Judge blocks Citrus hospice expansion into Hernando

Published Jan. 4, 2015

BROOKSVILLE — Officials with Hospice of Citrus County and the Nature Coast have failed to prove to an administrative law judge that they should be allowed to expand into Hernando County to provide for unmet needs and offer pediatric services for the youngest hospice patients.

Late last month, Judge John D.C. Newton II overturned the state Agency for Health Care Administration's ruling that granted the Citrus hospice a certificate of need allowing for the expansion into Hernando.

The state's decision to grant the certificate was challenged by Hernando County's sole hospice provider, HPH Hospice.

The judge's ruling was a win for HPH Hospice, and in a news release the organization's president and chief executive officer, Tom Barb, said he was pleased. He went on to say that having to launch the legal battle was "a needless drain of not only our resources and manpower but those of Hospice of Citrus County as well.''

Barb's hope for an end to the legal squabbles, however, was to be dashed.

Bonnie Saylor, chief operating officer for the Citrus hospice, said her organization already has filed an appeal of the judge's ruling and has submitted another application for a certificate of need to move into Hernando County. A decision on the new application could come by late February. There is no time line for when the appeal of the judge's order might be resolved, she added.

While Saylor acknowledged that the process has been a drain on resources, she also noted that this is the process a hospice organization must follow and that the Citrus hospice believes Hernando residents should have a choice of providers, and that young hospice patients need services that HPH Hospice does not provide.

Because the state's formula to predict need for services does not reflect a need for another hospice program in Hernando, the Citrus hospice had to apply based on "special circumstances.''

The Citrus hospice operates a special program in Citrus and 10 other counties called Partners in Care — Together for Kids. The licensed program provides support for children and adolescents facing life-threatening conditions who do not qualify for normal hospice care. The program doesn't provide medical care, but rather programs for support such as counseling, play, music and art therapies, and respite care.

The Citrus program had taken on a handful of sick children from Hernando at the request of a medical provider in Ocala who has partnered with the program. Saylor said that her organization continues to work with four of those children.

HPH Hospice has applied to be part of the same pediatric program. But Robin Kocher, director of communications for HPH Hospice, said the application process takes time and that HPH has not yet received approval to participate.

Kocher also noted that the number of children in need of hospice care is small and unpredictable. Parents of children who have some type of traumatic injury or birth defect — cases where survival is not expected — might sign up for the service. But those whose children are battling a disease such as cancer, "they are fighting up to the end,'' Kocher said.

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The judge noted in his order that, from the information collected, he could not conclude that the reason so few children were in the HPH Hospice program was that they were not being provided supportive services.

He also concluded that, despite arguments to the contrary by the Citrus hospice, "credible, persuasive evidence does not demonstrate that an identifiable rural population of Hernando County lacks access to hospice services.''

In addition, Newton questioned the Citrus hospice's projections for utilization of its services in Hernando. He called the agency's numbers "unreasonably optimistic,'' throwing into question the long-term financial feasibility of the proposal.

Contact Barbara Behrendt at or (352) 848-1434.