Although critics contend that it's a conflict of interest for guardians to receive payments from hospitals, Phillips said she has no problem placing the needs of her elderly charges ahead of a client hospital's financial concerns. South Florida Guardianship Program has fought hospital decisions to discharge patients the guardian deemed too ill to leave a hospital bed, she said.

"We would never compromise our integrity for the benefit of any individual or institution," she said.

In fact, Phillips has grown wary of taking referrals from some private hospitals, where she said social workers try to push patients into guardianship who don't need it.

"They just want to dump their cases in our lap," she said. "We've been told there are no relatives, and then we get the hospital chart, and there are relatives. It's so much easier (for the hospitals) to work with us. Maybe the family isn't cooperating, and we're fast."

Turning elderly patients over to guardians has become increasingly common as insurers pressure hospitals to get patients out the door quickly to contain costs, said Sylvia Corulla, social work supervisor at Pembroke Pines Hospital, which sometimes hires Phillips' company.

"They just want them out," Corulla said. "Because a patient is confused, that doesn't mean they can stay in the hospital. They will review it, and the patient becomes self-pay within 48 hours. After 48 hours, they become our problem. We need to move quickly, and we need a guardian who can move quickly with us."

In a typical case, Corulla said, the hospital pays South Florida Guardianship Program to initiate guardianship proceedings and arrange for discharge of a badly confused patient to a nursing home. Then the guardian takes responsibility for paying the home from the elderly person's assets, Corulla said. "That's a nice discharge plan," she said.

The financial arrangement with the guardian comes into play in more dramatic life-and-death situations as well. Recently, Pembroke Pines Hospital employees contacted South Florida Guardianship Program about becoming the guardian for an indigent man, 58, who had suffered a stroke and remained in a coma. After 45 days, Medicaid stopped paying for the man's care, and the hospital began to lose thousands of dollars, Corulla said.

The hospital expected South Florida Guardianship Program to go to court and win permission for doctors to turn off life support, Corulla said.

It never happened, because the man's son showed up from out of state, protested that his father was too young to die, and threatened to hire his own attorneys, Corulla said. The guardian company, after talking to the son, declined to seek guardianship, Phillips said.

The hospital now plans to transfer the man to a nursing home and pay his tab, an estimated $30,000 to $40,000 in the first 100 days, Corulla said.

She laments that the hospital was unable to hire the guardian for $1,800 instead. "It was a real bargain," she said.

South Floridians who don't want hospital employees and guardians to make life decisions for them can designate a friend or relative as their "health care surrogate," empowered to make decisions should they become too ill.

Otherwise, they check into a hospital and take their chances.

At Broward General, social workers typically make the decision to contact a guardian. Only rarely does a psychiatrist examine the patient first, said Christine Spratt, director of social work.

Jackson Memorial, by contrast, never initiates guardianship proceedings for a patient until three medical doctors, including a psychiatrist, examine the patient and conclude that extreme action is warranted.

"It's just good practice," said Lenney, Jackson Memorial's head of social work. "I have a very skilled staff of social workers. They can tell how the patient appears to be. But are they going to be able to look at the chart and know that a head injury patient on this medication is going to be confused and if they stop taking the medication in a few weeks they may not be?"

Some hospitals initiate guardianship proceedings only when patients have no lucid moments, can't communicate and appear to have no idea of who or where they are.

"If they just have a bad memory, then they are not incapacitated," said Janet Caraglio, director of case management for Cedars Medical Center in Miami. "If they have periods when they are clear and maybe they just get confused at night, they are not incapacitated."

Others, however, seek guardianship for patients described as confused, uncooperative, unrealistic about their ability to care for themselves, vulnerable to potential financial exploitation or in need of "follow-up care in an appropriate facility," court records show.

Frank Murphy, a retired state transportation worker, was not incapacitated when Imperial Point Medical Center in Fort Lauderdale helped place him in a guardianship in 1992.

He was just old and had a bad reaction to some medication, his friends said.

"When a guy is 79 or 80, and they say, 'How are you?', and he says, 'What?', then they say this guy is not doing too good," said the Rev. Robert Hanlon, a Roman Catholic priest and friend of Murphy for 25 years. "But people who knew Frank for years like I did knew that he was hitting on all buttons."

A judge agreed. One month after he left the hospital with a guardian, a judge revoked the emergency guardianship, ordered the guardian to return Murphy's assets immediately, and ruled that the way Murphy had been thrust into guardianship violated state law. Murphy was "not incapacitated in any respect," court records said.

Many hospital officials say they trust the court system to sort out whether the patients they propose for guardianship are actually capable of caring for themselves. They also say they are not responsible for what happens to their patients after they call in a professional guardian.

"It's up to the court to hear the evidence and decide," said Leonard Freehof, associate administrator of Hollywood Medical Center. "Obviously, we don't have a crystal ball, and we don't know when someone is going to become competent again."

Jablonsky said it didn't take a crystal ball to know that she was not incapacitated when she went to Northwest Regional in January 1993. The arthritic widow was temporarily confused after falling and spending two days on her kitchen floor with no food or water, she said. "I was dehydrated," Jablonsky told The Herald in September.

"There was nothing wrong with my head. It's my feet. I got arthritis, and you shouldn't know from that."

Northwest Regional asked Preston, the guardian, to arrange Jablonsky's care. Soon afterward, Preston visited the widow, dumped her purse upside down and confiscated her credit cards, according to Jablonsky and police records.

Preston then went shopping. While Jablonsky was in a nursing home, Preston ran up more than $800 in charges on her MasterCard and spent more than $300 in one day at a fancy women's shoe store in Coral Gables, according to Jablonsky and police records.

Jablonsky learned about the charges only because she insisted on moving back to her Margate home, and one day her credit card company telephoned about an overdue bill. "I was shocked," Jablonsky said. "She bought good stuff. I didn't spend that in a year, what she spent in a week.

"They ought to put that little witch behind bars."

Jablonsky hired an attorney to help her fight guardianship. The attorney filed a court document saying Jablonsky's doctor of 12 years found her physically and mentally competent.

An enraged Preston threatened and scared Jablonsky, the widow said. Having frozen her bank accounts, Preston left Jablonsky home alone with no groceries and no way to buy herself food, court records show.

"She was frightening me," Jablonsky said. "I asked her for some money for food. She told me she couldn't give it to me because the judge told her not to give me any.

"All my bank accounts were tied up. She tied up my mail. She tied up my Social Security. I couldn't get a red cent. This went on for two months."

Under pressure from Jablonsky's lawyer, Preston finally withdrew from the case.

Jablonsky regained control of her life, and Preston agreed to repay her for the more than $800 in charges she had run up on Jablonsky's MasterCard.

On Nov. 30, Broward Circuit Judge Paul L. Backman will sentence Preston for the eight felonies. Under sentencing guidelines, she could serve up to 22 months in prison.

"I'm sharper than she is," Jablonsky said. "Why would a hospital think she was fit to take care of anyone?"