More Trauma Drama: Hospital pushes back on expansion in Jax

Does the trauma drama never end?

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.

These hospitals pushed back on efforts by JFK Medical Center in Atlantis to open up a trauma center last year.

Read the whole News Service of Florida story by clicking here.

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?”

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.

borrego-photo
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?”

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.

borrego-photo
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.