AdventHealth Orlando seeks dismissal of lawsuit from family of man whose death sparked state’s guardianship scandal

Steven Stryker, seen here during his time working for the Environmental Protection Agency, according to his daughter. Stryker died while under the care of Rebecca Fierle, who according to investigators filed a "do not resuscitate order against Stryker's wishes.(Courtesy of Kim Stryker)

By Monivette Cordeiro

AdventHealth Orlando asked a judge Tuesday to dismiss a negligence lawsuit filed against the hospital company and former guardian Rebecca Fierle by the family of an incapacitated client who died under a “do not resuscitate” order that Fierle signed against his wishes.

The Altamonte Springs-based company said there are “no allegations” that it played a role in Fierle’s decision to authorize a DNR order on 75-year-old Steven Stryker or that it exercised control over his care after he was discharged from the hospital.

Stryker’s death last May at St. Joseph’s Hospital in Tampa sparked a statewide scandal that led to reforms of Florida’s troubled guardianship system and landed Fierle behind bars on charges of aggravated abuse and neglect of an elderly person.

“The complaint contains no ultimate facts establishing AdventHealth’s liability for any of the alleged events after Steven Stryker’s discharge from AdventHealth Orlando,” wrote J. Charles Ingram, the hospital’s attorney, in an April 21 motion.

Stryker was a patient at AdventHealth Orlando in 2018 when the hospital petitioned a judge to declare him incapacitated and appoint Fierle to be his guardian. Although Stryker had made his friend Linda Lanier his health-care surrogate, an attorney for the hospital said he wasn’t capable of choosing his decision-maker.

Lanier has told the Orlando Sentinel that AdventHealth seemed determined to put Stryker into guardianship and get him discharged from the hospital, despite her efforts to find him a new place to live.

Without the required court approval, Fierle billed AdventHealth nearly $4 million over a decade for providing services to Stryker and nearly 700 other vulnerable patients, according to an audit by the office of Orange County Comptroller Phil Diamond.

“Rebecca Fierle’s negligence, neglect, abuse, and exploitation of Steven Stryker caused his death,” said the lawsuit filed by Kimberly Stryker, the man’s daughter who is in charge of his estate. “AdventHealth created, facilitated, and funded the guardianship relationship between Rebecca Fierle and Steven Stryker and is therefore responsible for the actions that led to Mr. Stryker’s death.”

After Stryker became her ward, Fierle disregarded the opinions of his daughter, health care surrogate and a St. Joseph’s psychiatrist in signing the DNR, according to an investigation by the Okaloosa County Clerk of Circuit Court and Comptroller.

Fierle opted to cap Stryker’s feeding tube on May 9, despite him stating “several times that he wanted to live,” the Florida Department of Law Enforcement said. Stryker, who was using a feeding tube because he had difficulty swallowing, aspirated and went into cardiac arrest.

He died May 13.

Ingram said AdventHealth could not predict Fierle would enter a DNR against Stryker’s wishes or that his daughter and St. Joseph’s would not intervene to overturn her decision.

“The events at St. Joseph’s Hospital completely fail to allege anything creating liability on the part of AdventHealth in terms of duty, breach, causation or vicarious liability,” Ingram said. “Instead, these allegations suggest that St. Joseph’s Hospital owed a duty to Mr. Stryker as its patient, that there was a failure to protect Mr. Stryker from his court-appointed guardian, and that St. Joseph’s Hospital felt obligated to follow the instructions of the court-appointed guardian.”

After Stryker’s death, the hospital company announced it would no longer pay private guardians to take on patients and would form a review panel to ensure at least two doctors determine whether patients can no longer make their own decisions before asking a judge to appoint a guardian.

In addition to misusing DNRs and ignoring her wards’ wishes, Fierle, who is still under investigation by multiple agencies, has also been accused of double-billing and conflicts of interest.

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AdventHealth Orlando seeks dismissal of lawsuit from family of man whose death sparked state’s guardianship scandal 

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AdventHealth outlines guardianship changes after paying disgraced guardian nearly $4 million | Exclusive

AdventHealth Orlando CEO Daryl Tol in his office. Thursday, Nov. 21, 2019. Tol revealed changes the hospital is making to its guardianship practices in the wake of the Rebecca Fierle scandal. (Sarah Espedido / Orlando Sentinel)

AdventHealth Orlando will make sweeping changes to how it handles court-appointed guardianships for vulnerable patients after a probe found the hospital paid disgraced guardian Rebecca Fierle nearly $4 million to care for hundreds of its incapacitated patients.

The hospital will no longer pay private guardians to take on cases, will form a review panel to ensure at least two doctors determine whether patients can no longer make their own decisions before asking a judge to appoint a guardian, and will provide more training to care managers, said Daryl Tol, president and CEO for AdventHealth’s Central Florida Division, in an exclusive interview with the Orlando Sentinel.

The changes come after the hospital hired an outside law firm to conduct an audit of its campuses in Orange, Seminole and Osceola counties. Tol said the hospital will also put its political heft behind statewide reforms for the troubled guardianship program, advocating for lawmakers to increase funding, add more oversight for guardians and clarify the legal definition of incapacity.

“We have put too much trust in a flawed system,” Tol said. “And that is not something we want to continue doing or want to do again.”

Tol, who did not provide the Sentinel with a copy of the audit during an interview Thursday, said no wrongdoing was found on the part of hospital staff. He said the Sentinel’s reporting about flaws in the guardianship system served as a “positive catalyst” for some of the changes.

Fierle first came under scrutiny when one of her incapacitated clients, 75-year-old Steven Stryker, died at a Tampa hospital in May after staff were unable to perform life-saving measures because of a “do not resuscitate” order Fierle filed against his wishes and refused to remove, according to state reports. Less than a year before his death, AdventHealth Orlando had petitioned a judge to appoint Fierle as Stryker’s guardian when he was a patient there, despite him having a health-care surrogate.

The embattled guardian later admitted to routinely filing DNRs on her wards.

An audit by the office of Orange County Comptroller Phil Diamond later found Fierle improperly billed AdventHealth close to $3.96 million over a decade for services she provided to 682 of its patients, either as a court-appointed guardian, durable power of attorney, heath care surrogate or proxy. The hospital system paid at least $3.7 million, according to Diamond’s office.

Tol said the hospital spends about $30 million a year on care management for patients, which until now has included payments to guardians along with other costs, such as helping patients transition to group homes or other facilities.

As an example of the how challenging it can be to find long-term care for patients, he said employees once made more than 1,000 phone calls to find a group home for a man who was able to make his own decisions, but couldn’t live alone and didn’t have any money or family. AdventHealth Orlando is now paying for the man to live in a group home in California, he said.

About 70 patients a year are admitted to one of the hospital’s Orlando campuses who end up needing a court-appointed guardian because they can no longer make decisions and do not have family or friends who can do so for them, he said.

“If you call a smaller hospital, it could literally be years in between these situations because of the volume,” Tol said. “Because of the 140,000 admissions a year, it just so happens that a rare thing happens more frequently here.”

Typically, private and public guardians are paid through the ward’s assets or by the state to make all legal, financial and medical decisions for incapacitated people. But the multimillion-dollar arrangement, which is not allowed under Florida law without a judge’s approval, has been described by experts as virtually unheard of in the industry. It is problematic, they say, because the hospital’s wishes could conflict with the best interests of the ward.

“I would say, with regret, that it was a misunderstanding and the payments were made in good faith for the services as deemed appropriate by our care management team,” Tol said.

At times, Fierle submitted identical invoices to the hospital and the court to get paid twice for the same service and net three times the court-approved maximum fee, according to the comptroller’s probe. The probe only reviewed AdventHealth hospitals in Orange, Seminole and Osceola counties but did not look at the company’s other entities, which likely also paid Fierle.

“We were unaware that there was double billing happening, and we were an unwitting victim of that,” Tol said.

Tol said AdventHealth’s relationship with Fierle developed over 20 years. The hospital company used other guardians but primarily relied on Fierle because she was “responsive” and would take cases quickly.

“She would take on cases very easily, was easy to work with from the perspective of the team’s ability to get in touch with her,” he said. “And yet, of course, the team didn’t realize the things that have been brought to light. … Sometimes there are bad actors in the middle of a lot of good people trying to do good work.”

AdventHealth spokesman Bryan Malenius previously told the Sentinel the hospital petitions a judge to appoint a guardian as a “last resort” because it can’t discharge patients unless they have a safe place to go. AdventHealth asks the Florida Department of Children and Families to step in when those situations arise, but the state agency regularly declines, Tol said.

“We have faced over the years a very challenging dynamic in which DCF will reject the responsibility for the situation, and frankly, just leave it in our hands,” he said. “That leaves our team of advocates dealing directly with the courts and with guardians.”

DCF spokeswoman Kristi Gray has previously said guardianship is “not a DCF process.”

“When the agency identifies a need for guardianship on an open case, our attorneys navigate that judicial process,” Gray said in a statement in October.

Tol said AdventHealth has petitioned the courts for professional guardians in order to expedite safe discharges to a “better and healthier location” because the wait for a public guardian to be appointed can be lengthy.

“The hospital is not intended to be a long-term safe residential facility,” Tol said. “If the public guardian is not readily available, it is not in the interest of the individual when they’re not in an acute health care episode to remain in the hospital setting surrounded by other very sick people. They are much better off in the appropriate care setting.”

The hospital CEO and president said AdventHealth believes Florida should clarify and strengthen the responsibility of DCF to care for incapacitated people.

“We think there needs to be an intensive review of cases where DCF has refused to assist patients so that at least it’s understood why that was the case,” Tol said. “... We’re not looking to point fingers or identify bad guys, other than perhaps the guardian in question, but aside from that, we just think it’s got to be a better team effort.”

The AdventHealth Orlando CEO said the hospital is cooperating with law enforcement in criminal investigations into Fierle but the company is not pursuing independent legal action against the former guardian.

“We want to be a partner with all those trying to get to the bottom of it in this specific case,” Tol said.

Fierle, who has resigned as a guardian, is not currently facing any charges.

Full Article & Source:
AdventHealth outlines guardianship changes after paying disgraced guardian nearly $4 million | Exclusive

See Also:
Attorney General Ashley Moody fires back at embattled former Florida guardian

Ex-guardian Rebecca Fierle charged Altamonte Springs facility $100K, illegally pocketed refunds, investigation finds

Florida Elder Affairs chief announces ‘immediate’ changes as embattled Orlando guardian Rebecca Fierle resigns from all cases

Florida professional guardian Rebecca Fierle: Devoted or dangerous? | Exclusive

Cremated remains of 9 people found at Orlando office of disgraced former guardian Rebecca Fierle

Expert’s complaint against Florida guardian Rebecca Fierle was ignored for years before scandal erupted | Exclusive

Orlando guardian accused of filing unauthorized ‘do not resuscitate’ orders resigns from Seminole cases

Watchdog: In Short Hearing, Fierle Given Guardianship Over Patient

Judge releases confidential information to authorities investigating former Orlando guardian Rebecca Fierle

Florida’s guardianship system for elders needs guarding of its own | Editorial

The latest revelations about Rebecca Fierle — the woman at the center of the guardianship scandal — are shocking.

The Orange County comptroller’s office this week produced a report that shows Fierle was representing the interests of hundreds of elders without the oversight of a judge.

She was double-billing for her services, according to the report, presenting AdventHealth with bills totaling nearly $4 million over the past decade. Again, some of that was on behalf of vulnerable adults a judge may never have authorized her to represent.

The comptroller’s findings — the number of elderly people involved, and the amount of money improperly billed and paid — are breathtaking.

Let’s not forget, Fierle is the guardian who is accused of signing a “do not resuscitate” order against the will of one of her wards, 75-year-old Steven Stryker of Tampa. Stryker subsequently died, and doctors weren’t authorized to help him.

We don’t know if Fierle, who has not been charged with a crime, was a single rogue guardian among the many who help elderly people with personal affairs they can no longer handle on their own.

We do know that it’s essential that Gov. Ron DeSantis leads the charge in getting to the bottom of that essential question: Is this a case of one bad apple, or is this a symptom of a broken system that allows the type of elder and financial abuses outlined in recent Sentinel reports and in this week’s report by Orange County Comptroller Phil Diamond?

DeSantis’ staff is meeting Monday in Tallahassee with representatives from the courts and clerks office, Department of Elder Affairs, state attorney’s office, guardianship associations and lawmakers who have advocated elder law reform.

They need to act with urgency in finding and patching cracks in the guardian system. A state with so many elderly people can’t afford to have a faulty system that gives so much power — even that of life and death — over the wards in their care.

Yes, the state took steps in 2015 to improve the system for assigning guardians to someone.

One law was intended to stop the practice of “trolling,” where professional guardians descended on nursing homes to sway elderly patients into signing away their rights.

But as the Sentinel’s reporting has demonstrated, the system remains vulnerable to abuse.

For starters — and maybe foremost — how did Fierle manage to get paid for services on behalf of people she may not have been authorized to represent?

And how could an organization as large and sophisticated as AdventHealth pay bills submitted by Fierle without knowing whether she was authorized to submit those bills on behalf of a ward? And at an hourly rate double what’s allowed by law?

It’s possible AdventHealth is a victim here, too, by paying bills it shouldn’t have. For its part, AdventHealth said in a statement it was “surprised and dismayed” by the comptroller’s findings.

Another problem: It’s far too easy for guardians to authorize DNR orders.

These forms offer individuals the dignity to die on their own terms, but in Florida this only requires signatures from the doctor and patient or legal guardian on an official document.

Signing someone’s rent check because you manage their financial affairs is one thing. But signing what could amount to a person’s death order should require judicial oversight.

We also need more public guardians to take on the cases for those who can’t afford to hire a guardian in the open market. That’s going to require more money. Public guardians got a recent pay increase in the last session — $3,000 a year per client. It’s still not enough. Increase their pay, again.

Finally, our state needs to have a centralized database to track guardians and their wards.

Many professional guardians, like Fierle, represent clients from all across the state. Keeping track by going through each circuit court makes no sense.

Palm Beach County has already done the heavy lifting of creating a database. Make it mandatory that professional guardians use this system for their audits so judicial oversight can cut across county lines.

There’s likely a lot more that needs to be done. So do it.

Do what it takes to protect our must vulnerable neighbors from the bad apples.

Full Article & Source:
Florida’s guardianship system for elders needs guarding of its own | Editorial