Experts recommend revamp of Florida trauma system

May 8, 2013

The following article was published in the Sarasota Herald-Tribune on May 8, 2013:

Experts recommend overhaul to state trauma system


When a team of experts came to Florida early this year, they found a trauma-care system that needed change.

Parts of the overall structure of the system were outdated, the experts wrote in a report released this week. And in what they called “the most striking challenge,” various players in the hospital industry are in long-running battles about where trauma centers should be allowed to open.

“The conflict over trauma center distribution has resulted in deep divisions within the community of trauma advocates and providers and has stalled all aspects of system development,” said the report, which was produced by a team of the American College of Surgeons, at the invitation of the state Department of Health. “The conflict and the almost exclusive focus on issues surrounding trauma center designation have the potential to endanger the larger collective mission.”

The team, in a 117-page report, made recommendations that dealt with myriad issues, such as how the state should be carved up for trauma-care planning and how money should be distributed to trauma centers.

But the recommendations could slam into legal, political and regulatory reality.

The 1st District Court of Appeal is scheduled to hear arguments next week in a dispute stemming from Department of Health decisions in 2011 to approve new trauma centers in Pasco, Manatee and Clay counties. Also, another case is pending at the appeals court about the opening of a Marion County trauma center.

Meanwhile, lawmakers last week passed a bill that would help clear the way for a trauma center at Fort Walton Beach Medical Center, without the hospital having to go through a typical approval process. Fort Walton Beach Medical Center is in Okaloosa County, home to Senate President Don Gaetz, R-Niceville, and his son, Rep. Matt Gaetz, R-Fort Walton Beach.

And bigger picture, the Department of Health is in the midst of developing new rules for the trauma system, a major undertaking that became necessary after earlier legal fights led to the determination that the department had been relying on invalid rules in approving trauma facilities.

The department has held workshops across the state, though it is not clear when a proposed rule will be released. Molly Kellogg, a spokeswoman for the department, said in an email Wednesday that the agency is reviewing the report from the American College of Surgeons team as part of the rule-making process.

“We are evaluating the report in light of recent legislative activity, as well as the public input received during this year’s nine rule workshops,,” she said. “All options are being considered as we work collaboratively to make the system better.”

The trauma system has faced a series of controversies during the past two years that began when hospitals in the Tampa Bay and Jacksonville areas challenged proposed trauma centers at Blake Medical Center in Manatee County, Regional Medical Center Bayonet Point in Pasco County and Orange Park Medical Center in Clay County. The HCA health-care chain, which earlier outlined a strategy to expand trauma care, operates the Manatee, Pasco and Clay hospitals.

An administrative law judge, and later the 1st District Court of Appeal, ruled that the Department of Health used an invalid rule that dated from the early 1990s in evaluating the trauma proposals. Nevertheless, the department allowed trauma centers to open at the three hospitals, though the state later closed the Orange Park Medical Center trauma facility.

The other case pending at the 1st District Court of Appeal focuses on a department decision late last year to allow a trauma center to open at Ocala Regional Medical Center, another HCA hospital. Shands Teaching Hospital is fighting that decision.

The American College of Surgeons team’s report offers a glimpse of the factors involved in the industry fights, such as saying hospitals with existing trauma centers in metropolitan areas want to hold onto their volumes of patients. Trauma centers are costly to operate, and maintaining volumes plays an important role in funding.

The hospitals that challenged the Manatee, Pasco and Clay County trauma centers have been Tampa General Hospital, St. Joseph’s Hospital in Tampa, Bayfront Medical Center in St. Petersburg and Shands Jacksonville Medical Center — all of which operate trauma centers.

“Established trauma centers often resist the addition of new centers, arguing that dilution of patient volumes will be detrimental,” the report says. “Trauma centers seeking to enter the trauma system counter with benefits such as improving access to potentially underserved areas, shortening transport times, and easing overcrowding in existing trauma centers. All ultimately agree that trauma centers should be designated primarily to serve the needs of the population, but each group interprets need in a way that supports their position.”

The report calls for finding a “negotiated solution” to the conflicts, saying that the various parts of the industry need to accept a plan that would address issues such as determining the need for new trauma centers and how they should be distributed.

“Much work is needed,” the report says. “Change is often painful, but stagnation and an inability to adapt are unnecessarily costly on all levels.”

Among the recommendations in the report, the team calls for dividing the state into seven regions for trauma-system planning, with regions mirroring those used by domestic-security task forces. The department in the past has used 19 smaller trauma-service areas, which became an issue in the legal challenges.

Other potentially controversial recommendations include calling for changes in the way trauma centers are funded and considering the development of lower-level trauma centers than in the past.

“(The) designation of new trauma centers is viewed as a threat to existing centers, when ideally these new centers could allow for better matching of patients to hospitals with appropriate capabilities,” the report says. “Rather than creating a threat to current trauma centers, the development of a true regional network of facilities with known capability will improve availability and efficiency of care to injured patients. Matching patients to the lowest level trauma center able to provide necessary care will ultimately optimize trauma system efficiency.”

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