Broward Health hospice contractor VITAS denies admission to dying, indigent inmate

By Dan Christensen, 

Publicity photo for VITAS Healthcare's inpatient hospice unit at Broward Health North

Publicity photo for VITAS Healthcare’s inpatient hospice unit at Broward Health North

A dying homeless man ordered released from jail Friday so he could be sent for hospice care at Broward Health was instead denied admission to hospice after he refused to sign a form, according to email obtained by

Pablo Hernandez, a 65-year-old indigent suffering from terminal liver cancer, was back at the Broward County Jail today, his lawyer said.

Refusing to sign the form wasn’t the only apparent reason Havana-born Hernandez was denied access to hospice. In an email copied to Hernandez’s lawyer, Assistant Public Defender Lorena Mastrarrigo, Broward Sheriff’s transportation Sgt. Carl Richardt said a nurse had informed him “the onsite hospice provider VITAS (Healthcare) refused him due to him being undocumented.”

Mastrarrigo said BSO Inmate Health Manager Yusimir Arencibia told her Monday that profit was also a motive to deny hospice care to the terminally-ill Hernandez.

“She said VITAS is a for-profit company and they don’t like uninsured, undocumented people,” Mastrarrigo said.

Mastrarrigo’s boss is outspoken Broward Public Defender Howard Finkelstein.

“I am troubled with an indigent hospital contracting out some of their responsibilities and letting the private corporation decide whether to provide services, if that is what is occurring, which it seems to be,” said Finkelstein. “Is it financially or politically motivated, or both? Did (Broward Health’s) board intentionally contract it this way?”

Pablo Hernandez

Pablo Hernandez

The hospice form that Hernandez didn’t want to sign is called a DNR, or “Do Not Resuscitate,” which instructs health-care providers to do no rescue efforts if a patient stops breathing or his heart stops. VITAS, which operates the Hospice Unit at Broward Health North, requires hospice patients to sign a DNR form before they are admitted.

Mastrarrigo said Hernandez speaks little English and may not have understood the form, which he refused to sign a second time on Monday. VITAS manager Elizabeth Jerome said, however, that consent forms are in both English and Spanish.

Jerome referred a reporter to other VITAS officials, but they did not respond before deadline.

Court records show that Hernandez was arrested three weeks ago for violating the terms of his three-year probation for a felony conviction of driving after his license was permanently revoked. He was also jailed for a year.

Hernandez got into trouble last year when he walked away from Miami’s Salvation Army facility, where he’d been living with the court’s permission on March 23, 2015. He was charged with absconding and failing to report or pay various court and probation costs, but police didn’t catch up to him until last month.

Mastrarrigo saw Hernandez at Broward Health North in Pompano Beach on March 9. She described him as being in “good spirits and not in pain.” Two days later, BSO’s Arencibia wrote to say she’s received an update on Hernandez’s condition.

“He continues to decline. He was referred to hospice and hospice has accepted him,” Arencibia wrote. She also inquired as to whether there’d been any discussion regarding getting a judge to release Hernandez from jail. “Historically, hospice will not take him while he remains in custody status.”

Two hours later, Mastrarrigo wrote back. “I was just able to have Judge (Edward) Merrigan sign an order to ROR (release on own recognizance) Mr. Hernandez and to have BSO transport him to hospice based on your representation that he was referred to hospice and they have accepted him.”

But the deal fell apart Saturday with Sgt. Richardt’s email stating that VITAS had refused to admit Hernandez because he was undocumented. On Sunday, Arencibia wrote that when Hernandez “was interviewed by hospice he stated he did not want to sign the DNR form. That is a requirement for hospice!”

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Latest comments

  • I usually enjoy reading your work, but this story is truly over-the-top sensationalism.

    Mr. Mastrarrigo should be ashamed of playing the language card before he knew that Spanish language form was provided for the patient. Has anyone been to a medical facility in South Florida in the last 20 years which didn’t provide forms in both English and Spanish?

    The purpose of hospice care to alleviate the pain of those with terminal illness. It is not to extend life.

    The patient would not sign a DNR, which is a requirement for hospice treatment. Would you blame a surgeon who would not operate on a patient who refused to sign a form consenting to treatment?

  • Pathetic political game between BH, which has its own hospice unit, and VITAS. Delve deep into their past and current contentious and unethical relationship, and expect this “game” was commenced at the expense of an “insignificant” human life.

  • I am with awkward. I worked there…the vitas deal is another political scheme. Lots of patients fell through the cracks. Sickening..glad I got out..just could not take it anymore

  • Great. I thought I had seen it all with respect to the guv and BH folks figuring out how to move all that public money to their friends at private companies via no bid contracts. Add Hospice to the list that includes oncology services and the advertising agency. God only knows how much other stuff has been contracted out. This man is diagnosed with terminal cancer. Where is the compassion from our publicly funded hospital district? Makes me wonder how many other patients and their families have been victimized by the greed.

  • Broward Health ended their relationship with all hospices when they signed a lucrative deal with Vitas. Something isn’t right here!

  • And so we are all catching on. If consumers are wise, they will understand the care at BH is substandard for all, not just the poor. This kind of healthcare system should make those with good insurance question the medical necessity of their tests and treatments since BH has to make its bucks somewhere aside from tax support that they have so grossly mismanaged, and intended to help the poor. Why didn’t this patient get admitted to BH’s own hospice unit? Must be bad blood with VITAS who I hear nothing positive about either. Run to its competitors who have demonstrated their values and ethics through their actions, eg the south district who is has not paid the DOJ fines for unethical practices. That’s where I go for my care. I’d never permit BH to provide my or my family’s care. Not ever.

  • How is he undocumented? Correct me if I’m wrong but since he’s from Cuba wouldn’t “Wet foot-dry foot” apply here? VITAS doesn’t surprise me at all-there owned by Don & Matt Gaetz who ironically have served as President & members of the Florida Senate & House of Representatives for many years. In 2013, the United States Department of Justice filed a lawsuit against VITAS for allegedly committing Medicare fraud since 2002, when Gaetz still worked at the company, though Gaetz denied any role in any wrongdoing that occurred. They’re also great friends with Rick Scott, go figure! Unless you live on another planet you have to admit that something stinks here.

  • Broward Health regularly discharges very sick people directly to the streets of Broward County. As an advocate for the homeless, I meet these people on the regular. I’m talking about people who’ve had heart attacks and strokes, not colds or the flu. Whether BH is culpable in this particular situation is irrelevant. They’re embedded in a culture of negligence and hate directed at the least among us, and VITAS is a beneficiary of that same culture. Profits rule over people, and my fellow Americans are too ignorant and/or chickenshit to fight back.

  • We give great care to many non-compliant patients. If a patient refuses to sign a DNR upon entering a hospice, then question his motives! It’s not for him!
    This is a terrible example of an article!
    Yes, it would have been great if BH used its own hospice instead of contracting it out to Vitas. Maybe, Vitas bid was higher than the BH Hospice.
    Awkward, you are so incredibly wrong to lump every honest, kindhearted,hard working employee into a barrel of bad apples!

  • Did a fair amount of research last night on Vitas. I started with a simple Google search “Vitas medicare fraud.”

  • Interesting BOC agenda today: general counsel termination and replacement of acting ceo. Pray tell the train does not stop here as the BOC, and their political and non-political cronies assuredly are the true puppeteers!

  • Dear optimistic.
    When a health system displaces hundreds of millions of dollars in revenue over decades of time it falls behind competing organizations that appropriate those monies towards their infrastructure, supplies, volume of staff, experience of staff, etc. I am not blaming the talented and well-intended staff who try day in and day out, against the odds, to deliver quality care in such a system. In fact, this is why I raise my voice in loud objection. You must trust, that only by exposing the ugly and sordid details is there any hope for improvement. All well-intended and honest clinicians, and all patients served by this less than stellar healthcare system have that right. Using a patient to up the ante by BH’s own hospice service to pressure VITAS hit the involved patient below the belt. He did not deserve it. BH needs to find a far more palatable way to fight their own political monsters!

  • Awkward Moment, thank you for the explanation. From where I stand, I see excellence but it’s not in the corporate offices.. . Your point is understood and wrongdoings should be brought out.

  • I am truly on your side. I fret the politicians and their cronies will get away with this but I hope not. I hope if we all continue to raise our voices and expose the truth, that the Feds will return and force positive change. I live here. I’d be afraid to get my care at BH. I know how competitors work. I know where I feel safe getting care and where I don’t. I’m sorry BH feels so unsafe. But it is not your fault. It is not the fault of so many good and well meaning people

  • Thanks qui tam!

  • Anytime. The silence of BH’s leadership sends a very clear message. They apparently feel they owe no apologies to the tax paying citizens who paid their $69.5 million dollar fine, or for their lack of fiduciary accountability. Way to go BH!

  • I’ve been a hospice and palliative medicine physician for over thirty years. A DNR is NOT required to enroll in hospice.

  • Problems with Vitas,, PT forced to sign DNR or be discharged immediately from hospital while waiting for hospice care roomChoice sign DNR or go home with possible end stage liver Failure. Physician discussed nothing with patient..

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