This will be a hard series of posts to write. It wa triggered by the latest, and perhaps most gruesome chapter in the troubled history of the leadership of Cooper Health, the largest hospital system in southern New Jersey (known locally as South Jersey). As reported by the Philadelphia Inquirer on March 28, 2015,
Cooper University Health System CEO John P. Sheridan Jr. stabbed his wife to death, set their bedroom on fire, and then took his own life, authorities have concluded, closing a six-month investigation into the deaths that shocked New Jersey's political and civic communities.
The Somerset County Prosecutor's Office announced its results in a news release Friday, citing forensic evidence and a lengthy probe that included more than 180 interviews.
But it offered no conclusive motive to explain why Sheridan, described by family and friends as mild-mannered, would brutally stab his wife and kill himself.
'Many possible scenarios and theories were considered,' the prosecutor's office said in a statement after months of virtual silence. The evidence 'supports the conclusion that John Sheridan fatally stabbed Joyce Sheridan, set the fire, and committed suicide.'
The Story in Context: a Long History of Leadership and Governance Problems
We have often discussed bad leadership of health care organizations, and written a lot about the contrast between the munificent compensation paid to non-profit hospital CEOs and the lack of evidence justifying such pay. However, a murder-suicide allegedly perpetrated by the CEO of a large non-profit hospital system is way at the tail of the curve of questionable managerial behavior.
But it turns out that Cooper Health System has a very long record of leadership and governance troubles. The current chapter is the latest, and possibly most gruesome, in this sorry series. However, the context of this history has been lacking in the recent coverage, which has been so far limited to local media. The history deserves a more complete discussion, and maybe then it could lead to some reconsideration at least of this one institution's leadership and governance, and perhaps the larger troubles in leadership and governance in health care.
In the interests of full disclosure, I started my faculty career at what was then Cooper Hospital - University Medical Center, the main teaching hospital for the University of Medicine and Dentistry of New Jersey (UMDNJ) - Robert Wood Johnson Medical School (RWJMS) branch at Camden, NJ. During my four years there, 1983-87, I was impressed with the dedication of the physicians, nurses and other health care professionals there. However, even given my naivete at a young faculty member, the leadership of the institution, which was one of the early adapters of the generic management model, seemed strange. Little did I know how strange it was.
In the late 1990s, when I became seriously concerned about what I know call leadership and governance problems in health care, I ran into some folks from South Jersey who told me that Cooper had a tumultuous history since I left. I got around to researching it, leading to an article in our local American College of Physicians newsletter. The article, to which I had linked here, is no longer available on the internet. So I have reposted it below, with some minor modifications, put in square brackets . Again, the history is of major problems with leadership and governance at Cooper that had inspired no reconsideration by 2005.
The Curiously Quiet Case of Cooper’s Corrupt CFO
Embezzlement by Top Management
In 1994, two powerful executives at Cooper admitted their guilt in an elaborate embezzlement scheme. In 1978, John H. Crispo, the owner of Financial Management Corporation Inc., to keep his contract with the hospital, began paying monthly kickbacks of $2500-$10,000 to John M. Sullivan, the Cooper Executive Vice President for Finance. Sullivan then referred delinquent hospital accounts for collection to a new company Crispo set up. In turn, Crispo repaid him $340,000 in more kickbacks. Sullivan recruited Cooper’s Controller, P. John Lashkevich, and the three devised a scheme to defraud the hospital using fabricated bills, established a fictitious company to launder money, and falsified tax returns. A prosecutor claimed “Mr Sullivan blew this money on wine, women, parties, and a lavish lifestyle,”which included trips with girlfriends to the Plaza Hotel, and jewelry shopping at Tiffany’s. Sullivan had driven a Porsche, and lived in a $700,000 house. The conspirators also bought cars, boats, and racehorses.
Other conspirators were also found and prosecuted. Helene Weinstein admitted to helping establish a shadow company as a conduit for Sullivan to send money from the hospital to his estranged wife, Elarba Pagan. Pagan was accused of receiving money sent by Sullivan from Cooper to another firm. Weinstein testified that Pagan carried “briefcases of cash from the hospital to shop in New York for $1500 shoes.” Also, Cooper’s Vice President for Finance, Robert Schmid Jr, admitted embezzling money from Cooper to pay for home improvements. Finally, Thomas J. Damadio admitted helping launder up to $600,000 stolen from Cooper, and evading income taxes.
Sullivan was sentenced to 55 months in federal prison, Lashkevich, 25, Pagan, eight, Weinstein, three years of probation, Damadio, six months of house arrest. Crispo died before serving prison time.
The Internal Report, and the Murder Conviction of One of Its Authors
After these stories became public in 1994, Cooper’s Board of Trustees established a special committee to investigate its financial operations, which included Peter E. Driscoll, Chairman of the Board, Kevin G. Halpern, Chief Executive Officer (CEO), and a local Rabbi, Fred Neulander. The hospital pledged to make its investigation public, but then fought to keep it secret. Its report was finally released in 1998, after a discovery motion in a civil lawsuit. Prior to then, the Philadelphia Inquirer had revealed numerous financial conflicts of interest affecting Board members, including those on the special committee. For example, Cooper paid the law firm of Archer & Greiner, of which Driscoll was a senior partner, $2.1 million over three years from 1993-96.
The report revealed that the conspiracy had bilked the hospital of at least $21.8 million from 1987 to 1994, while “Cooper has been the victim of a massive crime wave.” It stated Sullivan, Lashkevich, and Crispo “had unrestrained and absolute control of virtually all the important financial functions at Cooper and they took full criminal advantage....” It also noted that “employees who became suspicious and questioned the accounting practices or tried to alert management were intimidated, transferred, or dismissed by the high-ranking executives.” Furthermore, it suggested “the ability to bypass or defeat controls grew from an institutional culture that delegated and outsourced too much responsibility, without developing effective controls....” The report also raised questions about how the internal investigation was conducted. It noted that Driscoll and Halpern “often locked horns with [the other] committee members....” Driscoll had objected when other board members called for an independent investigation. Halpern and Driscoll resigned their positions within days of the forced release of the report.
One member of the special committee became particularly notorious. Soon after the internal investigation was set in motion in 1994 Rabbi Neulander’s wife had been murdered. Soon after, Neulander had failed a polygraph test when questioned about it. He then resigned his clerical position after his extramarital affairs with members of his congregation were revealed. In September, 1998, he was charged with hiring the “hit men” who committed the murder. In 2002, he was convicted and sentenced to life in prison.
The Aftermath, Financial Woes and Impact on Patient Care
By 1997, Cooper was in financial trouble, although none of its managers ever admitted a connection to the conspiracy and resulting losses. However, during a related civil lawsuit, Cooper officials alleged “the hospital’s general operating fund was depleted” by the conspiracy. Cooper began merger discussions with several partners, including AHERF, although none were ultimately successful. Physicians started leaving in 1997, when all but one full-time cardiologists announced their resignations. Cooper revealed a $16 million loss for 1998, the largest ever incurred by a New Jersey hospital. Its bonds were down-graded to junk. The hospital then announced that it would stop accepting uninsured patients for elective treatments, departing from its historic mission of charitable care. Losses continued in 1999, again totaling $16 million, leading to additional budget cuts. [CEO Halpern and Chairman of the Board Driscoll resigned within days of each other in 1999, both denying their actions were related to the report.] By 2000, the hospital had cut its work-force to 3100, from 4000 in early 1999. and had closed various clinical sites and units. Only thereafter did Cooper began posting budget surpluses. [By 2002, more physicians quit Cooper en bloc, and the hospital was on its second new CEO since Mr Halpern.]
The Lurid Stories Remain Anechoic
The only published reaction to Cooper’s woes came from the related legal proceedings. The prosecutor in Sullivan’s trial claimed that his thefts were so big that they “threatened the financial stability of the hospital,” and “hurt the image of the city as a whole.” At Pagan’s sentencing hearing, Judge Joseph H. Rodriguez stated “society could not tolerate a system in which hospital executives ‘rake millions off the top’ that were intended for medical care for the poor.”
It does seem likely that Cooper’s scandals had major effects on its patient care and academic missions. Yet, I could find nothing published about such effects. Despite the luridness of this case, I also found no reaction from local or national medical groups, from academic organizations, accrediting groups, or government agencies.
In 2005, I wrote,... The case of Cooper’s corrupt executives can be viewed as the forerunner to the even more massive bankruptcy of AHERF [Allegheny Health Education and Research Foundation, see posts here]. One can only speculate that learning the lessons of the Cooper case could have mitigated the AHERF disaster. However, as noted in my last article, the lessons from AHERF are also not widely known. Yet, as George Santayana wrote, “Those who cannot learn from history are doomed to repeat it.”
As I will address in another post, events at Cooper after 2005 also generated few echoes, up to the latest tragedy. These events did not suggest much had been learned from the events through 2005.
So the unfortunate, and sometimes terrible case of Cooper Health has become one of the longest running examples - starting in 1978 - of the troubles with leadership and governance of large health care organizations, the bad effects of these problems on health care and the values of health care professionals, the lack of public attention to and discussion of these problems and their effects, and the failure of organizations to address on their own their problems with leadership and governance.
True health care reform, as we have said endlessly, requires governance that is accountable, transparent, true to the organization's mission, and honest, ethical, and without conflicts of interest; and leadership that understands health care, upholds its values, is honest, ethical, and without conflicts of interest, is transparent and open, and is willing to be accountable and subject to appropriate incentives.
Lewis L. Former official gets jail term for bilking Cooper: John M. Sullivan was sentenced to 55 months - the scheme netted $4 million. He spent his take lavishly. Philadelphia Inquirer, April 26, 1996.
Graham M. New panel at Cooper plans review: embezzling of $3.8 million by two former top aides and a vendor prompted the study. Philadelphia Inquirer, July 27, 1994.
Lewis L. Ex-hospital executive gets 2 years: he helped steal $4 million from Cooper Hospital - his lawyer said the investigation was going to spread. Philadelphia Inquirer, November 9, 1996.
Graham M, Turcol T. Inquiry widens into finances at Cooper Hospital: a federal grand jury subpoenaed several officials this month - the inquiry was spurred by testimony from two former Cooper executives indicted for fraud. Philadelphia Inquirer, February 27, 1996.
Lewis L. Woman admits role in bilking Cooper Hospital. Philadelphia Inquirer, September 6, 1996.
Lewis L. Ex-hospital executive admits theft: Robert Schmid Jr. pleaded guilty to embezzling about $50,000 from Cooper Hospital. Philadelphia Inquirer, September 24, 1996.
Lewis L. More charged in theft at hospital: six people have now been indicted in the embezzlement at the Camden facility. Philadelphia Inquirer, December 12, 1996.
Lewis L. Ex-wife of jailed Cooper Hospital official sentenced in scam: Elarba Pagan bought $1,500 shoes with medical center money, her business partner said. Philadelphia Inquirer, July 2, 1998. P. B5.
Lewis L. Business owner pleads: Thomas J. Damadio said he helped Cooper Hospital executives launder stolen money. Philadelphia Inquirer, January 18, 1997.
The Internal Report...
Anonymous. Cooper forms committee. PR Newswire, July 26, 1994.
Graham M. FBI is probing Cooper Hospital for violation of securities laws. Philadelphia Inquirer, April 3, 1997. P. A1.
Hollreiser E. Cooper urged to release audit results. Philadelphia Business Journal, May 30, 1997.
Graham M. Hospital gives state its audit: Cooper complied after the state threatened to withhold funding - the report will be kept secret. Philadelphia Inquirer, May 14, 1997, P. B1.
Graham M. N.J. finds nothing amiss at Cooper: the Attorney General’s office reviewed an internal hospital audit - no criminal wrongdoing was uncovered. Philadelphia Inquirer, July 11, 1997. P. A1.
Graham M, Cusick F. Listing Cooper’s board deals: companies associated with the hospital’s trustees have gotten some of its largest contracts. Philadelphia Inquirer, June 15, 1997. P. A1.
Anonymous. Report says Rabbi failed polygraph on wife’s death. The (Bergen County) Record, September 5, 1996.
Burney M. Rabbi charged in wife’s killing. Associated Press State & Local Wire, September 10, 1998.
Mulvihill G. Judge declares mistrial in case of Rabbi charged with arranging wife’s murder. Associated Press State & Local Wire, November 13, 2001.
Bell T. Rabbi found guilty of murder in wife’s 1994 death. Associated Press State & Local Wire, November 20, 2002.
Mulvihill G. Jury spares life of rabbi in wife’s murder; faces life in prison. Associated Press State & Local Wire, November 22, 2002.
Uhlman M. Cooper talks with Allegheny: the Camden hospital wants a partner, and the Pa. chain plans a further push into South Jersey. Philadelphia Inquirer, May 20, 1997. P. C1.
Gerlin A. Philadelphia hospital raids New Jersey system’s cardiology staff. Philadelphia Inquirer, September 27, 1997.
Kastor JA. Governance of Teaching Hospitals: Turmoil at Penn and Hopkins. Baltimore: Johns Hopkins Press, 2004. P. 41.
Goodman H. As Cooper suffers loss, it says care won’t suffer. Philadelphia Inquirer, February 11, 1999.
Rizzo N. Cooper Hospital announces cuts in staff. Associated Press State & Local Wire, March 18, 1999.
Goodman H. Cooper Health system cuts 103 employees: financial problems were cited - about 400 jobs could be lost this year, and uninsured care will be curtailed. Philadelphia Inquirer, March 19, 1999. P. A1.
Anonymous. As losses mount, Cooper Hospital’s debt rating falls. Associated Press State & Local Wire, April 16, 1999.
Goodman H. Cooper’s debt rating tumbles as losses rise: the 1998 figure is twice as bad as estimated - the poor rating means the hospital must pay more to borrow. Philadelphia Inquirer, April 16, 1999. P. B1.
Kent B. In Camden, a hospital finds itself seriously ill: Cooper, the city’s biggest employer, has ‘heavy losses.’ New York Times, May 9, 1999.
Anonymous. Cooper Hospital announces more cuts in staff. Associated Press State & Local Wire, May 20, 1999.
Anonymous. Camden hospital posts $16 million loss: president sees turnaround. Associated Press State & Local Wire, February 23, 2000.
Kiely E. Cooper Hospital to forgo charity-care payments - the state will not reimburse the Camden facility for uninsured patients for four months - the reason: the beleaguered hospital received the money from the state in advance last year. Philadelphia Inquirer, April 11, 2000. P B1.
Anonymous. Cooper Hospital president quitting. Philadelphia Business Journal, January 15, 2002.
Anonymous. Hospital company sues six departing surgeons. Associated Press State & Local Wire, July 4, 2002.