Bill would require OK from judge for DNRs

Proposed law comes after scandal involving ex-guardian Fierle

Guardians would be required to get a judge’s approval before signing “do not resuscitate” orders on behalf of incapacitated clients under legislation proposed by two Florida lawmakers.

The companion bills (SB 994/HB 709) filed Tuesday by state Sen. Kathleen Passidomo, RNaples, and Rep. Colleen Burton, R-Lakeland, prohibit the court-appointed decision-makers from signing or consenting to a DNR order for wards without obtaining “specific authority from the court.”

The bills also address several issues highlighted in a series of special reports by the Orlando Sentinel, which revealed potential conflicts of interest on committees that determine whether a person should be placed under guardianship and loopholes that allow guardians to seek their own appointment to specific cases, despite state law generally requiring a rotation system.

The legislation comes amid the statewide scandal sparked by Orlando guardian Rebecca Fierle, who refused to remove a DNR order she filed on 75-year-old Steven Stryker against his wishes and the protests of his daughter, healthcare surrogate and psychiatrist.

“They care very much about their wards. It’s unfortunate we have to actually put it in the law to rein in those who ignore the fact that it’s a conflict of interest or fly in the face of it.” Sen. Kathleen Passidomo, R-Naples

Stryker died at a Tampa hospital while staff were unable to perform life-saving measures.

Stryker’s health-care surrogate, Linda Lanier, in a statement said the proposed bill was “bittersweet.”

“I applaud Representatives Passidomo and Burton in their efforts for very needed change in this broken system,” Lanier said. “I am hopeful that it will literally save the lives of innocent wards in the future. … It was too late for Steve because of Rebecca Fierle. How many others suffered the same fate?”

In Florida, DNR orders, which indicate that doctors should not intervene if a patient’s heart or breathing stops, require signatures from the patient and a physician. But, if the patient is deemed incapable of making that decision, DNRs can be signed by guardians or other legal surrogates.

Fierle, who is currently under criminal investigation, has confirmed she routinely requested that her wards not receive medical treatment if their heart or breathing stopped. The former professional guardian is appealing a judge’s ruling that she abused DNRs, arguing the law doesn’t require her to seek permission from wards’ families or the court.

The legislation comes as state leaders, including Gov. Ron DeSantis, have pledged to fix Florida’s troubled guardianship program. Passidomo said in an interview Wednesday it was “troubling” to learn Fierle routinely filed DNRs for her wards.

“I did not realize that this was going on,” she said.

Passidomo and Burton met with DeSantis, Florida Department of Elder Affairs Secretary Richard Prudom, other legislators and industry leaders in September to discuss DNRs and other concerns with guardianship law.

“We needed to correct them,” she said.

Under the proposed legislation, guardians would also be banned from soliciting or receiving commissions, benefits, bonuses, rebates, kickbacks or split fees in return for getting goods and service on behalf of potential and current incapacitated clients.

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 an audit found Fierle billed hospital company AdventHealth nearly $4 million over a decade for services she provided to hundreds of patients — an arrangement not allowed under Florida law without court approval.

Experts told the Sentinel the financial relationship between AdventHealth and Fierle was virtually unheard of in the industry.

A second investigation from the office of Okaloosa County Clerk of Courts and Comptroller J.D. Peacock II found Fierle improperly billed an Altamonte Springs assisted living facility almost $100,000 to provide services to their vulnerable patients and pocketed refunds the facility issued to her incapacitated clients.

The bills filed by Burton and Passidomo also propose several notable changes to Florida’s guardianship statutes:

■ Before appointing a guardian to a case, judges would have to ask about and consider potential conflicts of interest and disqualifying factors.

■ Though state law already generally bans financial relationships between guardians and other people involved in the process, the bills list specific roles with which business ties would be banned, including people on county examining committees, which help decide the fitness of potential wards. A Sentinel report found those committees are often made up of a small pool of people with existing ties. In Fierle’s case, one of her attorneys was related to a doctor on Orange County’s examining committee, though the attorney and doctor denied any impropriety.

■ Professional guardians won’t be able to petition for their own appointment to a case unless they’re related to the ward, something Fierle and other guardians have routinely done while claiming no ties to the potential client. A Sentinel report found loopholes in Florida’s guardianship laws have led to judges in at least a half-dozen Florida circuits regularly disregarding a requirement that they follow a rotation when appointing guardians.

■ Petitions to place someone in guardianship would be required to include reasons an alternative is insufficient to meet the person’s needs.

■ Initial plans filed by guardians would have to include a list of preexisting DNR orders and advanced directives, as well as whether that order or directive has been suspended.

■ Annual guardianship reports would have to include payments or benefits received by guardians from any source for services rendered to their wards. The Orange County Comptroller’s Office found Fierle billed AdventHealth as much as $130 an hour for her services, despite guardian fees being limited to a maximum of $65 an hour in Orange.

Out of the 682 AdventHealth patients for whom Fierle provided services, only about a third were under guardianship, including Stryker. In some instances, the embattled guardian submitted identical invoices to the hospital and the court to get paid from the ward’s assets — billing twice for the same service and netting three times the court-approved maximum.

Passidomo said she knew of instances in which judges have appointed guardians who are their relatives or close friends without giving a compelling reason as to why the guardian was qualified for a case.

“There has to be some judicial discretion based upon the needs of the ward, but our concern was a judge routinely appointing a family member without a valid justification,” she said.

The bill is meant to curtail guardians who “abuse their powers,” Passidomo said. The senator emphasized the majority of guardians in Florida are good at what they do and follow best practices in line with the restrictions proposed in the legislation.

“They care very much about their wards,” she said. “It’s unfortunate we have to actually put it in the law to rein in those who ignore the fact that it’s a conflict of interest or fly in the face of it.”

Neither bill has been assigned to a committee.

DeSantis included in his budget request this week $6.4 million in new funding for the Office of Public and Professional Guardians, the state’s oversight agency for guardians. Federal lawmakers have also filed bipartisan legislation known as the “Guardianship Accountability Act” that would expand oversight and data collection to “hold guardians accountable.”

Fierle is not currently facing criminal charges.