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.

Trauma Drama: Tenet, HCA fighting over providing critical care

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.

TraumaHawk
Tenet and HCA healthcare companies are squaring off over which hospitals will provide trauma in the county.

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.

122611 (Alyssa Orr/The Palm Beach Post) Atlantis--JFK Medical Center off of South Congress Avenue in Atlantis.
.

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.

 

Florida Auditor General releases report on Health Care District

The state Auditor General released the much-anticipated report on the Health Care District of Palm Beach County — and despite resurrecting some ghosts of scandals past — this latest in a long line of audits found little new.

DarcyDavis
New CEO of the Health Care District Darcy Davis says taxpayers should be thrilled with the recent report from the State Auditor General that resurrected some old scandals but found little new.

The audit recommended the district get reimbursed for using the air ambulance Trauma Hawk out of county and put in conflict of interest safeguards when purchasing land or giving money away to outreach organizations. It also recommended increased independence when it comes to its internal audits.

Dave-Kerner-307
Rep. Dave Kerner of Lake Worth – and county commission candidate – wanted Trauma Hawk placed under the power of the Sheriff’s Office.

The district has undergone a series of audits in about a year and this latest one was a political animal stemming from a takeover attempt last year by the Sheriff’s Office of Trauma Hawk. That coup failed, but one of its most ardent supporters, Lake Worth state Rep. Dave Kerner, called for an audit.

For Darcy Davis, the newly enthroned CEO of the district, the Auditor General’s report was a good start to her tenure. It is especially good news when compared to what has happen to the south with scandal-plagued Broward Health where the chair was removed by Gov. Rick Scott last month and then ordered reinstated by a judge on Monday.

“The taxpayers should be pleased that this is all the Auditor General would find,” she said. “Not to minimize their efforts, but seriously this gives me reassurance that the tax dollars are being used wisely.”

The report alludes to a scandal five years ago when the district spurned free county land to rebuild the Edward J. Healey Rehabilitation and Nursing Center at its existing – but problematic – site. Instead, the district purchased land for $4 million in which the family of the real estate broker for the district had an interest.

On Trauma Hawk, the report did say that not all out-of-county services were trauma-related, and thus were not reimbursed. The county footed about $452,500 for counties that called in for help.

Davis said that the District will renew negotiations with other counties, but it is a tough task since withholding such services could cost lives.