Shalala said in May she’s done everything she can: “We’re in a brave new world in healthcare, both in terms of how we’re funded and in how fast we have to move.”

In a statement to the Herald on Thursday, the medical school’s dean, Pascal Goldschmidt, said, “Throughout my tenure at the Miller School we have focused on strategic initiatives to deliver the best possible care to our community, open new frontiers for research, and provide state-of-the-art training for our students and residents.

“We make decisions on the best information available and our assessment of where the field is moving. Not every decision is perfect, nor does the world around us function perfectly. ... What is important is that ... these programs are delivering life-changing discoveries, expanding our impact on the community, and building the reputation of UM as a great research institution.”

Early warnings

of trouble . . . and how they were dismissed

Signs of problems with UM’s finances go back to at least June 2011. That’s when the Chronicle for Higher Education ran an article: Fast-Growing Strategy Has Its Costs at U. of Miami. The story noted that the “expansion is looking overambitious to some” and quoted several anonymous faculty members as saying UM “promised too much and is now hustling to cover costs, even if it means taking from the poverty-plagued population that it pledged to serve.”

Shalala decried the article shortly after publication as “a shocking example of irresponsible and lazy reporting.”

Behind the scenes, others were raising alarms. In October, Braman, a longtime UM supporter, wrote a scathing letter to fellow UM trustees: “Poorly conceived decisions by the medical school administration have put the university at significant risk and, at the same time, injured Jackson Memorial Hospital.”

Braman said UM “looks nothing like the strong institution it was five years ago,” and blamed “the poor performance of the medical school, a half-billion dollars of new debt and the depletion of almost all our cash reserves.”

In his letter, Braman was particularly irate about UM’s purchase of Cedars, directly across the street from Jackson Memorial Hospital. UM leaders predicted the hospital would earn almost $90 million in its first six years, but Braman had serious doubts: “We have missed our projections ... by hundreds of millions yet we continue to accept forecasts from the same people as if they are credible.”

In February, Braman resigned from the UM board, fed up with what he viewed as the bungled finances at the medical school.

Twice in the few months after Braman’s letter, two former deans of the medical school met with Stuart Miller, the UM board member whose family donated $100 million to the medical school, to raise the alarm about the negative financial picture, according to UM insiders. Former deans Bernie Fogel and John Clarkson outlined a long list of major problems that needed to be addressed quickly, including the deteriorating relationship with Jackson.

Six months after the letter, UM leaders announced the layoffs, including the removal of several executives.

Shalala told The Herald in May that she reacted with reasonable speed to situations she couldn’t control. “No one wants to lay anyone off. We waited as long as we could possibly wait to make some very tough decisions. In the process, we were doing some very careful planning. There is nothing we’re doing that everybody else in healthcare is not doing.”