Hospital Regulation
2:35 pm
Mon December 3, 2012

Court Slaps State Over Trauma Center Sites

A state appeals court on Friday said the Florida Department of Health used an invalid rule to approve new trauma centers in Pasco, Manatee and Clay counties, handing a victory to nearby hospitals that have waged a long-running battle against the facilities.

Wrong Rule: A court held the state used an outdated rule to permit trauma centers where they might not be needed.
Wrong Rule: A court held the state used an outdated rule to permit trauma centers where they might not be needed.

At least in the short term, the ruling appears likely to have little effect on trauma centers that opened last year at Regional Medical Center Bayonet Point in Pasco County, Blake Medical Center in Manatee County and Orange Park Medical Center in Clay County. But the longer-term effect remains unclear as a related legal case is still pending.

State Won't Appeal

State Surgeon General John Armstrong, who heads the Department of Health, issued a statement Friday afternoon saying the agency will not pursue a further appeal and will create a new rule for approving trauma centers.

"(The) department has immediately started the rule-development process,'' the statement said. "Workshops will begin in December to develop an inclusive, sustainable trauma system that distributes trauma centers throughout Florida."

But the HCA health-care chain, which operates the Pasco, Manatee and Clay hospitals, issued a statement saying it was disappointed in the ruling and would seek to have it taken up again.

"We feel it is incorrect and not in the best interest of patients in Florida where there is demonstrated need for more timely and appropriate access to trauma care, and we will seek reconsideration by the court,'' the HCA statement said.

Five Plaintiffs, Split Court

The 1st District Court of Appeal, in a 2-1 ruling, upheld an administrative law judge's ruling last year that the department had relied on an outdated rule to approve the trauma centers. In doing so, the court sided with arguments made by Tampa General Hospital, St. Joseph's Hospital in Tampa, Bayfront Medical Center in St. Petersburg and Shands Jacksonville Medical Center.

Those hospitals operate trauma centers and face losing patients and physicians to the new facilities. Shands Jacksonville officials said Friday that the decisions by the appeals court and Administrative Law Judge W. David Watkins affirmed the state should not allow trauma centers to open until experts determine the facilities are needed.

"There are a range of important issues that need to be considered when it comes to trauma,'' said Shands Jacksonville President and Chief Executive Officer Jim Burkhart. "Our organization simply wants to make sure the state is following the rules that were created to benefit the public."

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. The rule used by the Department of Health in reviewing proposals for the three new centers dated to 1992.

Siting Rule Was Outdated

Judges Nikki Ann Clark and Philip Padovano, who agreed on the majority opinion Friday, wrote that the Department of Health had not updated the rule to take into account changes made in state law in 2004. Perhaps the biggest issue was that the 1992 rule led the department to review applications based on 19 geographical areas of the state. Clark and Padovano wrote that the 2004 law would have aligned the trauma-area boundaries with seven regional domestic-security task forces.

"Because the rule continues to set forth 19 trauma service areas that are not coterminous with the boundaries of the seven regional domestic security task forces, it does not implement the changes in the 2004 version of (state law),'' Clark and Padovano wrote.

But dissenting Judge Brad Thomas took issue with the majority's interpretation of the 2004 changes, pointing to part of state law that still includes the 19 geographical areas. Also, he wrote the Legislature has not disapproved during the past eight years of the department's use of the rule.

"This eight-year silence within the legislative branch constitutes evidence of its approval of the department's decision to retain the rule, until and unless the Legislature directs otherwise,'' Thomas wrote.

HCA, which announced in 2010 that it planned to add trauma centers in the state, said in the statement that it believes Friday's ruling will "have no impact on the ongoing operations" of the already-opened facilities. But with the rule being found invalid, opponents could use another pending legal case to challenge the department's actual approval of the new trauma centers. -- News Service of Florida

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