Miami-Dade Legislative Item
File Number: 101822
   

File Number: 101822 File Type: Discussion Item Status: In Committee
Version: 0 Reference: Control: Health, Public Safety & Intergovernmental Cmte
File Name: INFO RE: JACKSON MEMORIAL FOUNDATION Introduced: 7/12/2010
Requester: NONE Cost: Final Action:
Agenda Date: Agenda Item Number:
Notes: TLL- 7/12/2010 Title: PRIOR REQUESTED INFORMATION REGARDING JACKSON MEMORIAL FOUNDATION
Indexes: NONE
Sponsors: Sally A. Heyman, Prime Sponsor
Sunset Provision: No Effective Date: Expiration Date:
Registered Lobbyist: None Listed


Legislative History

Acting Body Date Agenda Item Action Sent To Due Date Returned Pass/Fail

Health, Public Safety & Intergovernmental Cmte 10/14/2010 1D1 Presented
REPORT: Assistant County Attorney Gerald Sanchez read the foregoing item into the record. Ms. Guerlina Escar-Mangos, Assistant Director for Governmental Relations, Jackson Health System, and Mr. John Copeland, Chairman of the Public Health Trust (PHT) were present for this discussion item. Chairwoman Heyman noted that Ms. Escar-Mangos and Mr. Copeland echoed the concerns of this Committee and the County Commission regarding accountability for the Jackson Memorial Foundation. She indicated that she received a letter from Mr. Roland Rodriguez, President and Chief Executive Officer (CEO) for Jackson Memorial Foundation (Foundation), along with attachments responding to previous requests she made along with Commissioners Diaz, Souto regarding the Foundation. She said this letter conveyed Mr. Rodriquez’ regrets that he could not attend today’s (10/14) Committee meeting. Chairwoman Heyman stated, for the record, that the records requests were done following the Committee’s consideration of Commissioner Martinez’ (Legislative File No. 101148) proposal that addressed a full audit of the Foundation, and possible suspension of any support from the County and/or the Jackson Memorial Hospital to the Foundation. Chairwoman Heyman noted this request was made four months ago, and Committee members were still waiting for a response. She also noted the documents submitted to members of the Committee by the Foundation were vague, non-specific, and questionable. Chairwoman Heyman asked Ms. Escar-Mangos and PHT Chairman Copeland to relay to the Foundation members that she would bring back Commissioner Martinez’ proposal, if they did not provide tangible and substantive information in response to this request. Chairwoman Heyman reminded staff of the following directive involving the Foundation, which she noted, were given to members of the County Administration at the June 10th, July 15th, and the September 16th Committee meetings. She noted the following directive given at each of the meeting mentioned above: Chairwoman Heyman noted the revenue gain reported by the Foundation were greater than the expenditures. She asked Assistant County Manager Alina Hudak to work with the representative(s) of the PHT to prepare a justification, in the form of a report, reflecting the return for each dollar spent and the amount of revenue collected by the Foundation, compared to the revenue collected by Mount Sinai and Baptist Hospital Foundations. She asked that this report be submitted at the next Committee meeting. Commissioner Heyman noted although she did received information from the Foundation in response her directive, that information was unacceptable. She clarified that she requested a comparative analysis on the return on each dollar spent and how much the Foundation collected compared to other local foundations. She indicated that if the Foundation’s intent was to spend monies to bring in funded patients, then this report should reflect that information. Chairwoman Heyman indicated that Jackson Memorial Hospital had great practitioners and a great record, recordkeeping was apparently an issue. Chairwoman Heyman stated if the Foundation was unable to provide this information, she was prepared to request an independent forensic audit or investigation to find out where the money was and how it was spent. She reiterated that the information provided by the Foundation was unacceptable; and that she would consider the possibility of not funding the Foundation in the future. Chairwoman Heyman and Commissioners Diaz and Souto questioned the status of the following directives that was given September 16, 2010: Commissioner Diaz asked that Assistant County Manager Ysela Llort work with Jackson Health Services (JHS) to prepare schematics (an operational chart) of the JHS (also known as Jackson International Health) insurance operations including their marketing strategies/concepts, target group, premium base, financial statements, and investment portfolio; and the number of companies represented by the public health trust that generated business. He asked that this report be submitted to all members of this Committee and the County Commission. Chairwoman Heyman asked that the report requested by Commissioner Diaz include line items of the Foundation’s operational budget reflecting the $9 million received for 2009 and the $7.2 million slated for 2010 for Foundation health services (known as Jackson International Health), and a separate report on its methods of operation. Chairwoman Heyman also requested that this report include a breakdown of Jackson Memorial Hospital’s (JMH) net revenue stream and how the $41.5 million from last year was used to fund JMH and Jackson Health System (JHS). Commissioner Souto asked that this report include a detailed report of services provided by Jackson International Health Services such as type of patients and their diagnosis, accomplishments, and the failure rate, particularly patients from Peru and Brazil. Commissioner Diaz noted the report he received did not include the information he requested from the Foundation. Commissioner Diaz asked Assistant County Attorney Laura Llorente if the County Commission could ask for an investigation of the Foundation. In response to Commissioner Diaz’ question, Assistant County Attorney Llorente explained that the County Commission could request an audit of the Foundation indirectly through the PHT pursuant to Chapter 25A (4) of the Code. She noted; however, that the PHT had the authority to audit the Foundation, not the County Commission. Commissioner Diaz noted his intent was to initiate a full-fledged investigation. Assistant County Attorney Llorente stated that the internal auditor for the PHT had the ability to audit the entire relationship including finances and expenditures, etc. Commissioner Rolle noted he would support auditing the Foundation’s records; however, he would not support an investigation. Commissioner Diaz emphasized the importance of members of the Foundation to appear before the County Commission and/or its committees and present complete and accurate information in the future. Mr. Copeland noted he shared the concerns expressed by Committee members today and he was frustrated with the Foundation members. He noted the international market represented a huge opportunity for Jackson Health System, and his frustration was fueled by the fact that Jackson was unable to move forward and be more aggressive in the international arena. Mr. Copeland indicated he would meet with staff to ensure that the PHT responded appropriately to commissioners concerns in the future; that after meeting with staff, he would address how the PHT and this Committee should move forward on this matter. Mr. Copeland noted the Office of the Inspector General (OIG) was currently investigating the Foundation with respect to its international operations; and that he was unaware of when the OIG would issue its findings. Commissioner Barreiro noted although he support an audit, his primary concern did not involve an audit or an investigation of the Foundation records, but rather the need for a site visit to gain in-depth knowledge of its operations. Mr. Copeland said he would schedule a site visit as recommended by Commissioner Barreiro, and would invite all stakeholders to visit the Foundation, which was housed in the Jackson Towers building. Commissioner Rolle questioned whether Foundation members were being defiant or just did not understand how to compile the information requested. Assistant County Manager Alina Hudak noted members of the County Administration followed-up immediately on issues raised by this Committee. Chairwoman Heyman stated that this Committee would continue to use the PHT and the Jackson Health System as a communication channel to voice the concerns of this Committee to the Foundation.

County Attorney 9/20/2010 Referred Health and Public Safety Committee 10/14/2010

Health, Public Safety & Intergovernmental Cmte 9/16/2010 1D3 Presented
REPORT: Chairwoman Heyman noted during a County Commission meeting, Commissioner Martinez requested that the Foundation be more accountable, specifically by submitting a detailed breakdown of expenditures that totaled $7,791,525. She also noted that she requested a comparative analysis of other hospital’s international programs like Jackson Memorial Hospital (JMH) that projected net revenue generated by the Foundation, which was indicated on page (3) of the document from the Foundation. Chairwoman Heyman noted, for the record, that she requested this information from the Foundation at the July 10, 2010 HPSIC meeting; however, she received a (10) ten page document that only contained a comparative analysis between JMH and Baptist Hospital. She also noted if there was a problem in obtaining this information, the County could have assisted by using its resources to develop an itemized budget for the Foundation. Mr. Rolando Rodriguez, President, Jackson Memorial Foundation appeared before the HPSIC, and clarified that an entire itemized budget of the Foundation had been provided to the Board of County Commissioners via the PHT, which was vetted by the Steering Planning Committee. Chairwoman Heyman explained that two (2) members of the HPSIC sat on the PHT, but the other members did not receive the itemized budget of the Foundation and she requested that a copy be provided to the all members of the HPSIC. Regarding Chairwoman Heyman’s request, Mr. Rodriquez emphasized how difficult it was to obtain comparisons from Baptist Hospital because the data needed from Medicare and private institutions was not available. He also noted the Foundation used consultants to gather the information and felt that the program provided through Baptist Hospital would be the most comparable to the Foundation and an excellent example of how the Foundation’s program operated. Mr. Rodriquez noted other than a program in Broward County, he was unaware of any other hospitals that had a similar to the international program as the Foundation. He also noted he would try to get more information regarding the facility in Broward. In response to Chairwoman Heyman’s inquiry regarding how international patients that received medical treatment from JMH were identified, Mr. Rodriguez explained that a number of codes were used to identify international patients during the screening process. Chairwoman Heyman questioned whether the reported net revenue reflected billing or incoming revenue. Mr. Rodriguez noted the net revenue reflected the incoming revenue and the International Department only served paying patients; that non-paying patients were not treated through the international program. Discussion ensued among the Committee members whether the Foundation’s marketing efforts intended to attract only paying international patients versus non-paying international patients to JMH. Commissioner Diaz asked Assistant County Manager Ysela Llort to work with Jackson Health Services (JHS) to prepare schematics (an operational chart) of the JHS (also known as Jackson International Health) insurance operations including their marketing strategies/concepts, target group, premium base, financial statements, and investment portfolio; and the number of companies represented by the Public Health Trust that generated business. He asked that this report be submitted to all members of this Committee and the County Commission. Mr. Carlos Lopez-Cantera, Vice Chairman, Jackson Memorial Foundation Board appeared before the Committee and clarified that the Foundation was responsible for raising funds for projects within the JMH; and the Foundation Health Services, which was the subject of today’s discussion, was responsible for the International Program. Chairwoman Heyman asked that the report requested by Commissioner Diaz include line items of the Foundation’s operational budget reflecting the $9 million received for 2009 and the $7.2 million slated for 2010 for Foundation Health Services (known as Jackson International Health), and a separate report on its methods of operation. Following further discussion, Mr. Cantera noted the $100 million was generated in revenue by the Foundation, and would go directly to JMH. He also noted that the Foundation was a marketing company. Additionally, Mr. Rolando Rodriguez clarified that 60 percent of the physicians on staff at JMH South and North were from the University of Miami and private practices.. Chairwoman Heyman also requested that this report include a breakdown of Jackson Memorial Hospital’s net revenue stream and how the $41.5 million from last year was used Commissioner Souto asked that this report include the services provided by Jackson International Health Services as well as the type of patients and their diagnosis, accomplishments, and failure rate, particularly patients from Peru and Brazil. Commissioner Sosa noted she was familiar with the level of health care provided at JMH because she had been treated there. She also noted that she had observed the work of the Foundation. In response to Commissioner Sosa’s question regarding whether donations were received from international patients, Mr. Carlos Cantera noted that within the past year the Foundation had received over a million dollars in donations from international patients and this program was progressively growing. Commissioner Sosa recommended this information be included in the report requested by Commissioner Diaz. Mr. Cantera noted those donations were not reported because the funding was from the Foundation and was used for capital projects, which eventually used for JMH. He explained that $60 million of the $100 million in gross revenue was used for physicians’ salaries and operating expenses. Commissioner Souto said he had not doubt that the Foundation contributed to the financial well being of JMH; however, he wanted to JMH to be more aggressive and creative in identifying resources to fund the hospital. Mr. Rolando Rodriguez noted he agreed with Commissioner Souto that JMH needed to be more aggressive in identifying funding sources. In response to Commissioner Diaz’ question regarding the number of companies that send business to JMH, Mr. Rodriguez noted patient referrals were made through 31 insurance contracts and 28 affiliation agreements. Commissioner Diaz requested that this information be included in the report as well.

County Manager 9/3/2010 Referred Health, Public Safety & Intergovernmental Cmte 9/16/2010

Health, Public Safety & Intergovernmental Cmte 7/15/2010 1D4 Presented
REPORT: Chairwoman Heyman stated the information provided by the Jackson Memorial Foundation, in response to the request made at the June 10, 2010, Committee meeting regarding the Jackson Memorial Foundation, was unsatisfactory. She reminded staff of her request for a comparative analysis on the return on every dollar spent and how much the Foundation collected compared to other local foundations. She indicated that if the Foundation’s intent was to spend some monies to bring in funded patients for the best care in the world, let alone South Florida, then this report should reflect that information. Chairwoman Heyman indicated Jackson Memorial Hospital had great practitioners and a great record, but there seemed to be an issue with recordkeeping. She pointed out it should also reflect the Foundation’s direct use of the funding and list the return on the monies spent. Chairwoman Heyman stated if the information could not be provided by the Foundation, she would be prepared to request an independent forensic audit or investigation to find out where the money was and where it was being spent. She stated she would not accept the information provided and possibly in the future not support funding the Foundation.

County Manager 7/12/2010 Additions Health, Public Safety & Intergovernmental Cmte 7/15/2010

County Manager 7/12/2010 Referred Health, Public Safety & Intergovernmental Cmte 7/15/2010

Legislative Text

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