After a bill to expand trauma centers once again failed in the state Legislature earlier this year, a new legal fight is underway in Jacksonville that could affect how catastrophic injuries are dealt with throughout the state.
UF Health Jacksonville has challenged a state decision to give preliminary approval to a new trauma facility at a rival hospital, according to the News Service of Florida.
The Florida Department of Health decision last month gave what is known as “provisional” approval for a trauma center at Memorial Hospital Jacksonville, according to documents filed in the case.
UF Health Jacksonville also has been in a legal battle over a state decision to allow a trauma center to open at Orange Park Medical Center in nearby Clay County.
The argument by existing trauma centers is that by opening new ones it dilutes the needed medical expertise necessary to respond to these life-threatening injuries. State law caps the number of trauma centers statewide at 44.
In Palm Beach County, there are two Level 1 trauma centers at St. Mary’s Medical Center and Delray Medical Center. The Health Care District of Palm Beach County runs the trauma system, though.
Jupiter Medical Center took out full-page ads in this newspaper and others and lobbied lawmakers to keep them from changing the rules on hospital expansion. From the result, it worked.
The Florida Legislature failed to pass one of Gov. Rick Scott’s pet bills that would have eliminated the certificate of need process. Under the certificate of need process, hospitals must show a significant need for the community to expand or move into specialized practice areas.
“The organization’s effort among others played a part in it not coming to a vote in the Senate,” said John Couris, the president and CEO of Jupiter Medical Center.
Thus, Florida remains one of 36 states and the District of Columbia that currently limit entry or expansion of health care facilities through certificate-of-need programs. In Florida, this process extends to acute hospital beds to organ transplants to psychiatric services.
Gov. Scott and House Republicans said getting rid of the certificate of need process would open up competition and lower prices.
But Jupiter Medical Center and other critics said deregulation would actually do the opposite by benefiting big hospital chains who could dictate higher prices and undercut patient pool are that is crucial for doctors to perfect their skills.
Couris said the open letter to the community published in full-page advertisements showed the hospital’s commitment to top-notch care. He said competition is already off-the-charts when it comes to certain areas of medicine, such as heart surgery and maternity care.
“We compete every day in healthcare. South Florida is a hyper-competitive market,” he said. “We were concerned for the consumer, for access, quality and cost.”
Couris reiterated that he isn’t against the free market but when it comes to health care appropriate regulation is necessary. Certificate of need “is appropriate regulation and it works,” he said.
The Legislature also let a bill die when the session ended Friday that would have expanded the number of trauma care centers in Florida. Critics had the same worries that the measure would undercut patient pools and thus hurt performance at existing trauma care centers.
The Health Care District of Palm Beach County monitored the progress of both bills.
Currently, Delray Beach Medical Center and St. Mary’s Medical operate Level-1 trauma centers. Both hospitals opposed plans by JFK Medical Center in Atlantis to get into the trauma business last year.
Robin Kish of the Health Care District released a statement on the issue:
“Our position remains constant,” she said. “The Health Care District, which oversees the county’s integrated, lifesaving Trauma System, treated more than 4,000 trauma patients in 2016 and we are committed to delivering the highest quality care so traumatically-injured patients can return to their daily lives.”
Palm Beach County got it’s annual physical and the news was good.
Diverse and with a population of 1.4 million, Palm Beach County moved up to No. 8. It has moved up one slot each of the last two years and health officials say it shows that wellness programs by the Department of Health are working.
All the other counties ahead of them have far less population.
The researchers look at physical environments, social and economic factors, health behaviors and clinical care.
“These rankings are a testament to the hard work and commitment our community partners have toward assuring a healthy community,” said Dr. Alina Alonso, Director, Florida Department of Health in Palm Beach County.
Patrick McNamara, president and CEO of Palm Healthcare Foundation, said programs such as Let’s Move, Diabetes Month and Healthier Together have paid off with healthier citizens.
He pointed to Joshua Timmer, a 14-year-old from St. Ann’s Catholic School in downtown West Palm Beach who took it upon himself to bring the Let’s Move program — a Palm Healthcare initiative – to his classmates. The program encourages 30 minutes of vigorous exercise a day to combat obesity.
On Wednesday, Joshua said between classes he was thrilled with the county’s ranking but wants to get people moving around the world.
He said it wasn’t easy putting down the video games at first.
“It was a hard change,” he said. “At the beginning, I wanted to play more video games, but then I realized I got stuff to do and I need to do more stuff outside.”
These days he plays basketball with his sibling and golf. “I do at least 30 minutes outside every day,” he said.
McNamara said it was Timmer and residents like him that moved the needle for Palm Beach County in the right direction.
“He was just an example of a resident taking it upon himself to be part of the solution,” he said. “One of the affirming things for us is that we are seeing growing numbers like him.”
Timmons is not alone. Andrea Bruton, the owner of SkyeHigh Fitness, leads an exercise program for older women in the black community in Delray Beach.
“Let’s Move has already made such a positive difference, such as bringing people and communities together–groups that would never otherwise mingle and building great rapport between the community and law enforcement,” she said.
The program gets companies, schools, colleges, non-profits, local community groups, families, to organize a team whose members log the minutes they have “moved” and compete against each.
Let’s Move is held each March for the entire month.
So let’s look at the numbers of the county’s annual checkup.
We got good numbers in the category of “health behavior” be it smoking tobacco or drinking excessively, ranking third among all Florida’s 67 counties. We landed in the top 10 in Life Expectancy (9) and Clinical Care (9).
Palm Beach County did get seem dings. It ranked 19th in Social and Economic Factors, such as income inequality and violent crime. It also ranked 32nd in “Physical Environment” that measures everything from pollution to driving alone to work.
We are lonely commuters, it appears.
The hospitals see it from a different perspective. They see a community benefiting greatly from the Charles E Schmidt College of Medicine at Florida Atlantic University which spins out doctors in training to five hospitals.
“It is kind of known fact whenever you have academic institution affiliated with a hospital provider that elevates the level care,” said Dr. Anthony N. Dardano, the vice president for Medical and Academic Affairs at Delray Medical Center.
He also said that increase the quality of care and cutting-edge medical care are due to the elderly population.
So next time you shake your fist at a senior maybe driving too slow think that he or she is to thank for heart surgery techniques not available in other counties and a host of other specialties that are available when it comes to treating cancer and brain disorders.
“The average age of a patient at Delray Medical Center is in the 80s,” Dardano said. “They are sicker people and in order to keep up we have developed state of the art techniques and have recruited physicians who can do all these specialties.”
The bill comes on the heels of another proposed law that would get rid of the requirement that hospitals show a community need to expand or add a specialized program.
And like that bill, this one has the blessing of Gov. Rick Scott, a former healthcare executive. Scott has called for getting rid of a limit of 44 trauma centers statewide.
Proponents of more trauma centers argue getting rid of caps will result in less time needed to transport injured people for care. Critics say these facilities require highly trained medical staffs and that adding new centers will siphon patients and staff from existing trauma centers.
St. Mary’s Medical Center and Delray Medical Center — run by Tenet Healthcare — are Palm Beach County’s state-designated Level 1 trauma centers, handling the most extreme cases. Right now the average time to get a patient to one of these centers is eight minutes.
Dr. Robert Borrego, medical director of the Trauma Center at St. Mary’s Medical Center, said it is important that trauma centers have a certain number of patients to remain proficient.
“Can you imagine coming to a center and you have traumatic brain injury and the neurosurgeons only do about 10 operations a year? Are you going to comfortable there or do you want somebody who does 1,000 operations a year?”
Hutson’s bill was introduced after an administrative law judge’s ruling last week that the state Health Department had improperly allowed Orange Park Medical Center in Clay County to open a trauma center in 2016.
Currently, regulations allocate one trauma center to a five-county region of Northeast Florida and UF Health Jacksonville was not keen on the Clay County trauma center.
Hospital competition in Florida is already at a fever pitch. A trauma center gives a hospital one more way to advertise, attract medical talent and raise its profile — not to mention it looks really nifty on a billboard.
The hospital wars — readily apparent on practically every other billboard down the interstate — has now bled over into trauma with accusations that expansion by a competitor into the area threatens “the entire care system in our country.”
The fight pits two giants against each other: Tenet Healthcare and HCA Healthcare and puts taxpayers in the middle as the whole system is administered by the Health Care District of Palm Beach County.
Currently, the county’s state-designated Level 1 trauma centers are St. Mary’s Medical Center and Delray Medical Center.
Trauma centers handle the most extreme cases of emergencies, such as car accidents, gunshot wounds. Life and death hang in the balance with each case that comes through the doors.
The current trauma drama stems from Tenet competitor JFK Medical Center in Atlanta filing a letter of intent with the Department of Health on Sept. 30 to upgrade its trauma care services to Level 2 that would cater only to adults.
It is a first step in formerly submitting an application next year.
In a letter sent out today by Mark Bryan and Gabrielle Finley-Hazle – the CEOs of St. Mary’s Medical Center and Delray Medical Center respectively – the Tenet hospitals excoriate the competitor’s plan, saying it would undercut a system in place for 25 years.
“There will be a lack of qualified trauma surgeons to cover an excess center and decrease trauma center staff proficiency,” the letter states.
In the letter addressed to its board members, the community, employees and doctors, the CEOs say that the proposal goes against the five-year plan approved and submitted to the Department of Health and the Health Care District.
The district is an independent taxing district that operates Trauma Hawk and provides a health care safety net for the county.
The letter states since JFK is only offering adult trauma services it means if a tragic event occurs involving an entire family, then parents and children will be split up.
The Post plans on interviewing all players in this trauma drama and will update this story as warranted.
Whether its heart surgery or maternity, hospitals are very aggressive in vying for patients in the county.
St. Mary’s closed down its pediatric heart surgery unit last year following criticism that is now being leveled at JFK’s trauma plan: that the program diluted the number of patients and undercut the proficiency of existing programs in South Florida.
In the letter, the Tenet hospitals point to an investigation by the Tampa Bay Times into how HCA is targeting trauma for profit, charging exorbitant fees that pale in comparison to competitors.
“HCA is capitalizing on a marketplace that is unchecked by politicians or regulators. That has allowed one of the nation’s largest for-profit hospital chains to bill injured patients record fees,” according to the March 2014 story.
Dr. Ron Wierwora left the Health Care District of Palm Beach County after the Board in July 2015 surprisingly gave him a no-confidence vote after a series of bad audits and a failed attempted coup by the Sheriff’s Department to take over Trauma Hawk.
It should be noted, it took the district — which provides a health-care safety net on numerous fronts — more than year to officially fill Wiewora’s shoes as both CEO and Chief Medical Officer.
On Tuesday, Dr. Belma Andrić, was named to the chief medical officer position. She follows a decision by the Board to name Darcy Davis as CEO in March. Davis had served in various positions with the district before being tabbed to lead it.
In the meantime, the district lost Nicholas Romanello, its legal counsel. He resigned after being passed over for the CEO position in favor of Davis. The attorney is currently on the state Board of Medicine.
So Andrić joins a revamped leadership marshalling a district with a $200 million-plus budget and 1,200 employees. The district runs Trauma Hawk, Lakeside Medical Center in Belle Glade, primary care clinics and school nurses, among other services.
Dr. Andrić will be responsible for quality and patient safety across the Health Care District and will directly supervise Trauma Hawk and patient safety departments, among other duties.
She previously served as medical director of the District’s C. L. Brumback Primary Care Clinics, which provides care to over 30,000 adult and pediatric patients annually. She oversaw eight clinic locations
“She brings her love of data analytics and performance outcomes to this new role,” Davis said. “Dr. Andrić is a demonstrated networker who is able to reach beyond institutional walls to attract, recruit and inspire our clinical team.”
It seemed to be courting further drama when it considered for the open CEO position at least two officials from scandal-ridden Broward Health – the public health system in that county – but ended up choosing in March internal candidate Darcy Davis.