The Miami Herald | EDITORIAL

The trauma over trauma


OUR OPINION: Jackson executives should protect quality of Ryder Trauma Center

For anyone wondering what all the drama was about at the Miami-Dade County Commission meeting this week involving workers from Kendall Regional Medical Center, here’s a clue: Trauma patients can mean big money for revenue-starved hospitals, and suddenly everyone wants a piece of the action.

For a trauma patient — someone badly injured in a traffic collision, say, or suffering from a gunshot or other life-threatening injury — the availability of high-quality emergency room care is literally a matter of life or death. That’s why the commission’s action bears scrutiny.

The issue was whether the commission should reconsider a vote to allow Jackson Health System to take legal action to defend its ability to provide quality trauma care to the community. Wisely, the commission decided to leave Jackson free to protect itself by resorting to the courts, if necessary, to defend the level of service offered by its Ryder Trauma Center, one of the top-rated emergency treatment hospitals in the country.

But the issue is far greater than a potential lawsuit. It’s about maintaining a first-class, Level 1 Trauma Center in Miami-Dade County without having to seek more help from the taxpayers who support Jackson as a public facility.

With revenues falling and a new healthcare law on the horizon that may result in hospitals having to do more with less, there has been more competition among hospitals for trauma patients — who, if insured, can be a major source of revenue. According to Jackson officials, after the Florida Department of Health granted a provisional license to Kendall Regional Medical Center, in November, 2011, Kendall took insured patients away from Jackson.

“The immediate impact was a reduction in net patient revenue at Ryder of approximately $28.5 million per year,” Jackson CEO Carlos A. Migoya wrote in a letter to Commission Chair Rebeca Sosa and other members of the panel.

When Jackson asked for two new trauma centers to serve north and south Miami-Dade, it found that the state Department of Health had frozen the applications process after another state agency ruled that DOH’s rules were flawed.

Jackson argues that DOH’s actions were “selective and capricious” — giving the go-ahead to a competitor at Kendall Regional, but preventing Jackson from proceeding with its own application.

Its executives make a persuasive case that “fully protecting the trauma program based at Ryder may eventually require legal action.” That’s why the commission rightly supported Jackson’s plea to give it the freedom to do whatever is necessary to protect Ryder.

But there are larger questions here that make it imperative for the state to resolve this issue. If the rules under which Kendall Regional was approved are no longer valid, DOH must come up with a new and better procedure.

And it should review the need for more trauma centers. A trauma center is not like a shoe store or a shopping mall. More is not necessarily good for competition, but instead leads to excess capacity, which, in turn, dilutes quality and winds up hurting trauma patients.

In South Florida, according to Mr. Migoya’s letter, private hospitals have a history of suddenly closing trauma programs that become unprofitable, “leaving taxpayers to fill the service gap at public hospitals such as Jackson.”

That’s what led to the creation of Ryder, in 1992. Today, it remains one of the top trauma centers in the country and deserves the full backing of the County Commission and the taxpayers.

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