House revamps trauma care plan


TALLAHASSEE, Fla. – A key House committee Monday scaled back a plan that would have eliminated a limit on the number of trauma centers in the state --- but the panel sought to ensure that a disputed Jacksonville-area trauma center can keep its doors open.

The House Health & Human Services Committee revamped a bill (HB 1077) that originally would have eliminated a limit of 44 trauma centers statewide and gotten rid of limits in 19 different geographic regions. The proposal, backed by Gov. Rick Scott, emerged after years of hospital-industry fights about new trauma centers.

The revised bill would keep in place the 44-center statewide cap, though it would set new criteria for the numbers of trauma facilities in seven metropolitan regions.

Under that criteria, what are known as "trauma service areas" with populations of more than 1.25 million people would be determined to have a need for a minimum of two trauma centers. A trauma service area with a population of more than 2.5 million --- currently only an area made up of Miami-Dade and Monroe counties --- would be determined to have a need for a minimum of four trauma centers.

Much of the discussion during Monday's meeting focused on a long-disputed trauma center at Orange Park Medical Center in Clay County. The Florida Department of Health last year allowed the Orange Park hospital to open a trauma center, but the move was challenged by UF Health Jacksonville, which has long operated a trauma facility in neighboring Duval County.

Administrative Law Judge W. David Watkins in January ruled that the Department of Health had improperly allowed the Orange Park trauma center to open, though the judge did not have the power to force the facility to close. Watkins sent the case back to the Department of Health, where it remains pending.

Watkins wrote that current requirements place a limit of one trauma center in a five-county Northeast Florida trauma-service area that includes Clay and Duval counties.

The House bill, as revised Monday, would determine a need for a minimum of two trauma centers in the region, which also includes Baker, Nassau and St. Johns counties. That change effectively would ensure that the Orange Park trauma center would remain open.

Steve Ecenia, an attorney for the HCA health-care company, which includes Orange Park Medical Center, told the House panel that the trauma facility has cared for about 1,500 patients during the past year.

"It's not a small-volume center, and it certainly underscores the fact that there is a desperate need for more than one trauma center to serve this big geographic area that spans from Baker County (to) … Nassau County to the north, all the way down to St. Johns County," Ecenia said. "This bill would clearly recognize that in that community, there is a need for two trauma centers, just like there is in all of the other big urban areas of the state."

But Mark Delegal, an attorney for the Safety Net Hospital Alliance of Florida, which includes UF Health Jacksonville, argued against the revamped bill. The alliance, which includes teaching, public and children's hospitals, also lobbied against the original version that would have eliminated the limits.

"I think it's worthy of pointing out that when litigation was commenced about this, there was a determination there was no need in Orange Park," Delegal said. "But this (revised bill), by legislative fiat, says there is a need."

The House Health & Human Services Committee, which voted 14-4 to approve the revised bill, is chaired by Orange Park Republican Travis Cummings. A Senate trauma-care bill (SB 746), however, has not been heard in committees.

Hospitals and the Department of Health have waged a series of legal battles about approvals of new trauma centers in recent years.

Supporters of eliminating limits on trauma centers argue that more facilities would help improve access to care for severely injured patients. But opponents of such proposals say trauma centers are costly to operate and require highly trained staff and that allowing more trauma centers would lead to a dilution of the quality of care.

House bill sponsor Jay Trumbull, R-Panama City, said the bill would also set a need for a minimum of two trauma centers in a metro area that includes Lake, Orange, Osceola, Seminole and Sumter counties; an area that includes Pasco and Pinellas counties; an area made up of Hillsborough County; an area made up of Palm Beach County; and an area made up of Broward County.