A plan to shield three disputed trauma centers from legal action — while also placing limits on trauma center access fees — saw its chances of becoming law dim Thursday after the House loaded it with language from other bills.
One attempt to remove a controversial component of the bill failed by a slim margin. The provision, which applies only to Miami-Dade County, would give the Miami-Dade Public Health Trust total control over contract negotiations between Jackson Health System and its labor unions.
Rep. Eddy Gonzalez, R-Hialeah, filed an unsuccessful amendment to remove that provision of the bill and restore the power of the Miami-Dade County Commission to have final say.
Jackson, Miami-Dade County, the Public Health Trust and the healthcare workers union all supported Gonzalez’s amendment.
“All this does is allow for the elected officials of Miami-Dade County to vote on union contracts if they go to impasse,” Gonzalez said.
But Rep. Carlos Trujillo, R-Miami, pointed out that a grand jury in 2010 had concluded that the Miami-Dade Commission exercises too much authority over the Public Health Trust.
“We have a Public Health Trust in place that is non-partisan and that is ultimately accountable for the financial well-being of that hospital,” Trujillo said. “We have put these people in a position of power ... but they are powerless in all labor negotiations [because] all impasses and negotiations will be sent to a county commission.”
Gonzalez’s amendment failed in a 53-62 vote.
Rep. Michael Bileca, a Miami Republican who sits on the Public Health Trust, voted against the amendment. Other Miami-Dade lawmakers who voted against the amendment included Trujillo and Republican Reps. Frank Artiles, José Félix Díaz, Jeanette Núñez and José Oliva.
The so-called “trauma drama” fix is weighed down with at least 10 other healthcare provisions, turning into an omnibus bill that may be too unwieldy to gain Senate approval.
House Bill 7113 is expected to be approved Friday in the House, but the Senate is already expressing reservations.
“Any time you have a piece of legislation that big, it’s usually problematic,” said Sen. Denise Grimsley, R-Sebring, the healthcare budget chief.
Both HB 7113 and Grimley’s SB 1276 grandfather in three HCA-owned trauma centers that have faced years of litigation: Regional Medical Center Bayonet Point in Pasco County, Blake Medical Center in Manatee County and Ocala Regional Medical Center in Marion County. They also create a one-year, $15,000 cap on trauma activation fees and a one-year moratorium on new trauma centers unless new rules are finalized for establishing future centers.
The fee limitations were added after a Tampa Bay Times investigation revealed that hospitals across the state were charging huge fees to trauma patients even when they needed little more than first-aid. HCA, which has entered the Florida trauma market in the past few years, had fees averaging $27,644 per patient in the first half of last year compared to $6,754 at other state hospitals.
The amendment approved by the House on Thursday also requires Ocala Regional, whose trauma center now holds provisional licensing status, to meet requirements needed to get to verified status by the end of the year. Legacy trauma centers like Tampa General Hospital, Bayfront Medical Center, St. Joseph’s Hospital and Shands Jacksonville Medical Center have agreed to drop their lawsuits challenging the HCA facilities if that condition is met.
“Safety net hospitals have always supported a statewide trauma system that gives all Floridians timely access to high-quality, life-saving care when they need it,” said Ron Bartlett, a spokesman for the Safety Net Hospital Alliance of Florida. “The amended legislation passed by the House today is a step forward that addresses our chief concerns with earlier bills and allows our hospitals to focus resources on patient care instead of the courtroom.”
But the House plan now also includes new requirements that doctors consult the state’s Prescription Drug Monitoring Program, authorization allowing highly trained nurses to practice independently, regulations for virtual doctor visits by certain types of providers and a statewide medical tourism marketing plan.
Still more was added to the bill on Thursday, including relaxing current rules so pharmacists can supervise more pharmacy technicians and doctors can supervise more physician assistants.
Other components of the omnibus HB 7113 are in direct conflict with Senate proposals. For example, the House wants to let highly trained nurses open practices outside of doctor supervision. The Senate legislation, SB 1352, allows nurse practitioners to perform additional tasks but stops short of allowing them to practice independently. The bill was never voted out of committee to get to the full Senate.
The Public Health Trust provision is not included in any Senate bill.
Herald/Times reporters Mary Ellen Klas and Kathleen McGrory contributed to this report.