Man died after Orlando legal guardian filed ‘do not resuscitate’ order against his wishes, investigation finds | Exclusive

Jul. 15--A man died at a Tampa hospital after staff could not perform life-saving procedures because of a "do not resuscitate" order his Orlando guardian filed against his wishes, state investigators determined.

The investigation into the final days of 75-year-old Steven Stryker of Cocoa caused Circuit Judge Janet C. Thorpe to seek the removal of his court-appointed guardian, Rebecca Fierle, from 98 Orange County cases at once in a hearing sealed from the media last week.

Thorpe found Fierle had "abused her powers" by requesting that incapacitated clients not receive medical treatment if their heart or breathing stopped -- without permission from their families or the court, records show.

Guardians are court-appointed decision-makers for minors and adults with mental and physical disabilities, known as wards.

The investigation into Fierle was done by the Okaloosa County Clerk of Circuit Court and Comptroller, part of the Clerks' Statewide Investigations of Professional Guardians Alliance. The Orlando Sentinel obtained a redacted copy of the report from the investigation, written by Andrew Thurman, an auditor and investigator under the Okaloosa Clerk's inspector general department.

The investigation concluded that Fierle refused to remove the DNR despite Stryker's desire for life-saving actions, and that her claims about his final wishes contradicted his daughter, friend and a psychiatrist.

"The ward had never previously expressed a desire to die, and it seems unlikely that, as soon as he was appointed a guardian, he would suddenly be unwilling to tolerate a condition that he had been dealing with for many years," investigators wrote.

Fierle and her attorney did not immediately respond to requests for comment. Ahead of the hearing Thursday, attorneys for Fierle tried to have Thorpe disqualified from the cases, arguing the guardian has "a well-founded fear that she will not receive a fair trial or hearing," according to court records.

The investigation began after Stryker's daughter, Kim Stryker, submitted a complaint to the Ninth Judicial Circuit on May 9 alleging that Fierle refused to remove a "do not resuscitate" order she had placed on Steven Stryker despite his expressed desire to live, court records show.

Stryker's daughter also alleged Fierle moved her father to multiple assisted living facilities that were unable to care for a chronic condition that made it difficult for him to swallow, which put him at a "great risk of aspirating."

"My father was appointed the guardian Rebecca Fierle last year by this court and I have serious concerns about the care he is getting under her guardianship," Kim Stryker wrote in an email to the court. "His guardian has insisted on including a DNR (Do Not Resuscitate) order on his medical records, despite his vocal opposition. He is doing much better and is quite lucid and extremely upset that this woman has full control over his medical and financial records."

The complaint was forwarded to the Office of Public and Professional Guardians (OPPG), a division of the Florida Department of Elder Affairs, according to the records obtained by the Sentinel. Although the ward's name and several passages were redacted from the report, Kim Stryker and a friend of her father's who was involved with his medical care confirmed to the Sentinel that he is the ward referenced in the report.

Steven Stryker, a Navy veteran, died four days after the complaint, on May 13 at St. Joseph's Hospital in Tampa.

When investigators interviewed Kim Stryker on July 2, she said Fierle told her a week before her father's death that keeping the DNR in place was a "'quality of life, rather than quantity' matter," the investigative report said.

"[The daughter] believed that if not for Fierle's actions, her father would still be alive," investigators wrote.

Linda Lanier, who was Steven Stryker's friend and health-care surrogate, told the Sentinel that he gave her durable power of attorney over him if he became incapacitated.

"Steve was capable of making his own decisions," she said. "He made all of his decisions. I was just there for backup."

Fierle was appointed Stryker's guardian after Florida Hospital Orlando, since renamed AdventHealth Orlando, petitioned the court in August 2018 for an emergency guardian while Stryker was a patient there because "the alleged incapacitated person is unable to make decisions that would be safe and reasonable for his plan of care, and is not able to effectively manage his finances," court records show. In the same motion, Florida Hospital Orlando recommended Fierle as a guardian for Stryker.

Lanier told investigators Steven Stryker was hospitalized several times due to chronic health conditions. In order to eat solid foods, he periodically required a procedure known as an upper endoscopy, Lanier said.

Stryker was scheduled to undergo the procedure a few weeks after the day he died at St. Joseph's Hospital, where he was receiving in-patient care, according to the report.

Investigators interviewed Kirtikumar Pandya, a licensed psychiatrist who examined Stryker at St. Joseph's Hospital and told them he was "concerned" about the "do not resuscitate" order filed by Fierle.

"While he acknowledged that the ward did not have the capacity to make all decisions, Dr. Pandya believed that he had the ability to decide that he wanted to live," the report said. "Dr. Pandya said that the ward wanted to be resuscitated and wanted to be alive."

Pandya told investigators Fierle's reasons for filing the order were "not rational" because Stryker's condition is generally not considered terminal, so he requested that the hospital rescind the DNR and order an ethics consult.

When investigators interviewed Fierle, she told them it was difficult to find facilities for Stryker because he was a registered sex offender for lewd exhibition. Investigators found that Fierle had moved Stryker to various assisted living facilities that did not meet his needs for care or supervision, resulting in multiple hospitalizations.

"Even though it was difficult to find a facility willing to accept him due to his sex offender status, as court-appointed guardian, it remained Fierle's responsibility to ensure the ward's medical care needs were met," the report said.

When asked about the DNR she filed on Stryker, Fierle gave investigators the same response she gave his daughter: it was "an issue of quality of life rather than quantity."

"Fierle stated that she discussed life-saving care with the ward and that he agreed to the DNR being in place," investigators wrote. "She also stated that this was common for her and that she files DNR for wards regularly."

Fierle told investigators she had attended an ethics consultation at St. Joseph's Hospital, but she decided to keep the DNR order on Stryker.

"The meeting determined that because she was the court-appointed guardian, she had the authority to decide on end of life care and life-saving procedures, and the DNR remained in place," the report said.

Lanier, who said Fierle refused to let her visit her friend, said Stryker choked to death.

"He knew everything that was going on," she said. "He was lucid."

Investigators tried to interview the hospital's case manager and the physician who pronounced Stryker dead, but the case manager was told by the hospital not to speak with them, and the physician did not return messages left with his office staff, the investigative report states.

Medical records confirmed hospital staff did not perform "life-saving procedures" on Stryker because of his guardian's order, investigators said. A spokeswoman for St. Joseph's Hospital said they could not immediately comment on Stryker's case because the Health Insurance Portability and Accountability Act requires patients' consent to discuss anything about their care.

"The note in the records written upon the Ward's death, and digitally signed by the pronouncing physician, indicated that they did not perform life-saving procedures due to the DNR in place," the investigative report said.

Lanier said neither she nor Kim Stryker were informed that Steve Stryker had died until Lanier sent flowers to her friend at the hospital with a note telling him Fierle had agreed to give up guardianship of him. A nurse informed her of his death.

"She's an evil person. ... How many other people did this happen to?" Lanier said.

The investigative report included a redacted email from Kim Stryker to Fierle on May 15 with the subject line, "My father is dead."

"Were you even going to tell me?" Kim Stryker asked in the email. "My family wants to know what is being done with my father's remains. He had specific instructions and preparations made, which you will no doubt ignore."

Fierle told Kim Stryker that she assumed a hospital case manager had let her know of her father's death.

"Any final arrangements can be handled by you and your brother," Fierle wrote. "That is not a task I handle if there is family. The funeral home of your choice can send an invoice to my office for payment from the funds I have in the guardianship account."

The report alleges Fierle violated several OPPG standards, including requiring people determined incapacitated retain the right to be "treated humanely, with dignity and respect, and to be protected against abuse."

"During our interview, Fierle stated that placing DNR orders for her wards is common and something that she does frequently," the report said. "Because she did not petition the court for approval to place the DNRs, and these records are not generally maintained in the guardianship case files, we do not currently know the extent to which Fierle's current or former wards may be affected."

Investigators also alleged Fierle's decision to file a DNR order against the ward's wishes amounted to "the removal of care necessary to maintain the ward's physical health" and cited criminal statues. Fierle is not currently facing criminal charges in connection with Stryker's death or her handling of other wards.

"The removal of this necessary care directly resulted in the ward's death," investigators said in the report. "Fla. Stat. states 'A person who causes the death of any elderly person or disabled adult by culpable negligence ... commits aggravated manslaughter of an elderly person or disabled adult, a felony of the first degree.'"

Kim Stryker said her father was charming, intelligent, funny and worked for the U.S. Environmental Protection Agency but also struggled with alcoholism, bipolar disorder and post-traumatic stress disorder from his time in Vietnam. She said she thinks Fierle should never be appointed as a guardian to anyone else, she said.

"She had a responsibility she neglected. ... But it's not enough to just get rid of Rebecca," Kim Stryker said. "I want to see the powers that be really examine the system because I think there's no way to pull the emergency brake on guardianship if the system is bad."

The statewide alliance of clerks' offices responsible for the investigation into Fierle is overseen by Anthony Palmieri, deputy inspector general and chief guardianship investigator for Palm Beach County Clerk and Comptroller Sharon Bock. Bock started a program in her office investigating guardianship fraud about a decade ago.

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"I was becoming concerned over the number of cases that were being filed in the guardianship realm," Bock said. "At the same time, I was becoming aware of the immensity of the problem due to the fact that there was so little oversight and so little monitoring of the guardian."

Bock said Fierle's case has a "far-reaching effect" into different Florida counties besides Orange County. The alliance has an ethical obligation to refer any alleged criminal conduct to the proper law enforcement, she added.

"One aspect I believe people don't fully understand is the powers that we give to a guardian," Bock said. "It only stands to reason that there must be a check and balance system so the guardian always acts in the best interests of the ward. The majority of guardians do, but when they don't, it's egregious like this case. We have a ward, who against his wishes, died."

[email protected] or 407-420-5774.

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