Rifts Remain Over Trauma Centers

Feb 25, 2014

The Florida Department of Health appears ready to move forward with a new proposal about divvying up trauma centers across the state --- but long-running battles about the issue could continue in the courts and spill into the Legislature.

St. Joseph's Hospital in Tampa is home to one of the trauma centers embroiled in a long-standing dispute with the Florida Department of Health.

Department officials held a hearing Tuesday about a proposed rule that would determine how many trauma centers would be allowed in 19 separate areas of the state.

The proposal comes after more than two years of hospital-industry legal fights focusing on department decisions in 2011 and 2012 that allowed new trauma centers to open in Pasco, Manatee, Marion and Clay counties.

An administrative law judge and an appeals court found that the department used an invalid rule in approving the new trauma centers. Related litigation, which is ongoing, could threaten the continued operation of trauma facilities at Regional Medical Center Bayonet Point in Pasco County, Blake Medical Center in Manatee County and Ocala Regional Medical Center in Marion County.

A trauma facility at Orange Park Medical Center in Clay County closed for other reasons.

Amid the legal cases, the department has drawn up the new proposed rule to help determine where trauma centers should be allowed. But it was apparent during the hearing Tuesday that the proposed rule could face more legal challenges if the department adopts it in the coming weeks. State agencies develop rules to carry out details of state laws.

The HCA health-care chain, which includes the Pasco, Manatee, Marion and Clay hospitals, is urging the department to move forward with the rule. Officials from the Kissimmee area also attended the hearing to support the rule, which could help HCA's Osceola Regional Medical Center open a trauma facility.

"Having a trauma facility right in our community is very important to us,'' said Karen Hunter, health and safety chief for the Kissimmee Fire Department.

But the proposed rule drew objections from some hospitals that have longstanding trauma centers and from the Safety Net Hospital Alliance of Florida, which includes public and teaching hospitals that provide large amounts of trauma care.

Hospitals challenging the department's approval of the HCA trauma centers have been Tampa General Hospital, St. Joseph's Hospital in Tampa, Bayfront Medical Center in St. Petersburg, UF Health Shands Hospital in Gainesville and UF Health Jacksonville.

Critics of the proposed rule said it doesn't adequately set criteria for determining whether needs exist in particular areas of the state for additional trauma centers, which are costly to run and require highly trained staff.

Also, Seann Frazier, an attorney for Shands, said the proposed rule includes "many of the mistakes" that led to the earlier trauma rule being declared invalid in court. He called it "disappointing."

"This (proposed) rule would allow for proliferation of unneeded trauma programs because it doesn't properly predict need,'' said Frazier, who is representing the Gainesville hospital in challenges to the Ocala Regional Medical Center trauma facility.

Stephen Ecenia, an attorney for the HCA hospitals, acknowledged that he expects the proposed rule to be challenged legally if it is adopted by the department. He pointed, for example, to questions that St. Joseph's Hospital attorneys asked of department officials during Tuesday's hearing.

"They were here cross-examining the department in advance of the rule challenge,'' Ecenia said.

But with the annual legislative session ready to start next week, HCA could try to get a bill passed that would resolve the disputes about the already-operating trauma centers and future facilities. A lobbying battle broke out at the end of the 2013 session about the issue, though lawmakers wound up approving relatively limited changes.

"I believe both the Senate and the House are looking at trauma legislation,'' Ecenia said after Tuesday's hearing.

The department proposed the rule after holding a series of public hearings and a January negotiating session, which was led by former Florida Supreme Court Justice Kenneth Bell. The proposal would allow at least one trauma center in each of 19 regions, with the numbers determined by criteria such as population, transportation times to hospitals, community support and numbers of severely injured patients.

As an example, a region that includes Osceola, Orange, Lake, Seminole and Sumter counties would be allowed to have as many as three trauma centers under the criteria. It currently has one.

But critics point to issues such as the proposed use of 19 areas, which was a key topic in the earlier rule challenge. They contend the department is required to use seven broader regions that are aligned with the state's domestic-security task forces --- an argument that department General Counsel Jennifer Tschetter disputed.

Another heavily debated part of the criteria is the role that community support should play in determining whether areas receive trauma centers. That issue stems from concerns that trauma centers should be based on need, as new facilities can draw patients and physicians away from existing facilities.

Physician David Ciesla, trauma medical director at Tampa General, said trauma providers are "very divided" on the community support issue. But he said it is important that the state assess the need for trauma centers, not simply look to add more of the specialized facilities.

But Tschetter reiterated the department's position that community support should be a part of the trauma-center calculus.

"The department has been adamant about including community support,'' she said. "It is an important factor."