica, West Indies

Ms. Grant has no prior adjudicated unpaid claims.

Please do not hesitate to contact the undersigned should you require anyadditional information to evaluate this claim.

Ve y truly yours,

~~EUGENE K. PETTISFor the Firm

Copies: Rocky Rodriguez, Chairman of the BoardChristopher Ure, Vice ChairLinda Robison, Secretary/TreasurerSteven Wellies, Board MemberBeverly Capasso, Interim CEO

EKP:HLW/dbp

P:ICASEFOLDERS\1301.00DIU.-Barrett,768 Notice.doc

(.._- _

Haliczer P SchwammATTORNEYS AT LAW

cstate of ~oridaK - , Florida Commission on Human Relations

C~'~,.n "~'` Art Equal Opporiunil~ Employer ~ ~ffirmalive ~clion EmployerRick Scolt

Rebecca Steele50vemar 4075 Esplanade Way •Room 110 •Tallahassee, Florida 32399-7020 ~«(850) 488-7082 /FAX: (850) 487-1007 Michelle Wilsonhttn:Ufchr.state.fl.us Ezea,tive ~t irectnrUnited In One Goal: Equal Opportunity and Mutual Respect

FCHR No. 20l 700502EEOC No. 15D201700284

Ms. Pauline Grantc/o Mr. Eugene Pettis, EsquireHaliczer Pettis & Schwamm Attorneys at LawOne Financial Plaza -Seventh Floor100 S.E.1'hird AvenueFort Lauderdale, FI.33394

COMPLAINANT

North Broward Hospital Districtd/b/a Browardc/o Mr. Kevin E. Hyde, EsquireFoley & Lardner LLPOne Independent Drive, Suite ] 300Jacksonville, FL 32202

RESPONDENT

DETERMINATION: NO REASONABLE CAUSE

Complainant filed a complaint of discrimination alleging that Respondent violated the Florida Civi] Rights Act of1992. The Florida Commission on Human Relations has completed its investigation of this matter.

Complainant worked for Respondent, a hospital system, as the interim chief executive officer. She alleged that shewas subjected to disparate trcatment based on her race and color. Complainant fails to prove a prima facie case.Respondent terminated Complainant afrer an investigation revealed that she violated the federal Anti-KickbackStatute. Complainant was the only employee implicated in this violation; however Respondent has ternunated otheremployees outside Complainant's protected class. Therefore, Complainant failed to provide evidence of similarlysituated comparators outside her protected class who were treated more favorably. Also, Complainant alleged thatRespondent retaliated against her. Complainant fails to prove a prima facie case because she was not engaged in aprotected activity.

On the basis of the report from the Commission's Office of Employment Investigations and recommendation fromthe Commission's Office of General Counsel, pursuant to the authority delegated to me as Executive Director of tl~eFlorida Commission on Human Relations, I have detemvned that no reasonable cause exists to believe that anun]awful practice occurred.

</~~~~~~~~~~"~N~"~ Dated: ~ , 20 17Michelle WilsonExecutive Director

COMMISSIONERSDerick Daniel Dr. Donna Elam Dianne Goldenberg Tony Jenkins, Vice ChairTallahassee Orlando Lake Worth Orlando

Latanya Peterson jay Pichard Gilbert Singer Billy Whitefox StallFleming island Tallahassee Tampa Panama CityRebecca Steele, Chair Sandra Turner ~~~~~~~Jacksonville Winter Springs

-- ----

~j

"~ State of ~~oric~ah

u Florida Commission on Human Relations~'aoo,,,r,+ ~n Equal OppnrEuniiy employ°' ~ ,~f}~irmalive ✓r4dian EmployerRick Scott

Rebecca Steele5overnar

4075 Esplanade Way +Room 110 •Tallahassee, Florida 32399-702D ~+~r(850) 488-7082 J Flit: (850] 487-1007 Michelle Wilsonhtto:!/fchrstate.fl.us Exccutiix rl7ireclorUnited !n One Goal; Equal Opportunity and Mutua! Respect

FCHR No. 2D17005D2EEOC No. 15D201700284

Ms. Pauline Grantclo Mr. Eugene Pettis, EsquireNaliczer Pettis & Schwamm Attorneys ai LawOne Financial Plaza -Seventh Floor100 S.E. Third AvenueFort Lauderdale, FL 33394

COMPLAINANT

North Broward Hospital Districtd/b/a Browardc/o Mr. Kevin E. Hyde, EsquireFoley & Lardner LLPOne Independent Drive, Suite 1300Jacksonville, FL 32202

RESPONDENT

NOTICE OF DETERMINATION: NO REASONABLE CAUSEThe Florida Commission on Human Relations bas determined that there is na reasonable cause to believe that anunlawful practice occurred. A copy of the determination is attached.Complainant may request an administrative hearing with the Division of Administrative Hearings by filing a Petitionfor Relief within 35 days of die date the determination was signed by the Executive Director. A blank Petition forRelief form is enclosed with ComplainanPs notice. It may be beneficial for Complainant to seek assistance fromlegal counsel prior to filing the petition.

This detem~inaUon of no reasonable cause will become final if Complainant does not file a Petition for Relief within35 days, and the Commission will dismiss the complaint.

The parties named in the deterniination may inspect the records and documents, in the custody of the Commission,which pertain to the deternunation. Please contact the Commission's Customer Service Office if you wish torequest copies.

I HEREBY CERTIFY that a copy of the foregoing Notice of Determination was mailed to the above-namedaddressees this ~ day of _, 20~, by U.S. Mail.

By:Clerk of the Commission Ar{

COMMISSIONERSDerick Daniel Dr. Donna Elam Dianne GoldenbergTallahassee Orlando Lake WorthLalanya Peterson Jay Pichard Gilbert SingerFleming island Tallahassee Tampo

Tony Jenkins, Vice ChairOrlando

Billy Whitefox StallPanama CityRebecca Steele, Chair Sandra TurnerJacksonvr)le Winter Springs

qf~ i

From_ anonymous user <

anonymousnbadreporter@gmail.com>

Senn

Friday, May 06, 2

016 12:14 P

MTo:

Trainor, Maureen; Miller, Heather L; Ellis, Kathy D; McDonald, Cari A; Halpine, Jodi M

; Stewart, A

nthony D; Fusco, Kevin; Perlman,

Lori; McAuley, E3rian; Rodriguez, Robert Garland, Margie A

; Fernandez, Alexander M

; Frantz, Rita; R

udi~, Bettiann; Walsh, M

artha

S; fluke, liil; Polemeni, Richard; Morelock, Sharel A; James-Francis, Maxine A.; Burke, D

awn; Miller, Nancy; Vones, Jessica A

;Lavallee, Andrea; T

odd-Atkinson, Sandra J; Massey, James; Seaver, Jean; cmather@browardheath.org; Schmidt, Maribeth; T

homas,

Linda M; D'aguilar, Gregory; Starr, Harvey, Lowther, Daniel W

; Dobin, A

va 1; Varo~, Robin C; Casares, Rafael; Cheever, P

enny M;

Cua, Genevieve; Sabin, Sarah; Colonna, Vince; Hayes, Marie L; Amini, Mina; Miller, Amy B; Kester, T

homas T; Ryan, Pairicia L;

Rutherford, Denise M; Stefanatci, Dennis; Johnson, Vince; Brown, D

eborah D; VScarson@browardhealth.org; Lewis, Cliff;

S~hlifstein,lamie; Kresge, Joyce; Davis, Lisa; Berges, John B; ganderegg@browardheatlh.org; Lipsmm6, Debbie; I

nman, Amy;

Valerioti, Qonna M; albryant@yahoo.com; Castro, Winfred; Pavlisko, Lorraine; Emrith, Kerry; Tellez, Robert A; Gallison, Barry 5;

Figueroa, Lymari; Naus, Marylou; Woods, Letitia; Wallace, Arthur, Blount, Tiana Q; Westphal, D

an M; Grossman, Drew; Taylor,

Alice; Brandenburg, Ronald; Moritr, Todd; Grant, Claudette; Shur, Traci; Mackie, Jenny; R

eed, Sandra; Bracci, Scott; Epes, Barbara;

Wechsler, Stewart; Bivins, Marc N; W

heelock Call, Bethany, Rodrigue, Christian; Parra, Cathleen; D

ominguez, Diana; Qendeil, A

bbe;

Pechenik, Jennifer, Mantel, Marcos; Shorter-Meares, Bernice; Colodny, Lisa R; Malcolm, Gavin V; Hali, Vinnette; Ellison, Thomas

Delzell, John E; Patel, Sonal; Finkelstein, Jill; jsraphaelC~browardheaith,com; Nicolaou, Panayiotis; Bates, Kenneth; Marrero,Summer, Anderson, Brent; ludovici, Patricia K; Trach, Natalie; Perez-Irizarry, Carlos; O'8rien, Eileen; G

raham, Kimberley )utras;

Persaud, Darmindra (A_K.A Richie); Cigala, Gina; Keys, Kelly R; Clancy, Elenita U (Lenie); Rappoport, Bruce; Saba, Susan; Noel,

~Marisa; Bor, Beth A

nn; Noe, Yvette; Dimarzo, Scott A

; McCloskey, Fiona G

; Rusinowski, Joseph W

; Bottge, Melissa A

; Calderon,

~Ana E; Klenk, Marilyn; Lyons, Gerardo; Schrot, Ellen; Marcelus, Kestia; Daly, Eileen; Shirley, Jasmin; Phelan, Patricia; Scuotto,

~Michael A; Lewis, D

onna L; Bugg, Robert T.; Nicholas, Brian J; Sprada, Mark; Payne, Scott R; N

ewton, Susan; P

eek (aka Crain},

~Doris; M

ontmann, Ro~aldo; gking@browardhealth.o~g; d

shofFy@msn.com

~g

Subject: Broward Health Certifying a

nd Sub-Certifying Employees -Please R

ead

Certifying and Su6certifying employees, please read the following letter sent to the Board of Commissioners today. Content of this letter directlyaffects your e

mployment and status as a certifying or subcertifying employee. If you d

o not read the whole letter, please at m

inimum read section

IV.7.

To the Commissioners of the North Broward Hospital District

urge you to read the following in its entirety. I implore you to honor your responsibility in performing appropriate oversight a

nd

making reasonable inquiry into the allegations contained in this letter.

.sa~aa~

1 must relay this m

essage anonymously, due to t

he increasing culture of fear, intimidation a

nd retaliation at B

roward Health. Despite w

hat you may

have heard, Broward Health`s "

anonymous" internal reporting s

ystem is anything but. I will explain in m

ore deeail b

elow.

i assure you that I a

m not writing for political, personal or private gain. M

y sole p

urpose is t

o put y

ou an notice, a

nd create a

record of impropriety a

nd unethical behavior that has yet to b

e addressed in a

ny meaningful w

ay. Your lack o

f action h

as

encouraged this behavior.

The most egregious occurrence t

ook place after t

he Board Meeting of 04/27/16. I c

annot wait until t

he next meeting to s

peak. i

cannot participate in betraying the trust of the entire workforce a

nd the taxpaying public.

i. The General Counsel is permitted to e

ngage in deceptive behautar a

nd fs cailecting all "

anonymous" employee complaints a

nd reports

Before discussing the issue at hand, please review the b

elow Broward Health Policy, created b

y General Counsel with assistance o

fExternal Counsel {Foley &

Lardner):

Broward Health Policy G

A-004-~42 —Response and Prevention o

f Offenses —Sections D

.7 and E.7 state:

"No Broward Neolth Workforce M

ember, with the exception o

f the General Counsel or hrs o

r her designee, or o

ny person o

r entity retained b

yBroward Health to assist it in conducting a

Preliminary Review or Focused Investigation will e

ngage in a

ny deceptive orpre-textual conduct".

Compare this with the Florida Bar's Rulesof Professional C

onduct 4-&,4 ~c), w

hich states.

A Icrwyer shall not e

ngage rn c

onduct involving dishonesty, fraud, deceit or misrepresentation, except that it shall n

ot be professional m

isconduct

for a lawyer for a trimina! lc~w e

nforcement agency or regulatory a

gency to advise others a

bout or to supervise a

nother in ran u

ndercover

investigation, unless prohibited bylaw ar ru1e, a

nd it shall n

ot 6e professional m

isconduct far a lawyer ernp(oyed in o

capacity other than as rr

lawyer by a criminal (

ow enforcement agency or regulatory a

gency to participate in a

n undercover investigation, unless prohibited b

y law or rule".

Policy 6A-Q04-Z42, drafted at least partially b

y the General Counsel, alfaws her to e

ngage in deceptive conduct, despite t

he Florida Eiar's

prohibition to the contrary.

You may ask yourself, w

hy would "any person ar entity retained b

y Broward Health to assist in conducting a

Preliminary Review of Focused

Investigation" be allowed to e

ngage in deceptive conduct, if their goal is truth-finding? That's a

good question.

Under EI-Sanadi's leadership, the role o

f Genera! Counsel w

as greatly e

xpanded, and many other d

epartments were re-aligned ofF

the record to be subordinate to her office. A

s before, y~►u m

ay ask yourself, w

hy would the e

mployee {the General C

ounsel, due to

her expanded oversight) b

e allowed to e

ngage in deceptive c

onduct? There is n

o good answer.

This has allowed the G

eneral Counsel's p

ower fio e

xpand without any meaningful oversight, after all, s

he is a

llowed to engage in

deceptive conduct. Many wasteful, inefficient a

nd even unethicalpolicies, p

rocedures and processes have been created and

implemented since.

ti, pecep#ive CiA Compliance under the General C

ounsel

The Management Certification a

nd Sub-Certifica#ion Process (the "Process") is required b

y the Corporate Integrity A

greement (°GA"), which

impacts 100 employees. T

he Process is a

way of having e

mployees attest that their area o

f responsibility is in compliance with policies, procedures,

and laws. T

he forms used as part o

f the Process w

ere changed by the General Counsel a

nd Foley &

Lardnerto literally r

emove the ability o

f the

attesting employee to certify that their area o

f responsibility w

as rrat in comp#lance. This w

as done intentionally- meetings occurred -with Dr. E!

Sanadi, General Counsel, and Foley &

Lardner to discuss the need for "clean certifications"- m

eaning not only that there w

as no way to indicate

that the employee's area was not in compliance, but also no w

ay for the employee tohand-write in further details regarding their area's

compliance. Further, instruction was given b

y General Counsel and Foley &

Lardner to remove written e

xamples of compliance issues

for employees to report, leaving t

he workforce in a position t

o blindly g

uess over which sorts o

f problems should have been

reported in the first place. T

he General Counsel, who is allowed t

o be deceptive, h

as now created a

shadow over any employee

who wants to accurately fill o

ut their Process f

orms.

This has created endless red t

ape, and has turned what was supposed to b

e a regulated c

ompliance process into a

nother egregious

example of misconduct.

What will h

appen when the CIA annual reporfiing period e

nds and employees are required t

o provide t

he annual Management

Certification? Questions will arise as to why were they certifying c

ompliance on a m

onthly basis (

due to the ethically m

assaged

forms discussed a

bove) but cannot provide a

n annual certification, d

ue to the lack o

f the ability t

o state that they're n

ot in

compliance. Could one reasonably s

ay these monthly certifications w

ere crafted to b

e deceptive by the employee who is

empowered to engage in deceptive c

onduct? The C1A h

as stipulated penalties o

f $SO,000 per occurrence of a falsified

Management Certification. I u

rge you fia ask e

mployees what they think o

f this process a

nd prepare for w

hat will h

appen in six

months.

Why else is it important for e

mployees to h

ave the ability to say, "

na, !cannot certify" that they are in c

ompliance and be allowed to provide a

n

explanation?

On or a

bout December 31, 2015, Bob Martin, Chief Financial Officer {°CFO"j, w

as asked to c

omplete the CFO Certification. T

he CFC~ Certification

included an attestation that Unallowable Costs related to legal fees in defending B

roward Health in United States of A

merica ex rel. M

ichael Reilly,

M.D. vs. North B

roward Hospital L7istrict w

ere removed from the Cost Report. Although t

he action o

f removing Unallowable Casts h

ad to b

e

performed within 90 days according to the Settlement A

greement, the C

FO Certification w

as not required to b

e signed until t

he First A

nnua) Report

was due later in 2

016 per t

he CIA {

page 28}. U

pon being asked to c

omplete the CFO Certification, M

r. Martin specifically asked that his C

FQ

Certif'scation form be revised to include the ability to s

ay "no" regarding compliance. M

r. Martin w

as explained that u

nder the direction o

f General

Caunse! and Folep &

Lardner, the lack of ability to say "no" or to include reasons w

hy were removed €rom various G

A certification f

orms. Mr.

Martin then asked for the farm to b

e changed, so that h

e could certify (with regard to w

hether he was in c

ompliance) to say, "yes, with

exceptions". Did Mr. Martin h

ave something important to c

onvey?

Below is M

r. Martin's attestation that Unallowable Costs w

ere removed from the Cost Report.

Yes, with the fallowing exceptions:

`?his Certificotian only covers the period up to a

nd including D

ecember 31, 2015. Based on advice a

nd direction f

rom Broward Health's interntr/

G'enerot Counsel, Dnly External costs were to b

e considered n

on-allowable a

nd removed from i~he Cast Reports. Att internal Costs w

ere canside~ed

allowable and were not removed from the Cost Reports. also, d

ue to lack o

f adequate record keeping b

y Broward Health's previous External G

enero/

Counsel Firm, an estimate o

f 2036 w

as used to determine the portion o

f the Firm's fe

es from 2D12 through Z

DZS that w

ere considered non-oltowable

(as defined in the Settlement A

greement) based on the advice a

nd direction f

rom Broward Heo/th's internal G

enera! Counsel"

Why could M

r. Martin not simply state, "Yes —

the requirement w

as met"? Was there doutat in guidance given b

y General C

ounsel {who is allowed

to be deceptive? Did t

he Ctffice of Inspector General a

nd Department of Justice intend o

n an estimate being calculated rather t

han precise

accounting practices? Do we have documentation that this estimate w

as appropriate a

nd met our CIA obligation? M

r. Martin's certification s

ounds

unsure. Mr. Martin w

as terminated s

oon thereafter.

lit. Aggressive Threats toward Medical Staff

There were Board Meetings s

pent discussing physicians not signing t

he initial C

ode of Conduct and hospital Policies. A

ny layman can read p

ages 8-

9 ofthe CIA a

nd see that t

he requirement actually m

andated distribution of t

he Code and Policies to ai( C

overed Persons {

which included

physiciansJ, not signatures. Other organizations with t

he exact s

ame C1A language h

ave done just that—distributed a

nd succeeded —without

damaging their reputation with the medical staff. H

ow much time, staff hours a

nd money was wasted conducting witch r

unts and putting doctors

on trial at Board Meetings with threats o

f medical staff revocation b

ecause of a

signature r~quiretnent that was unnecessary? This is o

ne of many

overzealous, wasteful responses to what should h

ave been an easy implementation with appropriate foresight a

nd interpretation. W

ho made the

decision to carry out such a

simple requirement in this manner while spending millions of dollars o

n legal advice that w

as at best, inefficient, a

nd at

worst, misinterpretation —all unmonitored and unquestioned?

P~

Finally, there 9s the engagement of Baker Danelson, a

nd the m

ost recent d

evelopment associated with t

hem that necessitated writing this fetter

today. Broward Hea(#h w

as required per CIA (pages 4

Q-42j to engage an Independent Review Organization ("IRO") to perform a

Systems and

Transactions Review related #

a Focus Arrangements. T

he requirements regarding qualifications, responsibilities a

nd independence/objectivity of

the IRO are a!{ listed o

n pages 40-42 of CIA, yet t

hey have been ignored.

1. General Counsel has stated that the I

RO was unilaterally selected b

y Dr. EI Sanadi — an all tr~a c

ommon. response and excuse these days for

scenarios t~lat should have involved legal g

uidance and/or review.

Z. Scott N

ewton of Baker Doneison expressed to a B

roward Heath employee that h

e was actually contacted o

n his cel! p

hone By Myla Reizen o

f Foley &

Lardner, the law firm that 8

roward Health continues to p

ay unquestioned a

nd unnecessary legal f

ees to. M

s. Reizen also h

as a prior relationship with

General CaunseL How exactly w

as this I

RQ chosen? Are they truly i

ndependent? Are they allowed to b

e deceptive u

nder the Broward Health policy

discussed above?

3_ There is question as to w

hether Baker D

onelson has t

he necessary experience a

nd qualifications t

o bean tRO. Interviews a

nd billable h

ours thus far h

ave

demonstrated lack o

f experience including t

he billing to B

roward Health for tasks a

nd work product that a

n IRO should already b

e knowledgeahle in a

nd

possess. The IRO should n

ot be charging B

roward Health for a learning experience. W

here is d

ocumentation of the due diligence for s

uch an important

obligation?

4, Brotivard Nealth has already b

een charged in excess o

f $200,Q00 for w

ork not substantive o

r related tc~ a

n actual S

ystems or Transactions R

eview related

to Focus Arrangements. in fact, a S

ystems and Transaction R

eview cannot even be performed yet according to the t~IG m

onitor. What are ure (

and the

taxpayers) paying €or? Are we being d

ouble or triple billed for attorney a

ttendance at m

eeting and interviews? A

re we paying far necessary services? D

ocharges billed line u

p with t

he contractual s

cope of representation?

5. One employee interview with B

aker Donelson (that t h

ave personal k

nowledge of} w

ent completely off s

cope including a

line of questioning regarding

personal relationships between executives. l"her2 is n

o reason for a

n outside, s

upposedly independent organization to b

e asking t

hese questions unless

they are being instructed by other B

roward Health e

mployees to d

o so. T

here would have been no knowledge on the part o

f Baker Donelson to ask

these questions unless prompted by other e

roward Health e

mployees. The interview that occurred with B

aker doneisan immediately prior t

o this

occurrence of inappropriate questioning w

as that o

f the G

eneral Counsel Is t

he 6enerat Counsel and the I

RO using their ability to b

e deceptive t

o ferret

out dissent? A

re we paying v

endors to p

erform a witch h

unt? Does this s

ound like a

n independent review?

6. As a result ofithe r

unaway billing (outside course a

nd scope), a

n estimate o

f hours and expenses was requested f

rom Baker Donelson by the Corporate

Compliance Department to k

eep expenses reasonable. S

oon afterthis request, B

aker Donelson requested to b

e transferred u

nder and report t

o the

General CounsePs office citing +nference. D

oes this re-alignment u

nder the oversight o

f General Caunse(allow them to be deceptive?

7. MOST IMPQRTANTIY: On May 4, 2016, Baker Donelsan made a formal request to General t4unsel to provide t

hem with ALL documents relating t

othe Corporate Cornpliante Disclosure Logs, d

atabase, interviews, reports s

ummaries, reporter identities, includins all d

ocuments related t

oanonymous and confidential reports m

ade by ernglovees. I

mmediately after this requestr G

eneral Counsel forwarded it t

o the Corporate Compliance

Department with t

he expectation that this confidential d

ocument turnover occur immediately. baker Donelson has not been retained t

o ferret o

ut

anonymous employee complaints. A

Systems and Transaction R

eview related t

o Focus Arrangements DOES NOT include provision o

f confidential a

nd

anonymous reporting m

aintained in t

he Disclosure L

og far t

he entire B

roward Health w

orkforce. This is a

complete betrayal o

f (previously

encoureged} employee confidentiality a

nd trust. It is t

he right o

f every employee to know that this b

ehavior would be encouraged on the watch of

General Counsel. This action will chill t

he ability o

f any employee #o anonymously report actual a

r suspected compliance issues w

ithout retaliation a

rimproper provision o

f canflde»tial information t

o undeserving third parties. This action W

ILL undermine the entire m

echanism in w

hich the

workforce is e

xpected to report actual o

r suspected issues. l will leave it t

o the reader to i

magine what the true m

otive for this inappropriate a

ttempt

at accessing information w

as for. i wif#not s

tand by as a silent witness wh(le this b

ehavior occurs. This is u

nacceptable,

A formal c

omplaint with d

otumentation will b

e submitted to the OIG Monitor whom was previously assured t

he independence of Baker Donelson.

AA employees have the right t

o know that this confidential reporting m

echanism is in j

eopardy. The anonyrnaus complaints have been requested

by persons inside a

nd outside flf B

roward Health. All Certifying a

nd Sub-Certifying e

mployees have the right t

o know as t

hey are included in t

hese

policies and processes a

nd their e

mployment'rs aft'ected w

hen these behaviors occur.

The appropriate next steps ere n

ot to figure o

ut who is writing t17is e-mail, o

r haw to retaliate agains# t

hem. Communications from f~evirt F

usco

and Commissioner Di Pietro o

n 3jZ/16 and Commissioner Rodriguez on 3j22j16 assure that retaliatory k

aehavior is n

ot condoned.

Will the first s

teps be to identify a

nd retaliate o

r will it b

e to address the actuaf message and demonstrate accountability?

The appropriate n

ext steps are to m

ake reasonably inquiry into these matters including:

1. Review of Policy G

~-00~-242 and the Florida. B

ar Rules o

f Professional C

onduct.

2. Review of ownership and decisions m

ade during CIA implementation including w

orking documents for M

anagement Certification c

hanges and other

tasks.

3. Review of Mr. Martin's Chief Financial Qfficer Certification history.

4. Review of the relationship with B

aker Donelson including initial e

ngagement, scope of work, actual w

ork performed, expenses paid, a

nd the relation t

oactual s

cope of engagement versus a

ttempted scope. Objective review o

f whether they are truly "independent."

S. Review of the attempt by General Counsel on May 4, 2015 to provide entire, n

on-redacted Disclosure Logs, confidential e

mployee reports a

nd

allegations to Baker Qonefson.6.

Review alleged unilateral decisions m

ade by Qr_ Ei Sanadi including contract a

warding, personnel hiring, role a

nd oversight a

nd departmental shifting,

without review or approval.7.

Review of collateral d

amage including costs o

f bad decisions, loss o

f morale and ineffective policies, p

rocedures and processes initiated b

y General

Counsel (that are n

Qt simply a

ccounted for in taudgeted or u

nbudgeted legal costs m

excel spreadsheets)8.

Review of the continued a

bsence of legal guidance in areas w

here acivalty n

eeded.

9. Re -review o

f legal guidance given regarding appropriateness of S

hade Sessions at Special B

oard Meetings. Contrary t

o Commissioner Ure's recollection,

actual meeting minutes reflect that General Ct~unsel stated a S

hade Session to discuss o

ngoing investigations w

as appropriate. C

ommissioner Di Rietra is

the one that requested a separate legal opinion h

e received_

Unfortunately, this is just scratching t

he surface. Y

ou have been given t

he appropriate starting paint. Willful i

gnorance and naivete are no !anger an

option.

We are nearing t

he end of the road w

here employees will bring issues to t

he Board internally. If this is n

ot addressed with swift a

nd immediate

action from the top dawn by the responsible governing b

ody, this information wit) b

e handled from the bottom up. Further a

bsence of appropriate

oversight and inquiry can only b

e considered w

anton disregard. Further a

bsence of appropriate oversight a

nd inquiry will leave n

a choice b

ut for

employees to communicate with a

ny agency ar stakeholder with w

hom Sroward Health d

oes business o

r is e

xpected to provide o

utcomes to that

will lis#en to their complaints, including but not limited to: OfFicer o

f Inspector General, D

epartment of Justice, Officer o

f Inspector G

eneral

Monitor, Laura Ells, Florida Bar, Agency for Health C

are Administration, Joint C

ommission, State Attorney's office, citizens, ail e

mployees, fielevision

stations, newspapers, bloggers, Heath Care Compliance Associate, Society of Corporate Compliance a

nd Ethics, qui t

am attorneys, e

mployment

attorneys and other healthcare organizations in Florida_

Others have stood and spoke at Board Meetings, stating that this corporate chaos has not afFected healthcare services that w

e provide —

respectfullydisagree. Tfie continuum of healthcare includes aH e

mployees and departments within Broward Health, W

hen one department

struggles orfaiis, it will directly or indirectly impact all others. When one department cannot hire FfEs, has to flex d

own staffing o

r cannot order

supplies as the result of corporate waste, it will directly or indirectly impact others. It may not b

e immediately apparent or easily m

easureable, but

these behaviors including conflict of interest, lack ~f accountability and policy supported deception absolutely impact the overall function of thisorganization and services that w

e provide.

urge all employees and the Board to ask questions and demand answers. Attend Board Meetings a

nd demand answers as to w

hy this is allowed at

the corporate IeveL Demand answers as to w

hy this is not addressed with fihe supposed transparency that is verbaltytfluted at B

oard Meetings.

Demand answers as to w

hy a direct report to the Board is not held to the s

ame standard as other 8

roward Health employees.

~7

--~----~,*----^-- ~~-r--~--

----

- -f~-~-~

---_

-----

- --

—Y__

_ _.

_ _

_..~...,...-,~.,,.~....~..~ _.._

From: Ellis, Laura E (OIG/OCIG) [Laura.Ellis@oig.hhs.gov]Sent:. 6/3/2016 5:24:37 PMTo: Lewis, Donna L [Dllewis@firowardhealth.org]CC; - Ashford, Candace M (OIG/OCIG} [Candace.Ashford@oig.hhs.gov]Subject: RE: Compliance Concerns and Issues

Donna:

1 recommend that any concerns raised about the IRO should be investigated by the independent party retained toinvestigate the previous May X016 anonymous disclosure. Concerns raised about the IRO need to be investigated, butNorth Broward personnel should not be investigating the IRQ.

Sincerely,

Laura

Laura E. Ellis(202)205-9366

~~~~~~~

~ ~x

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LAllRA E, ELLIS, SEMOR COUNSEL

ADMWI9TRATIVE & CIV1L REt~D[ES BRANCH

OFFICE OF COUNSEL TO THE INSPECTDR dEN1:FlAL

330 WDEPENDENCE AvtT1l.1B, $W

CottPN Bw.~Wo - RooM 5527

WASHtNoroN, DC 20201

TeLrrxoNe:(202)205-9366

FACSIMt~e; (202) 205-0604

Et+tAn.: LAt~!.E[,~tsCd101(3.H_HS a0V

June 13, 2016

VIA ELECTRO1vIC &REGULAR MAIL

Donna L. Lewis, RN, MBA, CHC

Vice President/Chief Compliance Officer/I'rivacy Officer

Broward Health Hospital District

1800 N, W. 49~' St.

Fort Lauderdale, FL 33309

Re; Independent Review Organization (IRO)

Dear Ms. Lewis:

A number of people associated with Broward Health have raised concerns that Sc

ott

Newton, the IRO under Broward Health's Corporate Integrity Agreement (CIA), is

acting

beyond the scope of his engagement in requesting copies of or access to Broward

Health's complete disclosure log. These concerns were raised through an anonymo

us

email to the Board members and other individuals at Broward, and through other

means

to Broward Health and to me directly., I have also been made aware that concerns

have

been raised that Mr. Newton lacks the necessary qualifications to complete the

engagement and that his independence has been unpaired.

I have reviewed the CIA. and spoken with Mr. Newton. I am satisfied that Mr, N

ewton,

in requesting copies of or access to the complete disclosure log, is acting within t

he scope

of his engagement under the CIA in making this request, I have been asked wheth

er Mr.

Newton is acting as an agent of the government or whether a Business Associat

e

Agreement is necessary if PHI is present in the disclosure log. The OIG does not

consider Mr. Newton, in his capacity as the TRO, to be an agent of the governm

ent. The

OIG cannot provide legal advice to Broward Health as to the necessity of a Busi

ness

Associate Agreement, I am aware that entities under CIAs routinely enter into

Business

Associate Agreements with their IIZOs. If Broward Health determines a Business

EXH!

' P

Page 2 —Donna Lewis

'Associate Agreement is required, I believe that this can and should be .entered intoexpeditiously with Mr. Newton;

Appendix A of the CIA affords OIG a 30-day period (with extensions if additionalinformation is necessary) to review an entity's selection of an IRO and to object, in itssole discretion, if it determines that the IRO is unacceptable. In reviewing the selectionof the IRO, the OIG looks to see if the IR.O has the necessary qualifications to performthe reviews required by the CIA and if it has the necessary independence. I reviewedinformation about the IR.O provided by Broward Health with its Implementation Reportin January, Based on my review, I was satisfied that Mr. Newton possessed the necessaryqualifications and independence to perform the Arrangements Review required byBroward Health's CIA. Based on the information made available to me since that time, Iremain satisfied that Mr. Newton possesses the necessfuy qualifications andindependence to perform the Arrangements Review,

I etcpect that Broward Health wi11 promptly execute a Business Associate Agreement, if itdeems that necessary, and will provide Mr. Newton access to the complete disclosure log,I also expect that Broward Health will expedite its response to any outstanding or futuredocument requests made by Mr. Newton. If there are any concerns as to theappropriateness of any document request made by Mr. Newton, I ain available to addressthat concern.

If you have any questions about this letter or the CTA; please call me at (202) 205-9366 orwrite ox email me at the address above,

Sincerely,

.1 I ~ '~~Laura E. EllisSenior Counsel

cc (via email only):Pauline Grant, Interim CEO, Broward HealthLynn Barrett, General Counsel, Broward HealthRocky Rodriguez, Board Chair, Broward Health

November 30, 2gi6

Board of Commissioners

North eroward Hospital D(str(ct

(via e-mail)

Dear Commissioners:

armv~rd Heetlh Mc~kcd Center8row~rd Hem North

Bruwuii Health Impe~hl AoinlB~ward Ne~Nh Coral SpringsChris Ewrt ChHdrai's Hospq~l

erowarrl Neellh Weston8roward Hcaflh Cnmmuniry Maagh Services

Brawerd lieahh Physkun Gfcwparoward HeaHh InlcmaUo~alBrowerd Hrarth Urgent Care&owerd Hglth FaundaUon

The purpose of this letter is to provide clarification and to set the record straight regarding allegations

made against me to the report from the Independent Review O~ganizatfon (IRO) dated October 7, 2016

and a recent article published (11/23/16) in Politico.

Specf~cally, there are three critical items requ(ring discussion and clarification:

(Z) Allegations that I supported leakage of negative stories to the media about the IRO;

(Z) ANegatfons of collus(on and cover-up between the Office of Compliance and me;

(3} Lack of notification/knowledge of a potential conflict of interest {C01) with the John Knox

Village Board of Directors.

on page 131 of the IRO report, the IRO stated details of a meeting fn which the Compliance Officer (Donna

lewis), Doris Peek, and I discussed and created the contents of a negat(ve article that was later published

by Compliance Monthly regarding the IRO. This is inaccurate and not true. The truth is I was totaAy

unaware of a phone interview conducted on June 1, 2016 between a journalist at Compliance Monthly

and Ms. Lewis. !was informed of the article published (n Politico on June 6, 2416 by a concerned BoardMember, Upon learning of the article, 1 immediately called a meeting wikh the Communications

Department (Danfella Aird and Dor(s Peek) and Donna Lewis in an attempt to learn the contents of the

art(cle, the intended audience, the interview process and the interview/publication timeframe. Ms. Lewiswas unaware that the phone Interview conducted with Compliance Mon#hly magazine on June 1, 2016was subsequently published by Politico on June 6, 2015.

During this open meeting, Ms. Lewis was reprimanded and restricted from speaking to any media outletregard(ng Sroward Health. While I am not Interested In who the sources are that m(sunderstoad thepurpose and content of the open meeting, 1 am extremely Interested as to why the IRO never asked mg

about the meeting and why the IRO would state that they believed I had advance knowledge ofthe articleand that I supported such negative actions. Please note: I was Interviewed by Mr. Scott Newton on

September 7, 2016 end this matter was never discussed; nor dId the IRO advise me that they would expectthat I have knowledge of and approval for all media publications as they stated in the report. I wassurprised and dismayed when I read the allegations in the report which was dtstr(buted only a few daysfollowing the personal Interview with Mr, Newton. I want to emphatically state I had no knowledge ofthis article. Furthermore, I did not (nor would I) endorse or support negative comments or stories to anymedia outlet — not this article —not any article —not ever.

180D N.W, 49th Stneet, Sultc 4id, Fort I.aududafa, FL 393x9 ~ 954 473.7QOQ •t ~ 954.413J009 -f j arowardWeafth.org

~~~~~~~

Qn pages 132-135 of the IRO report, the IRO alleges that by withholding the disclosure (og from the IRO,the Compliance Officer attempted a cover-up of the allegations made against Grant and two others. TheIRO states that the Compliance Officer did not investigate the complaint. This statement is inaccurate. Infact, Ms. Lewis investigated the matter and collaborated with two attorneys from the eroward HealthGeneral Counsel's office during July 2016. The Compliance Officer provided the interview notes and otherdocumentation to General Counsel fn July Zg16. However, the complaint remains open (even today) asthe General Counsel requested a "do-over" of the investigation and subsequently hired three exCemalattorneys from Tennessee to conduct a second investigation. i was interviewed on October 18, ~p16 for45 minutes with only five minutes' notice of the meet(ng from the General Counsel. Findings from thesecond investigation are currently unknown to me. The IRp falls to mention that the first (nvestfgationwas conducted and alleges only that there was an attempted cover-up and collusion between Ms. Lewisand me.

A second point of notification is that of the 84 or so open complaints contained within the confidentialcompliance disclosure log, the only complaint "called-out" in the IRO report was the compla(nt againsCme. it Should be noted that there are/were several open complaints aga(nst fihe General Counsel, theEthics Officer and other senior leaders at Broward Health. This appears to be a retaliatory action anddeliberate effort on the part of the IRO (and anonymous sources) to damage my character and producesuspicion and mistrust of the Office of the CEO.

The third Item of notif(catfon is the perceived conflict of interest regarding my Board membership withJahn Knax Village. puring the second investigation, the three outside attorneys referenced a knownconflict of Interest regarding my membership on the Board of pirectors ofJohn Knnx Vlliage. t wes withoutwords as I had no prior knowledge ref the issue and when i asked the Chief Ethics Officer about this matterhe asked me how I knew ~f this issue. E then asked him to put his concerns in writing, which he did.responded Immediately and sent a letterof resignation to the Chairman ofthe Board of John Knox Village.l provided a paper copy of my resignation letter to Mr. Perez-Irizarry, Eth(cs C?fficer. I did not share theletter with anyone except tf~e Ethics Officer. How surprised I was to learn the letter was published inPolitico on November 23, 2Q16 -Thanksgiving Eve. When (Investigated the source of this negative storyto the media, I learned that It was not the result of a 1I9 request from any media channel or Individual.Rather the letter was deliberately shared with the media from an insider. This is biatanf disrespect,unprofessional behavior, and character assassination.

My requests are s(mpie. i am requesting:

(lj A retract(on of false allegations from the IRO in writing and an amended report;(2) Your assistance in stopping future malicious slander, liable, and character destruction for all of

eroward Health employees;(3j Be informed of ail Broward Health investigations sa as not to be caught by surprise when internal

and externa(sauress cite investiga#ions of which 1 am not aware; and(4) Access and opportunity to defend/discuss allegations when unjustly accused. That expectat(on (s

part of our culture of inclusion and respect of community. i expect that future allegations andreports based on gossip and anonymous sources be validated for accuracy and tha# the accusedparties be allowed equal opportunity to discuss/defend their side of the story should they desireto do so.

It is my expectation that we all do what is rtght, respectful and professional. 1 am here to do the best jobi can do for Broward Meaith. I expect the same from others. I expect that efforts are made to clear myname and the names of ethers accused of wrongdoing in the fR0 reporC. I expect that any contact withmedia ga Chrough the Broward Health Communications pepartment prior to speaking to or releas(nginformation to the media.

Thank you for your attention to this matter.

Sincerely,

~w~tV,.~"'~'"'"

Pauline Grant, FACHEInterim President/CEO