A day after getting hit with another legal challenge to the opening of a trauma center, the Florida Department of Health on Friday began an effort to revamp the way the state approves new trauma facilities.
The issue has sparked battles in the hospital industry and led to an appeals-court decision last month that found the department was relying on an invalid rule in deciding whether to approve new trauma centers. The department began a series of meetings Friday to take input about drawing up a new rule, with state Surgeon General John Armstrong saying it is time to "move beyond conflict to conversation."
"Our frame of reference must be the most important person in trauma --- the acutely injured patient,'' Armstrong told a group of industry officials, attorneys and trauma physicians who attended a meeting in Tallahassee.
But the meeting came a day after Munroe Regional Medical Center in Ocala, Shands Hospital at the University of Florida and Shands Jacksonville Medical Center filed a lawsuit challenging a department decision this month that allowed a trauma center to open at Ocala Regional Medical Center.
The lawsuit points, in part, to the Nov. 30 decision by the 1st District Court of Appeal that found the department was using an invalid rule. It contends that the department doesn't have the authority to approve new trauma centers until a new rule is put in place and that the decision to grant what is known as "provisional" approval to Ocala Regional should be blocked.
"Without this court halting these actions, the department's rogue and outrageous conduct will be unchecked, the directive (in state law) for a uniform and integrated state and local trauma system will continue to be disregarded and petitioners (Munroe and the Shands hospitals), their staff and their patients will be irreparably injured,'' says the lawsuit, which was filed in Leon County circuit court.
But Stephen Ecenia, an attorney for the HCA health-care chain that operates Ocala Regional, said the department acted appropriately in approving the new trauma center. He said the appeals-court ruling is not final, as HCA is seeking a rehearing of the decision.
"I think Ocala's provisional approval was correct and appropriate and consistent with the law,'' Ecenia said.
The appeals-court ruling and the effort to draw up a revised rule stem from a legal fight about the approval in 2011 of new trauma centers at Blake Medical Center in Manatee County, Regional Medical Center Bayonet Point in Pasco County and Orange Park Medical Center in Clay County. Like Ocala Regional, those three hospitals are operated by HCA.
Four hospitals that have long operated trauma centers -- Tampa General Hospital, St. Joseph's Hospital in Tampa, Bayfront Medical Center in St. Petersburg and Shands Jacksonville -- challenged the approvals. Ultimately, an administrative law judge and the appeals court found that a 1992 department rule was invalid, though the three new trauma centers have continued operating.
The appeals court found that the department 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 trauma-center applications based on 19 geographical areas of the state. The court said the 2004 law would have aligned the trauma-area boundaries with seven regional domestic-security task forces.
Department officials said after the appeals-court decision that they would revamp the rule, though they did not indicate Friday what changes they are considering. Similar meetings to take public comments will be held in Duval, Escambia, Hillsborough and Miami-Dade counties, said Armstrong, who is the department's secretary.
Many of the speakers during the meeting said Florida has a high-quality trauma system and expressed concerns that adding trauma centers would siphon off patients from existing facilities.
Such siphoning, they said, would make it harder to adequately train trauma physicians and other staff members and also would reduce the amount of money available to run the centers. Also, they said more trauma centers would create competition for specialists, driving up costs.
"We're at a crossroads in our trauma system,'' said Lawrence Lottenberg, an associate professor of surgery at the University of Florida.
Several speakers called for an independent study, possibly done by the American College of Surgeons, to determine the need for new trauma centers.
HCA announced in 2010 that it planned to add trauma centers in the state and argues, at least in part, that the new facilities provide greater access to trauma services. Randy McVay, chief executive officer of Ocala Health, which includes Ocala Regional Medical Center, said in a statement after getting approval Dec. 7 that the hospital's new trauma center will meet a "true community need."
This designation means we can now provide residents of Marion and surrounding counties with trauma care in their own community and ensure that critically injured patients have access to treatment faster, which could mean the difference between life and death, McVay said.
Ecenia did not make comments during Friday's meeting but said later that he was not surprised speakers gave a "protectionist perspective of the existing trauma centers."
While the department allowed Ocala Regional to open a trauma center, it sent notifications Dec. 13 to at least two other hospitals -- Munroe and Jackson North Medical Center in Miami-Dade County -- that it could not approve their proposed trauma centers until the rule-making process is finished.
The department did not immediately respond to questions Friday about why it took that stance with Munroe and Jackson North. But the lawsuit filed Thursday questioned whether the department was treating Munroe differently than its competitor, Ocala Regional.
"The department's position with regard to Munroe's application is totally inconsistent with its approval of Ocala Regional's application one week earlier,'' the lawsuit says. "The legal circumstances are identical and the approval of Ocala Regional as a provisional trauma center must be reversed."
