In 2000, with a year remaining in his term, Orlando resigned as mayor to run for president of the autonomous region of Sicily (an election he lost to Salvatore Cuffaro, who was later convicted and jailed for aiding and abetting the Mafia). Most of the commissioners and managers resigned with him. Many of the remaining key personnel were dismissed by the succeeding administration. Although some improvements stuck, many initiatives faltered under the new leadership. Diego Cammarata -- a top aide to former Prime Minister Silvio Berlusconi -- succeeded Orlando as mayor. During Cammarata's tenure from 2001 to 2012, the political culture shifted. Palermo lost its Aa3 rating, and by 2012, city hall was no longer an efficient and accessible institution. Public services declined considerably as garbage piled up on the streets because of striking employees. The garbage and transportation companies were once again in dire financial straits. The Adopt a Monument program lost momentum, and the Café Concerto series ended.
Some blamed Orlando's early departure for the lack of sustainability, while others blamed his administration for not taking more steps to institutionalize the reforms and nurture a next generation of leaders. Franco Nicastro, a journalist and anti-Mafia activist, cited lack of sustainability as a critical problem: "[Orlando] started the new process, but he wasn't able to carry it out to the end... He built a new administration locally. He gave us hope, but then the most difficult part wasn't completed." And although during Orlando's term the Mafia shifted strategy away from high-profile violence, it still continued to operate.
In January 2012, Cammarata resigned as mayor in the midst of several investigations of fraud and abuse of office. Orlando ran again, and in June of 2012, began his fourth term as Palermo's mayor after receiving 72 percent of the votes in a run-off election.