Former state health director Ezike under scrutiny by ethics investigator

The state's former public health director - a well-regarded adviser to Gov. J.B. Pritzker during the COVID-19 crisis - is under investigation by a state ethics agency for taking a CEO job at a medical nonprofit overseen and funded by the state agency she led.

Dr. Ngozi Ezike, a steady, reassuring figure alongside Pritzker during pandemic news conferences, stepped down from her $178,000-per-year state post in March. In April, she accepted an offer to lead Sinai Health System - one of the state's top medical nonprofits.

The Illinois Ethics Act requires department heads like Ezike to wait a year before accepting positions with companies that hold contracts overseen by their departments, or with companies their departments license or regulate. And while in office they cannot engage in job negotiations with companies that lobby their agencies.

The law is designed to prevent the cozy revolving door between state officials and the companies their agencies fund and regulate.

The Illinois Office of the Executive Inspector General opened an ethics investigation of Ezike amid inquiries by the Better Government Association.

Contacted by telephone, Ezike - once a fixture in daily media - declined to be interviewed. Instead she said the BGA would get a call from her attorney. "Let me have your contact information and I can have them reach out to you," Ezike said.

One of her attorneys told the BGA Ezike's new position was not subject to the state's revolving door law because the more than $2 million in grant agreements Ezike signed with Sinai were not "contracts."

"I do not believe Dr. Ezike violated the revolving door," said Heather Wier Vaught. "From a legal perspective, it's not clear cut. That's part of the problem with Illinois' law. The revolving door law is not clear cut. It's very gray."

Vaught until 2018 was counsel for 11 years to former Speaker of the House Michael Madigan, who was a powerful voice in shaping the language of the revolving door law and other state legislation during the past 40 years.

"I understand the legitimacy of the questions. I absolutely believe that someone has to ask them," Vaught told the BGA.

"Dr. Ezike consulted with the appropriate people, and she engaged counsel to provide assistance to her with her transition from the state, and she was advised that it was permissible to accept employment with Sinai," Vaught said.

"She is an incredibly ethical person and had multiple people review this," Vaught said.

The BGA investigation examined government emails and contract documents that raise questions about Ezike's swift move to a company intricately involved with her agency.

Defining 'contract'

From March 16, 2021, until the end of Ezike's tenure as director a year later, the Illinois Department of Public Health awarded five grants to Sinai Health totaling $2,160,803, according to documents provided to the BGA by the state comptroller.

Each of the five grant agreements are labeled "CONTRACT" in bold type on the first page. The word "contract" is on the footer of every page. IDPH's oversight is spelled out. And the grant agreements bear Ezike's signature. The funds were for the Hospital Health Protection Grant Program and the Asthma State Plan, among other programs.

Vaught said these grant agreements do not qualify as contracts under the state's revolving door law.

"I think that's boilerplate language required by the comptroller," Vaught said of the word 'contract' on every page of the documents. "They're statutorily mandated grants, not contracts subject to the revolving door provision in the ethics act."

"I would say it's an interpretation,'' Vaught said. "She wasn't directly involved in awarding the grant."

On April 11 - about a month after she left her state post, and three days before she accepted the Sinai job - Ezike sent an email to the Office of the Executive Inspector General to defend the legality of her rapid transition to the private sector.

"My counsel advised me there were no contracts, regulatory or licensing decisions related to Sinai that would invoke a prohibition," Ezike wrote to OEIG chief Susan Haling.

Ezike informed Haling she had discussed the issue with Gov. Pritzker's ethics officer as well as the ethics officer for her own public health department.

Sinai gets three state licenses

In addition to the contracts prohibition, the revolving door law also places a one-year ban on department heads taking compensation from entities regulated or licensed by the agency they oversaw.

Sinai Health System includes three hospitals licensed by IDPH during the last 12 months of Ezike's state tenure: Mount Sinai Hospital Medical Center, Schwab Rehab Hospital and Holy Cross Hospital.

Illinois hospitals must display their up-to-date state licenses in public places, and under the Illinois Hospital Licensing Act, IDPH reviews Illinois hospitals to ensure they have sufficient capital and medical staff to care for patients.

Vaught disputed the meaning of the phrase "licensing decision" in the revolving door prohibition, saying Ezike and her public health department had no control over whether a hospital could renew its Illinois license.

"I do not believe DPH has any discretion to deny renewal if the hospital files as required by the statute," Vaught said. "It's automatically renewed. ... Licensing is a perfunctory, ministerial act. ... It's not a decision."

In her April 11 email to the inspector general, Ezike said her Department of Public Health ethics officer "confirmed there were no regulatory or licensing decisions made by DPH during the prior year, apart from a perfunctory renewal that every hospital received on December 31, 2021."

Discussing a new job

Sinai's long-standing former CEO Karen Teitelbaum announced her departure from the nonprofit medical system in September 2021, and Ezike was soon a leading candidate to replace her.

Email communications obtained by the BGA through open records laws show Ezike contacted then-IDPH ethics officer Evan McGinley in February - a month before she resigned - to solicit guidance about her upcoming transition to the private sector.

IDPH said it could not provide the BGA any records showing the analysis or advice McGinley provided Ezike - even though he was not her private attorney but a state employee serving a top government leader.

"The Acting Ethics Officer for IDPH at the time had preliminary discussions on the 'Revolving Door' provisions and how they apply to Dr. Ezike," an IDPH spokesman said in an emailed response to BGA questions. "Those discussions were confidential."

McGinley declined comment.

Days after Ezike's February outreach to McGinley, records show, Pritzker's ethics officer Whitney Rosen responded to a separate communication from Ezike.

Emily Bittner, Pritzker's Deputy Chief of Staff for Communications, said Ezike never gave Rosen any information about where Ezike might land, and Rosen neither conducted an analysis for Ezike nor gave her specific advice.

Instead, the BGA found, Rosen sent Ezike a single page summary of the revolving door law, and spelled out the prohibition from negotiating with an entity that lobbied Ezike's agency while Ezike was in office.

Rosen's summary of the law added that Ezike could engage in "informational interviews" that discuss employment and the salary range. Discussions beyond a salary range were prohibited, Rosen wrote.

Government records and news accounts suggest Sinai was already talking with Ezike about the CEO position.

On March 4, while Ezike was still IDPH Director, Crain's Chicago Business reported that Ezike "has been offered a job as the next President and CEO of Sinai. ... Sinai Chicago gave an offer to Ezike for the top role in February, according to a Crain's source. It's unclear if she has accepted the offer."

WBEZ also reported that day that "the Sinai board of directors has been authorized to negotiate an offer with Ezike."

Vaught said Ezike did not improperly negotiate for the Sinai CEO position while she was in state office.

"I can tell you that she did not engage in any negotiations related to employment while she was still at IDPH," Vaught told the BGA.

"Someone having a conversation, someone reaching out to someone and saying, 'We'd like to talk to you about a job,' does not constitute an offer, does not constitute a negotiation," Vaught said. "So having a conversation does not trigger the revolving door."

In her April 11 email to Haling, Ezike said she did not negotiate for her new Sinai position until after she left IDPH.

"After my final day with the State, I began discussions and negotiations with Sinai," Ezike wrote to Haling on April 11. "I intend to sign a contract with Sinai this week and will begin employment in June."

In its most recent public tax filing, Sinai disclosed spending $280,000 annually on lobbying, and separate state records show Sinai retained two firms that lobbied the Illinois public health department.

A Sinai Health spokeswoman told the BGA Sinai welcomed Ezike as its new CEO but would not answer questions about her salary or hiring. Sinai paid its last CEO $1.2 million per year, according to its federal tax filings.

"In consideration of a current review of the process by the Office of the Executive Inspector General, Sinai will not comment further," spokeswoman Olivia Arns said.

Bittner, a spokeswoman for Pritzker, called the questions raised by the BGA "perverse," and noted that Sinai is one of Illinois' most essential medical institutions - a nationally recognized safety net and urban teaching system that treats mostly Black and Latino patients at its two main hospitals.

"Dr. Ezike demonstrated her strong moral compass and commitment to the people of Illinois every day for three years during an awful global pandemic," Bittner said in an emailed statement.

"It is perverse to try to tarnish a strong and respected leader who could go anywhere she wants but chose to again serve the most vulnerable," Bittner said.

A Madigan-sponsored reform

Potential violations of Illinois' revolving door law and its one-year cooling off provision are investigated by the state Office of the Executive Inspector General, which refers alleged violations up to the Illinois Attorney General.

The AG acts essentially as prosecutor in bringing the "founded" cases before Illinois' nine-member Executive Ethics Commission.

A 2009 revision to Illinois' revolving door law drew a sharp line between low-level "C List" state employees and the so-called "H Listers" above them.

The low-level C Listers trigger revolving door cases if they personally and substantially took part in a contract or licensing decision by their agency, then were compensated by the contractor.

Vaught helped write the 2009 legislation, which was sponsored by her boss at the time, then-Speaker Madigan. His revisions expanded the revolving door provisions to encompass "H Listers" - department heads and top officials who might be held responsible regardless of whether they personally or substantially participated in making the regulatory or licensing decisions at issue.

The law was written to create an absolute ban against "H Listers" taking jobs with companies that hold contracts with their agencies, Madigan said on the floor of the General Assembly on May 21, 2009.

"They are absolutely prohibited from accepting employment compensation for one year from an entity if that entity was party to a state contract or state contracts worth $25 thousand or more," Madigan said.

Since then, Illinois has seen only two similar revolving door allegations against department heads.

After yearslong litigation, both former leaders paid a total of $120,000 in fines without admitting wrongdoing.

Former Department of Healthcare and Family Services Director Barry Maram was accused of violating the revolving door provision after he stepped down from state government in 2010 and began working for a law firm that had contracts involving his agency.

Maram - a top health care adviser to then-Gov. Pat Quinn, a Democrat - settled his case by paying $100,000 in 2014, four years after he left his state position.

In a letter to the OEIG, Quinn's office defended Maram, saying he was an ethical person who made a good-faith effort to seek advice and comply with the law, case files show.

Former insurance chief Anne Melissa Dowling, who was appointed by then-Gov. Bruce Rauner, a Republican, paid $20,625 to settle her case in 2019, two years after she left office.

Dowling was accused of violating the provision when she stepped down in 2017 and took a board position with an affiliate of an insurance company regulated by her agency. She argued that her department's regulation of the insurance firm was "perfunctory, non-substantive, and non discretionary," case files show.

Maram and Dowling did not respond to requests for comment.

'A squirrely loophole'

If Ezike is allowed to skirt the revolving door law under these circumstances, then the law itself is essentially worthless, one ethics reform advocate told the BGA.

Alisa Kaplan, executive director of the transparency organization Reform for Illinois, said the revolving door provision should have been triggered if Ezike had conversations with Sinai.

"This 'negotiation' versus 'informational interview' business is the kind of squirrely loophole that makes people distrust government," Kaplan told the BGA.

"Does anyone really believe that a 'discussion' of 'opportunities and salary range' is not an important step towards employment? Of course such a discussion could pose a conflict."

Kent Redfield, professor emeritus of political science at the University of Illinois at Springfield, also reviewed the BGA's reporting and Vaught's responses.

"It seems clear that the prohibition should apply to her taking the job with the hospital," Redfield said. "The rule of law should apply to everyone in an equal manner. Nobody gets a pass, regardless of whether they are a good person or a bad person.

"If Heather's interpretation stands, then the revolving door statute is much less than it seems and probably much less than those who sponsored it claimed at the time," Redfield said.

"This is about one case, but it is also about how Illinois legislatures and governors often produce ethics legislation that turns out to be much less than what meets the eye - way too much 'feel good,' and not enough reform."

• This story was produced by the Better Government Association, a nonprofit news organization based in Chicago.