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Talks Aimed at Healing Trauma Divisions

With a former Supreme Court justice shepherding the talks, negotiators Thursday tried to break through a long-running disagreement about how Florida should approve new trauma centers across the state.

Trauma surgeons, hospital lawyers and the Florida Department of Health's top attorney held a day-long negotiating session aimed at coming up with a rule that could play a key role in determining where trauma centers will be allowed to open in the future.

The unusual session came after more than two years of legal and political battling in the hospital industry about decisions by the department to allow hospitals affiliated with the HCA health-care chain to open trauma centers --- and amid debate how to handle future applications.

The Department of Health late last year proposed a rule that likely would lead to more trauma centers across the state. Under the draft rule, the department would use a scoring system that takes into account factors such as population, transportation times and community support to determine how many trauma centers should be allowed in each of 19 areas of the state.

But the proposed rule continued dividing the industry, prompting Thursday's negotiating session led by former state Supreme Court Justice Kenneth Bell.

The negotiators discussed potential changes to the proposed rule and said they made progress on issues such as using population as a factor in trauma decisions. But it was also clear that divisions remained about parts of the rule, including the department's stance that community support should be an important factor in determining whether trauma centers get approved.

Critics argued that giving substantial weight to community support would politicize a process that should be based on need. Trauma centers are relatively expensive to operate and rely on specially trained physicians and staff.

"I don't know how community support equates to the need for a trauma center,'' said Fred Moore, a trauma surgeon at the University of Florida.

But HCA and other supporters of more trauma centers argue that communities should have increased access to care. Jennifer Tschetter, general counsel for the Department of Health, made clear that the department will not back away from using community support as a factor in the rule.

"The department feels very strongly that that needs to be part of this analysis,'' she said.

Department officials will use information from the negotiating session to revise the proposed rule, a process they hope to finish by April 1. That revised rule would be subject to public comment --- and could ultimately face legal challenges if opponents are not satisfied.

Looming behind Thursday's talks were legal battles that began in 2011 when Tampa General Hospital, St. Joseph's Hospital in Tampa, Bayfront Medical Center in St. Petersburg and what was then known as Shands Jacksonville Medical Center challenged a two-decade old rule the department used in reviewing trauma applications. The Tampa Bay and Jacksonville hospitals have long operated trauma centers and were trying to block the approval of new trauma facilities at Blake Medical Center in Manatee County, Regional Medical Center Bayonet Point in Pasco County and Orange Park Medical Center in Clay County.

An administrative law judge found that the old rule was invalid, but the department later allowed trauma facilities to open at the three hospitals, all part of the HCA chain. Blake and Regional Medical Center Bayonet Point continue to operate trauma centers, though the Orange Park facility was later ordered closed by the state for separate reasons.

Also tossed into the controversy was a decision by the department in late 2012 to allow a trauma center to open at Ocala Regional Medical Center, a move that has drawn opposition from UF Health Shands Hospital in Gainesville. The department told a House panel this month that it faces 19 legal cases related to decisions about approving trauma centers, including cases that threaten the continued operation of the HCA trauma facilities.

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