Death and Profits

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"We applied and we were selected," Westbrook says, still somewhat amazed. "We were surprised because at the time we didn't know anyone in Washington. This gave us the financial base to take this idea that Esther and I had, and instead of taking care of one patient at a time, which is what we were doing, we actually were able to get up to five patients at a time."

Their program in South Florida began to expand. They branched into Broward and called their new operation Hospice Inc., which of course was nonprofit in keeping with the Florida law. They went from serving one patient at a time to five, then to dozens.

Westbrook was confident the Medicare experiment would prove that hospices were cost effective. But there was no guarantee Congress would accept the results and permanently expand Medicare coverage to hospice programs. Before the test results were announced, he began organizing nationally to lobby Congress. "We found that there was a hospice group, or somebody trying to put together a hospice, in every single congressional district in the country," Westbrook says. "We pulled those people together and we started to lobby."

Helping Westbrook was Don Gaetz. The two men were opposites in many regards. Westbrook was an ordained Methodist minister whose clerical assignments had introduced him to cancer wards and inner-city poverty. He had taught and read scripture at York Memorial United Methodist Church on North Miami Beach. He was a Democrat. Gaetz was a Republican who had worked several years as an aide to two United States senators before becoming vice president of a chain of hospitals in Florida.

Hospice was virtually the only common ground they shared. Gaetz had tried to form programs in Wisconsin and in Jacksonville, Florida, and soon after meeting Westbrook and Colliflower, he quit his job to work with the two Miami hospice pioneers.

Building on what he had already accomplished in the Florida legislature, Westbrook, along with Gaetz, began piecing together a bill that would provide Medicare reimbursement for hospices. Florida's legendary congressman Claude Pepper was an obvious and early supporter. "But the real person who got behind us was a congressman from California named Leon Panetta," Westbrook says.

By 1982 a Medicare funding bill that reflected Westbrook's ideas was in both the House and the Senate. Then the Congressional Budget Office reported that the recently completed experiment showed that hospices would likely save $110 million in federal tax dollars over three years. "When that report came out, everyone jumped onboard," says Westbrook. "Two-thirds of the Senate and two-thirds of the House signed on as co-sponsors of the bill." It passed in August 1982 and has been amended and expanded several times since. "That bill allowed hospices to become a reality," Westbrook continues. "It was the only expansion of the Medicare program during the Reagan administration."

Westbrook's ascent to a position of influence within the Democratic Party is understandable in light of these early days of the hospice movement. He was the young, affable minister, the humanitarian who sought only to find some way to help the terminally ill. And many of the politicians he befriended were still in the infancy of their careers. Today, for example, Graham is a United States Senator, Meek is the first black member of Congress from Florida since Reconstruction, and Leon Panetta has moved from California congressman and Westbrook supporter to the powerful position of budget director for the Clinton White House. So it's no surprise that not long ago Westbrook served on a panel with Hillary Clinton, and more recently received a personal briefing on the administration's health-care proposals at the Old Executive Office Building.

The fact that Westbrook is now wealthy has simply added clout to his connections. In the last few years, he has steered hundreds of thousands of dollars to federal congressional and presidential campaigns. In 1992, for instance, Westbrook and his key executives, family members, and various corporations contributed at least $470,000 to federal candidates, according to election records. Using this informal political action committee, Westbrook directed nearly $50,000 to his old friend Carrie Meek. Sen. Bob Graham received more than $18,000.

After shepherding the Florida licensing law and then the Medicare funding law through the political maze, Westbrook in 1982 created the Miami-based Hospice Foundation, a nonprofit organization that would help raise money to support his two nonprofit hospices in Dade and Broward. But Westbrook nurtured a dream that was bigger than South Florida. He wanted to build a national chain of nonprofit hospices, and that would require more money than his newly formed foundation could collect.

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Jim DeFede
Contact: Jim DeFede