Medical Fellowship Program

Our history

Hospice of Palm Beach County has been providing end of life care since the 1970’s.  It was founded in February 27, 1978 by Stella Monchick-West and incorporated as a 501© (3) not for profit agency.  The first medical director was Dr. Isio Wasserman, a retired surgeon who believed in Mrs. Monchick’s vision of providing quality care to people dying with terminal illnesses.  He first served as a volunteer physician from 1978 until 1981, when he was appointed as Medical Director; a post he held until 1985.

In 1979, the first offices were donated to HPBC at the Mental Health Building, 909 Fern street, in West Palm Beach.  Soon after, they moved into a three room office suite at the Commerce Building located in Datura Street. That same year, the Hospice Bill was passed by the Florida Legislature and signed by then Governor Graham, one of the first states to do so.

By 1980, the average daily census had grown to 20 patients and the first 2 inpatient beds were located at the Noreen McKeen Residence for Geriatric Care, on South Flagler Street.  The offices moved to the Gallo Building on Dixie Highway, Lake Worth.

In 1981, Hospice of Palm Beach County was awarded a Certificate of Need (CON) and a Hospice License by HRS.  The Hospice Medicare Benefit was passed by Congress.  During that same year, Helen Messic, a Palm Beach resident who had seen her brother suffer as he died of cancer, formed the Palm Beach Guild to raise funds for the erection of the Gerstenberg building.

In 1984, HPBC was certified as a Medicare provider and was the first program of its kind in Florida to be accredited by the Joint Commission for Accreditation of Healthcare Organizations (JAHCO). In 1987 it was certified as a Medicaid provider.

Dr. Wasserman retired in 1985.  That year, Dr. Elizabeth McKeen, MD, an oncologist who had trained with Dr. Josefina B. Magno, MD, a pioneer in end of life care, was appointed as Medical Director of the hospice.  She was assisted by Dr. Sydney Weinberg and two volunteer physicians, Dr. Jack Rogers and Dr. Pierce Weinstein.  Under her leadership, Hospice of Palm Beach County attracted a group of committed physicians as Associate Medical Directors:  Dr. Larry Tepper, Dr. Neal Rothschild and Dr. Daniel L. Spitz.

In 1988, Helen Messic’s vision came to fruition.  The Charles W. Gerstenberg Inpatient unit opened its doors.  This was a 24 bed free standing unit, the first to be built east of the Mississippi and one of three in the country.  That same year, HPBC formed a team to serve the Western Communities of Belle Glade and Pahokee.

Dr. McKeen made it a point to educate community physicians about pain management and end of life care by giving presentations on the topic at their offices. She also coordinated and hosted pain lectures and was a presenter at the Fifth Annual Symposium of the International Hospice Institute.  She was also involved in development of an educational curriculum for physicians wanting to acquire expertise in Hospice and Palliative Care.   In September of 1990, Hospice of Palm Beach County, under her leadership, hosted a group of 15 physicians from around the country for a hands-on symposium on End of Life Care.  This course was recognized as groundbreaking and received a service award by the nascent Academy of Hospice Physicians that same year and in, 1991, by the National Hospice Organization (NHO).  She remained Medical Director until December of 1994 when she stepped down from her position, but remained on the Board of Directors. During Her tenure, several doctors, who are still on staff today, joined the ranks of HPBC: Dr. Karen Klapper, DO, Dr. M.J. Rothschild, MD, Dr. Gail Cooney, MD, Dr. Daniel Fortier, MD, and Dr. Dana Krumholz, MD.  She was replaced by Dr. Molly Noonan, Ph. D., MD, who had been the director of the Palliative Care unit and Alzheimer’s disease Unit at Western Massachusetts hospital in Westfield, MA.  She had additional expertise in Medical Ethics and she pioneered a fledgling service in our community.

In 1996, with funding from the Foundation, HPBC developed the Bereavement Program and started a Music Therapy program, a research oriented department that has since contributed to the education and development of evidence based data on the benefits of this intervention for both, patients and families.  That same year, Gail Cooney, MD, who had been an associate medical director for five years, took over as Medical Director of Hospice.  She had been trained in Internal Medicine, Neurology and Neuro Oncology.  She trained at Sloan Kettering, in New York, with Dr. Kathleen Foley, MD, a pioneer in cancer pain management.

In 1997, HPBC inaugurated the SHARE program, geared toward adults who are dealing with a pregnancy or infant loss, or the death of a child under the age of five.

1999 was the first year that bereaved children were hosted at Camp Horizons, a two day camp full of activities and fun.  That year, the music therapy program was accredited by the American Music Therapy Association as a site for Music Therapy Internships.  Also, HPBC became the first host site in Florida for a Christmas Box Angel Statue. The Christmas Box Angel Statue is dedicated to all parents who have lost a child. The statue was commissioned by Richard Paul Evans, author of “The Christmas Box,” to help parents seeking a place to grieve.  Under the leadership of CEO David Fielding, HPBC began to pay for complex therapies (radiation, IV fluids) that were not traditionally covered under the Medicare Hospice benefit.

In 2001, the Jay Robert Lauer Hospice and Palliative Care Unit were inaugurated at JFK Medical Center.  It was the first hospice-operated unit within a medical facility in Palm Beach County.   Over the next eleven years, HPBC opened up five more units:  Bethesda Hospital (2003); Good Samaritan Medical Center (2005); Palm Beach Gardens Medical Center (2007); Pinecrest Delray (2007); Jupiter Pavilion (2011).

Under Dr. Gail Cooney’s leadership Hospice of Palm Beach County, with grants provided by the foundation, explored a disease management program (Spectrum Care Management) that aimed to keep patients with heart failure out of the emergency room by using an interdisciplinary approach to care.  While the program was successful, it was clearly ahead of its time and did not receive great acceptance in the community.  She also spearheaded the “open access” philosophy for which HPBC is well known today.  This allows patients with life limiting illnesses- less than six months- to continue to receive complex care (chemotherapy, IV fluids, blood transfusions, radiation therapy, etc.).  The types of patient who were admitted to the inpatient units became progressively more complex.  This required additional skill sets for the nurses and physicians.  HPBC started to admit patients on ventilators for compassionate removal of life support and patients who were receiving non invasive ventilation (CPAP and BiPap).  HPBC developed a relationship with Nova Southeastern University School of Osteopathic Medicine and MSIII students started doing a one month rotation with volunteer physicians.  She also oversaw the development of a program to do blind palliative paracentesis in the patient’s home.  Hospice of Palm Beach County was the first institution of its kind to present the results of this program at a meeting of the America n Academy of Hospice and Palliative Medicine.

In 2005, HPBC started Integrative Therapies department to provide complimentary therapies to patients, such as:  Massage, Aroma therapy and Reiki. In 2007, Hospice of Palm Beach County received a Gold Standard Accreditation from JAHCO and the afterhours Triage/OnCall program received the Award of Excellence from Florida Hospices and Palliative Care, Inc., the state organization that represents hospices.   That same year, the board of directors agreed to form Spectrum, a holding company and a separate foundation under that company to manage funds donated to Hospice of Palm Beach County.  Spectrum would manage HPBC, The Hospice of Palm Beach county foundation and other affiliated companies, including The Medical Store, a DME company that allowed HPBC to provide equipment to patients.

Dr. Cooney resigned her position in 2008 and temporarily left Hospice of Palm Beach County to run the program at the Sari Asher Center for Integrative Cancer Care.   She was replaced by Dr. Richard Levene, DO.  Dr. Levene Joined HPBC in 1997.  Prior to becoming Medical Director, he was instrumental in opening and staffing the different inpatient units.  He also pioneered the concept of admitting patients to hospice before removing them from life support.  Traditionally, patients had to be removed from life support before they could be admitted.  Dr. Levene developed protocols for premedicating patients who were about to be separated from ventilators in order to reduce post extubation symptom burden.  While there was some initial resistance on the part of hospital staff, it is now the standard of care in the community and Hospice of Palm Beach County’s physicians supervise more than 80% of the removals of life support.  He was also instrumental in developing the first Hospice and Palliative Medicine fellowship, a one year post graduate program for physicians who wanted to specialize in this area.  The first graduate of that program was Dr. Katherine Brazzale, MD, who joined the staff of HPBC as a full time physician after finishing the fellowship.  Funds for the training were supported by a grant from the foundation.  Dr. Levene pursued accreditation for the program and negotiated affiliation with the University of Miami’s Miller School of Medicine.  He also pursued accreditation of an American Osteopathic Association approved fellowship in partnership with Columbia Hospital and the Veteran’s Administration Medical Center in West Palm Beach.  In 2010, the fellowship program received accreditation from the ACGME.  That year, Dr. Levene stepped aside to dedicate more time to the teaching program.  Since its inception, the fellowship has graduated several physicians.  Dr. Ellen Babinski, DO, (2010-2011) who was originally trained as a Physiatrist, joined a group of Physical Medicine specialists in Palm Beach County. Dr. Sufana Alkhunaizi, MD, (2011-2012) went on to do a Geriatrics fellowship at the University of Miami. Dr. Richard Teitzman, DO, (2011-2012), is currently working with Hospice of Palm Beach County doing inpatient palliative care at the Bethesda and Delray units.  Faustino Gonzalez, MD, who had been working for HPBC since 2001, was appointed Medical Director and, subsequently, Vice President of Medical Affairs.  Doctor Gonzalez came to HPBC as a team physician and as director of the Spectrum Care Management program.  During his tenure, Spectrum started South Florida Palliative Medicine Specialists, a group of physicians and ARNP’s who provide consultative and symptom management services to patients who have life limiting illnesses but may not yet be ready for hospice.  He also started hiring ARNP’s to help with the palliative service and to do Face to Face visits. Currently, there are five nurse practitioners working at HPBC.

In 2008, the American Board of Medical Specialists recognized Hospice and Palliative Medicine as its own specialty.  Soon after, the American Osteopathic Association followed suit. The majority of the HPBC’s doctors were eligible and took the exam.

Hospice of Palm Beach County has a legacy of teaching and academic excellence in Palliative Medicine.  Besides helping to teach MSIII students from NSU, they are involved in teaching the Internal Medicine residents at the University of Miami Miller School of Medicine campus at JFK medical Center.  There, PGYI residents do a two week clinical rotation under the supervision of HPBC doctors and the Hospice and Palliative Medicine Fellow.  There is a monthly lecture series provided to the Osteopathic Internal Medicine residents at West Palm Hospital.  HOBC physicians have also presented abstracts at meetings of the American Academy of Hospice and Palliative Medicine and posters at International Palliative Medicine symposia.  They have also published case reports in peer reviewed journals.  Dr. Gail Cooney was the first President of the American Academy of Hospice and Palliative Medicine who came from a community hospice and not an academic medical center.  As a result, several physicians have achieved the status of Fellow of the American Academy of Hospice and Palliative Medicine (FAAHPM).