Florida Legislature ends the tenure of state Surgeon General Armstrong

The 2016 Legislative ended on Friday – and so did the tenure of Florida Surgeon General Dr. John Armstrong.

Dr. John Armstrong is no longer Florida Surgeon General.

The Florida Senate declined to bring his confirmation vote to the floor and Gov. Rick Scott quickly appointed Dr. Celeste Philip, the department secretary for the Department of Health, as Acting Surgeon General.

Scott first appointed Armstrong in 2012 and reappointed him this year, but the Senate refused to confirm over questions about cuts to staff at the Department of Health, implementation of medical marijuana and his response to the growing HIV rate in South Florida.

There was also concern over children being dropped from the state’s Medicaid rolls and the disbanding of cardiac panel of renowned physicians that reviewed pediatric heart programs of hospitals. The move came after the panel reviewed the pediatric cardiac program at St. Mary’s Medical Center in West Palm Beach – a program that has since been shut down.

Scott lauded Armstrong in announcing Philip’s appointment, saying he made Florida a leading destination for cancer research and treatment and responded to epidemics like Zika.

“Even while battling cancer in recent months, Dr. Armstrong displayed unwavering determination to protect Florida families, and I truly appreciate his hard work,” the governor said in a statement..

Gov. Scott signs guardianship reform law to protect seniors

More than four years ago, concerned families went to lawmakers for the first time with their stories of how professional guardians were ransacking the estates of the elderly.

Groups such as South Florida-based Americans Against Abusive Probate Guardianship talked about how unethical guardians appointed by judges were isolating seniors from their families, over-medicating them and then taking their money through frivolous fees.

On Thursday, Florida Gov. Rick Scott signed a bill giving the state its first regulatory authority over professional guardians who are appointed by courts to take over the lives of incapacitated senior citizens. The bill was one of 25 Scott signed into law.

The new law creates an Office of Public and Professional Guardians and requires the office standardize practices and create rules for professional guardians. It also gives the office enforcement power, including the ability to revoke a guardian’s registration.

It follows in the wake of a guardianship reform bill signed last year by Scott that imposed criminal penalties for exploitation or abuse of a senior in guardianship among other changes.

Sheila Jaffe (left) and Natalie Andre (right), President of FACTS (Families Against Court Travesties), protest last month with a group of people about the state of guardianship outside the South County Courthouse in Delray Beach. (Lannis Waters / The Palm Beach Post)

Guardianship reforms are not just happening in Tallahassee.

Following The Palm Beach Post’s series Guardianships: A Broken Trust in January on how judges are complicit in allowing the savings of seniors to be soaked by guardians and their attorneys, the chief judge acted.

James Vassallo with his father, Albert. Vassallo claims professional guardian Elizabeth Savitt – wife of Judge Martin Colin – took money without court approval and failed to account for all of his father’s assets.

Palm Beach County Chief Circuit Judge Jeffrey Colbath transferred Circuit Judge Martin Colin out of the Probate & Guardianship Division.

Colin’s wife, Elizabeth “Betsy” Savitt, works as a professional guardian, compiling complaints from families for taking tens of thousands of dollars in fees without court approval. The chief judge required the south county judges to recuse themselves from her cases and instituted other reforms, as well.


James Vassallo’s father was in a Savitt guardianship. He said the new law signed by Scott could be the right remedy.

“Nobody was looking at the professional guardians watching what they were doing,” he said. “They are abusing their guardianship privileges.”

Dr. Sam Sugar, co-founder AAAPG, said the passage of this law is clear progress.

“We look forward to being intimately involved – as promised in the legislation – in the development of rules and regulations of this new department as advocates for victims of abusive guardianships,” he said.



Indicted Delray Beach doctor is focus of $4.8M whistleblower lawsuit

A newly unsealed whistleblower lawsuit alleges insurance giant Humana knew that a Delray Beach doctor for seven years bilked the government through fraudulent Medicare billing for $4.8 million, according to a report this week by the Center for Public Integrity that was published by NPR.

A billing practice called a “risk score” is what a Delray Beach doctor used to perpetrate fraud, according to a whistleblower lawsuit.

The lawsuit claims that Humana  – which operates some of the nation’s largest private Medicare health plans –  did little to curb the practice even though it could harm patients.

The Center for Public Integrity is a nonpartisan, nonprofit investigative news organization.

The whistleblower suit was filed by South Florida physician Mario M. Baez and accuses Humana and his former business partner, Dr. Isaac K. Thompson, of Delray Beach, in engaging in a lucrative billing fraud scheme that lasted for years.

In Thompson’s case, Humana paid 80 percent of the money it received to the doctor and retained the rest. Prosecutors charged that fraudulent diagnoses submitted by Thompson between January 2006 and June 2013 generated overpayments of $4.8 million.

Thompson was indicted early last year on health care fraud charges and has indicated he would plead guilty.

The whistleblower suit was filed in October 2012 but remained under a federal court seal until Feb. 26.

Humana, which had no comment, is based out of  Louisville and covers more than 3 million elderly patients in its Medicare Advantage plans nationwide. At question in the whistleblower suit is a billing formula called a risk score that pays higher rates for sicker patients.

To read the whole story by the Center for Public Integrity click here.

FAU study first to look at lack of paid sick leave, medical care delays

A new study by Florida Atlantic University is the first to look at the relationship between paid sick leave benefits and delays in medical care in the United States that makes our health care more expensive and less efficient.

The results again puts the U.S. behind other highly ranked countries.

The study,  published in the March issue of Health Affairs, found lack of medical care for both working adults and their family members. The study, done in conjunction with Cleveland State University, found that workers without paid sick leave were three times more likely to delay medical care than were workers with paid sick leave.


Sick at work in America? Good luck. In the U.S., there are 49 million employees without sick leave. (Photo: Creative Commons)

They were also three times more likely to forgo needed medical care altogether. The lowest-income group of workers were at highest risk of delaying medical care.

“Paid sick leave is an important employer-provided benefit that helps workers and their dependents receive prompt preventive or acute medical care, recuperate from illness faster, and avert more serious illness,” said LeaAnne DeRigne, lead author of the study and associate professor in the School of Social Work at FAU.

FAU researcher LeaAnne DeRigne says the lack of mandated paid sick leave leads to more complicated and expensive health outcomes down the line.

She said the results from the study contradict public health goals to reduce the spread of illness.

“Policymakers should consider the potential public health implications of their decisions when contemplating guaranteed sick leave benefits,” she said.

The U.S.  lags behind 22 other highly ranked countries in terms of economic and human development when it comes to mandating employers to provide paid sick leave. Only Connecticut, California, Massachusetts and Oregon – along with a few dozen municipalities mandate paid sick leave as an employee benefit.

That leaves 49 million U.S. workers without paid sick leave, which in the long run contributes to higher health costs for all when conditions and illness go untreated.

“The personal health care consequences of delaying or forgoing needed medical care can lead to more complicated and expensive health conditions,” DeRigne said.

FAU’s main campus is located in Boca Raton.


Marriage annulment upheld in controversial guardianship case

In a decision underscoring the great power of the courts over seniors in guardianships, an appellate court in West Palm Beach upheld the annulment of a couple’s marriage in a controversial case that has already set legal precedent.

Glenda Martinez Smith smiles as her husband Alan Smith opens his eyes while waiting for a doctor’s appointment last year. (Richard Graulich / The Palm Beach Post)

A panel of judges on the 4th District Court of Appeal ruled 2-1 to uphold the annulment of the marriage of Glenda Martinez and J. Alan Smith.

The Palm Beach Post wrote about the case last April after Martinez won the right to care for Smith as he had specified in his pre-need directives before falling ill. The case showed how incapacitated seniors’ legal rights were taken away in guardianships.

Even though Martinez succeeded in ousting the guardian last year, she was not able to convince the 4th DCA to undo Palm Beach County Circuit Judge David French’s ruling to annul the couple’s marriage.

Judge David French listens to arguments at the South County Courthouse Thursday, May 21, 2015, during a hearing surrounding the guardianship of James Vassallo's father. (Damon Higgins/The Palm Beach Post)
Judge David French listens to arguments in a case at the South County Courthouse. (Damon Higgins/The Palm Beach Post)

The majority of the 4th DCA appellate panel – Judges Dorian Damoorgian and Melanie May – said the couple married without the approval of French as stipulated by the guardianship of Smith.

Martinez’s attorney Jennifer Carroll argued that the requirement flew in the face of state statute, but Damoorgian said in the written ruling that a court could indeed make such a requirement.

Judge Martha Warner, however, in a 8-1/2 page dissenting opinion, said the right to marry is a fundamental right guaranteed by the U.S. Constitution. The dissent possibly sets up the case for the Florida Supreme Court to look at the issue.

Warner noted evidence of how Martinez and Smith fell in love, vacationed together and how he named her his health care surrogate before a 2010 car accident sent his health on the decline. Warner said the only restriction put on Smith by the guardianship was the right to enter into contracts regarding finances.

Warner also noted how Martinez opposed court-appointed guardian John Cramer’s decision to put Smith in a nursing home, where Martinez felt Smith received sub-par care and how a court-appointed attorney to represent Smith failed him.

The 4th DCA eventually ruled that Martinez – not Cramer – was Smith’s designated health surrogate. She brought him home last year and takes care of him to this day

“I do not believe due process of the ward was sufficiently protected,” Warner wrote, adding that the Legislature’s intent in guardianship is to protect the rights of the ward, not infringe upon them.

“This has not happened in this case,” the judge went on. “Instead, this frail gentlemen has been deprived of his fundamental right to marry, in proceedings which violated his fundamental rights to due process and without a consideration of his best interest.”

In January, The Post published its investigative series into guardianship of seniors and the role of judges. One judge in particular, Martin Colin, is married to guardian and his friend, French, heard the majority of her cases. As a result, Chief Judge Jeffrey Colbath transferred Colin and instituted a plan to train court personnel on probate matters, among other reforms.

Senate holds fate of Florida Surgeon General

It’s been a tough year for Florida Surgeon General Dr. John Armstrong.

Gov. Rick Scott’s head of the Department of Health is having trouble getting reconfirmed.

Florida Surgeon General Dr. John Armstrong

A Senate’s Ethics & Elections Committee is scheduled Tuesday to consider again the confirmation after a previous hearing was postponed partly out of fear Armstrong didn’t have enough votes.

It looks a bit better for him today as in the last week some medical groups have offered a show of support. Of particular concern among  AIDS groups  was Armstrong’s response to a spike in HIV cases in the Sunshine State. Armstrong has made HIV prevention a priority issue in the last few months.

He has also received questions about a drop in the number of people receiving services from county health departments as staff has been slashed.

Armstrong narrowly escaped an earlier panel – the Senate Health Policy Committee – when it voted 5-4 to approve the surgeon general’s nomination

Late last year, Armstrong announced he had colon cancer, undergoing surgery. Gov.  Scott issued a statement of support on Monday:

“Dr. John Armstrong is a fighter. Not only is he currently fighting against colon cancer, but he has continued to fight for the well-being of everyone in our state – whether it is against epidemics like Ebola and Zika, or illnesses like cancer or AIDS that are still affecting far too many in our state.”

The 2016 session is the final opportunity for confirmation or he will be forced to step down. Armstrong was appointed in 2012.



Concussion doctor blasts Academy Awards for racism

The discussion about the lack of black nominees for this year’s Academy Awards dominated the ceremony Sunday night – from host Chris Rock’s opening monologue to acceptance speeches.

Dr. Bennet Omalu, left, and Will Smith at the New York photo call for Columbia Pictures “Concussion,” which opened in theaters on Christmas Day 2015.

Absent from the ceremony was black actor Will Smith, whose nuanced performance in Concussion captured the doctor who brought the issue to the forefront of the NFL and the public.

Dr. Bennet Omalu, in an interview with the Palm Beach Post in January, spoke about the lack of Academy Award black nominees.

The doctor said the issue isn’t about Smith not receiving a nod, but the fact the Academy of Motion Picture Arts & Sciences has failed for two consecutive years to nominate for a major award any black, Hispanic or Asian actor, calling the Academy “a country club of exclusivity” and a “remnant of our dark past.”

“I think it is high time to find an alternative to the Academy that will reflect modern times,” he said.

Omalu is on a mission to enlighten the public about how repeated concussions in sports causes the neurological condition CTE that brings on dementia, mental illness and other problems for pro athletes.

The Post spoke to parents  who say they wouldn’t allow their children to play football in the light of Omalu’s discovery.


Post investigation: Another blow to Judge Colin

After weeks of speculation, the chief judge confirmed that Palm Beach County Circuit Judge Martin Colin is out as coordinator of a new guardianship program to resolve family disputes.

Chief Judge Jeffrey Colbath transferred Colin from the Probate & Guardianship Division – as well as the family division – following The Palm Beach Post’s investigation into Colin. Now Colin is out as coordinator of the Eldercare Coordination Program, thus severing all ties with adult guardianship.

Judge Martin Colin presides over a hearing on Thursday, August 20, 2015 at the South County Courthouse in Delray Beach. Judge Colin's wife Elizabeth Savitt, who is a professional guardian, was simultaneously participating in a hearing in another courtroom with Attorney Sheri Hazeltine. (Madeline Gray / The Palm Beach Post)
Judge Martin Colin now has no ties to adult guardianship following latest move by chief judge. (Madeline Gray / The Palm Beach Post)

Colin’s wife – Elizabeth “Betsy” Savitt – works as a professional guardian for incapacitated seniors and adults. The Post found numerous complaints about Savitt taking tens of thousands of dollars in fees without judicial approval, double-billing and funneling cash to suspect family members of the seniors in her care.

Her work as a guardian created what a former Florida Supreme Court justice dubbed an appearance of impropriety for Colin and conflicts for the judiciary as a whole. Colin wouldn’t hear Savitt’s cases, but did allow for years attorneys who represented his wife and referred her guardianship cases to appear before him. Colin would at times grant lucrative fees to these attorneys.

In the meantime, families said Colin’s colleagues would turn a blind eye to their complaints about Savitt – particularly Circuit Judge David French, reportedly a friend of Colin and Savitt.

Elizabeth Savitt appears at a hearing with Attorney Sheri Hazeltine to discuss attorney fees for Albert Bach on Thursday, August 20, 2015 at the South County Courthouse in Delray Beach. Elizabeth Savitt is the wife of Judge Martin Colin and also a professional guardian. (Madeline Gray / The Palm Beach Post)
Families say Colin’s fellow judges turned a blind eyes to their complaints about his wife, professional guardian Elizabeth Savitt . (Madeline Gray / The Palm Beach Post)

Besides his job as judge, Colin helped coordinate the Eldercare program,  which sought to resolve disputes among family members of seniors in guardianships. The program uses professionals – such as psychologists, lawyers and former judges – to sit down with families over a two-year span in hopes of resolving issues over money and care.

Circuit Judge Janice Brustares Keyser will now oversee the program, which is still in its infant stages but aims to save money by decreasing litigation in court. Some guardianship attorneys make thousands of dollars in fees – taken from the seniors’ accounts – by exploiting family discord, according to guardianship reform advocates.

Mayor wants to open supervised heroin injection facility

HeroinIthaca’s mayor has a unique plan to address the drug epidemic in his community: a supervised heroin injection facility.

“I have watched for 20 years this system that just doesn’t work,” Svante Myrick, 28, explained in an Associated Press interview. “We can’t wait anymore for the federal government. We have people shooting up in alleys. In bathroom stalls. And too many of them are dying.”

Myrick’s plan is to create a facility where heroin users can shoot the illegal drug with a clean needle under the supervision of a nurse, and without fear of being arrested by police. Medical staff will be available if the user should accidentally overdose, and other resources will be available if the addict wants to seek recovery treatment.

“I think for a lot of people this is going to sound like a weird concept — ‘Aren’t you just encouraging them to use drugs?'” he said. “But I think it’s more possible now than at any time in our history. The opioid epidemic is affecting more people and we know we can’t wait any longer for the federal government to do something.”

The plan faces legal hurdles in New York’s legislature, where heroin use has not been deemed a state health crisis yet. These types of facilities are already in use in Canada, Europe and Australia, according to the AP, so there is precedent for the approach.

Read more about Myrick’s background, how he came up with the idea and the opposition he faces here.

Lawsuit: HCA doctor performed unnecessary heart surgery

Nearly a decade ago, a nurse at Lawnwood Medical Center and Heart Institute in Fort Pierce came forward with a startling claim: doctors at the hospital were performing unnecessary heart surgeries to pad hospital profits.

John Austgen
John Austgen of Fort Pierce explains how an HCA doctor put in an unnecessary pacemaker, almost killing him at Lawnwood Regional Medical Center.

The nurse was told his services were no longer required, but he continued up the chain of the nation’s largest hospital chain, HCA Inc., with his complaint.

And indeed, HCA determined in 2010 that about 1,200 surgeries were performed on patients who did not have serious heart disease at Lawnwood and other Florida HCA hospitals, according to internal documents from the company obtained by The New York Times.

But the doctor that sparked nurse C.T. Tomlison’s alert to HCA never lost privileges at Lawnwood, and now a new lawsuit claims he continued to do unnecessary surgeries.

The medical negligence complaint filed this week in St. Lucie County says Dr. Abdul Shadani placed an unnecessary pacemaker in retiree John Austgen in 2013.

The severe complications that followed transformed the 73-year-old  from a senior who played tennis three times a week to a man who can barely muster enough energy to watch television.

“I went in as a well man. I came out as an old man,” he said at a news conference in West Palm Beach. “I was a runner. I’m having trouble walking.”

Austgen ended up suffering through several surgeries and a lengthy hospital stay. At one point, his heart was punctured and at another time it stopped all together and he had to be resuscitated. You can read his lawsuit by clicking here.

The hospital billed more than $400,000, Austgen’s West Palm Beach attorneys – Jason Weisser and Michael Baxter – said at a news conference on Wednesday. They said HCA doctors are still performing unnecessary surgeries for financial gain, calling it a systematic problem with the hospital chain. The lawyers say they are working on other cases similar to Austgen’s.

“Lawnwood generates 35 percent of their gross revenue just from its cardiac unit. It’s a huge revenue generator for the hospital,” Weisser said.  “I think the financial gain of the doctor and the hospital came before the patient’s care.”

Lawnwood spokeswoman Ronda Wilburn emailed a statement to The Palm Beach Post saying the hospital was aware of the lawsuit: “We dispute these allegations, and we intend to vigorously defend the suit. At Lawnwood Regional Medical Center & Heart Institute, we remain focused on providing the best possible medical care to our patients.”

Shadani’s attorney did not return an email and phone call for comment.

The nurse said he witnessed Dr. Shadani perform unnecessary surgeries back in 2008, according to the internal documents.

Austgen ended up in Shadani’s care after complaining of dizzy spells. The doctor diagnosed him with a complete “heart block” and in need of an emergency pacemaker, according to the lawsuit.

Weisser and Baxter say their research shows that there was only a minor blockage that could have been treated with medication. Austgen said he has since learned his dizziness was due to low blood pressure.

Austgen said his mother, sister and daughter are nurses and that he has respect for hospitals and doctors, but he hopes his lawsuit will keep Shadani from practicing.

The New York Times reported in 2012 that the Justice Department was investigating whether cardiologists at HCA hospitals in Florida performed unnecessary – and sometimes dangerous – procedures.

It is unknown whatever happened to that investigation but Weisser said HCA has failed to live up to its promises to address the systematic problem that was identified not only at Lawnwood, but at HCA hospitals in Tampa and Miami Beach.

HCA owns about 160 hospitals – including JFK Medical Center in Atlantis and Palms West Medical Center near Wellington.

Weisser said that the fact that Shadani was still on staff at Lawnwood one year after the New York Times article that shows that HCA never intended to stop such erroneous procedures. “Obviously, they don’t care,” the attorney said.