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.”
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.”
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.
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.
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.
“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?”
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.
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 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.
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.
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
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.
CNN deliberately exaggerated the death rate of infants undergoing heart surgery at St. Mary’s Medical Center, purposefully painting a renowned surgeon as an incompetent doctor who butchers babies for profit, the physician’s lawyer told a judge on Friday.
Dr. Michael Black is suing CNN for libel and defamation for its story on June 1, 2015, about St. Mary’s pediatric cardiac surgery program. The hospital closed the program a few months later and its CEO resigned.
“CNN intentionally manipulated statistical data to support its false narrative that Dr. Black was unfit to perform operations on these very sick children,” said his attorney, Libby Locke, after a hearing on whether to dismiss her client’s lawsuit.
“Through their defamatory articles and videos, CNN has deprived Palm Beach of an incredibly valuable pediatric cardiac surgery program.”
She urged Circuit Judge Richard Oftedal to reject the motion to dismiss and to allow a jury to decide what Black’s reputation is worth. She noted how the news network took a quote from one grieving parent that Black was offering up babies as sacrificial lambs,” and juxtaposed it with a photograph of the doctor.
Black contends in the defamation and libel lawsuit that CNN;’s story unfairly disparaged him and forever damaged his reputation. He still is employed at St. Mary’s, but has not done any surgery since the program was closed in August 2015.
The doctor is also facing several malpractice suits filed by parents of babies who died after heart surgery at St. Mary’s, but Friday’s hearing was about Black’s defamation claims against the cable news giant. CNN is trying to get Oftedal to dismiss the lawsuit.
Locke, his attorney, told the judge CNN went so far as to manipulate the calculations to report St. Mary’s death rate as three times the national average for pediatric heart surgery programs. She said CNN ignored data from the Society of Thoracic Surgeons that found St. Mary’s death rate for infant cardiac surgeries fell within the norm.
Instead, the news network compared raw data of open and closed heart surgeries with just open heart surgeries. It also compared raw death rate figures with those adjusted for the complexity of the surgery and illness of the patient, Locke said.
The Palm Beach Post reported in several articles about troubles with CNN’s data. The network eventually posted on its website a story explaining its methodology. Florida’s Agency for Health Care Administration got into the fray, calling CNN’s reporting sensationalistic.
Friday was the first time the two sides really squared off in front of the judge since Black filed his suit in February as judge entertained argument over CNN’s motion to dismiss Black’s suit.
The cable news network told Oftedal that CNN’s reporting is protected because Black as a prominent surgeon of a major pediatric heart surgery program was a public figure.
The network’s attorney, Charles Tobin, also argued that the doctor couldn’t prove malice by the network.
Tobin added that Black or St. Mary’s can’t dictate the methodology of a news organization and that reporters asked the hospital for its own figures but never received them. CNN anchor Anderson Cooper is one CNN talent named by Black in the lawsuit.
Locke said St. Mary’s was under no obligation to cooperate with CNN and that the methodology used by the cable news network is not a matter for debate or interpretation. “These are statistics. This is math,” she said.
One of Tobin’s best moments on Friday was when he told Oftedal that Black claims he is not a public figure but was somehow defamed by criticism of St. Mary’s as a whole. Tobin said that was because Black was the public face, and thus a public figure.indeed The Post wrote a feature on him when the hospital started up the program.
And indeed, The Post wrote a feature on Dr. Black when the hospital started up the program.
Locke says CNN bears the burden of proving Dr. Black was essentially a public figure.
“There is no dispute Dr. Black had a pristine solid reputation before CNN defamed him, but that does not make him a public figure,” she said in court.
If Oftedal — who asked plenty of questions throughout the hearing — finds Black a public figure, the doctor will have to prove CNN had malice to defame him personally.
Also, present in the courtroom was defendant Kelly Robinson, the heart mom who was used as an unnamed source by CNN in the investigation.
Black claims she made disparaging remarks about him and was trying to drive business to Nickalus Children’s Hospital in Miami where her son had heart surgery.
Robinson’s attorney, Deanna Shullman, said her client is a minor player in the lawsuit, yet faces the same liability as a major cable news network.
She has asked the lawsuit to be dismissed because her client’s comments are protected speech.
A story about Robinson’s role in the CNN story was explored by The Post. Click here to read the story.
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.
Rivera lost her own battle Saturday with the disease after a bone marrow transplant on Aug. 23 from her mother failed because it wasn’t a perfect match.
She was 28 and leaves behind her two sons, Liam, 4, and Logan, 2.
“She fought a hard battle for 10 years ,” her mother, Wanda Laracuente, said on Monday. “Ten years is long time to fight this disease, but she left me a piece of her. I have her boys, her two precious miracles.”
Barbara Abernathy, the CEO of Pediatric Oncology Support Team (POST) on the campus of St. Mary’s Medical Center, called Rivera a “brave ambassador” who showed keen interest in others battling with leukemia.
“By telling Nicole’s story, we were able to get that message out there about the impact this disease has on the family, both financially and emotionally,” she said.
In April 2015, as Rivera struggled to find a donor, she urged Hispanics to get tested. Hispanics make up just 10 percent of the U.S. bone marrow donor list, compared to 61 percent of caucasian donors.
“They are afraid to get tested or they don’t have the knowledge that Hispanics donors are rare or that Hispanics do get sick like this,” she said.
Laracuente said that increasing bone marrow donors among Hispanics is difficult because of socioeconomic reasons. “A lot of them are misinformed, thinking if they are here illegally and joining the donor registry that is going to put them at risk at being deported,” she said.
POST will hold a bone marrow donor drive in Rivera’s name on Oct. 1 at Roger Dean Stadium in Jupiter. All is needed is a cheek swab to join the donor list. A blood test is not necessary.
Rivera came to the public eye in 2007 when The Palm Beach Post featured her in its “Season to Share” annual holiday campaign, which rallies assistance for struggling individuals and families.
When she was a teenager, Rivera was diagnosed with the Philadelphia chromosone associated with chronic myelogenous leukemia, a difficult form of the disease to disease
Still, she beat back the cancer through chemotherapy and proved predictions wrong by giving birth to her two boys.
Her family, though, knew even after she was cancer free for five years, that without a full bone marrow transplant, the disease could always return for Rivera.
And it did in early 2015. At first her mother didn’t believe her daughter’s complaints of lethargy until blood tests confirmed that indeed the leukemia was back.
“I don’t know how many times a person has to be tested to prove that they should be here,” Laracuente said at the time.
“I don’t know how I’m going to help her fight. I told her, ‘You have two boys you have to fight for. You have to come back to them.’
Her mother did help her fight in the most personal way possible. After a public outreach to find a suitable donor for Rivera failed, it was Laracuente in August who became a donor but she was only a half-match.
“Because she was Hispanic she was not able to find a perfect match,” Abernathy said.
And the toll of the disease continues. Rivera’s family is struggling to bury her. “Her family is financially depleted from caring for her,” Abernathy said. “They don’t have the money for a proper service.”
She said people who want to donate to offset funeral costs can contact POST, at 561-882-6336.
The 2016 Legislative ended on Friday – and so did the tenure of Florida Surgeon General Dr. John Armstrong.
The Florida Senate declined to bring his confirmation vote to the floor and Gov. Rick Scott quickly appointed Dr. Celeste Philip, the department secretary for the Department of Health, as Acting Surgeon General.
Scott first appointed Armstrong in 2012 and reappointed him this year, but the Senate refused to confirm over questions about cuts to staff at the Department of Health, implementation of medical marijuana and his response to the growing HIV rate in South Florida.
There was also concern over children being dropped from the state’s Medicaid rolls and the disbanding of cardiac panel of renowned physicians that reviewed pediatric heart programs of hospitals. The move came after the panel reviewed the pediatric cardiac program at St. Mary’s Medical Center in West Palm Beach – a program that has since been shut down.
Scott lauded Armstrong in announcing Philip’s appointment, saying he made Florida a leading destination for cancer research and treatment and responded to epidemics like Zika.
“Even while battling cancer in recent months, Dr. Armstrong displayed unwavering determination to protect Florida families, and I truly appreciate his hard work,” the governor said in a statement..