Busted: Roger Williams Medical Center, Its CEO, Two Former Executives Indicted

Things just got much worse for Roger Williams Medical Center here in Rhode Island, its current (but suspended Chief Executive Officer [CEO] Robert A Urciuoli, and two of its former executives.

The Providence Journal reported:

Roger Williams Medical Center yesterday became the first nonprofit institution in Rhode Island ever to face federal corruption charges when a grand jury issued a 38-count indictment against the hospital, its president Robert A. Urciuoli and two others.The indictment, charging conspiracy and mail fraud, alleges that Roger Williams and its representatives stole the "honest services" of a Rhode Island senator, John A. Celona, by putting him on the payroll to do their bidding at the State House.
Also charged were Peter J. Sangermano Jr., the former president of The Village at Elmhurst assisted-living center; and Frances P. Driscoll, a former Roger Williams vice president.
The indictment alleges that Roger Williams Medical Center and the others hired Celona as a consultant to The Village at Elmhurst, which is partially owned by the hospital, but that Celona's real work was using his public office to influence legislation and perform favors.
The hospital, Urciuoli and Sangermano were each charged with 37 counts -- 1 of conspiracy and 36 of honest services mail fraud. Driscoll was charged with two counts -- one of conspiracy and one of honest services mail fraud.

The indictement charged "that the defendants conspired to hire Celona as a consultant in 1998, and that the senator was paid more than $260,000 over the next six years 'to cause him to use his influence, power and authority as a state senator to benefit the political and financial interests' of Roger Williams." Furthermore, " As part of the alleged conspiracy, the indictment says, the hospital disguised the true nature of Celona's work and deceived the state Ethics Commission when it sought an advisory opinion regarding the senator."

"The indictment chronicles a litany of actions that Celona allegedly performed at the direction of Urciuoli, Sangermano or Driscoll, from seeking to influence legislation to using his political muscle and powers of persuasion." These included:

• " At Urciuoli's direction, the indictment charges, Celona pressured Blue Cross and UnitedHealthcare to increase their insurance reimbursements to Roger Williams. "
• "The indictment alleges that when Roger Williams was seeking a merger with a for-profit corporation, Urciuoli and Driscoll informed Celona that they opposed a Senate bill prohibiting hospital officials from serving on the board of a converted hospital."
• "The indictment also accuses Urciuoli and Driscoll of telling Celona to oppose a 1999 bill creating a Rhode Island Cancer Council, to coordinate research and treatment, because it could hurt hospital finances and because they expected it would be led by a former Roger Williams doctor for whom they 'felt animosity.' Driscoll subsequently directed Celona to threaten an unidentified state representative, the indictment says, 'and advise her that she would suffer negative political ramifications if she supported the Cancer Council.'"
• " Urciuoli and Driscoll were also accused of directing Celona to attempt to influence municipalities to increase ambulance runs to Roger Williams. "
• "Driscoll was charged with directing Celona to amend legislation to reimburse Roger Williams for a bone-marrow donation program."
• "She was also accused of directing Celona to work to kill a bill to require nonprofit corporations in Providence to make payments in lieu of taxes."
• "In 2000, the indictment says, Driscoll directed Celona to oppose a proposed merger between Lifespan and Care New England, 'because the merger could have an adverse financial impact' on Roger Williams."
• "In 1998, Driscoll and Sangermano allegedly directed Celona to work against a bill prohibiting health facilities, including The Village at Elmhurst, from offering care for Alzheimer's disease. "
• "Sangermano was also accused of asking Celona to work behind the scenes to extend a moratorium on new nursing-home beds in Rhode Island, to help The Village at Elmhurst's finances."

CEO Urciuoli was unavailable for comment. "When the indictment came down yesterday, he was with his family in Florida. Last summer, his wife bought a house on a golf course, the Country Club at Mirasol, in Palm Beach Gardens, for $939,000, according to Florida land records."
The indictment of an entire not-for-profit hospital may be another first in the annals of health care mismanagement. In an accompanying article in the Providence Journal, Rick Wade, Senior Vice President of the American Hospital Association is quoted, "I have no inkling of how you would indict and try an entire institution." Furthermore, "It could be that indicting the hospital is sending a message to every hospital, that it's just not one person acting -- there is institutional responsibility for these kinds of things," he said. "For boards of trustees everywhere, it's a reminder of how serious the responsibility of hospital trusteeship is."
The hospital's Board issued a statement that they were "shocked and deeply disturbed," furthermore,

This decision has threatened a respected 128-year-old institution that employs more than 1,400 people and provides millions of dollars of free care annually to Rhode Islanders who can't afford to pay for care. Hundreds of nurses, doctors and other dedicated caregivers devote themselves to caring for patients on a daily basis at Roger Williams. Their livelihood is now at risk

True enough, but the question is: who was ultimately responsible for the threat, the grand jury who indicted the hospital, or the leaders of the hospital who allegedly took the actions that lead to the indictment?

The membership of the Medical Center's Board has changed since the 13-3 vote to keep Urciuoli on despite evidence of his financial improprieties, since Urciuoli hired Celona, and since the events allleged in the indictment. If the new Board wants to protect this 128-year old institution, it clearly needs to clean up the Medical Center's administrative act.

As each new case of mismanagement of health care organizations makes headlines, awareness that such organizations' leadership is all too often ill-informed, inept, conflicted, and even corrupt should grow.

That awareness should motivate making such leadership more representative, transparent, accountable, and ethical.