An Updated Summary on the Fiasco at Emory, Grady, and Beyond

I just realized that anyone that picks up this story in the middle would get lost in its many mazes and connections. If anyone reads every single story in the Emory University tag, they would get a full picture, however that maybe beyond reason. First, I must disclose some things. There are things that I can prove. There are things I can assert and there are things that I believe. Finally, there are things that follow the Latin phrase, Res Ipsa Loquitor (the facts speak for themselves). I use different language for each.

So, let's start at the beginning. Emory University's Medical School runs a network of hospitals in the Atlanta area. There are five in all if my facts are right. Three are actually owned by Emory and service predominantly the affluent making them quite profitable. The other two are public hospitals and Emory has sort of contracts to staff them with their professors and students. This is no different than many teaching hospitals and if there are any ER fans, the fake hospital in that show runs in a similar manner.

That said, I want to focus a bit more on the two public hospitals with little profit potential. The first is the VA since veterans get set bills, and the second is Grady. Grady is a hospital for the indigent or very poor. Since poor folks rarely have money or insurance, it is much more difficult to make a profit on them. Grady is also a public hospital meaning that the tax payers ultimately are the ones that finance it. (as most indigent hospitals would be for the reasons that I mentioned. No one is going to want to bankroll a hospital that has no hope of making any real money so it is left to the government) Grady is also massive, one of the biggest hospitals in the country, and so while it provides little profit, it provides a bulk of the training.

Here is where things get interesting. Emory enjoys a lucrative relationship vis a vis Grady (I will explain as I go along how that relationship get consummated so to speak). For instance, they get a fat yearly fee of about 50 million dollars to provide staffing at Grady. Keep in mind that Grady is the training vehicle for most of its medical students. Emory already charges its medical students tuition and uses Grady for a lot of the training that this tuition is supposed to go for. Many people refer to this as double dipping. In other words, Emory University has one of the premiere medical schools in the country and one of the main reasons is their association with Grady Hospital, one of the largest hospitals in the country. Thus, Grady provides just as much to Emory is Emory does to Grady. Furthermore, since Grady is a public hospital it is ultimately the tax payers that are stuck with the bill that Emory charges Grady yearly. Also, Grady Hospital pays for Emory's malpractice insurance. It goes without saying that such a relationship invites exploitation.

Exploitation and corruption is what you have at Grady in my opinion, and I really only need to do a Google search to provide plenty of evidence. For instance, Grady Hospital settled a case for Medicare fraud in the late 1990's for about 5 million dollars. A few years later former State Senator Charles Walker committed so much criminality at Grady and beyond that he was ultimately convicted of 127 felonies. (you can click this link for a full write up of the case including its particulars and most importantly what each hero and villain wound up receiving from Grady and Emory) In 2004, the Dept. of Health and Human Services conducted an investigation of Grady Hospital and here are the conclusions,

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

That is frankly the equivalent of a builder building you a house that falls down on top of you when you move in. (Only one person was let go in the aftermath, Dr. Andrew Ogwunobi, who has continued to travel an interesting path. You can find his full dossier here. It is important to note that the Chief Medical Officer of Grady Hospital, William Casarella, was cited most often in the actual report. I point this out because Casarella has since been promoted within Emory University. This is important for several reasons not the least of which because it goes to show that in many ways I believe the two entities cross over whenever it suits the powers that be)

Finally, currently Grady is in such financial turmoil that is about to be shut down unless there is a huge infusion of cash, about a hundred million minimum by my estimation. There were also other investigations that started and stopped like an interesting one conducted by the NIH in 2000. While there was ultimately no damning conclusions to those reports, I have my suspicions about how it was exactly that they ended. (for more information on that report and more importantly the role of Kent Alexander, Chief Legal Counsel for Emory University, please go this link. This is probably my most incendiary piece and illicited a flurry of looks from the Emory admin IP upon publishing)

This body of evidence is in my opinion an example of Res Ipsa Loquitor.

Now, while Grady is staffed by almost entirely Emory faculty, it is still a public hospital. It has a board and a CEO. The board chooses the CEO, and the board is chosen by the CEO of Dekalb County. The current CEO of Dekalb County is Vernon Jones. He is an elected official with a remarkable knack for thriving in what I would think are dicey political situations. (when I say dicey I mean things like rape accusations, shady land deals, and all sorts of malfeasance by those close to him Just like everything else, I have written a full write up of Jones as well. Jones is I believe the link between the corruption at Grady and the corruption that infects much of Georgia. We have a running debate about who the ultimate ringleader is and one theory is the Dixie Mafia, and you can vote in my fun poll after getting the full scoop)

Now, the problem as I see it is summed up by this cliche, the fox guarding the hen house. The board is supposed to oversee the CEO who is supposed to oversee the staff, and the CEO of Dekalb County is supposed to oversee all of them. The problem is that all the entities, in my estimation, are corrupted. From Jones, to the board, to the CEO, to the staff, the foxes are guarding the hen house so to speak. For instance, one very prominent member of the board was until two years ago Robert Brown. Robert Brown also runs an architecture firm. Three guesses which firm gets many of the most lucrative contracts for Grady expansion. If we dig deep enough, I have no doubt that there would be an almost endless amount of transactions with really or perceived conflicts of interest.

Enter, whistleblower Kevin Kuritzky...first, there is full disclosure here. Kevin and I have developed a tight relationship, and I have even done a radio show with. (It is linked at the end of my piece on Kent Alexander. Kevin is the calm one and I am the hyper one) I have never claimed traditional journalistic objectivity, and I am not a traditional journalist. I believe the quality and accuracy of the information I have provided speaks for itself. Every piece of data has been double and triple sourced minimum. I have hard copies for anything I don't link to like the aforementioned HHS report. (I can email or fax to anyone upon request)

Kevin has made some incendiary accusation about the quality of patient care at Grady Hospital. He claims that Emory staff goes to one of their for profit hospitals when they are supposed to be at Grady and many times he claims they leave medical students unsupervised. (In fact, in this piece I give an example that was verbalized to me by Kuritzky that is frankly straight out of a bad nightmare.) It goes without saying that his accusations, if true, amount to not only an obscene violation of several laws but frankly every doctor's oath. Kuritzky was expelled from medical school with forty one days remaining. (That is in a four year program) Kevin believes the charges are trumped up and he is now in the middle of a law suit. The Emory Wheel inaccurately reported that Kuritzky's case has been dismissed. It hasn't Kuritzky's side has lost a motion that is being appealed. (again, I have seen the disposition of this motion and it is NOT a dismissal) This was inaccurately reported in a trade journal for academics. (The fact that this was written in a trade journal for academics obviously raises all sorts of issues and I explored them here)

Finally, I have counted four former Emory professors that have been paid off for silence. I have only seen the settlement agreement for one pay off. That is for Dr. Jim Murtaugh. He was paid off right around the time that the NIH investigation was happening and he was paid off along with another person, Diane Owen (though her agreement I haven't seen) Murtaugh's settlement has been the subject of much media buzz because State Senator David Shafer has lead a group of state senators who have demanded that it be unsealed (and one main reason why I was able to see the agreement. (If you go here I explore the case of his records being unsealed. Interestingly enough, certain links disappeared in the aftermath of me publishing that, and I explored that here) (also, the Shafer link has some interesting information about who did and didn't approve his settlement so I encourage you to link there)

Now, why should you care? If you are a resident of Georgia, then it is your tax dollars that will ultimately go to fund something you should see is totally corrupt. This corruption is in my opinion part of even bigger corruption that I probably don't even have the full story to. If you are an Emory student, then your tuition, and likely your parent's money (who are you kidding), is contributing to this corruption. Furthermore, if Kevin really was only expelled because he dared blow the whistle on this, what is to stop Emory from targeting someone else. What if you become a threat to them for this or for anything? Clearly, if you believe my assertions, Emory eliminates all threats to them. They pay some off and they expel others. If you believe Kevin, then he had his life ruined for daring to the right thing. (he often tells me that his friends still in the medical school tell him that he should have kept his mouth shut and graduated and moved on) Furthermore, if you believe Kevin, then your school exhibits the traits of the common sociopath. Sociopaths with power is the worst combination you can have. If you are a citizen, then you should want that all corruption be dealt with appropriately and people be held responsible.


(UPDATE)

Some of you may be wondering where the media in Atlanta fits into all of this. This piece should drive home how the media's coverage, or rather lack thereof, fits into this whole story. This piece contrasts the Atlanta media with another situation in which the media actually did its job. Finally, here is an example of the sort of reporting you will find at the AJC.

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.

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.

Dr. Andy: The Follow Up

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

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

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

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

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

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

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

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

Here is the most interesting part from Pharma,

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

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

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

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.