Carlos Migoya was running late.
The then-fairly new president and CEO of a financially hemorrhaging Jackson Health System was on a campaign around Miami-Dade County to raise community support for a proposed hospital revitalization project that relied on $830 million in taxpayer support.
On that Saturday morning in 2013, Migoya was scheduled to meet with UP-PAC, or the Unrepresented People’s Positive Action Council, a Miami Gardens community organization known for asking tough questions of community and business leaders, and then with the public service Delta Sigma Theta sorority.
Quite uncharacteristically for Migoya, who made his name as a steadfastly professional businessman, he had missed his second appointment during a critically important time for Jackson. When he took over in 2011, taxpayer-owned Jackson had lost $419 million over three years and local officials were suggesting selling it or trimming down the operation. The passage of the project would cement Jackson’s place in the future.
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“Carlos is known to be on time. And an hour had passed. Carlos is not there yet,” recalled County Commissioner Audrey Edmonson, who campaigned for the project with Migoya. “He is not answering his phone.”
Then, when it seemed he wouldn’t make it after all, Migoya comes running down the hall.
“He’s speeding this way, and he says ‘That is some meeting. Those are some mad people.’ They were grilled something awful, and he was still sweating and nervous from that meeting,” Edmonson said, laughing as she remembered the flustered Migoya. “[The Delta sorority] all laughed because they all knew what he had gone up against with UP-PAC.”
The way he explained to the voters how important our hospital was, he stood there, stood his ground, he answered tough and difficult questions. He was able to to convince the public of his commitment.
Miami-Dade County Commissioner Audrey Edmonson
Edmonson says Migoya’s perseverance — through challenges as large as rescuing Jackson from financial disaster or small as facing questions from UP-PAC — has been a driving force behind Migoya’s local accomplishments. (Voters approved the $830 million debt bond project in November of that year).
His commitment to Jackson earned him this year’s Greater Miami Chamber of Commerce’s Sand in My Shoes award, given to community leaders who make significant contributions to the South Florida region. The award, considered the chamber’s highest honor, will be presented Wednesday at a sold-out dinner.
“The way he explained to the voters how important our hospital was, he stood there, stood his ground, he answered tough and difficult questions,” Edmonson said. “He was able to convince the public of his commitment.”
Migoya’s commitment was evident from the moment he took the job. Little more than a year after becoming CEO, Migoya had replaced the hospital’s management team, instituted best practices, proposed furloughs and cuts in pay and benefits, slashed its annual agreement with 65-year partner the University of Miami by more than $50 million, and cut nearly 1,200 jobs.
Jackson started to transform. The quality of care increased while injuries and infections plummeted. Now, the hospital system is on its fourth straight year of a surplus — $62 million in 2015, according to the most recent report from an outside auditor.
Joe Arriola, chairman of the Public Health Trust, Jackson’s governing board, said he advocated for Migoya to get the top job, even though he was a healthcare outsider. Migoya had previously served as City Manager in Miami and had nearly 40 years experience in the banking industry, most recently as regional president of Wachovia in North Carolina and the CEO for the Atlantic region.
“People wanted to hire a former county manager. They brought some doctors from New York,” Arriola said. “I think it was an absolute no brainier to hire him and why was because we needed a businessman with very strong financial knowledge. It was not about medicine.
“I got a lot of criticism for pushing him but it was the best decision we ever made.”
It was an absolute no brainier to hire him ...I got a lot of criticism for pushing him but it was the best decision we ever made.
Joe Arriola, chairman of the Public Health Trust
Migoya’s leadership changed public perception of the hospital, Arriola said. Renovations and improvements in patient care have elevated the hospital’s status.
“When this whole thing started, people always said, ‘If you’re dying, go to Jackson where you will have great doctors, [but] if you need anything else, go someplace else.’ ” Arriola said. “We can see it now that Jackson is a hospital of choice.”
“He has been better than anyone I ever worked with,” said Donna Shalala, UM’s former president and a former Sand in My Shoes honoree. “It’s just because he starts with optimism, a let’s-get-it- done kind of attitude. Those elements are shared by the university. We never had harsh words for each other — we always try to work out.”
For his part, 66-year-old Migoya said repairing Jackson has been a way to give back to the community that took him in as a Cuban migrant in 1961 and to the hospital that was vital in key moments in his life. His son, Jose Migoya, was born prematurely at Jackson in 1978, “and only survived because of a great partnership between UM and Jackson neonatal,” Migoya said. His mom donated a kidney to his aunt at Jackson in 1982. And Jackson Memorial’s Ryder Trauma Center patched up his right hand after a cycling accident.
“I understood the value Jackson had,” Migoya said. “We had to make sure we have this jewel out there in the community.”
He has been better than anyone I ever worked with. It’s just because he starts with optimism, a let’s get it done kind of attitude.
Donna Shalala, UM’s former president and a former Sand in My Shoes honoree
And to be sure, the job has paid. Migoya made more than $1 million in 2015, making him the best-paid county employee as of the most recent compensation survey.
But the job is becoming more challenging. The Low Income Pool, a federal program that pays hospitals like Jackson that care for the uninsured, has been cut drastically in recent years and is expected to end altogether this summer. The Affordable Care Act, which insures an estimated 600,000 people in South Florida, could be eliminated under the new federal administration. And Gov. Rick Scott said last month he wants to reduce barriers for new healthcare facilities and repeal the statewide cap on the number of trauma centers (of which Jackson has two), which could create more competition for Jackson.
Arriola said he hopes Migoya, who has previously said he doesn’t expect to stay with the hospital for many more years, will stick around a bit longer.
Migoya has committed to stay at Jackson through completion of an outpatient campus in Doral and a rehabilitation hospital in downtown Miami; both are expected to be completed in 2019.
As of yet, he hasn’t had much time to reflect on his work, he said.
“I haven’t done a good job of stopping to smell the roses,” Migoya said. “The one thing I have done from time to time is I have seen a lot of the people that I have worked with, helped develop and mentor, and see them grow and continue to grow. That’s the part to me is most important to my accomplishment.”
Miami Herald writer Daniel Chang contributed to this report.