SEPTEMBER / OCTOBER 2023
36
The Fierle Fallout
In May , 2019 , Rebecca Fierle was the guardian of Navy veteran Steven Stryker . Mr . Stryker died in a Tampa hospital because Ms . Fierle had signed a Do Not Resuscitate medical order against the wishes of Mr . Stryker and his daughter . 1 The medical professionals who examined Mr . Stryker believed he was capable of making end-of-life decisions for himself and told Ms . Fierle that he had a strong desire to live . Despite that , Ms . Fierle ordered the doctors to not perform any lifeprolonging measures because she preferred “ quality of life ” over “ quantity of life .” 2
At that time , Ms . Fierle provided services for 682 patients . She was the guardian of about one-third of them . 3 She also had been paid by facilities for placing her clients in those facilities .
The actions of Ms . Fiele prompted people to take a new look at guardianship abuses .
First , the Fierle / Stryker incident generated a new law in Florida that required guardians to get court approval before signing a Do Not Resuscitate Order for incapacitated clients . 4 The Florida Probate Rules were amended to provide that any Petition for Court Approval for a Guardian to Execute a Do Not Resuscitate Order must include the following information in the Petition :
( a ) Name and location of the ward ; ( b ) Names , relationship to the ward , and addresses , if known , of i . The ward ’ s spouse and children ; ii . The ward ’ s parents ; iii . The ward ’ s next of kin ; iv . Any guardian or court-appointed health care
v . decision maker ; Any person signed by the ward in a living will or other document to exercise the ward ’ s health care decisions ; vi . The administrator of the hospital , nursing home , or other facility where the ward is located ; vii . The ward ’ s principal treating physician and other physicians known to have provided medical opinion or advice about the ward ’ s conditions ; viii . All other persons that the guardian believes may have information concerning the expressed wishes of the ward ;
( c ) Facts sufficient to establish the need for the relief requested . 5
Notice must be given to the ward , next of kin , and those requesting notice . The hearing must be held within 72 hours after the filing of the petition . 6
By William D . Slicker
Local probate judges may require additional information . For example , Pinellas County Judge Pamela A . M . Campbell ’ s Practice Preferences sets forth other information that should be included for the judge ’ s consideration , including , but not limited to :
“ 1 ) Information as to any advanced directives the Ward may have executed in the past ( Living Will , Health Care Surrogate , Organ Donation intent , previous DNR ;
2 ) Medical condition of the Ward , including any physician recommendations ; is Hospice involved ; 3 ) Family or friend input or consents ; 4 ) Any knowledge of the Ward ’ s preferences considering the Ward ’ s values , culture , religious preference and a statement as to how the Guardian has complied with Rule 58M-2.009 ( 10 ): Professional Guardians shall determine the extent to which Wards under guardianship identify with particular ethnic , religious , and cultural values . To determine these values , Professional Guardians shall consider the following :
( a ) The Ward ’ s attitudes regarding illness , pain , and suffering ; ( b ) The Ward ’ s attitudes regarding death and dying ; ( c ) The Ward ’ s views regarding quality of life issues ; ( d ) The Ward ’ s views regarding societal roles and relationships ; and ,
( e ) The Ward ’ s attitudes regarding funeral and burial customs .” 7
In a recent interview , a judge from Orange County opined that the testimony of the doctors as to whether the incapacitated person could recover if resuscitated and what his or her quality of life would be , such as causing them pain or suffering , is crucial input for the court to hear . 8
The Florida legislature recently passed another statute that requires guardians to file any advanced directive of the ward upon discovery of the advanced directive , regardless of when the advanced directive is discovered . The court must then determine whether the health care surrogate named in the advanced directive or the guardian shall have the decision making authority . 9
Second , the number of clients that Ms . Fierle was overseeing was the basis for Florida legislation that requires the clerks of court to establish a statewide database of guardians and guardianship cases so that any judge can