As Jackson Health System grapples with its budget and its relationship with the University of Miami, Jackson’s leaders are making crucial decisions out of public view.

On Friday morning, the Jackson board held a closed-door session to discuss strategic moves to turn around the system that has lost $419 million the past three years.

Jackson executives also have been holding private sessions this month with board members to discuss budget plans for the next fiscal year, which begins Oct. 1. The budget must be approved by the Miami-Dade County Commission next month.

The private meeting comes as Jackson executives seek to finalize a much-debated annual operating agreement with the UM Miller School of Medicine. Jackson Chief Executive Carlos Migoya has promised to present the agreement to a board committee Thursday.

At the board’s last meeting, on July 19, board members expressed deep frustration with the progress of negotiations with UM and voted to start putting $3.6 million a month — about 30 percent of its monthly UM payments — into an escrow account. Migoya tried to soothe the angry board by issuing a statement later saying “incredible progress” had been made in the negotiations in recent weeks.

Florida’s Sunshine law allows public hospitals to have closed door meetings to discuss strategic planning so that competitors don’t learn their plans, Assistant County Attorney Eugene Shy said Friday. Jackson held a similar meeting last November. Shy said he would be in the private session to make certain that other issues — such as the budget and the UM agreement — were not discussed.

Jackson Board Chairman Marcos Lapciuc said he asked for the closed-door meeting to discuss “physician strategy.” About 90 percent of the doctors at Jackson Memorial are UM faculty. For several years, Jackson’s leadership has been talking about bringing more community doctors onto the staff to lessen the dependency on UM.

Martha Baker, president of SEIU Local 1991, representing nurses and other healthcare professionals, was one anxious bystander not at the meeting. “I hope they’re working on the right strategies.”

Migoya said Friday that the new agreement with UM will be a blend of market-based prices for faculty services along with the current system of lump-sum payments. The agreement will serve as a transition as Jackson works to completely redo its relationship with UM.

Under Migoya’s predecessor, Eneida Roldan, public discussion of the budget stretched over several months. So far this year, there has been no public discussion of next year’s budget.

Instead, Migoya and his team have been meeting with board members one at a time to discuss budget plans. Board member Joaquin del Cueto said he had already had one meeting with executives and was going to ask for another to clear up questions.

When Migoya, a former Miami city manager, took over as Jackson CEO last year, he said it was “basic Sunshine 101” to meet individually with board members to talk about issues so that they didn’t need to be aired at public meetings. He said Friday he’s also planning such briefings on the proposed UM agreement.

The Herald made a public records request for the latest budget draft on Wednesday. The request has not yet been fulfilled. Migoya said he was reluctant to release a draft when the numbers kept changing.

In another development, Florida regulators have examined Jackson Memorial’s pediatric heart surgery program and granted a one-year authorization rather than the usual three years.

A July 20 letter from the Department of Health raised four concerns, including the departure of one surgeon that caused the annual number of surgeries to drop near the minium of 150. Regulators generally require a minimum number of surgeries at a facility to meet quality standards. Jackson spokesman Edwin O’Dell said UM and Jackson were working to recruit another surgeon to do children’s heart surgeries.

The DOH letter also expressed concerns about the “highly documented funding and staffing cuts” at Jackson and the University of Miami, which provides the pediatric physicians, and “the loss of the leadership of Dr. Steven Lipshultz, an internationally renowned pediatric cardiologist,” who lost his departmental position in a recent shakeup of UM leaders.

The letter also praised Jackson, particularly Migoya for his “outstanding leadership role.”