Cecero is out as chief at JPS in Fort Worth

FORT WORTH -- JPS Chief Executive Officer David Cecero is out after a seven-year tenure that produced multimillion-dollar budget surpluses but also brought escalating tensions with medical staff and increased community concern about patient care.

The JPS Health Network board agreed unanimously Wednesday to a deal that allows Cecero to retire when his contract expires in September. But he will be paid his annual salary of more than $700,000 through July 2009 to continue to act as an adviser.

Board members did not say they were dissatisfied with Cecero's leadership. Rather, Chairman Steve Montgomery said, the action culminated several weeks of discussion with Cecero about his desire to "exit the organization."

In announcing his retirement, Cecero listed accomplishments including expanding facilities and improving financial performance.

Since Cecero was hired in 2001, the network's annual budget surpluses have risen from $25 million to $97 million in 2007. Cecero led the expansion of school-based clinics, community health centers and the addition of an Arlington hospital. A new patient tower -- the capstone of expansion efforts -- is about to open.

But the expansions and JPS' financial success came at a price.

Some doctors and patients said the network was more attuned to dollar signs than vital signs. They complained of squalor in parts of the hospital, intolerable delays and callous treatment of patients, concerns underscored last year in a scathing report by consulting firm hired by JPS.

What doctors say

Dr. Ronald Blanck, former president of the University of North Texas Health Science Center in Fort Worth and now a healthcare consultant in Delaware, said Cecero did much good at JPS that might be overlooked.

"He was an agent for change and expanded outreach," he said. "He did lots of good things in a hospital system that was ripe for change. They were somewhat in the Dark Ages in terms of how hospitals should be run.

"Unfortunately, coupled with that, he alienated lots of physicians in the community and didn't, it seemed to me, reach out as much to the other hospitals in town. So, lots of the good that he did wasn't as effective as it could have been."

Some JPS physicians have told the Star-Telegram that they resented pressure to bring all their private practice patients to John Peter Smith Hospital. They also said the poor were displaced by the commercially insured patients at the hospital.

The president of the Tarrant County Medical Society criticized JPS for shifting resources away from the indigent. JPS' intended mission, Dr. Greg Fuller said, "is to take care of the uninsured and underinsured, in which they are doing a below-average job."

Physicians and community leaders questioned the district's purchase of a $14.7 million Arlington hospital, which was intended to attract patients with private insurance. The patients didn't come, and in part because Arlington has no public transportation, neither did the indigent.

Dr. Chuck Webber, a longtime trauma surgeon at JPS, said Cecero did many good things but went about them the wrong way.

"He alienated practically his entire medical staff, and he alienated himself from the employees because he treated everybody like they were widgets," he said.

"I think it's time for a change," said Webber, who also retired Wednesday. "I think leadership starts at the top."

What Cecero says

In an interview last month, Cecero said that the hospital district has "expanded access, in terms of facilities, technology, locations and personnel." The district has also made strides in emergency medicine, women's services, behavioral medicine, cardiology and cancer treatment, he said.

"What we have accomplished in the last seven, eight, nine years has been, I think, far and wide," Cecero said.

In a statement Wednesday as he announced his departure, Cecero thanked political leaders for support. He also thanked JPS employees, calling JPS' accomplishments a "joint effort."

And he also said he was proud of JPS' stout financial condition, high bond ratings and declining tax rate.

"It sends a message to all of our constituencies that we understand long-range planning," he said. "We understand good fiscal stewardship. By the end of next year, we would have invested $315 million in technologies, facilities and major movable equipment, all state-of-the-art.

"More importantly, we borrowed only $70 million against that number. Our financial status is just a highway we travel to greater access to improve quality."

What is Cecero's pay?

Including performance incentives, Cecero is eligible to earn up to $736,450 this year.

As an adviser to the board beginning Oct. 1 through July 31, 2009, he will be paid $775,268.

If he resigns between Oct. 1 and July 31, 2009, he is entitled to the full amount of the compensation, according to the terms of the contract.

The JPS board wanted Cecero to stay on as an adviser to allow for a smooth transition, Montgomery said.

"We wanted to be very careful and methodical in that transition," Montgomery said.

The board did not name an interim chief upon Cecero's departure.

The Star-Telegram report

The announcement of Cecero's retirement comes during a six-part Star-Telegram report on the state of Tarrant County's taxpayer-financed healthcare system.

During Cecero's tenure, enrollment in its charity-care program, Connection, grew only slightly, according to data JPS provided to the Star-Telegram. Administrators had no easy answers for why the program hasn't grown more as the county population expanded.

Some doctors worried about barriers to treatment, particularly copayments for Connection patients. At times, JPS patients were discouraged from returning for test results because of fees, physicians said. In the worst cases, some skipped surgeries.

Cecero said the health network has reached out to the community, investing millions in opening new locations, adding physicians and buying state-of-the-art technology. JPS also started a new discount program in October.

"We have not done anything that has directly, negatively impacted access to healthcare," Cecero said in an interview in April.

On Wednesday, he criticized the Star-Telegram coverage, saying the "local paper has strung together a list of anecdotes that don't represent an accurate picture."

Near the beginning of the board meeting, Montgomery addressed the newspaper series.

The JPS board and administration took the issues seriously, he said. He would not "counter, argue nor dismiss the information presented," Montgomery said.

He praised the JPS staff, saying, "I have been amazed at the level of professionalism, dedication, and sincere commitment to mission exhibited by the men and women who make possible what this hospital is here to do.

"It is work that makes such an important difference in the lives of so many."