Miami-Dade County

Hospital wars? Aventura gets trauma center, Jackson South does not

Aventura Hospital and Medical Center received provisional approval from Florida’s Department of Health last week to operate a Level II trauma center effective May 1.
Aventura Hospital and Medical Center received provisional approval from Florida’s Department of Health last week to operate a Level II trauma center effective May 1. Miami Herald

Competition for trauma patients among Miami-Dade hospitals is heating up. The Florida Department of Health last week turned down an application from Jackson Health System to open a trauma unit in South Miami-Dade but granted provisional approval for Aventura Hospital and Medical Center to open a trauma center in the northern end of the county.

The state’s decision gives one of the nation’s largest for-profit hospital chains, Hospital Corporation of America or HCA, two of the three adult trauma centers in Miami-Dade. HCA-owned Kendall Regional Medical Center opened a trauma center in November 2011. Jackson Memorial Hospital in Miami has the third.

That raises the stakes for Jackson, which had hoped to win approval for a trauma unit at Jackson South Community Hospital to get ahead of possible new competition.

In a memo to elected officials dated May 1, Jackson CEO Carlos Migoya called the state’s denial of the application “a disappointing development.”

Migoya noted that the application process is “complex and highly technical” and that administrators were considering next steps, including an appeal of the state’s decision.

Aventura Hospital received provisional approval to operate a trauma center effective May 1. Hospital officials issued a press release Wednesday saying that the hospital has built infrastructure for trauma services including emergency room renovations to add two new trauma bays, specialized equipment and a new helipad with immediate access to the ER.

Those renovations have equipped the hospital to “provide critically injured patients in Aventura and the surrounding areas with timely access to medical care when saving time is crucial, which greatly increases the chance of survival,” CEO Dianne Goldenberg said in a written statement.

The push for trauma centers may be related to a significant increase in funding. The centers are funded through vehicle registration taxes and red light camera fines.

As red light cameras have proliferated, the amount of money sent to the state’s 27 trauma centers has spiked — from $5.1 million in 2011 to more than $12.6 million in 2012, according to a March 2014 assessment of Florida’s trauma centers by the Department of Health.

In an April 30 letter to Migoya, Florida health officials cited numerous deficiencies in Jackson’s application but noted that the hospital system can reapply in the future.

Among the ways that Jackson’s application failed to meet state standards:

▪ Some of the trauma surgeons listed in the application already work in that capacity at Jackson Memorial, raising concerns that those doctors cannot cover two facilities effectively.

▪ Some of the trauma surgeons and many of the nurses listed did not meet continuing medical education requirements.

▪ The helicopter landing pad at Jackson South is not licensed by the state Department of Transportation, and no documentation was provided that the Federal Aviation Administration has approved use of airspace.

▪ The proposed trauma center does not have at least one adequately staffed operating room immediately available for all trauma patients 24 hours a day.

Jackson administrators had planned to add adult trauma centers at the system’s hospitals in South Miami-Dade and North Miami Beach as part of a strategy to position itself for a potential increase in competition. But the only applications received by the April 1 deadline were from Jackson South and Aventura Hospital, said Mara Burger, press secretary for the Department of Health.

For 14 years, Jackson had the only adult trauma unit in Miami-Dade. But shortly after the state changed its regulations to allow up to six trauma centers in the county, Kendall Regional applied for and received provisional approval for a trauma center in November 2011.

That competition took a bite out of Jackson’s revenues.

In Kendall Regional’s first two months of operating a trauma center, Ryder Trauma Center at Jackson Memorial saw revenues decline by about $3 million. And in a 2012 memo to Jackson’s board of trustees, Migoya warned that private competition could siphon away 50 to 60 percent of the patient volume at Ryder.

The amount of funding received by trauma centers from the state depends on the number of patients treated.

Ryder is the county’s only Level I adult trauma center, meaning it has specialists on site around the clock. Kendall Regional is a Level II, as is Aventura Hospital, with specialists on call. Just six miles north of Aventura, Memorial Regional Hospital in Hollywood operates a Level I trauma center.

Ambulances are required to take trauma patients — usually victims of car accidents or acts of violence — to the nearest trauma center. According to the state’s assessment, criteria used to evaluate the number and level of trauma centers needed should include population, transport times, community support and number of severely injured patients.

Martha Baker, a former Jackson trauma nurse and president of the local doctors and nurses union, said state health officials missed an opportunity to create a trauma center network among Jackson’s three hospitals in Miami, North Miami Beach and South Miami-Dade.

“It doesn’t make sense,’’ she said, “that other, for-profit sector hospitals try to learn trauma when you have a Level I trauma center [at Jackson Memorial] that’s the best in the country, that trains the U.S. Army, and they have two community hospitals that would have two Level II trauma centers that would link to a Level I.’’

Adding more trauma centers in Miami-Dade is something that has been tried before and failed. In the 1980s, the state deregulated trauma centers and many hospitals opened the units, then closed them because they lost money on uninsured patients or couldn’t find doctors willing to staff the units.