Sunday, December 20, 2015

Record Investigates University of St. Augustine: 3235 Word Investigative Report

Thanks to The St. Augustine Record for its excellent 3235 word investigative story by Jake Martin in today's newspaper, probing the University of St. Augustine for Health Sciences, a for-profit school accused of defrauding some of its students.

This St. Augustine Record article by Jake Martin is journalism prize-worthy and sheds light on a for-profit institution with tight ties to former President Bill Clinton and to certain present and former City of St. Augustine officials, who made it a 450th partner and pal around with Stanley v. Paris, the founder and Chancellor, who plowed some of his profits into a multi-million dollar yacht, Kiwi Spirit, that he has attempted to sail around the world.

Colorful, evocative print headline:
"Did the University of St. Augustine for Health Sciences DELIBERATELY MISLEAD STUDENTS? Nor eligible for state licensure, students say they are 'unemployable' after spending more than $70,000 for graduate degrees at college."

Dull online headline: "University of St. Augustine challenges lawsuits filed by former orthopedic students"
Posted: December 19, 2015 - 9:33pm | Updated: December 19, 2015 - 10:24pm

The University of St. Augustine for Health Sciences has been challenging two civil cases brought forward by former students who say the school deliberately misled them to enroll in its Master of Orthopedic Physician Assistant program on the basis it was marketed as “unique and superior” to other physician assistant programs.

Court documents show students claim they enrolled in the program under the impression they would be able to practice as licensed PAs with specialized training in orthopedics, thus making them more desirable for employment following graduation.

The MOPA program, launched in May 2011 on the school’s St. Augustine campus, was packaged as a two-year graduate program consisting of six trimesters of didactic and clinical study.

Just months before the inaugural class of the program was set to graduate, USA informed students and faculty that the program’s name would be changing to Master of Orthopedic Assistant as the “orthopedic physician assistant” profession was not licensable in the state of Florida and professionals working under the OPA title would practice under the same statute allowing medical assistants and other unlicensed professionals to practice.

Students were questioning whether their investment of nearly two years and more than $70,000 in tuition, let alone fees and living expenses, would be worth a degree granting them no more freedom to practice medicine in Florida than a high school diploma could have accomplished.

Both complaints — suing for damages resulting from the school’s alleged acts, omissions, negligence and misrepresentations regarding the MOPA program — were filed with the Seventh Judicial Circuit and assigned to Judge Howard Maltz.

The first complaint, filed Aug. 12, 2013, was submitted by plaintiffs Michelle Hemingway, Holly Wheeler, Christina Mollica and Lauren Hofius. Hemingway and Mollica were identified as residents of St. Johns County at the time of the original complaint. An amended complaint was filed Sept. 12, 2013. That case is ongoing.

A second complaint, filed April 9, was submitted by 27 plaintiffs, three of whom were identified as St. Johns County residents at the time of the complaint. That case was dismissed with prejudice Nov. 17, with each party bearing its own costs and attorney’s fees.

Kevin Jakab, founder and managing attorney at Jakab Law in Jacksonville, is representing Hemingway, Wheeler, Mollica and Hofius.

Jakab said representation for the plaintiffs behind the second complaint had reached out to him prior to filing their suit and essentially used his complaint as a template.

He said although the school had reached a swift resolution with that larger group, USA seems to be taking a somewhat harder line against Jakab’s clients.

There are more than 350 entries on the case docket with more to come.

“They still have not admitted liability,” Jakab said. “Their stance is: If there is any fault, it should be shared.”

The school

USA, originally known as the Institute of Graduate Health Sciences, was founded by Stanley V. Paris in 1979. The Institute moved to St. Augustine in 1991 and changed its name to the University of St. Augustine for Health Sciences in 1997.

Paris retired as the university’s first president in 2007, but returned in 2009 as its third president. On April 16, 2011, Wanda Nitsch became the fourth president and Paris assumed the role of chancellor, a title he still holds.

USA was a Florida for-profit corporation before converting into a California limited liability company on Nov. 21, 2013. It has other campuses in Miami, San Marcos, California, and Austin, Texas. The university’s administrative headquarters is in California.

In November 2013, Paris sold 80 percent of his full stake in USA to Baltimore-based Laureate International Universities network.

According to its website, Laureate’s network of more than 80 campus-based and online universities offers undergraduate and graduate degree programs to more than 1 million students in 28 countries.

Laureate’s holdings include just five institutions in the U.S. but 31 in Central and South America. Ten of its 11 Middle East institutions are in Saudi Arabia.

According to a report on Laureate published Dec. 15, former President Bill Clinton served as “honorary chancellor” to Laureate’s colleges and universities, collecting more than $16 million before his wife, Hillary Clinton, began her White House run.

Scope of practice

Hemingway and Wheeler enrolled as part of the inaugural class of the MOPA program in May 2011; Mollica and Hofius enrolled for the program’s next offering, in January 2012.

As written in their complaint, “USA represented to Plaintiffs that its MOPA Program was unique and superior to other PA programs because it offered specialized training in orthopedics, as opposed to more general PA training, and USA possessed faculty for its MOPA Program ‘renowned from all corners of the world.’”

Both lawsuits filed against USA alleged a breach of fiduciary duty on the school’s part for not advising students of the practice limitations related to the MOPA program degree, and, instead, exaggerating the anticipated scope of practice following their completion of the program. The complaints also claimed practicing medicine in a professional setting, within the scope USA was training its students in the MOPA program, is a third-degree felony in the state of Florida.

As alleged in the complaint by Hemingway, et al., graduates of the program would be legally limited to working in the health care industry in Florida as unlicensed medical professionals under the direct supervision of a physician and therefore “performing rudimentary tasks that persons with a high school diploma, or equivalent, are eligible to perform without an advanced degree or mandatory certification.”

According to the “History of the University” page on USA’s website, graduates of the MOPA program are indeed not eligible for licensure as an orthopedic physician assistant or as an orthopedic assistant in the state of Florida — “nor have they ever.”

The school’s history page also cautioned that practicing with an OPA designation in Florida is considered by the Florida Board of Medicine to be the practice of medicine without a license and citations are issued.

“There is no licensure for what we were training our students to do,” Paris said in his deposition, taken July 14, 2014. “I don’t believe they need licensure. They’re working under the physician’s license, particularly the orthopedic physician’s assistant. Whereas, a PA has some autonomous rights, the OPA does really not have any.”

Paris declined to comment for this story.

According to a spokesperson at USA, the school’s MOPA program was a response to the “unmet needs of a longstanding profession,” elaborating that the OPA profession dates back to the Vietnam War.

“At all times the institution and this program met all necessary accreditation and license requirements and the institution accurately explained and described both the purpose of the program and its approvals to its students,” his statement continued. “The University has resolved litigation with the largest group of former students, and is disappointed that litigation with a small number of students remains.”

What’s in a name?

According to Paris’ deposition, the school initially explored the idea of starting a physician assistant program at USA between 2005 and 2007. However, USA was not a regionally accredited school and was therefore unable to get support from requisite PA professional and accrediting bodies, including the American Academy of Physician Assistants.

Paris said he felt USA was qualified to start a PA school, given it had started a physical therapy school and an occupational therapy school, and that those did not require regional accreditation.

He said those programs were offered at a master’s and doctoral level while PA programs are often offered at a bachelor’s level. He also made note that USA was nationally accredited.

On the genesis of the MOPA program, Paris said he had received a letter in 2009 from the then-chair of the education committee for the American Society of Orthopedic Physician Assistants, Arlow Bailey.

“It was a well-written, one-page letter that asked if we would be interested in starting a program for the OPAs,” Paris said.

He said he and Bailey soon met and that Paris began researching the OPA profession, which he said he had not been aware of prior to receiving Bailey’s letter.

Cindy Mathena, vice president of academic operations, said in her deposition, taken July 16, 2014, that the university did contemplate potential confusion between the phrases “orthopedic physician assistant” and “physician assistant” prior to offering the MOPA program. She said USA ultimately determined it wasn’t the school’s role to change the name of the profession.

According to Mathena, the school was aware that scope of practice varied from state to state and facility to facility prior to offering the MOPA program.

“It’s not the typical practice for us to discuss scope of practice in marketing materials,” she said in her deposition. “It’s just something we’ve never done ... It’s very important and we’ve definitely added that to our marketing materials now.”

Patrick Killeen, then-president of American Academy of Physician Assistants, and Dayne Alonso, with the Florida Academy of Physician Assistants, expressed their concerns to Paris regarding the name of the MOPA program in a letter dated March 14, 2011.

As written in that letter: “It is clear that similarities in titles do not make a graduate from your OPA program a physician assistant or eligible for state licensure as a physician assistant. We bring this to your attention because we are confident that you would not want to create a situation that would place your graduates at risk for violation of a state law.”

Suggested was the title “orthopedic assistant.”

“Using this title would eliminate the potential violation of state law,” the letter continued. “We strongly urge you to alter the title of your curriculum and make plain to graduates that they will not be ‘physician assistants’ upon graduation.”

In Paris’ letter of response, dated March 22, 2011, he said the school had no intention that any graduates of the MOPA program would ever call themselves PAs but rather OPAs.

Paris said the OPA profession was well established, with or without licensure.

“As to the licensure it seems to some that such is not necessary when working under the license of a physician and not functioning autonomously,” he wrote.

Mathena said USA did not contemplate any criminal liability on behalf of its students for carrying out the curriculum of USA’s MOPA program either leading up to its May 2011 launch or anytime thereafter.

“We thought the profession was already practicing legally,” she said.

In March 2013, the Florida Department of Health announced it had identified — in an effort known as “Operation Vandal” — four unlicensed persons calling themselves OPAs and practicing as PAs in hospitals, clinics and doctor’s offices around the state. Bailey, John Bent, Jason Mazza, and Evilio Prendes were issued citations for the practice of medicine without a license.

Paris and Mathena said they were surprised by the citations, particularly Mazza’s, as he was a USA faculty member. Bailey and Bent provided clinical rotations for USA students but were not members of USA’s faculty. No relation between USA and Prendes was identified.

Paris said in his deposition that he felt DOH was in error for citing the OPAs.

“If they were to cite anyone, it should have been the surgeons,” he said. “And the surgeons, if they complied, they, too, were in error, but they didn’t want to struggle, perhaps. Nobody wants the struggle. Intimidation is a powerful force, not always used for good.”

Mathena said Mazza continued to be a site for clinical rotations, but not Bailey or Bent.

By March 2013, the DOH in both Florida and Texas had taken the position that professionals practicing under the OPA title were practicing as unlicensed PAs.

A letter from Nitsch and Mathena to students and faculty of the MOPA program, dated March 20, 2013, outlined reasons for the program’s name change to Master of Orthopaedic Assistant (MOA) and its implications.

“The anticipated result of this change is minimal,” the letter said. “It is expected that graduates will compete for the same employment opportunities, working under the direct supervision and license of an Orthopedic surgeon until such a time when licensure in each state is achieved.”

The letter also informed students although they would be practicing under the same statutory limits as medical assistants and other unlicensed professionals, the school would pursue lobbying for licensure for the profession during Florida’s spring 2014 legislative session.

Potential “negative considerations,” as outlined in the letter, were: employability until the name change has become more well-known and understood; impact on salaries if it was perceived to be a lesser position or title; difficulty in procuring clinical rotations; and objections from third-party reimbursing agencies or other professionals.

Potential “positive considerations,” also included in the letter, were: strengthening and growing the profession; providing a pathway for licensure in many states; “spotlighting” of the profession; and allowing for better working relationships with PAs in the workplace.

Intentions and outcomes

The university denied any responsibility, liability or legal fault for any damages sought by Hemingway, et al., in USA’s answer to their amended complaint, filed Feb. 11, 2014.

As written in USA’s affirmative defenses, “The Defendant alleges that any purported damages suffered by Plaintiffs were the result of their own comparative negligence, and that negligence was either the sole legal cause or was a contributing legal cause of the alleged damages such that any recovery should be barred or should be reduced proportionately by the percentage of such negligence apportionable to each Plaintiff’s own actions or omissions.”

USA also argued the students waived any claims based on a breach of fiduciary duty, negligence, and/or negligent misrepresentation by accepting the benefits of the MOPA program, performing under the Enrollment Agreement and by participating in the MOPA program.

“The Plaintiffs cannot recover under a theory of negligent misrepresentation to the extent the cause of action is premised on representation by Defendant of future promises or future action, as a promise to do something in the future is not actionable fraud,” the defense continued.

In its response to the plaintiffs’ motion to amend their complaint to add punitive damages, dated March 2, USA claimed it never represented to the MOPA students that they would be “licensed” by the state of Florida, or anywhere else, following completion of the program.

However, referring to an early marketing pamphlet for the MOPA program, Mathena said the “nomenclature wasn’t correct and we corrected it.”

“It says, ‘This is not a typical physician assistant program.’ And we didn’t mean to imply that it was a program, but some people read it that way,” she said in her deposition. “Our intent was to say that this is not a physician assistant program; it’s not like it. But what people interpreted it as, we later learned, is that we were saying it’s a physician assistant program that’s not typical.”

In March 2012, students in Mazza’s Professional Issues I class participated in a web-based forum in which one of the course topics was “Who we are — what we do.”

Student Shannon Magee, an eventual plaintiff in the second complaint filed against USA, asked Mazza if physicians they would be working under would have to approve any treatment they provide or notes and orders they make.

“This seems as though it can get bothersome and time consuming for the physician,” Magee wrote.

Mazza replied Magee would have a generalized scope of practice as an OPA but that she would not practice independently or semi-autonomously.

“The supervising physician must sign off on all notes and orders,” he wrote. “Most physicians actually appreciate this fact as they are able to have a better sense of control on treatment of their patient’s (sic).”

Of the 11 students participating in that discussion — including Mollica and Hofius — six filed suit against USA as part of either complaint.

Mollica had asked if PAs were relatively new to the health care system and not received well by all patients and other health care professionals, “how hard will it be for us to become integrated in the system?”

Mazza replied both PAs and OPAs had been in existence since the 1970s but that it wasn’t until recently that they were “really embraced and understood by patients.”

He said aside from training, he tries to stay away from the comparison between OPAs and PAs.

“They are completely different professions,” he wrote.

Mathena said in her deposition it was never USA’s intent to produce students via its MOPA or MOA program who would have to work under Florida’s medical assistant statute after graduating.

“That ended up being kind of where we landed,” she said. “But the reason that we still felt it was important to offer this education at the master’s level is because we felt that this person needed to be grounded in evidence-based practice ... they needed the master’s level courses to do so.”

According to the university, all graduates of the MOPA program — now MOA — are eligible to sit for certification as a surgical first assistants.

Ultimately, marketing materials for the program were revised and it was no longer offered on the school’s St. Augustine campus but had been moved to USA’s Austin campus.

According to USA’s 2015-16 General Catalog, the MOA program is no longer accepting new students.

An ongoing matter

A memorandum of law in support of recovering costs incurred in mitigating damages, dated Oct. 30, indicates all four plaintiffs of the initial complaint were employed as health care professionals and three were either attending or had already graduated from another school.

Jakab said Wheeler ended up completing the MOPA program — graduating at the top of the inaugural class — but found that she was “unemployable.”

The other three left the school in spring 2013.

As written in a judge’s order, signed by Maltz on Nov. 16, it was determined that under Florida law, the students would not be entitled to recover compensatory damages in excess of the amount that “represents the loss inflicted by the actions of USA.”

USA’s motion to exclude expert witness testimony regarding compensatory damages to the plaintiffs was thus granted in part and denied in part.

“To permit the Plaintiffs to recover their expenses and costs incurred in attending USA and the costs and expenses of education at the post-USA institutions would result in providing them with free educations, which is not the situation they would have been in had USA not committed the alleged torts,” Maltz wrote. “Awards of such damages would bestow a windfall on Plaintiffs.”

A proposal for settlement had been served by USA to Hemingway, et al., on Oct. 26, but Jakab said the amount was insufficient “given the facts and nature of the case and the damages at issue.”

Jakab said tuition for the two years in the MOPA program was between $70,000 and $80,000 — not including fees or living expenses — and that the school has refused to give the plaintiffs a refund.

He said the school has maintained that although the name of the program changed, it was not discontinued — at least not at the time.

Hemingway, Wheeler, Mollica and Hofius declined to comment while the case is pending.

On Friday, the plaintiffs filed a motion to amend their complaint to add three additional claims against USA: a claim under Florida’s Deceptive and Unfair Trade Practices Act, fraudulent concealment and punitive damages.

USA filed a motion that same day to set a case management conference in which each party, their representation and the judge would meet and discuss how to handle the case moving forward.


Bigjosh92 12/19/15 - 10:48 pm 00For profit Universities
I would think you would have
to be somewhat skeptical of a
for-profit college or university!
With all of the not for profit
colleges and universities why
would a person go to a for-profit
College? You have UF, Flagler
College, JU, and Univ of North
Florida within 75 miles of St
Augustine. Buyer Beware!!!

Firstcoaster 12/20/15 - 08:23 am 20Clinton
Beware of any institution with a Clinton name attached.

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