Jupiter Medical wins battle with Legislature over deregulation

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.”

 

John Couris, president and CEO, of Jupiter Medical Center.

Trauma center, certificate of need bills die in Legislature again

This was the year that Gov. Rick Scott and Republicans in the Florida Legislature delivered on all their talk about opening up competition in health care. Like with medical marijuana legislation, it was a big failure.

One only needs to see every other billboard on Interstate 95 to realize the hospitals are in an all out war for patients in areas of heart surgery and maternity care. But Scott and House Republicans wanted to open up it even more in some very troublesome areas, critics said.

They wanted to add trauma centers across the state and to eliminate the requirement that hospitals prove community need before expanding into an area of practice.

Both bills (HB 7 and HB1077) died on Friday when the Senate refused to take them up. This is not the first time that Scott, a former health-care executive, has tried to get rid of these regulations.

This blog explored both issues during the session that also saw lawmakers fail to implement voter-mandated medical marijuana laws. 

When comes to specialized hospitals programs and trauma, hospitals need as many patients as they can get so they can perfect the practice. You know, brain injury and pediatric heart surgery are not exactly easy.

Governor Rick Scott holds a brief press conference at Palm Beach International Airport announcing his order for Florida National Guard recruiters to work from nearby armories after attacks in Tennessee on July 18, 2015. (Richard Graulich / The Palm Beach Post)
Governor Rick Scott wants to eliminate the need for hospitals to prove a community needs them to expand.

Trauma centers are no different.

Scott called for getting rid of a limit of 44 trauma centers statewide. Right now, Palm Beach County has two level-one trauma centers: St. Mary’s Medical Center and Delray Beach Medical Center.

Dr. Robert Borrego, medical director of the Trauma Center at St. Mary’s Medical Center, told The Post earlier this year that it is important to limit the number of trauma centers.

“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?”

Judge gives doctor’s defamation lawsuit against CNN green light

CNN had the heartbreaking stories from parents who lost their children. It had damning statements by some of the state’s top cardiologists.

But in its zeal to shut down St. Mary’s Medical Center’s pediatric cardiac surgery program, did CNN purposefully fudge the death rate, reporting it was three times the national average?

Did the cable news giant intentionally defame the physician at the center of the program, Dr. Michael Black, whose photograph was splashed on television sets and websites with the headline: “Babies as sacrificial lambs”?

A Palm Beach County Circuit judge ruled Friday that a defamation lawsuit brought by Black against CNN could move forward, rejecting a motion by the network to dismiss it. Judge Richard Oftedal order 15-page order was built on a foundation of solid libel law that included a federal defamation action against CNN by St. Mary’s former CEO.

“We are pleased with the court’s decision. CNN intentionally misled its readers and intentionally manipulated statistical data to portray Dr. Black in a negative light,” said Libby Locke, the attorney for Black.  “We have every confidence that a jury will reach the same conclusion when CNN’s reporting is scrutinized.”

CNN’s attorney, Charles Tobin, could not be reached for comment late Friday.

Oftedal’s ruling echoes another by a federal judge in Atlanta in February when it allowed the defamation case brought by St Mary’s former CEO, Davide Carbone, against CNN to also move forward. U.S. District Judge Orinda Evans found that Carbone’s allegations were sufficient to establish that CNN was acting “recklessly with regard to accuracy.”

 

Dr. Michael Black

Oftedal, in his order, repeatedly referenced the Carbone decision in denying CNN’s motion to dismiss.

The pediatric cardiac surgery program at St. Mary’s shut down and Carbone resigned following CNN’s June 1, 2015, story titled, “Secret Deaths: CNN Finds High Surgical Death Rate for Children at a Florida Hospital.”

As reported by The Palm Beach Post in several stories, the data used in CNN’s report that St. Mary’s sported a death rate of infants in the unit three times the national average was widely disputed by the hospital and the state’s Agency for Health Care Administration. St. Mary’s said at the time that CNN failed to use risk-adjusted data in determining the death rate.

St. Mary’s, owned by Tenet Healthcare, said CNN missed numerous operations and procedures in its analysis.

Black has gone further, saying in court CNN purposefully manipulated the data in order to justify its narrative.

After the criticism, CNN published a story on its methodology as the statistics took center stage, overshadowing the parents featured in the story and a report finding problems with the program by the state’s Cardiac  Technical Advisory Panel. Black is the defendant in lawsuits brought against him by parents of his tiny patients who died or who ended up crippled.

Oftedal rejected CNN’s efforts to dismiss Black’s suit by arguing that the doctor was a public figure and that it was really criticizing St. Mary’s and not the physician. He didn’t buy CNN’s argument that the sensationalized headlines used in the story were just “rhetorical hyperbole” and protected free speech.

The judge noted CNN reported that Black made a “total mess of the babies,” juxtaposing the phrase with the doctor’s photograph.

 

 

Nixed: Judge rejects plan to revamp state’s trauma-care system

A judge in Tallahassee rejected a Florida Health Department’s plan to revamp the state’s trauma care system.

According to Florida News Service, the judge rejected a plan by the Florida Department of Health that likely would have led to an increase in trauma centers across the state. A contingent of lawmakers are following Gov. Rick Scott’s lead in trying to inject more competition into medical care, saying it will lead to better services and lower prices.

A contingent of lawmakers are following Gov. Rick Scott’s lead in trying to inject more competition into medical care, saying it will lead to better services and lower prices despite many medical professionals saying it will actually do the opposite.

In a 70-page ruling, Administrative Law Judge Garnett Chisenhall, in a 70-page ruling, said the Health Department’s position actually turned two state laws on its head.

Five major hospitals — UF Health Jacksonville, Tampa General Hospital, Lee Memorial Hospital in Fort Myers, Bayfront Health-St. Petersburg and St. Joseph’s Hospital in Tampa —had challenged the plan. Currently, Florida caps the number of trauma centers statewide to 44 as well as the how many can operate in 19 different regions in the state.

The battle is not over. A House subcommittee on Monday approved a bill that would eliminate the limits opposed by Gov. Scott and HCA health care company.

Scott was CEO of Columbia/HCA, but resigned in 1997 after the company came under fire for Medicare billing practices.

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Dr. Robert Borrego, medical director of the Trauma Center at St. Mary’s Medical Center.

In Palm Beach County, Tenet Hospitals runs two Level 1 trauma centers at St. Mary’s Medical Center and Delray Medical Center.

Dr. Robert Borrego, medical director of the Trauma Center at St. Mary’s Medical Center, says most trauma surgeons would be opposed to lifting caps on the number of trauma centers in the state.

Borrego told The Palm Beach Post earlier this year that more trauma centers will lead to worse service. He 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? he said. “Are you going to comfortable there or do you want somebody who does 1,000 operations a year?”

Former pal of Aaron Hernandez sues Sheriff, St. Mary’s

Alexander Bradley ended up shot in the face and left for dead in a Riviera Beach industrial park by one-time NFL superstar-turned killer Aaron Hernandez. The former New England Patriots and Florida Gators tight end wanted to silence his buddy about other murders in New England, investigators believe.

Bradley never spoke to law enforcement since his near-death experience, but he has been busy filing lawsuits in the last four years

His first, against Hernandez, ended in a settlement. He then filed a lawsuit against CNN in Connecticut for showing images of him lying bloody and unconscious in the hospital without his consent.

Now Bradley has focused his litigation wrath on St. Mary’s Medical Center and the Palm Beach County Sheriff’s Office and again the hospital photograph is central to his case.

The new federal lawsuit accuses PBSO “upon information and belief” of visiting St. Mary’s in order to gain images of Bradley in his hospital bed and then without consent illegally provided those photos to media outlets, including CNN.

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Aaron Hernandez sits in the courtroom of the Attleboro District Court during his hearing on August 22, 2013 in North Attleboro, Mass. (Photo by Jared Wickerham/Getty Images)

St. Mary’s allowed the sheriff access to Bradley without his consent in order to photograph him, the lawsuit claims.

The civil complaint also claims it’s possible that PBSO has nothing to do with the photograph and that St. Mary’s snapped them and provided the images to media outlets.

St. Mary’s released a statement last night on the lawsuit:

“We take these allegations very seriously. The privacy of our patients is of utmost importance to our employees and physicians.”
The sheriff’s office did not respond to a request for comment.

Hernandez is serving a life sentence for the 2013 murder of Odin Lloyd, who was dating the sister of Hernandez’s fiancee at the time of his death. Before his arrest, Hernandez s igned a $40 million contract that delivered a $12.5 million bonus.

The New England Patriots won their second Super Bowl in three years earlier this month, but Hernandez will go on trial in March for the murder of two other men.

The photograph at the subject of the Bradley Shoot was shown in a March 31, 2015 broadcast on CNN entitled CNN Special Report: Downward Spiral–Inside the Case Against Aaron Hernandez.  The show is available on Youtube and has been viewed more than 50,000 times.

The image shows Bradley with a tube down his throat with a bandage around most of his upper head. He ended up losing his right eye. The photograph was “highly offensive to a reasonable person of ordinary sensibilities”  and has caused Bradley severe emotional distress.

 

St. Mary's Medical Center in West Palm Beach, Florida on June 5, 2015. (Allen Eyestone / The Palm Beach Post)
St. Mary’s Medical Center in West Palm Beach, Florida, (Allen Eyestone / The Palm Beach Post)

The lawsuit names St. Mary’s, Sheriff Ric Bradshaw and two deputies identified only as John and Jane Doe.

“Aaron Hernandez’s life and criminal behavior may have been of legitimate public concern, the photograph of plaintiff itself in the condition he was in was not,” the Feb. 15 lawsuit states.

The Palm Beach Post reported in May 2015 that Hernandez shot his pal Bradley because he had quipped about the tight end capping two men outside a Boston night club in 2012.

Bradley, a Connecticut resident who did prison time for cocaine trafficking, is believed to have been in the passenger seat of Hernandez’s SUV when he shot the men over a perceived slight.

In June 2013, Bradley sued Hernandez for negligence in U.S. District Court in Miami, saying in the civil complaint that the two had argued before he was shot in the face.

Bradley later told a judge that Hernandez had grown increasingly paranoid, believing he was being followed by helicopters. He was one of the last prosecution witnesses in Hernandez’s trial in the Lloyd murder, helping tie the defendant to the gun used in the slaying

Legislature looks to allow more trauma centers

Another day at the state Legislature and another proposed bill pitting hospitals against each other.

The News Service of Florida reports that SB 746 filed by Sen. Travis Hutson, R-Elkton, would eliminate the caps on the number of trauma centers statewide.

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.

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Dr. Robert Borrego, medical director of the Trauma Center at St. Mary’s Medical Center, says most trauma surgeons would be opposed to lifting caps on the number of trauma centers in the state.

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.

St. Mary's Medical Center in West Palm Beach, Florida on June 5, 2015. (Allen Eyestone / The Palm Beach Post)
St. Mary’s Medical Center in West Palm Beach is one of two Trauma Centers in Palm Beach County.

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.

Palm Beach County is hardly immune to trauma drama.

JFK Medical Center in Atlantis filed a letter of intent with the Department of Health on Sept. 30 to establish a Level 2 trauma center that would accept only adult patients.

Tenet, to put it mildly, was not pleased, saying a JFK trauma center would undercut a system in place for 25 years.

“This action threatens the entire care system in our county,” stated the letter on the issue by Tenet.