More Malfeasance vis a vis Wellcare (Update)

The hat tip goes to Pharma Fraud blog for bringing this to my attention. My initial interest in the story centered around Dr. Andrew Agwunobi, former CEO of Grady Hospital. Now, Dr. Agwunobi appears to me at least to have some explaining to do vis a vis Wellcare. He arrived there in early 2006 to serve on the board. He only stayed about six months. He cashed out for about a million bucks worth of options. He then took over at the AHCA of Florida, and suddenly the AHCA is one of the bureaus involved in investigating his former employer Wellcare. That doesn't pass the sniff test.

The scoop from Pharma fraud also leaves a malodorous odor. Sandy Murman (pictured right) was a Florida State Representative for Hillsborough until March 2005. Then, she became a lobbyist for Wellcare and subsequently politicked her way onto the newly formed county Health Care Plan Study Group. According to Pharmafraud, that wasn't revealed while she politicked to get on the board.

Wellcare had plenty of incentive to have one of their own on this board. Here is what their CEO said in February 2005. (Imtiaz "MT" Sattaur would be the CEO)

We (WellCare) are interested in pursuing bidding for Hillsborough County's indigent care program.

Once it came to light that Murman had ties to Wellcare, there became a political battle over her role in the group. She was ultimately removed in June of 2005. (Here are notes from the meeting)

Now, it appears that Murman has made totally contradictory statements regarding Wellcare in two separate interviews. (Here is a link to the first one)

Sandy: “But I would say when you have 200 agents go into an office they have a finding of something… that probably there’s something wrong. And our state needs to be really concerned about that.”

PF: Considering Sandy’s strong alliance to WellCare, her comments seem especially potent.

(Here is a link to the second one)

Sandy: “I was shocked, absolutely shocked, because obviously WellCare is one of the top 5 companies in the nation.”

PF: In which category might one include WellCare among the top 5?

Sandy: “You’ve got a company that has grown really big really fast, and it always leads to a suspicious cloud. How did they get… you know, how did they grow that fast.”

PF: The most favorable statement about WellCare came from reporter Don Germaise, who attributed the following quote to Murman, “Sandy Murman says that
WellCare Is a very ethical company and its CEO would never knowingly break the law.”

Lot's of questions. Stay tuned...

I started following the goings on at WellCare as a result of my initial interest in the mess at Grady Hospital. I firmly believe that this WellCare scandal is thoroughly underreported and I will do my part to get this story out, however my main priority is breaking the scandal at Grady Hospital. 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 this relates to that crisis.

A Plea to John Sugg of Creative Loafing (UPDATED)

(For reference on this story simply hit the Emory University tag at the bottom and you can read everything that I have written so far)



Here is what I have learned so far about the corruption at Emory University, Grady Hospital, and the Atlanta area in large: a man of questionable character and/or competence is currently running the Florida bureau that specializes in providing health care to poor folks, a man of questionable character and/or competence is now running for Senator of the United States in Georgia (and leading in the Dem primary from what a few people tell me), Grady Hospital was home to an obscene amount of corruption that was only matched by the disposition of the case that followed, and and finally there is eye witness testimony to not only continued corruption at Grady, but tragically sub standard care and dangerous conditions.



As far as my own feelings, I feel that I have only scratched the surface on the curruption that goes on at Grady, Emory and beyond. How can so much corruption go on and no one know it? I firmly believe that much of the media is either in the tank for much of this, too scared, or maybe just too incompetent to report on it. Case in point: State Senator Charles Walker...he was convicted on 127 felonies, he received 10 years in jail without flipping on anyone, and finally no one but him, his daughter and the companies they ran were charged or convicted. Does this seem possible? Yet, very little has been said about this peculiar set of events in the media in Atlanta.



Here is another case in point. Here is a response by Kent Alexander and Tim Jefferson to an editorial by the AJC.

The AJC's Oct. 5 editorial "Come clean on lawsuit" resurrects (and misstates) old charges of conspiring to misuse government funds, charges the government reviewed seven years ago and declined to pursue. This has the devastating effect of casting public suspicion on two entities -- Grady Memorial Hospital and Emory University -- that are working together in an increasingly challenging environment to meet the health needs of the most vulnerable members of our society.

The editorial surprisingly calls on Emory and Grady to open the sealed settlement and court records in a case involving Dr. James Murtagh. For the record, Emory and Grady did not move to seal the record; Murtagh did. Emory had already supported unsealing the proceedings -- the complete, entire record -- as had Grady. We simply awaited the doctor and court's approval. Judge Wendy Shoob has since unsealed the record, which is now of course fully open to the public. The real victim in all of this is Grady, the largest public health hospital in the Southeast. Grady is struggling to survive while misinformation circulates that, unintentionally or intentionally, diverts attention from the real issues.

Now, what they are referring to is Jim Murtaugh and a suit in which Grady and Emory paid Murtaugh about 1.6 million dollars and he along with Emory and Grady each had air tight language in which no one could talk to anyone. Now, when someone gets paid off and told to keep quiet, where I come from that is hush money. According to Jefferson and Alexander it was Murtaugh, not their side, that wanted to records from the case sealed. Obviously, it is ludicrous to believe that the person being hushed is the one pushing to keep the records sealed. Furthermore, since they know that he has to stay quiet he is an easy target. Finally, since the agreement calls for both sides to keep mum, it is this non lawyer's opinion that this response breaks the very agreement that they are referring to. There's more.



Now, do you want to know how corrupt the media is? That editorial as well as the response is no longer available on the AJC's site. (Don't believe me click the link and then click the link that says, Come Clean on the lawsuit, you will get to an empty page) In fact, the response I found is on a site run by Emory and no doubt that will be eliminated as soon as Emory gets wind of this piece. (I referenced the editorial at least twice and the link leads you nowhere each time. It also leads you nowhere from the Emory site I found that currently though I suspect not for long still has their response to the now absent editorial.)



I was told that there maybe a beacon of independent journalism in Atlanta. There maybe one news organization that is more interested in the truth than making friends and contacts and limiting powerful enemies. I was told that news organization was Creative Loafing. I was even heartened when they wrote a piece that referenced my blog. Unfortunately, since then they have remained quiet despite breaking news by me, State Senator David Shafer, and frankly the growing chorus of concern about Grady Hospital (which may go under and will certainly need up to nine digits in tax payer money to stay open).



Thus, I was moved to write this to the editor, John Sugg,

Mr. Sugg,

My name is Michael Volpe and I am writing to you regarding coverage of the corruption at Grady Hospital. A few weeks back your online arm wrote an article about Kevin Kuritzky. That article referenced a piece on my blog, http://www.proprietornation.blogspot.com/. I received a fairly large amount of traffic coming over from your site. I was glad to see that there was an outlet in Atlanta that had the courage to bring this story in the open. Since then, I have broken several pieces of important information on my own blog. Senator David Shafer broke some important information as well, and your paper has not followed up at all.

With all due respect, it is NOT good enough to simply go through the motions on this story but to take it wherever it leads because its tentacles are everywhere. Did you know that the former CEO of Grady Hospital, Dr. Andrew Agwunobi, the same CEO that was employed when an HHS report was issued saying this, “the patients at Grady are in serious and immediate danger”, is now head of the AHCA in Florida? Did you know that prior to that he was on the board at WellCare? Did you know he cashed out one million bucks worth of options after only six months? Finally, did you know that his bureau, the AHCA, is among several currently investigating WellCare? Guess what, the stock plummeted right after he cashed out.

If you publish one story about the terrible plight of Kevin Kuritzky, pat yourself on the back for standing for the little guy and then move on, that is frankly not good enough.

I hope you will take a minute and read my latest piece. I hope after reading it you
appreciate just how deep the corruption most likely goes and then realize that the only way to break it all, is for non stop and intense media coverage.

http://proprietornation.blogspot.com/2007/11/murder-suicide-connecting-more-dots-in.html

I firmly believe that those involved in the corruption at Grady and beyond it are bad, really bad, and they aren’t going to give up power without the biggest battle they can put on. Putting out one article and then going away does nearly nothing. Kevin told me that he believed your organization to be a model of independent and uncorrupted journalism in Atlanta. I believe that is rare if non existent in your city. You can prove me wrong by following this story wherever it leads not merely popping your head up to report a small bit and going away.

Now, I call on everyone else to help me fight this battle to expose what is really going on. Everyone that reads please send Mr. Sugg an email here and insist that Creative Loafing be the model of independent, fair and honest journalism in Atlanta. Demand that Creative Loafing take this story wherever it goes not just where they want to lead it. A lot of people have sacrificed a lot, some with their lives, in trying to expose and root out the corruption that is going on. The powers that be won't go down without a fight and they won't go down if they know the media is in their back pocket. So far, the evidence I have seen tells me at least that the media is, however Creative Loafing can change that and you can help them do it.

(UPDATE)

I realize that anyone that picks up this story at any of its individual part like this particular piece will likely be confused. 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. Also, please check out the recommendations that I and my colleagues have put together for fixing Grady Hospital.

The Definitive Dossier on Dr. Andrew Ogwunobi (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.

Why is this man working? (UPDATED)

Dr. Andrew Agwunobi took over at Atlanta area hospital South Fulton, a fairly small hospital specializing in providing services to poor folks. in mid 2001. The Joint Commission on Accreditation of Healthcare Organizations (JCOHA) issued its first report toward the beginning of his tenure. This report was critical of South Fulton however they did give the hospital a passing grade though with conditions. The JCOHA issued the final report of his tenure a few months after he left in mid 2003 and this report did not just find South Fulton to be sub par in some areas but in fact no longer in compliance with their standards. Here is a list of the policies and procedures that South Fulton was no longer in compliance with.

1)Competence to perform job responsibilities is assessed, demonstrated, and maintained.

2)The leaders develop and implement policies and procedures for care, treatment, and services.Informed consent is obtained.

3)The organized medical staff oversees the quality of patient care, treatment, and services provided by practitioners privileged through the medical staff process.

4)Medications are properly and safely stored throughout the organization.

5)Emergency medications and/or supplies, if any, are consistently available, controlled, and secure in the organization’s patient care areas.

6)Medication orders are written clearly and transcribed accurately.

7)There is a process for granting, renewing, or revising setting-specific clinical privilege

8)Medications are safely and accurately administered.

9)Patients are reassessed as needed.

10)The organization fulfills the expectations set forth in the Universal Protocol for Preventing Wrong site, Wrong procedure, Wrong person surgery and associated implementation guidelines

In layman's terms, he took over a fairly subpar hospital and by the time he left the sub par hospital had turned into a hospital that could no longer meet governing body standards for compliance.

As a result of his performance at South Fulton, he was rewarded with the CEO position at Grady Hospital, the largest hospital hospital in Atlanta, one of the largest hospitals in the country, and also a hospital that specialized in providing health care to the indigent. His tenure ended as a result of the conclusions of yet another government report. I have no doubt that medical professionals will look to pick apart my analysis of his tenure at South Fulton and try and spin his performance in a more favorable light. That is fine, however there is no spinning the conclusions of the report of the Center of Medicaid and Medicare Services (CMS) of the Department of Health and Human Services leaves absolutely no doubt. (I couldn't find the report online though I have one in hard copy) Here is the conclusion of this report.

Based on the findings, we believe that the conditions at your hospital (Grady Hospital) pose an immediate and serious threat to the health and safety of your patients.

The specifics were broken down into four different categories.

#1) Serious medical errors and complications resulting in deaths or adverse outcomes were not investigated and the Chief Medical Officer, William Casarella
ignored them
#2) The Governing Body of the hospital was ineffective and ignored quality assurance standards mandated by law.
#3) There was a lack of accountability and required supervision of medical staff that resulted in deaths and serious adverse outcomes.
#4) There were violations of medical note/record keeping rules and standards.

In other words, the leadership Agwunabi, was totally absent in fulfilling any of the responsibilities of being a leader. If we are keeping score, Dr. Agwunobi took over one hospital that was sub par and left when the hospital failed to meets its requirements for even being in compliance. After that he took over a hospital that was deemed to pose an immediate and serious threat to its patients.

Now, the details of the report are of course more complicated. For instance, the report laid most of the blame on this man, William Casarella, who was Chief Medical Officer at Grady and in charge of all of the clinical departments. (as you can see from the link not only was Casarella not reprimanded but in fact he has since been promoted) Of course, ultimately, as the head person, which Dr. Agwonabi was, he takes the responsibility for everything anyway. That also gets into semantics and speculation. The bottom line is that this report was scathing. The hospital wasn't merely run poorly. It wasn't just below average or even failing to meet requirements for being in compliance with standards set by a governing body, but rather it was in such bad shape that

the conditions at your hospital pose an immediate and serious threat to the health and safety of the patients.

If you are in charge of a hospital, as Agwonabi was, it doesn't get any worse than that indictment. Since he was the only one that faced any punishment as a result of this report, some could speculate that he took the fall or fell on the sword if you will. That may or may not be true, but at this point it doesn't matter. If he took the fall and he was the only one, then his employer, through their actions, said that he was the one responsible for

the conditions at your hospital pose an immediate and serious threat to the health and safety of the patients.

Thus, an honest observer would expect that after such a finding that Dr. Agwunobi's career could and should be over. One could say that for Dr. Agwunobi, his future career path could be describe by these famous words from A Few Good Men

teaching typewriter maintenance at the Rocko Clubbo School for Women

One would be wrong. Agwonabi then resurfaced as the COO of St. Joseph's Hospital System a fourteen unit conglomerate of hospitals in California. That's right everyone after being ultimately responsible for the scathing findings of two separate government inquiries, this man was essentially given a promotion. He moved from a small hospital in South Fulton, to a large hospital in Grady, to a group of hospitals at St. Joseph's. In other words, whoever was in charge of hiring either read this

the conditions at your hospital pose an immidiate and serious threat to the health and safety of the patients

and was impressed, or just simply didn't bother to find out how the hospital was run when Agwunobi was there.

While I still haven't gotten the whole story here, his career path takes another curious route. He left this conglomerate after about a year or so and is now in charge of the AHCA in Florida. The reason this is curious is because he moved cross country from Atlanta to California to a job that paid well. It seems odd that after only a bit more than a year he would uproot his family again and move back across the country one more time.

Now, what is the AHCA you might be wondering? Well, the AHCA is a Florida bureau part of the Department of health whose goal is to provide quality health care to poor folks. That's right, all you Floridians, the man in charge of the government bureau who's purpose is to provide quality health care for the poor has run two separate hospital's that specialized in providing such health care, and both of those hospitals were the subject of scathing government reports relating to his tenure there. How did he get this job? Only the powerful know, however this is interesting. It turns out Dr. Agwunobi's ran Florida's department of Health under Governor Jeb Bush.

I know what some of you cynics are thinking right now. That is just how the game works, Volpe. True, however, it doesn't have to. Things don't have to work out so that someone fails and fails and constantly has that failure rewarded. It doesn't have to work out like this and we can start here.

Is this the best we can do? Is this how things work among the powerful? Perform your job in a totally incompetent manner and you eventually get rewarded with promotions? I don't know, but I would like to find out. If the good people of Florida are happy to have someone running the department that provides quality health care to the poor despite failing to do it when ran two hospitals for the poor, then don't read any further. If you are happy having your tax payer money go to this incompetent don't read any further. If you aren't then please make your voice heard. Here is a link to the Florida Department of Health, and here is another one to the Governor of Florida, Charlie Crist. Please ask them how running two hospitals into the ground qualifies anyone to run a department dedicated to providing quality health services to the poor.

UPDATE: For the most part the story behind the mess that now engulfs Grady is extremely confusing and complicated. Thus, if you were to find your way to any of the many stories I have written on it, and it was your first exposure, you would likely get confused. I don't believe this is one of those stories. You should be able to follow this one regardless of your exposure to the mess in general. If not, let me know. That said, 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.
That way, you can see how Dr. Agwunobi fits into the entire nightmare. Also, please check out the recommendations that I and my colleagues have put together for fixing Grady Hospital.