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Dennis Brown
A Long Trail to Follow
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Dennis Brown, the Tenet vice-president who is claimed to
have played an important role in overseeing Redding
hospitals operations first came to my attention when he was
CEO of an international hospital in Singapore in the late
1980s. He later became CEO in Australia where I blew the
whistle on Tenet's conduct. There were law suits involving
the Singapore Medical Council, the Singapore courts and I
faced defamation actions in Australia and Singapore. This
web page tracks what I know of the allegations made about
him, as well as what has been said about him and the conduct
of the operations under his control
The series:- Tenet and its
doctors
In July 2003 I wrote a web page titled "Tenet Health Care and its
doctors" which included the story of Tenet's relationship with its
doctors going back into the 1990s. In 2007 I put the material about
Redding hospital into a separate web page and wrote two more about
this revealing scandal within a scandal. The kickback allegations too
had become a major player in the wider scandal. This has also been
moved to a separate web page and updated. More Tenet sagas which
involve doctors have come to light and these throw additional light
on the many problems in Tenet's operations. While they deal with more
than just the doctors they all contribute to the story of doctors and
form a saga. I have therefore arranged them as a series called "Tenet
and its Doctors".
The web pages are
Of particular interest to me was the accounts of involvement of Tenet's regional vice president, Dennis Brown, in the Redding scandal.
Brown was a hospital administrator and CEO of Tenet's Singapore hospital during the 1980s. The hospital was sold in 1995 after the scandal.
I had crossed swords with the hospital in the late 1980's. When I started asking questions I became aware of stories of buying patient referrals in the region but was never able to get proof. My own assessment of the hospital mirrored that of a US whistleblower who described the hospital he worked at as a "dysfunctional family unit". It made vast profits and staff identified with its model - but in my experience and my assessment of what I was told it did not work for patients. I asked a colleague attending a conference in the region to make some tactful inquiries about adverse outcomes at this very profitable and apparently reputable hospital. The information he got was compatible with my fears.
Jun 1990 Hearsay
"With regard to the other matter in Singapore the situation becomes worse as I speak with people who have had dealings in Singapore, stories of over servicing, passengers removed from aeroplanes without sufficient cause and hospitalised (one doctor known as the "bandit of Singapore"), administration of unneeded expensive treatment and difficulties in getting the authorities to confront issues and act."
Letter by J M Wynne to Lawyer in the UK dated June 14, 1990
Mar 1990 Experiencing Tenet/NME doctors
Most of them (doctors) related well. They were kind and empathic. Some offered real friendship.
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One is forced to the conclusion that there is something wrong with the environment - - - - . Somehow a pathological medical social group has arisen which is able to isolate itself from its colleagues. It is able to build a set of ideas and presuppositions, a perceptual set unchallenged by outside norms.
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There is evidence to suggest that the structure of medicine in this hospital is such as to isolate the group from other groups and to limit critical interaction among peers. This has enabled them to create the illusion - - - - - - and they seem to believe this themselves.
Complaint to Medical Council March 1990
July 1991 Reporting it to Medical Council
"It (the information I obtained) suggested the exploitation of patients and the presence of unscrupulous and criminal activities in some portions of the medical services provided. Even allowing for the fact that many of those I spoke to might have axes to grind, I feel that there cannot be so much smoke without a large fire. Some of the tales were frightening. Many of these related not only to financial matters, medical standards and practices in the hospital but particularly to the conduct of the Airport Medical Centre and its assumed relationship with the hospital. Others related to air ambulance services and practices of referral from surrounding countries."
Letter J M Wynne to Singapore Medical Council July 1991
I came to suspect that there were financial relationships between the hospital and doctors inducing them to admit patients needlessly and keep them there as long as possible, but could find no evidence of payments. I corresponded with some of these patients who were Australians passing through Singapore.
In 1993 a Singapore surgeon made unrefuted court allegations describing the pressure put on him to enter into a contract in which reductions in office rental (even free rental) would be linked to the number of admissions he made. This confirmed what I suspected. I also suspected that one authoratative doctor held a senior position more because of his profitability than his clinical expertise. The surgeon's evidence supported this too. If this surgeon failed to meet the hospitals conditions he was likely to be ejected.
1993 Favouring big admitters
(Page 23) The third alternative was to get out of the units because I was on a month-to-month lease. These were their words, not mine.
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At that time, they were very keen to increase the hospital admission rate, and they wanted to control the other units so that they could rent to high hospital admitters.
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(Page 25) I said since they wanted to gain control of the other units, with high admitters like X_Y_Z (a senior doctor), then I was prepared to rent the other units to them.
Notes of evidence. Court action Dr Alan Ng vs Mount Elizabeth Hospital, Suit No 620 of 1989 - Civil Appeal No 122 of 1993 Singapore 1993 page 18 (See my 1996 submission to Tenet for more extracts from this)
A 1992/3 brief curriculum vitae reveals that Tenet (then called National Medical Enterprises or NME) had awarded Brown a "Circle of Excellence" award for his efforts. A doctor in a court action in the 1990s was very critical of another of NME's "Circle of Excellence" recipients. Some of those caught up in the second scandal were also recipients and one wonders what the criterion for the award were.
The Singapore surgeon in court evidence accused Brown and his colleagues of attempting to trade the admission of surgical patients for reduced rentals - an unethical kickback scheme. The terms of the proposed contract would have encouraged unnecessary surgery.
Brown and the hospital denied the allegations but none were prepared to give evidence. According to the evidence the doctor gave in court (page 18 of statement of evidence), at a meeting with Brown and another administrator, the doctor was told "that you don't have to worry anything about ethics. He (Brown's colleague) said that all these incentive documents could be signed and hidden in a safe where no one could see them."
Jul 2003 Circle of Excellence Awards
The hospital later pointed to its high accreditation score as evidence of quality health care. But Tenet critics take little comfort in such endorsements and outright ridicule the company's own "Circle of Excellence" awards for hospital administrators. They claim that Tenet has showered the prizes on hospital executives who've placed profits ahead of patient care. And they point to allegations looming over two recent recipients of "Circle of Excellence" prizes -- one hospital is suspected of performing unnecessary surgeries and another has been accused of paying illegal doctor kickbacks -- as evidence of their theory.One former hospital executive, - - - - also admitted that he has watched Tenet's recent collapse with more dismay than shock.
"I know how Tenet operates," he said simply. "Some people are really too aggressive."
Whistleblower Wants Tenet to Come Clean The Street.Com (Melissa Davis) Jul 25, 2003
Sep 2003 Allegations in Singapore in 1993 resurface
Besides targeting the top brass, he's (Senator Grassley) seeking explanations from at least four Redding CEOs and, just as notably, a regional boss who's been tied to trouble before.More than 10 years have passed since Dennis Brown was first accused of rewarding foreign doctors for patient admissions. Brown, who currently oversees the northern California region that includes Redding, served as CEO of Tenet's Mount Elizabeth Hospital in Singapore at the time. And Alan Ng, a gynecological surgeon, was complaining that Brown and his superiors wanted promises of high patient admissions in return for discounted -- or even free -- office space.
"I told them if they went around offering doctors incentives to increase hospital admissions, there would be such a scandal that a public inquiry would be held," Ng said in pre-trial documents. "I told them that things were done differently here [than in the] USA ... I said they could go to prison for this."
Tenet has long since exited the Singapore market, and Brown has continued to climb the corporate ladder in the U.S. His last rung before taking over the northern California region? He presided over physician services at a time when the company was allegedly paying sky-high prices for physician practices in hopes of boosting referrals.
"If you pay a doctor more than is commercially reasonable, then you are in essence giving him a kickback," said one former Tenet executive. "Is that illegal? Gosh, I think so."
Holy Smoke
Hearts Harden as Tenet Faces the Senate The Street.com (Melissa Davis) September 7, 2003 http://www.thestreet.com/pf/stocks/melissadavid/10113497.html
Brown became the CEO of Tenet's Australian operations in 1991. While I never met him personally, I spoke to others who had. I read the comments made by the West Australian newspaper which was critical of Tenet. I came to see him as self-confidant, aggressive, and unable to consider the possibility that he was doing anything wrong. What he lacked in intelligence he made up for with assertiveness and glib rationalisation. He would do whatever was required and find some way of justifying it.
I had met with his deputy at the hospital in Singapore in 1991 and was subjected to a lecture on quality and accreditation. It consisted of claims to high quality and monitoring of standards. The discourse was linked together by a pattern of words with associative meanings rather than logical connections. While it was impressive it was meaningless when the content was analysed. At the same time the administrator was clearly genuine and believed what he was saying.
In 1992 a letter by Brown to NSW Health was equally impressive and NSW Health accepted the claims made. Once again this was a collection of words without logical connections or supporting evidence. Other company correspondence and documents showed similar patterns and I came to realise that this was how these people thought. They really believed what they were saying even when it was disconnected from reality.
They were so confident and buoyed by their economic prowess that something became real or legitimate simply because they said it was so. A false reality was created. I coined the term "NMEspeak" to draw the comparison with George Orwell's term "newspeak". He described just this. I had encountered other people like this in the past. While these people do know what they are doing or have done it is simply put away in a little corner (compartmentalised) and never considered - even denied when confronted.
Over the succeeding years I attempted to blow the whistle on the company's conduct using material from the USA and Singapore. Brown and his Tenet/NME colleagues had not produced the Singapore court action when requested to do so by authorities. Authorities were given decidedly deceptive information about the company's conduct in the USA.
When these assurances were shown to be false the NSW health department recommended that the company's licence application be denied citing a "lack of frankness and candour" in their dealings with the department. The matter was referred by the state government to a retired judge who had been driven into early retirement because he was at risk of improper influence. The government were strongly supporting the company and the minister was on first name terms with the Australian chairman.
The judge granted the licence with ineffective conditions. He modified these to allow Brown to continue as CEO. He permitted Brown to introduce the Tenet/NME business practices that the local company was paying for. They were the root cause of the company's early and recent scandals.
The company attempted to silence me by first funding Brown to commence a defamation action against me. When I tried to force him to court the action was withdrawn but another was commenced by the hospital in Singapore. This was never prosecuted.
When Tenet was forced out of Australia in 1995/6 Brown returned to the USA where Tenet put him in charge of relationships with doctors, which seems to have been his specialty. This was even though the US government and Tenet's new ethics committee had been supplied with the Singapore court documents.
Feb 1997 Becomes Vice president
Most recently he (Brown) headed Tenet's Northern region, where he is being replaced by Dennis Brown, who becomes senior vice president, operations. Brown most recently headed Tenet Physician Services.
Tenet strengthens management structure following OrNda acquisition BUSINESS WIRE--Feb. 12, 1997
Fen 1998 Relationships
In Nebraska, Tenet's approach is to look for cooperative relationships, said Dennis Brown of San Ramon, Calif., senior vice president of operations for the corporation's northern division.
Health Systems Continue Talks Over Projects Omaha World-Herald February 26, 1998
By 1998/9 Brown was Tenet's regional vice president in the Redding region and responsible for what happened there.
I was interested that Brown was one of those whose correspondence and email was requested by Senator Grassley and wondered if he had been involved. The senator was interested in his involvement in outlier payments as well as the Redding debacle. He asked Tenet to supply material about Redding to his committee.
Sept 2005 Grassley's request for documents
11. From 1990 through the present, all documents relating to communications between any doctor (including, but not limited to Dr. Patrick Campbell, Dr. Bruce Kittrick, Dr. Roy Pick, and Dr. Thomas Drakes), and Tenet administrators, officers or directors (including, but not limited to Stephen Corbeil, Kenneth Rivers, Stephen Schmidt, Hal Chilton, Thomas Mackey, Neil Sorrentino, Dennis Brown, Jeffery Barbakow, Christi Sulzbuch) that raise questions or concerns regarding Tenet's cardiac or related programs, including, but not limited to the necessity for cardiac procedures and surgeries.
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32. From 1998 to the present, all documents (including, but not limited to E-mails) that were drafted, sent, received, copied, or forwarded by any of the following persons: Thomas Mackey; Neil Sorrentino; Dennis Brown; Jeffrey Barbakow; Christi Sulzbach; any Tenet administrators, officer or director, which refer to Medicare outlier payments.
Letter from Senator Grassley, chairman of the Senate Committee on Finance to Trevor Fetter, CEO Tenet Healthcare September 5, 2003
It is also interesting that another doctor, Israel Chambi, from Brown's region was accused of not dissimilar practices and was suspended by his hospital some time after the Redding affair. He too had been made head of neurosurgery about 1 year after Brown became vice-president. Once again Senator Grassley wanted to know if Brown had anything to do with him. For more click here.
Sep 2003 Problems with neurosurgeon
The chief of neurosurgery at Western Medical Center Santa Ana, a major center for head trauma in Orange County, has been suspended from clinical practice by top officials at his hospital.
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The exact reason for the Wednesday night action by the hospital's Medical Executive Committee was not made public Thursday. Dr. Israel Chambi Venero has been accused repeatedly of malpractice, unnecessary surgery and incompetence -- all of which were detailed in an Orange County Register investigation in May.
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Last week, the U.S. Senate Committee on Finance said it, too, is investigating Tenet, and it told the company to hand over any documents regarding its relationship with Chambi.
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In the Register's stories, patients and their families described how Chambi persuaded them or their loved ones to undergo brain or spinal surgery that left them severely disabled. In some cases, other doctors reviewed the records and suggested surgeries should not have been performed.Chambi has been sued 36 times for malpractice or wrongful death since 1992. He won most of the lawsuits.
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But Western Medical Center, the flagship Orange County hospital for the Tenet Healthcare chain, made Chambi chief of neurosurgery in 1998.
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A Register analysis of public records found that Western Medical billed $38 million for neurosurgeries in 2000 and had the highest per-patient charges in Southern California.
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"The action by the hospital's medical executive committee is certainly appropriate in the context of the numerous well-documented deficiencies of Dr. Chambi over several years," said Dr. James Doty, a San Francisco neurosurgeon who has reviewed a number of Chambi's cases and is scheduled to testify against him in a trial this year."It is unfortunate that the peer-review system requires a major investigation by a news organization before such action is instituted," Doty said. "The delay only confirms my belief that major financial producers for a hospital are not closely scrutinized."
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"Senator Grassley is particularly concerned about the type of peer review Tenet is doing or not doing and whether the company is prohibiting the peer review of these doctors with the goal of keeping them in place and keeping their high billing practices for the company."
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36. From 1995 to the present, all documents (including, but not limited to E-mails) that were drafted, sent, received, copied, or forwarded by any of the following persons: Thomas Mackey; Neil Sorrentino; Dennis Brown; Jeffrey Barbakow; Christi Sulzbach; any Tenet administrator, officer or director, which refer to Dr. Israel Chambi.
Santa Ana, Calif., Neurosurgery Chief Suspended The Orange County Register, Calif. September 12, 2003
I had no further information about Brown until I read Klaidman's 2007 account of Brown's involvement in negotiating contracts with the doctors. I read these with great interest.
According to Klaidman (page 99) Brown traveled up to Redding twice a month to keep a close watch on financial performance, confer with administrators and supervise what was happening. According to Klaidman senior Tenet staff including Mackey and Sorrentino "often conferred privately with Moon and Realyvasquez about this all-important 'cardio-network'".
Klaidmen (page 100-101) describes a system of non-transparent rewards for the two doctors which it is suggested were in breech of the Stark anti-kickback laws. He claims that when a new contract was due Realyvasquez demanded over US $1 million a year. When the existing CEO strung him along Realyvasquez angrily went to management threatening to quit. The CEO was replaced and the new CEO and Brown negotiated a new confidential contract for Realyvasquez; and then another for Moon soon after.
Klaidman quotes an administrator's description of the contract with Moon. He linked the payments in this contract to a mammoth 300 catheterisations a month - remarkably similar to the contract a Singapore doctor claimed he was asked to enter in the late 1980's when Brown and his superiors Ford and Focht were running operations in Singapore.
Klaidman (page 208-210) also quotes the hospital intensivist, a Dr, Sebat. Sebat and others were concerned about the standard of care and the lack of peer review. Sebat, a member of the hospital's board of directors was named to a task force formed to "identify and recommend ways to improve peer review, the in-house oversight process designed to monitor quality of care".
After only three meetings the group was "summarily disbanded on orders from Dennis Brown". When Sebat objected to Brown the response "was brief and to the point - their work was done and he should let it go". Sebat believed that quality of care was suffering because "bottom line considerations were driving patient care decisions".
"Physician peer review was suppressed. " he (Sebat) said, "because the heart program was a golden goose". Sebat also indicated he was aware of occasions in which the "hospital administration had overridden medical staff decisions". Sedat also claimed he knew of cases where "patients' charts had been falsified".
Sebat (page 217) continued to pressure the administration. He was threatened and ostracised by staff. He was told that his contract would not be renewed, his research office would be closed , and that he would be frozen out by the administration.
"All three of these things happened. First Brown forbade him to continue raising money for the critical care office and withdrew the hospital's support, which, as a practical matter, made it impossible for him to get grants. Then when Sebat was away on a trip, the office was shut down and the staff was fired. And when Sebat's contract expired in 2004, it was not renewed. He got no responses from emails - only from registered letters." Sebat said he "even suspected that he had been frozen out by the administration on Brown's orders."
I am not alleging that Brown was involved in anything underhand in Redding. I am merely setting the reports of his involvement in Redding, described by Klaidman, into the context of his career, his early award of a "Circle of Excellence" by NME, NME's conduct at that time, the recent scandal, and my impressions of the man when I was in conflict with him. I am entitled to ask about this and would welcome information from Brown, Tenet or anyone else that adds to or refutes the observations here.
Page 99-100 Company's interest in the doctors and finances
Although Ken Rivers (Redding CEO) was formally his direct superior, Gibson (past Redding administrator) actually reported to Dennis Brown, Tenet's regional vice president.
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Gibson was particularly struck by the close watch Tenet executives like Brown kept on RMC's financial performance.
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- - - - Tenet hospitals were required to produce reports that included narrative sections detailing key events that influenced each hospital' financial performance, and a statistical section that, among other things, analyzed the contribution of individual doctors to each hospitals bottom line. There was a point during Gibson's tenure at which a decision was made to separate these accounts for individual physicians from the main report. After that they were handled with secrecy; these reports were never sent by email . Brown hand carried them to corporate headquarters in Santa Barbara for the monthly meeting, which was attended by Tom Mackey. Gibson sometimes received phone calls from these meetings and was asked questions like "Moon's off a little bit, what's up?" And while Gibson was at RMC, Tenet executives sent daily messages pressing for ever-greater profits from the heart program. Gibson also heard comments at board of directors' meetings to the effect that the already prolific Moon and Realyvasquez had to increase the number of procedures they were doing because Tenet was giving the heart program tens of millions of dollars annually for building and equipment.
"Coronary: A true story of medicine gone awry" by Stephen Klaidman Scribner New York 2007
Page 101 Contracts with the doctors
Rivers was replaced as CEO by Steve Schmidt and after that the contract negotiations with Realyvasquez progressed fairly rapidly with the help of Dennis Brown and others. Gibson said great care was taken to give Realyvasquez what he wanted while structuring the contract to avoid violating the Stark Law. After several meetings a contract was drafted that met Realyvasquez's approval, although its details were kept confidential. According to Gibson (a hospital administrator who left soon after), a similar process was followed with Moon soon thereafter, also leading to a lucrative new contract whose terms were also kept confidential. Gibson said what Tenet wanted - and got - from Moon in return was three hundred caths a month, a number far higher than could be justified by the disease rate in the local population or very likely anywhere. And it was a pace no cardiologist could maintain with a professional level of competence, not even Chae Moon, the fastest catheter in the West. But more caths begat more bypass surgery, which would appear to have been Tenet's goal.
"Coronary: A true story of medicine gone awry" by Stephen Klaidman Scribner New York 2007 (page 101)
1993 Evidence about a contract in Singapore
"I met Brown and/or Riddle 3 times in February, 7, 19, and 24 Feb. At these meetings, Brown and/or Riddle made various proposals about discounted prices based on number of patients I admitted into the hospital. They mentioned $50,000 and $100,000 related to number of patients. I can't remember how they were related because I rejected it outright.
Notes of evidence. Court action Dr Alan Ng vs Mount Elizabeth Hospital, Suit No 620 of 1989 - Civil Appeal No 122 of 1993 Singapore 1993 page 18 (See my 1996 submission to Tenet for more extracts from this)
Tenet is reported to have cleaned out over 90% of middle managers - its vice-presidents. I wonder whether the clean out was based on clinical outcomes or on financial performance? Was Brown among those to go? Was his (financial) performance too good to lose? He had been a loyal performer for Tenet for at least 20 years and had been awarded by them. He had been responsible for two of Tenet's most profitable hospitals, the Mount Elizabeth Hospital in Singapore and the Redding hospital in California. Was he too close to top management to lose (as suggested by Klaidman's account)? Would his loyalty and service be rewarded by retention. The accounts suggest that he is a good example of Tenet's culture? Has he been retained to retain the true cultural values of the company in preparation for its successful revival?
Fetter is one of Barbakow and Tenet's stalwarts and logically should have been the first in line for the clean out. As a traditional stalwart Brown should be another.
At the very least Tenet's new ethics and integrity processes should be scanning the track record of all those who have been involved in any of the allegations surrounding Tenet to see whether these people are a potential threat to reform. Brown's close association with allegations of kickbacks in Singapore, with a lack of frankness and candour in Australia, with Yeldham's vulnerability to influence, with Redding hospital's doctors, and with the questionable neurosurgeon must surely deserves close scrutiny.
April 2006 Clean out of staff
Fetter, who was finance chief at the movie studio Metro- Goldwyn-Mayer Inc. before joining Tenet in 1995, moved the corporate headquarters to Dallas from Santa Barbara, California, and cleaned out the top ranks of management. Only a few of the 97 former vice presidents remain.
Tenet Healthcare Courts Doctors in Search of Financial Recovery Bloomberg News April 14, 2006
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This page created July 2007 by
Michael
Wynne
