Judge revokes ‘do not resuscitate’ orders filed by Orlando guardian accused of acting without permission

By Monivette Cordeiro

A judge has revoked any “do not resuscitate” orders in nearly 100 cases involving an Orlando guardian accused of filing them on the behalf of incapacitated clients without permission.

State investigators have determined at least one person died in a Tampa hospital after staff could not perform life-saving procedures because of a “do not resuscitate” order filed by his guardian, Rebecca Fierle, against his wishes.

Circuit Judge Janet C. Thorpe sought the removal of Fierle from 98 cases after finding that she “abused her powers” by requesting that clients not receive medical treatment if their heart or breathing stopped — without permission from their families or the court. Guardians are court-appointed decision-makers for minors and adults with mental and physical disabilities, known as wards.

At a hearing last Thursday, Fierle resigned from all her cases in Orange and Osceola counties, court records show. Thorpe has since ordered all advanced directives signed by Fierle for her wards, including DNR orders, revoked.

“Any future Do Not Resuscitate Orders or Advance Directives must be approved by the Court,” Thorpe said in her order.

The investigation released by Florida’s Office of Public and Professional Guardians concluded Fierle refused to remove a DNR order she had filed on 75-year-old Steven Stryker of Cocoa, despite Stryker’s desire for life-saving actions and concerns from his daughter, a friend and a psychiatrist.

“The ward had never previously expressed a desire to die, and it seems unlikely that, as soon as he was appointed a guardian, he would suddenly be unwilling to tolerate a condition that he had been dealing with for many years,” Andrew Thurman, an investigator with the Okaloosa County Clerk of Circuit Court and Comptroller, wrote in the report.

Medical records confirmed St. Joseph’s Hospital staff did not perform “life-saving procedures” on Stryker because of his guardian’s order, Thurman said. A spokeswoman for the hospital could not immediately comment on Stryker’s case because of patient privacy concerns.

Thorpe also denied a motion to disqualify herself from the cases. Fierle’s attorneys had requested the judge step aside, claiming the guardian “has a well-founded fear that she will not receive a fair trial or hearing.”

“Fierle has no knowledge or notice of what witnesses or evidence the Court has relied upon to make its findings, or if the evidence relied upon was under oath, or what witnesses and evidence will be brought forward at the hearing,” the motion for Thorpe’s disqualification said.

Neither Fierle nor her attorney have responded to multiple requests for comment.

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Judge revokes ‘do not resuscitate’ orders filed by Orlando guardian accused of acting without permission

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Guardian filed DNR orders without permission, says judge who seeks her removal from nearly 100 cases

Guardian filed DNR orders without permission, says judge who seeks her removal from nearly 100 cases

“I have been working in the elderly and disabled industry in the Central Florida area for over 20 years,” Rebecca Fierle wrote on the website for her practice, which was taken down Thursday. “My experience helps my clients and their families tremendously.”

By Monivette Cordeiro 

A judge is seeking the removal of a guardian from close to 100 cases after finding she “abused her powers” by requesting that incapacitated clients not receive medical treatment if their heart or breathing stopped — without permission from their families. 

In an unusual move, Circuit Judge Janet C. Thorpe filed a “notice for removal” against Rebecca Fierle in 98 cases at once last week, after determining Fierle had filed numerous “do not resuscitate” orders on behalf of her wards without permission from their families or the court, records show.

Florida law allows a guardian to be appointed by a judge for minors and adults with mental or physical disabilities, who are known as wards. The guardian, who is usually a lawyer, makes all the determinations for the ward, including legal, financial, estate, housing and medical decisions.

Thorpe held a hearing on Fierle’s removal Thursday afternoon, attended by attorneys representing many of her wards, but news outlets were not allowed inside and the outcome was not immediately clear.

In early July, a guardianship court monitor was appointed to the case to investigate “abuse neglect, threatened harm and exploitation,” according to court records. The findings of the investigation were not made public Thursday.

Thorpe also wants Fierle removed for allegedly compensating herself as a Medicaid caseworker for her wards, which included receiving payments from hospitals and other facilities without disclosing those payments to the judge, court records said.

Fierle also “failed to disclose related interests and employees” and violated practice standards for professional guardians, including considering the ward’s preferences when making medical treatment and end-of-life decisions, Thorpe said.

“The Court finds that Ms. Fierle has abused her powers, developed conflict of interest with the Ward, and become a disqualified person, thereby establishing grounds for removal as guardian of the person and/or property of the ward,” Thorpe wrote in the removal notice.

Attorneys for Fierle filed a motion Wednesday to disqualify Thorpe from the cases because the guardian “has a well-founded fear that she will not receive a fair trial or hearing.”

“Fierle has no knowledge or notice of what witnesses or evidence the Court has relied upon to make its findings, or if the evidence relied upon was under oath, or what witnesses and evidence will be brought forward at the hearing,” the motion said.

Fierle and her attorney did not immediately respond to a request for comment.

On the website for her practice, Fierle said she was a “professional guardian,” as well as a “certified geriatric care manager for over 10 years.” The site was taken down Thursday.

“I have been working in the elderly and disabled industry in the Central Florida area for over 20 years,” Fierle wrote on the website. “My experience helps my clients and their families tremendously.”

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Guardian filed DNR orders without permission, says judge who seeks her removal from nearly 100 cases

Doctors and Hospitals are Placing Secret DNR Orders in Patient’s Files

At Right to Life of Michigan we’ve been flooded with a rash of calls and requests lately of a most disturbing nature. Patients and their families are finding themselves subject to Kafka-esque actions designed to take aware their autonomy and wishes—with deadly effect.

Jack Lessenberry, Michigan Radio’s senior political analyst, has written an article claiming legislation we’re working on to fix these issues are some sort of fundamentalist religious plot to force patients to stay hooked up to machines forever. He wistfully recalls the days of “Dr. Death,” Jack Kevorkian, killing patients across Michigan.

In his article he quotes an ethicist from GVSU [Grand Valley State University], Dr. Jeffrey Byrnes:

House Bills 5075 and 5076 and SB 597, are being sponsored and pushed by the religious right, primarily Right to Life of Michigan. They are billed as being written to stop abuses, to stop hospitals and doctors from forcing people to die without their consent. But that’s not what’s really happening.

As Dr. Byrnes put it, “Such a bill would allow for a family member – even a family member who had no real concern for their relative’s wishes or well-being – to keep the patient alive for an indefinite period of time.”

What is the real purpose of these bills? They address two distinct problems.

First is the practice of secret do-not-resuscitate orders being placed in patient’s files. Secret DNR orders are just plainly wrong, and it’s wrong for Lessenberry to frame his piece around patient autonomy when he seeks to defend the practice of patients being deceived about the care they expect.

The second problem is equally troubling. We’ve learned that some hospitals are going behind the backs of patients’ families and legal patient advocates to obtain secret court orders to establish guardianship over patients. Family members are showing up at the hospital only to discover hospital staff have taken control over their loved one to end their life.

That is an indefensible abuse of our court system. Secret court proceedings resulting in life or death decisions belong in Soviet Russia, not an America with robust constitutional protections. Patients have a right to have someone defend their life.

The bills would require hospitals to notify family members that they intend to go to court. In addition, the bills would require the doctor or medical facility to prove by clear and convincing evidence that the patient advocate or family is not acting in the best interest of the family before a guardian can be appointed. They also create a standard that assumes it is in the patient’s best interest to be alive, and the hospital has to prove otherwise before taking control of the patient.

There is a creeping assumption in our society that the sick and disabled are better off dead, and some courts are making that the controlling presumption. The default presumption should be that a special case should be required for hospitals to take over a patient’s autonomy to end their life.

There really are situations where a patient’s family is being unreasonable or a patient advocate is violating the patient’s wishes, and hospitals have a duty in those cases to represent the patient’s interest in court. Those situations must be handled in the light of day in a fair court process, however, not railroaded through a star chamber court in the dark.

Dr. Byrnes exposes his real concern, that patients will be in control of their own care, not him:

True, there may be some possibility of abuse today. But he said, “Medical cases in these situations are immensely complicated and can’t be addressed by the simplistic wording” in these bills. He told me [Lessenberry] they would “stop doctors and hospitals and clinical ethicists like myself from being able to stop treatment.”

How could you trivialize abuses like secret court proceedings and secret DNR orders? These are not trivial issues, nor are they complicated. The purpose of a guardianship hearing is to sort out care conflicts, not to rubber-stamp cost-cutting measures that sacrifice patients’ lives.

One of our own staff members directly experienced this, when her conscious father who was asking to be treated discovered the hospital had given up on him and placed a DNR order in his file without his request. What about Bob’s wishes and autonomy? Are death wishes the only ones that count? You can pick whatever treatment you like as long as it’s no treatment at all?

The purpose of these bills is not to let family members keep patients alive indefinitely, as Mr. Lessenberry falsely claims here. Patients do have a right to refuse unwanted medical treatment, and that right should be equally as important as patients who want medical treatment. The purpose of these bills is to prevent hospitals from deception and unjust violations of due process designed to end a patient’s life against their will.

Lessenberry writes, “Many of us want some element of control over our final destiny…”

That’s precisely our point!

As we’ve begun working on these bills and publicizing these cases, we’ve discovered a vast undercurrent. Many believe hospitals will abuse their power to mistreat patients in service of cost cutting concerns. Many of these cases and examples are egregious and have never been publicized. For whatever reason many people don’t believe anyone will speak up for them on this issue, and that there’s nothing they can do about it. That’s about to change.

We’ll see how the broader hospital establishment confronts these proposed change in the law, and if any changes are needed in the legislation as it moves forward, but we ask Mr. Lessenberry and Dr. Byrnes this: are secret DNR orders and secret court orders really the hill you want to die on? What sort of message will that send to an already cynical public?

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Doctors and Hospitals are Placing Secret DNR Orders in Patient’s Files