Originally Posted - August 19, 2006

return home

"We've got to corner the market", Mary Labyak, executive director of The Hospice of Florida Suncoast told hospice employees at one of her monthly meetings.

She was talking about the death market.

Christina Brundage, a registered nurse employed by The Hospice of Florida Suncoast from 1995 until 2000, said that comment uttered by Labyak after a federal audit of the Hospice in 1995 was a turning point for her.

"It was like the old hospice was long gone. When I first went there, they were very supportive of the nurses. It was a very good working atmosphere at first and then things began to change. This was a whole new thing. The focus was different after that. I was happy to leave, I took early retirement".

Labyak is the president of the corporation which owns Woodside Hospice where the late Terri Schindler-Schiavo resided for the last five years of her life although hospice eligibility rules require that a patient must be terminal with a life expectancy of six months or less to be admitted.

Terri Schindler-Schiavo was handicapped. She was not terminal.

In 1980, Labyak became program director of Hospice of the Florida Suncoast and has been president and executive director of the corporation since 1983. According to corporate filings with the state, the hospice program employs approximately 1,000 people, has more than 3,000 volunteers and an average daily census of more than 1,800 patients. It touts itself as having become a natural resource center for end-of-life issues.

Labyak has been associated with the Hospice of the Florida Suncoast since 1977 when she began as a volunteer on behalf of dying people, according to financial reports for the hospice filed with the state that show revenues for 2003 of over $81 million with assets of more than $47 million.

The Hospice of Florida Suncoast is the subject of a collection action totaling $14.8 million by the U.S. Department of Health and Human Services as the result of a federal audit in 1995 which determined that the hospice under CEO Labyak had been admitting ineligible people to the hospice and unlawfully billing the federal government for their care under Medicare. The federal government has been trying to recover the Medicare overpayments made to the hospice since May, 1997 at the time when George Felos (right), attorney for Michael Schiavo (left), was chairman of the hospice board.

Michael Bell, hospice spokesman and vice president, was recently quoted as saying the matter had been resolved but the 2004 annual report of HHS, issued Dec. 31, 2004, indicates that the collection action for nearly $15 million against the hospice organization is still active.

"At the time of the HHS audit, the hospice went berserk", Brundage said. "They are so image conscious. All kinds of things were coming down from the main office, from Labyak. There were articles in the newspapers about it. They called us all together and said we were cleared of any wrongdoing and told us to go tell your patients that".

"But we found out later we weren't cleared. That made me mad because I was lying to my patients without knowing, they were using us. After that they became real paranoid about admitting patients improperly".

Not only was Terri Schiavo never properly certified as required by law for entry into the Woodside Hospice where she remained for five years, but a review of the records and circumstances indicates that there may have been many egregious violations of federal Hospice Law as well as state and federal Medicaid and Medicare regulations by Hospice of Florida Suncoast under the leadership of Labyak as CEO and Martha Lenderman, also a former chairperson and current board member. Regulations require that the hospice, and James Avery, would have had to recertify every six months that Terri Schiavo was terminally ill in order to be eligible for Medicare.

Schiavo, the brain damaged woman who died March 31 as the result of starvation and dehydration due the court ordered removal of her feeding tube as petitioned by her estranged husband, Michael Schiavo, had been moved to the hospice in April, 2000, by Schiavo, and his attorney, George Felos.

Felos was a member of the hospice board of directors at the time of the move and a past chairman and associate of Labyak.

Felos failed to disclose his position as chairman of the Hospice board to the opposing party in the guardianship case, the Schindlers, then resigning in 2001 amid public pressure and scrutiny after he and Terri Schiavo's estranged husband had surreptitiously moved Terri to the facility without court authorization in April, 2000, reportedly as a result of arrangements made by Felos. By moving her to a facility where Felos was chairman of the board, all of Terri's caregivers including her doctors and the hospice medical director were presumably under the total control of Felos and his client----but it appears that Felos knew, or should have known, that the proper certification had not been completed and that she was not eligible for hospice care.

It also appears that Labyak and Lenderman should have known of the ineligibility of Terri Schiavo and the improper certification filed as well as the Hospice's new senior medical director at the time, Dr. James Avery.

In fact, according to the hospice law, Terri Schiavo should have been cared for in her home----or that of her parents, Mary and Robert Schindler Sr., who battled for nearly 10 years to take her home.

Brundage was employed by the hospice in the home care program and after learning of the Schiavo case, helped to create the original www.terrisfight.org website and worked tirelessly as a volunteer for the Terri Schindler-Schiavo Foundation to provide news and information concerning the contentious battle to save Terri's life.

She left the hospice in February, 2000, prior to Terri's admission to Woodside and prior to the arrival of Dr. Avery as senior medical director for hospice.

She said that after the HHS investigation, there were different guidelines at the hospice for different diagnoses. Brundage said Hospice didn't want to get patients in there too early.

But they improperly certified that Terri Schiavo was terminal, having less than six months to live, and kept her there for five years.

"Between the Medicare investigation and 2000 when I left, they really got tight about admitting people and that's when Felos was on the board so he had to know that Terri was being admitted illegally", Brundage said. "Dr. Victor Gambone, Terri's doctor at the hospice, had testified that Terri wasn't terminal. The whole thing was like Alice in Wonderland. After I left the hospice, I went through the medical charts for Terri. They were very bizarre. Anything controversial, the hospice jumped in and controlled everything. The whole atmosphere was incredible control.

"It was a very good working atmosphere at first and then it began totally to change. Mary Labyak would have these monthly meetings, we'd all have to go to Largo and listen to her visions for hospice, like a 'don't we all love hospice' meeting, a pep rally. When I heard her say, "we've got to corner the market", that really hit me. It was a turning point---she's one tough woman.

"They were working on all these ways to get more patients in that weren't terminal, they were going to have all these new programs-a palliative care program, a home health program. . When I first started there, everything was patient oriented and I really appreciate that as a nurse---like they were trying to bring in more and more people and fought so hard to keep any competition out. It became money oriented rather than patient oriented".

"We did a lot for people but there was a side the people didn't see, like the donation envelopes. When a patient was near death, we always tried to be there for the family. They told us that after the patient dies, when the family is still there, try to get the family to donate, put a check in these envelopes and I refused.

"A lot of these people gave. I met a woman whose husband was deliberately starved to death at Woodside, just as Terri was, even though his Living Will said he wanted everything done to prolong his life so he could be with his family. I tried to get the family to talk about it but sadly, the children of the widow don't want her to report it or even talk to me about it. The children were terrified that hospice would come after them. Their father was murdered---just like Terri---and they were afraid to speak up.

"I think the public assumes that the hospice had to do what they did" Brundage says in speaking of Terri's case. "They did not have to do this".

"All these nurses, except for two or three went along with everything they were told to do. There was an air of intimidation, of fear. The Terri stuff was in all the papers, there was nothing private in the form of ethics. I would mention to a friend of mine, another nurse, about the case and she would get terribly upset, said they were told they could not talk about it even among themselves, anywhere, anytime. These nurses didn't even work there at Woodside. It was orders from hospice, they said.

"You couldn't think about the moral aspect of this, we weren't violating patient confidentiality, it's in the newspapers. That's something that's out there. Even privately between the two of us, she was afraid of hospice, like Big Brother was watching us and that's the kind of feeling there was there, it was a loyalty thing, keep your mouth shut.

"I had a patient who was dying of melanoma, she wanted to do a website to tell people about it, to warn them of the dangers and I helped her do it. After she died, the family asked me to place a notice on the website to tell her friends of her death. I got called into the office, apparently it had come down from the head office that my name was in the public and who was I to do this without permission. That's how controlling they are. It's a strange atmosphere".

"I worked for The Hospice of Florida Suncoast from 1995 to 2000, leaving just a couple of months before Terri was admitted. I did not work at Woodside, however, but on one of the home teams. I was familiar with Woodside though because I often had patients moved there when they were too sick to stay at home and had no one to care for them.

"When I was there, there was no sign of euthanasia, but I always thought it would come to that eventually because the upper management was all New Age, pro-homosexual, actually promoting it, not just accepting it, and there began to be talk of "keeping open a dialogue" with those who were pro-euthanasia.

"There was an atmosphere in Hospice I had never experienced in other places I had worked-as if it was a cult. No one could speak to the media, even if promoting Hospice, without it being cleared by the main office. The New Age outlook was enforced, it was strongly suggested that we give lots of volunteer time on weekends and evenings after working hours.

"As far as Terri's situation, I only know what any of us in the group working with the Schindler family knew. But I did review the Hospice charts for Pat Anderson when she was the attorney. Pat had mentioned some of the suspicious charting by the staff. Having been a nurse so long, I know what charting using looks like and Terri's wasn't the usual.

PATTERNS IN CHARTING AT HOSPICE, 2000-2002

1. Several months after admission, patient (pt) being cared for by a limited group of staff members unlike the usual variety of staff members which would be expected.

2. Charting, at same time as above, begins to be primarily confined to one of the above staff members, rather than occasional charting by other shifts.

3. Some days no charting at all - oversight? or are those days when selected staff members off?

[Some verification of 2 and 3 could be checked by matching days' charting with med sheets - if pt. is getting pm medication, it should be charted by whatever staff member administers it.]

4. The same 3 statements frequently appear, often together - 1) Family is offered emotional support, refuses, says "everything is just fine". 2) Husband is open to support, grateful to staff. 3) Pt. is in PVS.

5. Elaborate charting of what pt. can't do.

6. Only 1 instance noted of pt. being taken outside of room. (Not all entries read, however.)

7. Exaggerated concern for charting obtaining guardian's permission for everything, even something as automatic as permission to evacuate pt. in case of some type of emergency (presumably, flooding, fire, etc.)

8. Charting pt.'s visiting priest going into the room of another pt., a crying child, to comfort him and being told he was not to do that. If that needed to be charted at all, it should be in the child's chart.

9. Charting is very "scripted."

• Making incorrect determinations of a person's life expectancy, for the purposes of meeting hospice eligibility criteria.



• Engaging in marketing/sales strategies that offer incomplete or inadequate information about Medicare entitlement and restrictions under the hospice program, in order to induce beneficiaries to elect hospice and thereby waive other treatment benefits.



• Encouraging hospice beneficiaries or their representatives to temporarily revoke their election of hospice during a period when costly services covered by the hospice plan of care are needed, so that the hospice may avoid the obligation to pay for these services.

• The hospice benefit is restricted to patients with a diagnosis of terminal illness and prognosis of 6 months or less to live.

• A hospice should not refuse to address health care needs relating to a beneficiary's terminal diagnosis.

• A beneficiary has a right to expect a hospice to provide complete and accurate information about the consequences of hospice election and revocation.

• Hospice recruiters failing to notify prospective patients or their representatives that they will no longer be entitled to Medicare coverage of curative treatment if they elect the hospice benefit.



• Hospice personnel inducing beneficiaries to revoke their hospice election when more costly treatment is needed.



• A hospice refusing or failing to provide or arrange for needed care;



• Nursing home residents being induced to elect hospice but not receiving the additional benefits of hospice care;



• Non-hospice providers charging Medicare for services to hospice patients that hospices can and should provide, such as counseling or medical equipment.

© 2006 North Country Gazette