In a case that could have ramifications for hospitals in other parts of the state, an appeals court Thursday waded into an industry fight about whether the Florida Department of Health properly approved new trauma centers in Clay, Manatee and Pasco counties.
The Department of Health and hospitals affiliated with the HCA health-care chain want the 1st District Court of Appeal to overturn an administrative law judge's order from last year. That order found a DOH rule that allowed the hospitals to open new trauma centers to be invalid.
On the other side are hospitals in the Jacksonville and Tampa Bay areas that have long provided trauma care and face additional competition from the new facilities, which are at HCA's Orange Park Medical Center in Clay County, Blake Medical Center in Manatee County and Regional Medical Center Bayonet Point in Pasco County.
Jeffrey Frehn, an attorney for Tampa General Hospital and St. Petersburg's Bayfront Medical Center, which have fought the new trauma centers, said the administrative judge found that the department used an outdated 1992 rule in reviewing the trauma centers. Also, he said the department had not carried out a legislative requirement to do annual reviews that involve where --- and how many --- trauma centers are needed in the state.
"The real question is, why has the department not conducted these reviews?'' Frehn told the three-judge panel.
Judge Brad Thomas asked a series of questions that appeared to indicate he thinks Administrative Law Judge W. David Watkins intruded on the Legislature's power to make decisions about issues such as whether more trauma centers are needed. State law requires that Florida be divided into 19 trauma regions, sets an overall cap of 44 trauma centers and directs the Department of Health to use a rule to allocate the number of centers that will be allowed in each region.
"Isn't that a question for the Legislature and not the ALJ?'' Thomas, a former legislative committee staff director, asked at one point.
Watkins issued his order in September 2011, siding with Tampa General, Bayfront, Shands Jacksonville Medical Center and St. Joseph's Hospital in Tampa against the new facilities. But two months later, the department allowed the trauma centers in Pasco, Manatee and Clay to open, saying it could do so because the appeal was pending.
HCA announced in 2010 that it planned to add more trauma centers in the state. But that has raised concerns from hospitals with already-existing trauma centers, which face the possibility of losing patients and competing for specialists needed to staff the facilities.
Regulations on the number and locations of trauma centers stem, at least in part, from the relatively high costs of providing trauma care and making sure enough specialists are available.
Stephen Menton, an attorney representing Regional Medical Center Bayonet Point and Blake Medical Center, told the judges Thursday that hospitals already have to go through a detailed process and spend millions of dollars before they are allowed to open trauma centers. He said that process includes showing they have resources in place, such as enough specialists.
It is unclear when the appeals court will rule. Also, if the court upholds Watkins' order, it was not immediately clear what effect that would have on the operations of the new trauma centers in Pasco, Manatee and Clay counties.
Stephen Ecenia, an attorney for HCA, said after the hearing that he thinks such a ruling would only affect future applications for trauma centers elsewhere in the state. He described the hospitals opposed to the three trauma centers as "chasing a rainbow."
Frehn said after the hearing that he was not authorized by his clients to comment.
Regardless, the judges' ruling might not end the legal wrangling about the issue. The Tampa Bay and Jacksonville-area hospitals also filed another series of administrative challenges last year to the opening of the trauma centers.
The Department of Health rejected those challenges, which spurred three additional appeals to the 1st District Court of Appeal. Those cases, which have been consolidated, remain pending, according to an online docket.