State Politics

Long-running drama over hospital trauma centers ends with new legislation

Trauma nurse Luis DeRosa checks on systems in one of the new trauma units at Jackson South Community Hospital in 2016. Jackson South’s trauma center is part of the compromise deal reached by the Legislature.
Trauma nurse Luis DeRosa checks on systems in one of the new trauma units at Jackson South Community Hospital in 2016. Jackson South’s trauma center is part of the compromise deal reached by the Legislature.

More than a decade of legal squabbling over who can run trauma centers — and where — is being resolved under a deal passed in the waning days of the legislative session.

A bill that cleared the Senate on Tuesday would overhaul regulations overseeing the state’s trauma system, which treats serious injuries like severe burns and gunshot wounds, by setting new standards for what can be designated as a trauma center while grandfathering in some that have been subject to lawsuits. The rare compromise between for-profit hospital chains like HCA and “safety net“ hospitals like Jackson Memorial Hospital in Miami, brokered by lawmakers, calms a series of feuds over where trauma centers can be built and who should operate them.

The deal ends most of the legal battles over trauma centers, particularly some in Miami-Dade, and adds a strict need formula that makes it unlikely the state will add any more trauma centers anytime soon.

“Trauma has been causing deep divisions in the hospital community for many, many years,” said Bruce Ruben, president of the Florida Hospital Association. Until the compromise struck by Sen. Dana Young, R-Tampa, and Rep. Jay Trumbull, R-Panama City, a resolution felt “out of reach,” he said.

Trauma centers are regulated by a series of laws and the Department of Health, which requires a trauma center obtain approval to receive a trauma designation. Because the number of trauma cases that occur each year are limited, hospitals with more established trauma centers have contended that having too many centers would cut into their current number of cases and lessen the amount of practice their providers get treating complicated injuries.

But HCA, whose plans to open new trauma centers have drawn some lawsuits, has argued that adding more facilities expands access to care for seriously injured patients.

Trauma cases have also drawn contention because they can bring in more money for the hospitals that operate them. They often require additional follow-up care and can be paid for from more sources like auto insurance or workers compensation coverage in cases like car crashes of workplace injuries. They also draw funding from vehicle registration taxes and red light camera fines.

The system currently caps the number of trauma centers in the state to 44 across 19 “trauma service areas,” though the legislation reduces the number of those areas to 18 and sets a new cap for the number of trauma centers at 35. (There is an exception for Memorial Hospital in Jacksonville, which might receive the 36th designation depending on ongoing litigation.)

The legislation also cements the status of four trauma centers in Miami-Dade: Jackson Memorial’s Ryder Trauma Center, a pediatric center at Nicklaus Children’s Hospital and two run by HCA at Aventura Hospital and Medical Center and Kendall Regional Medical Center. Jackson South Medical Center, which currently has a provisional designation, would be able to open a trauma center under the deal.

Jackson spokeswoman Lidia Amoretti praised the deal, saying it “will ensure that residents of Miami-Dade County continue to receive the highest quality trauma care.” She added that the county is “adequately served by the existing trauma centers.”

Pinellas will keep Bayfront and Johns Hopkins All Children’s Hospital as trauma centers, though Northside Hospital in St. Petersburg, an HCA facility, would be blocked from approval for a center.

Under the bill, HCA receives trauma center designations for three of its facilities, including one at Orange Park Medical Center in Clay County.

“We are pleased that access to care has been greatly improved for all Floridians as a result of the legislation,” said Bryan Anderson, HCA vice president of government relations, calling the trauma battles a “long-running dispute.” The last time a bill regulating the trauma system passed the legislature, according to a staff analysis, was in 2004.

The bill also creates an advisory council, which must be established by Oct. 1, to meet quarterly and provide recommendations to the department. The department would be required to analyze the state’s trauma system by August 2020 and repeat such an analysis every three years.