state agency action report - Agency for Health Care Administration

137 Pages·2010·0.79 MB·English

by  Qi Zhou

STATE AGENCY ACTION REPORT

ON APPLICATION FOR CERTIFICATE OF NEED

A. PROJECT IDENTIFICATION

1. Applicant/CON Action Number

Compassionate Care Hospice of Florida, Inc./CON #10061
18 Aquamarine Avenue
Naples, Florida 34114

Authorized Representative: Ms. Judith Grey
[phone]

Odyssey HealthCare of Collier County, Inc. d/b/a Odyssey
HealthCare of Central Florida/CON #10062
717 North Harwood, Suite 1500
Dallas, Texas 75201

Authorized Representative: Mr. Jason S. Howard
[phone]

Seasons Palliative Care of Florida, Inc./CON #10063
6400 Shafer Court, Suite 700
Rosemont, Illinois 60018

Authorized Representative: Ms. Marcia Norman
[phone]

United Hospice of Florida, Inc./CON #10064
1626 Jeurgens Court
Norcross, Georgia 30093

Authorized Representative: Mr. Neil L. Pruitt, Jr.
[phone]
CON Action Numbers: 10061-10065

VITAS Healthcare Corporation of Florida/CON #10065
505 East Huntland Drive, Suite 270
Austin, Texas 78752

Authorized Representative: Ronald T. Luke, JD, PhD
[phone]

2. Service Area/Subdistrict

Hospice Service Area 4A (Baker, Clay, Duval, Nassau, and
St. Johns Counties)

B. PUBLIC HEARING

A public hearing was not held or requested regarding the proposals to
establish a new hospice program in Hospice Service Area 4A. Letters of
support are detailed below:

Compassionate Care Hospice of Florida, Inc. (CON #10061) included
two letters of support in its application and the Agency independently
received one letter. All three letters were signed and dated during
December 2009. Sandra L. Murman, former member of the Florida
House of Representatives (1996-2004) stated she served as chair of the
Health and Human Services Appropriations Committee and the Health
Care Council. Representative Murman stated she has come to know
Compassionate Care over the last year and that the organization has her
highest respect. She also stated that she believes the applicant would
bring a commitment to excellence and professionalism to the people of
Duval and surrounding counties. James Wood, President and CEO,
Memorial Hospital-Jacksonville and Thomas Pentz, Chief Executive
Officer, Orange Park Medical Center (located in Clay County, Florida)
submitted letters indicating that they would be willing to enter into
appropriate agreements for the applicant to use their facility‟s hospital
beds to provide inpatient level hospice care.

Odyssey HealthCare of Collier County, Inc. d/b/a Odyssey
HealthCare of Central Florida (CON #10062) submitted 46
unduplicated letters of support. These letters were arranged in the
following order: the Dream Foundation (one letter) acute care hospital,
skilled nursing facility (SNF), assisted living facility (ALF) and related
support (11 letters) and family letters of thanks (34 letters).

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CON Action Number: 10061-10065
Thomas Rollerson, Founder/President of the Dream Foundation, stated
that his foundation is the first national wish-granting organization for
adults 18 years of age or older with life-limiting illnesses, and that it was
founded in Santa Barbara, California in 1994. According to Mr.
Rollerson, the Dream Foundation is made possible in part by a grant
from the Odyssey VistaCare Hospice Foundation and has had the
pleasure of working with Odyssey‟s Florida programs by granting wishes
to Florida patients. Mr. Rollerson stated that he has been impressed
with Odyssey‟s dedication and that the company is a national provider of
quality hospice services.

The 11 support letters from a Hospice Service Area 4A acute care
hospital, SNFs, ALFs and related facilities/providers were dated during
November through December 2009. These were from James Wood,
President and CEO, Memorial Hospital-Jacksonville; Kevin Harris, MSH,
NHS, RHP, Executive Director, Administrator, W. Frank Wells Nursing
Home (located in Baker County, Florida); Jacqueline Smith, RN, BSN,
Director of Nursing, Jacksonville Nursing and Rehab Center; Neil
Ramski, NHA, Administrator, Cedar Hills Healthcare Center; Paul Callis,
Director of Social Services, Moultrie Creek Nursing and Rehabilitation
Center (St. Johns County, Florida); John Schaum, Executive Director,
Sunrise Assisted Living of Jacksonville and Barbara Tidwell, RD, LD,
MHA, FACHE, Owner/Administrator, Some Place Like Home, Inc. A
recurring theme is that increased competition and choice will enhance
existing hospice services. The hospital and SNF support letters make no
mention of entering into appropriate agreements for the applicant to use
hospital or SNF beds to provide inpatient-level hospice care. Ms. Tidwell
of Some Place Like Home, Inc. (an ALF) specifically expresses concern
with the existing hospice landscape in Hospice Service Area 4A regarding
a need for more communication with family during the dying process.

The 34 support letters of thanks from family members served by the
applicant were mostly hand written notes and cards of appreciation for
the care provided a loved one. Five of these were from Daytona Beach,
six had a Miami-Dade County, Florida address but most did not
distinguish a location.

Seasons Palliative Care of Florida, Inc. (CON #10063) submitted 105
unduplicated letters of support and the Agency received one support
letter independently. These were categorized by the applicant as 17
professional and 89 family and friend support letters.

The applicant‟s 17 professional support letters were from Florida and
non-Florida hospitals, a Florida university professor, a Hospice Service
Area 4A local bank, non-Florida medical doctors, non-Florida nursing
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CON Action Numbers: 10061-10065

homes, and Seasons Hospice staff. All of these letters were signed and
most were dated December 2009. A sampling of these follows: Hoyt
Ross, Chief Executive Officer, Kindred Hospital - North Florida (Clay
County, Florida); staff from Henry Ford Hospital (located in Detroit,
Michigan); Martin Gorbien, MD, Rush University Medical Center (located
in Chicago, Illinois); Christopher Holroyde, MD, Phoenixville Hospital
(located in Phoenixville, Pennsylvania); Caprice Knapp, PhD, Assistant
Professor, University of Florida College of Medicine and Liz Porter,
Business Development Specialist, Heritage Bank of North Florida (located
in Clay County, Florida). Mr. Ross, of Kindred Hospital - North Florida,
stated he would welcome the applicant into his facility and is willing to
contract for general inpatient levels of care. Mr. Ross‟ letter is not dated.
Caprice Knapp, PhD, of the University of Florida‟s College of Medicine
stated she is impressed by the applicant‟s devotion to providing pediatric
palliative care and the Kangaroo Kids program in Chicago. Dr. Gorbien
of Rush University Medical Center commented on the applicant‟s “open
access” program. Dr. Gorbien stated this program allows individuals in
hospice to continue to receive certain treatments or procedures that
might be considered too aggressive (i.e., highly costly), by other hospices.
Matthew Shuster, MD, Co-Medical Director, Seasons Hospice and
Palliative Care of Massachusetts described “open access” as a policy in
which no patient is rejected simply because they choose to continue
some element of life-sustaining therapy. The Agency recognizes that as
part of Season‟s admissions policy, the patient/legal representative must
make an informed decision to forego curative treatment for the terminal
illness in preference for palliative treatment/services. A recurring theme
is that increased competition and choice will enhance existing hospice
services.

The 89 unduplicated support letters of thanks from family members
served by the applicant were mostly hand written notes and cards of
appreciation for the care provided a loved one. None were from Florida
residents, as the applicant does not operate in Florida. Many of the
letters were not dated and did not distinguish a location. Most expressed
exceptional thanks and gratitude for hospice services provided to family,
friends or loved ones. The Agency notes the many comments in these
support letters and cards about the applicant providing services beyond
those commonly or frequently offered by hospice providers (such as
ventilator care). Many of these cited the applicant‟s promptness, genuine
caring and attentiveness to patient and family needs.

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CON Action Number: 10061-10065
United Hospice of Florida, Inc. (CON #10064) submitted 63
unduplicated letters of support and the Agency received two support
letters for this applicant independently. The applicant categorized these
letters as follows: community and United Hospice staff (20 letters); UHS-
Pruitt subsidiaries (five letters) and United Hospice patients and families
(39 letters).

The 21 unduplicated support letters from the community and United
Hospice staff were all signed or at least had distinguishing applicable
provider letterhead. Most were signed between November 12 and
December 14, 2009. A sample of these support letters include: James
Wood, President and CEO, Memorial Hospital-Jacksonville; Hoyt Ross,
CEO and Administrator, Kindred Hospital-North Florida (located in Clay
County, Florida); Kevin Harris, MSH, NHA, CASP, Administrator, W.
Frank Wells Nursing Home; Tamara Patton, Coordinator, Emergency
Services and Homeless Coalition of Jacksonville, Inc.; Brian Snow,
Director of Family Services, I.M. Sulzbacher Center for the Homeless;
Ju‟Coby Pittman-Peele, CEO/President, Carla White Mission, Inc.; Mark
Landschoot, Executive Director, Family Promise of Jacksonville; Julie
Wood, BSRN, Nurse Care Coordinator, The Medical Home for Homeless
Children Project; Van Snead, Home Safe Program Manager, Presbyterian
Social Ministries, Inc.; Mary Canestorp, Administrator, Buckingham
Smith Assisted Living Facility (located in St. Johns County, Florida); Paul
Callis, MS, Social Services Director, Moultrie Creek Nursing and
Rehabilitation Center and Andrew McCraw, MD, McCraw Family
Medicine (located in Simpsonville, South Carolina). Many of these
support letters had an emphasis on care for the homeless (both adults
and children). Ms. Canestrop stated that she has met with United
Hospice representatives and believes they share “our quality and
compassion to provide our residents with the highest level of care”. She
also stated that her facility is affiliated with the St. Johns Welfare
Federation. Bill Saunders, RN, BSN, MBA, Administrator, Confident
Care of Florida Corp (located in Jacksonville, Florida) and Carol Waters,
life coach, licensed massage therapist, hypnotist, and Clay County
resident, expressed dissatisfaction with the current hospice environment
in Hospice Service Area 4A, with Mr. Saunders commenting on decreased
care of hospice patients in some instances, particularly with regard to
nursing care. Ms. Waters stated that existing hospices in the area are
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CON Action Numbers: 10061-10065

less receptive to massage, aroma and music therapy than the applicant.
Gayle Eckerd, Chief Executive Officer, River Point Behavioral Health and
Wekiva Springs Center for Women (both located in Duval County,
Florida); John Griggers, Administrator, Life Care Center of Orange Park,
(Clay County, Florida) and Stephen Jordan, Administrator, Quality
Health of Fernandina Beach (Nassau County, Florida) indicated their
willingness to contract or enter into appropriate arrangements with the
applicant for general inpatient levels of care.

The five letters from UHS-Pruitt subsidiaries were signed with a
December 9, 2009 signature date. All signatories indicate a location of
Norcross, Georgia. Richard Gerhardt, Vice President of Health Services
issued two of the five letters. Mr. Gerhardt indicated that his company
would provide appropriate medical equipment and supplies. Other
subsidiary letters indicated interest in providing pharmacy, nutritional,
dietary counseling, physical, occupational, speech and respiratory
therapy and related services.

The 39 unduplicated support letters of thanks from family members
served by the applicant were mostly hand written notes and cards of
appreciation for the care provided to a loved one/family member. Many
of these thank United Hospice and some Peachtree Christian Hospice (a
Georgia Hospice managed by UHS). Many of the letters and cards were
not dated. Of those dated, the year was 2008 or 2009.

VITAS Healthcare Corporation of Florida (CON #10065) submitted 53
unduplicated letters of support and the Agency independently received
two letters of support. Nearly all were signed and all have applicable
affiliate letterhead; most are dated December 2009. The letters are
described below in the following order: those received by the Agency
independently, three found in CON Application #10065, Tab 11-
Charitable Contribution Condition Letters and 50 letters in Tab 15-Letter
of Support. The applicant‟s Tab 15 included a list of these „non-
charitable contribution‟ condition letters. Four support letters lack a
signature: John Drew, Tax Collector, Nassau County, Florida; Sharon
James, President, Daytona Beach Black Nurses Association; Leonard
Love, Archbishop, Truth for Living Ministries (Duval County, Florida) and
Nancy Austin, RN, CHPN, Chapter President, Hospice and Palliative
Nurses Association (Miami-Dade County, Florida). Thirty-seven of the 55
support letters have a Hospice Service Area 4A address. The support
letters are identified by the following groups: charitable contribution
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CON Action Number: 10061-10065
letters, elected officials, willingness to contract letters, Hospice Service
Area 4A support, and non-Hospice Service Area 4A support. A relatively
common theme is the applicant‟s seeking to provide hospice services to
the African American population, the HIV/AIDS population and patients
with other non-cancer diagnosis that are in need of hospice service.

Michele Querry, Director of Major Gifts, Florida State College Foundation
provided a $298,690 proposal stated to outline unique partnership
opportunities for VITAS to assist in the Foundation‟s „critical funding
needs‟, $285,000 of which will be submitted for State matching funds
and $13,690 matched by the Foundation for Florida‟s Community
Colleges for the Blue Cross Blue Shield of Florida Nursing and Allied
Health Scholarship. The State matching funds consist of $190,000 for
the Northeast Florida Initiative for Nursing Workforce Diversity, $55,000
for a VITAS Innovative Hospice Care Endowed Teaching Chair and
$40,000 for a VITAS Innovative Hospice Care Endowed Scholarship.
Barbara Drake, Chair, Board of Directors and Connie Hodges, President,
United Way of Northeast Florida, stated that the United Way would be
willing to steward a VITAS gift of up to $500,000 that would span over a
two to three year period beginning in the summer of 2010. According to
this letter, the funds would be used to expand the Elder Care Advocacy
Program provided to Shands Jacksonville Medical Center. Richard
Danford, President, Jacksonville Urban League (JUL) indicated that a
proposed $50,000 VITAS grant would be used to support anti-obesity
programs promoted by the JUL, educational end-of-life JUL quarterly
seminars and workshops and expansion of JUL community health and
end-of-life care awareness initiatives.

Eight elected officials support the applicant‟s proposal. These officials
include: the Honorable Audrey Gibson, District 15, Florida House of
Representatives; the Honorable Stacey Johnson, County Commissioner,
Nassau County Board of County Commissioners; the Honorable John
Drew, Tax Collector, Nassau County; the Honorable Tommy Hazouri,
Representative, Duval County School Board and the Honorable Richard
Clark (Council President), William Bishop, AIA, Michael Corrigan, Jr. and
Warren Jones, Councilmen, Office of the City Council, City of
Jacksonville. These letters indicated that VITAS is a leader in end-of-life
care and would make an excellent additional choice of hospice providers
in the area.

Representatives of six Hospice Service Area 4A skilled nursing facilities
expressed commitment or interest in entering into appropriate
agreements to provide inpatient hospice beds, should this applicant be
approved. These providers are: Chris Adams, Executive Director; Harts
Harbor Health Care Center; Elizabeth Sholar, NHA, Fleet Landing;
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CON Action Numbers: 10061-10065

Raymond Prudencio, NHA, CNA, Administrator and Preceptor, The
Terrace at Fleming Island (Clay County, Florida); Glenford Wright,
MSHRM, BSBA, Administrator, West Jacksonville Health and
Rehabilitation Center; Jerry Tomack, MHSA, NHA, Executive Director,
San Jose Health and Rehabilitation Center and Eric Weisz, Executive
Director, Governor‟s Creek Health and Rehabilitation Center (Clay
County, Florida).

Letters from Hospice Service Area 4A were received from Neal Henning,
PhD, Dean of Workforce Development, Florida State College of
Jacksonville, Dr. Steven Wallace, President, Dr. Barbara Darby, North
Campus/Nassau Center President and Gwendolyn Yates, Vice Chair,
Duval County, District Board of Trustees, Florida State College at
Jacksonville. Kevin Harris, MSH, Administrator, W. Frank Wells Nursing
Home stated confidence that residents of his county will significantly
benefit from this project, if approved. Archbishop Leonard Love, Truth
for Living Ministries, stated interest in the applicant‟s cultural sensitivity
to the African American community. Deborah Thompson, Owner,
Deborah Thompson Consultants identified herself as a Board Member of
the Jacksonville Urban League and Agape Community Health Center, a
federally qualified health center [FQHC], and stated that VITAS is a
proven leader with a record of accomplishments and that she is confident
that VITAS will implement out-reach programs for the African-American
community.

Many of the applicant‟s letters of support from outside Hospice Service
Area 4A attest to VITAS‟ success in other parts of Florida and the nation.
These include Jerry Santeiro, Executive Director, Guardian Program of
Dade County, Inc., Public Guardian for the 11th Judicial Circuit (Miami-
Dade County, Florida), Linda Quick, President, South Florida Hospital &
Healthcare Association cited the success VITAS has experienced in the
South Florida area particularly with African American and terminally ill
non-cancer patients. Max Rothman, JD, LLM, President and CEO,
Alliance for Aging, Inc. (Miami-Dade and Monroe Counties, Florida) also
cited the applicant‟s excellent service to the African American terminally
ill and indicated that like results might be realized in Hospice Service
Area 4A with approval of this applicant. Maria Lazo, Miami-Dade County
Hispanic Affairs Advisory Board Director, indicated that VITAS has
community outreach programs which recognize that hospice outreach is
necessary for persons of Hispanic descent and African American descent,
and that those with non terminal illnesses are better served. She stated
that she is confident VITAS will address these needs in District 4A.
Sharon Jones, President, Daytona Beach Black Nurses Association,
stated that VITAS has provided scholarships for student nurses at
Daytona State College and at Bethune Cookman University for the past
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CON Action Number: 10061-10065
four years, has been especially sensitive to African American end-of-life
issues and is uniquely qualified to provide culturally appropriate
information, services and care to African Americans and traditionally
underserved populations. Maria Pams, MHS, Project Director, Senior
Community Services Program, American Association of Retired Persons
(Miami-Dade County, Florida) recognized the applicant‟s success in
reaching out to the African American population in her area. Martha
Sanchez, Chief Executive Officer, Area Health Education Center (Miami-
Dade County) makes similar comments. Nancy Auster, RN, CHPN,
Chapter President, Hospice and Palliative Nurses Association (Miami-
Dade County, Florida) stated that the applicant will provide a
tremendous service to the underserved of the area, particularly the
African American community. Deborah Alexander, President, the
Amyotrophic Lateral Sclerosis (ALS) Association of Florida Chapter
(Hillsborough County, Florida), indicated that VITAS has consistently
demonstrated commitment to ALS patients. Marco Carrasco, NHA,
MHSA, Administrator, West Gables Health Care Center and Region 1
Vice President, Florida Health Care Association, indicated that VITAS‟s
programs bring value to his community and would bring similar value to
the proposed area. Barbara Grasch, LMFT, Director of Program Services,
Alzheimer‟s Association Southeast Florida Chapter (Palm Beach County,
Florida), and Patricia Lange, Executive Director, Florida Assisted Living
Association (located in Tallahassee, Florida) also submitted letters of
support.

Support letters from national African American organizations were also
included in the application. Iva Carruthers, PhD, General Secretary,
Samuel DeWitt Proctor Conference, Inc. (located in Chicago, Illinois),
indicated that VITAS has had success with hospice care from an African
American faith perspective. Bishop Arthur House, Jr., Full Gospel
Baptist Church Fellowship International, Office of Home Missions
(located in Hampton, Virginia) also indicated that VITAS has had
successful efforts to reach out to the African American community
concerning end-of-life concerns. Millicent Gorham, Executive Director,
National Black Nurses Association, Inc. stated that for the past five years
VITAS has provided continuing education programs at her organization‟s
national conferences including one in Broward County, Florida in 2006.
Ms. Gorham also indicated that recently, principals from VITAS engaged
the Daytona Beach Black Nurses Association to discuss issues around
end-of-life care.
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CON Action Numbers: 10061-10065

Summary of Contractual Letters of Support

CON Application #10061 (Compassionate Care) included two acute
care hospital letters of willingness to provide inpatient beds for hospice
services – one from Memorial Hospital-Jacksonville (Duval County) and
one from Orange Park Medical Center (Clay County).

CON Application #10062 (Odyssey) does not include an acute care
hospital or SNF commitment letter to enter into inpatient bed
arrangements.

CON Application #10063 (Seasons) included a letter of willingness from
Kindred Hospital-North Florida to provide inpatient beds for hospice
services.

CON Application #10064 (United) included four letters of willingness to
provide inpatient beds for hospice services. These were from River Point
Behavioral Health which also operates Wekiva Springs Center for Women
(Duval County inpatient psychiatric hospitals) and two SNFs – Quality
Health of Fernandina Beach (Nassau County) and Life Care Center of
Orange Park (Clay County).

CON Application #10064 (VITAS) included six letters of willingness
from SNF providers to provide inpatient beds for hospice services. Two of
these are located in Clay County, The Terrace at Fleming Island and
Governor‟s Creek Health and Rehabilitation Center and four are Duval
County nursing homes: Fleet Landing, Harts Harbor Health Care Center,
San Jose Health and Rehabilitation Center and West Jacksonville Health
and Rehabilitation Center.

C. PROJECT SUMMARY

Compassionate Care Hospice of Florida, Inc. (CON #10061), a for-
profit provider, proposes the establishment of a new hospice program in
Hospice Service Area 4A, consisting of Baker, Clay, Duval, Nassau and
St. Johns Counties. Compassionate Care was founded in 1993 and has
developed 23 start-up hospice programs in 15 states: Delaware, Georgia,
Illinois, Kansas, Massachusetts, Michigan, Minnesota, Missouri,
Nebraska, New Jersey, New York, Pennsylvania, South Dakota, Texas
and Wisconsin. Compassionate Care also has CON approval via CON
#10036 to establish a program in Hospice Service Area 6B and states
this program is projected to be operational in February 2010. According
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