Trauma train on life support in Senate, prognosis not good

Sen. Aaron Bean's 135-page bill has been saddled with 250 pages of proposed amendments and so, the sponsor said, it may be time to pull the plug.

"We had a record 57 (amendments),'' said Bean, R-Fernandina Beach. Among them, inserted by some of the busiest lobbyists occupying the Fourth Floor rotunda: provisions to change policy not only on certificate of need for trauma care centers, but dozens of other health care programs from HIV programs to carving out dental care for medicaid reform to tightening regulation on assisted living facilities. 

Bean said early Thursday the bill "may just not come up." In Tallahassee parlance, that's another way of saying it may be loved to death. 

One provision of the bill, that remains a major interest of Senate President Don Gaetz -- which would allow his local county to build a trauma center -- is likely to be added to another bill relating to certificate of need for a nursing home for The Villages.

Democrats meet with governor, tell him they're prepared to stall session

At an early morning meeting at the governor's mansion, the top Democratic leaders of the Florida House urged the governor to consider vetoing the entire budget as a statement of his opposition to the legislature's expected failure to pass plan to expand health insurance for the poor. They also urged him to call a special session to enact the law. 

Reps. Perry Thurston of Fort Lauderdale, and Mia Jones of Jacksonville told the governor at their 6:30 a.m. meeting that with four days left in the session, they are prepared to used procedural moves to demonstrate their protest as well, said Mark Hollis, the Democrat's spokesman. "They feel an absence of an adequate plan to expand health care coverage is unacceptable,'' he said. 

The House is awaiting action by the Senate today as it takes up its plan to accept federal funds under the so-called Negron plan. "We want passage of the Senate bill,'' Hollis said.

If the House fails to adopt that bill, House Democrats are prepared to use their parlimentary tools to call attention to the issue. Among the options they have used in the past is a requirement to read bills in full. 

Democrats also know that the governor's priority, the expansion of the tax break for manufacturers, has not passed the House or Senate and it requires a two-thirds vote to happen. In the House, that means that Republicans need five of the 44 Democrats for the bill to pass. 

Weatherford on Medicaid expansion: 'I have not had to twist a single arm'

House Speaker Will Weatherford said that the high-level attention given to House Republican freshmen does not involve using strong-arm tactics, as he and his deputies try to hold the Republican caucus position to reject federal dollars on Medicaid reform. 

"There's not been a single member of the freshman class that has come to me and told me they did not want to vote for the our plan,'' he told reporters Wednesday. "I have not had to twist a single arm. We've simply supplied them with the facts and I think the facts support that the House plan helps the most vulnerable of our state and also creates sustainability for the state of Florida."

Rep. Jim Waldman, D-Coconut Creek, disagrees that Weatherford and Rep. Richard Corcoran, R-Trinity, would have the votes if they weren't demanding that Republican vote in a block. He said he has talked to enough Republicans to persuade him they have the votes to support the Negron plan, that would accepte the federal funds.

"If he were to let his members vote, the votes are there,'' Waldman said of Weatherford.

Weatherford is not backing down from his argument that taking federal money to insure the poor in Florida is a bad bet for the state. He said he read today that U.S. Rep. Paul Ryan said that one of the first things to go when they balance the budget in Washington "is going to be this idea that they fund this match at 90 or 100 percent. I agree with Congressman Ryan on that." 

So does the House leave  any room for compromise?

"We never say that our way is the only way,'' he said. "If a compromise is taking $7 billion of federal funds that is unsustainable to give health care to everybody without creating the right criteria, without taking the targeted approach that the House has taken, we don't think that's compromise."

 

Legislators have one more plan for federal Medicaid money: do nothing

As the clock winds down on the legislative session, Florida lawmakers are sending signals that they are likely to end the session without resolving the issue of whether the state should accept federal Medicaid money to insure the poorest in Florida.

 “It’s not something you put together in a week,’’ said Sen. John Thrasher, R-St. Augustine, chairman of the Senate Rules Committee and a close advisor to Senate President Don Gaetz. “It’s a very big, complicated issue and these issues take some time.”

He said he does not expect there would be any political repercussions if the Republican-led Legislature waits another year, even though it would mean forgoing for one year at least the estimated $5 billion in federal funds that could be drawn down under the plan to implement Medicaid expansion.

“There is no fallout,’’ Thrasher told the Herald/Times on Monday. “Anytime you walk away from something, there is going to be someone who is not happy. On something like this, however, it needs to be done right.”

Business groups, the Florida Hospital Association and the union that represents health care workers have launched television and lobbying efforts to urge lawmakers to implement a plan that draws down the federal money. If legislators adjourn their 60-day session on May 3 as scheduled without resolving the issue, those groups said Monday they will work to keep pressure on lawmakers to resolve the issue before next year.

Out-of-state group airs TV ads as the trauma battle moves to Tallahassee

 A dispute between Florida hospitals over who should treat the most critically injured patients has hit the  airwaves.

"Powerful special interests are keeping us from the emergency care we need, restricting access, risking lives," says an advertisement depicting a car crash that has begun airing in Tallahassee. Viewers are urged to call their legislators in support of "life-saving" trauma care.

The advertisement was paid for by the 60 Plus Association, a Virginia-based organization that bills itself as the conservative alternative to the AARP.

Trauma care has been the subject of legal wrangling ever since the state Department of Health allowed the HCA hospital chain to open new trauma programs around the state. This provoked a lawsuit from several existing trauma centers, mostly located in the Tampa Bay region.

Late last year, Florida's second-highest court declared invalid a 20-year-old rule used to justify new trauma programs, handing at least a temporary victory to established programs that argued they would be hurt by the loss of trauma patients. The department of health is now in the process of rewriting the rules by which trauma centers are approved.

-- Letitia Stein, Tampa Bay Times

Senate Medicaid plan would cut funding for Jackson

Miami’s Jackson Health System could see its crucial Medicaid funding cut by $46 million, or about 13 percent of what it was expecting, under a bill that is scheduled for a floor vote in the Senate by the end of the week.

Jackson isn’t the only South Florida hospital that would take a hit, according to a preliminary analysis by the Safety Net Hospital Alliance of Florida. Miami Children’s Hospital would face a $15 million cut to its anticipated Medicaid funding, the report concluded. And Memorial Healthcare System and Broward Health would each shoulder about $3 million in reductions.

All told, the state’s safety-net hospitals would lose out on an estimated $104 million, according to the analysis. For-profit hospitals, meanwhile, would benefit to the tune of about $81 million.

“This would put a tremendous roadblock in front of us,” said Carlos Migoya, CEO of Jackson Health, which would still receive about $315 million in Medicaid money.

Migoya and other safety-net hospital CEOs are running out of time to make their case. The proposal will be read on the Senate floor on Wednesday, and will likely receive a vote on Thursday.

Read more here.

Next health care fight: limiting liability for doctors and hospitals

 

A year ago this month, Michael Lawley of Melbourne disconnected the respirator that was keeping his brain-damaged daughter alive.

Shannon Lawley had entered a Brevard County emergency room suffering from what an autopsy would later determine was acute pancreatitis. She waited five hours as the understaffed team failed to monitor her vital signs or transfer her to intensive care, her father told the House Subcommittee on Civil Justice last week.

Doctors eventually administered heart medicine without realizing Shannon’s heart was functioning properly, he recalled. She went into cardiac arrest. Her lung collapsed as the medical team attempted resuscitation and her brain was deprived of oxygen for seven minutes, causing irreversible brain damage and gangrene, he said.

“After multiple tests and second opinions, I took her off the respirator and she died two days later,’’ Lawley told the panel. “My daughter deserved better. She didn’t get it. The health care system in Florida failed her.”

Lawley, 60, a certified public account, has no recourse. The state’s medical malpractice laws were rewritten by lawmakers in 2003 and included changes that prevent parents of adult children from recovering most damages. Shannon, a University of Florida graduate with a degree in chemistry, was 31 years old and had no spouse or children.

Now, Lawley wants the law changed, and he’s speaking out.

Bills moving quickly through the Republican-controlled Florida House, and under review in the state Senate, would expand Florida’s medical malpractice laws, adopt legal standards used in other states, and shield hospitals, doctors and nursing homes from lawsuits under certain conditions. Story here. 

Atwater: wait to expand Medicaid, forgo the money

Jeff Atwater may not be calling everyone's attention to his opposition to Gov. Rick Scott's plan to expand Medicaid in Florida as Adam Putnam has, but the Republican chief financial officer is on the same page.

"This is going to obligate us to either in future years to a legislature that will significantly change the tax code or this takes (away from) education dollars, transportation dollars and everything else," Atwater told the Tampa Bay Times editorial board today. "I look at the general revenue stream. It will not carry this. It's just that simple."

Florida would be better off watching to see how it plays out for at least a couple years — even if it means forgoing 100 percent federal funding of the expansion — before plunging ahead without more questions answered and alternative options developed.

"I understand all the compassion. I'll put my record up against anybody when I was in the Legislature," he told the editorial board, which agrees with Gov. Scott that expanding Medicaid makes the most sense for Florida.

The legislature's Medicaid dilemma: Meet some of the lives in the balance

Florida’s Medicaid system today serves more than 3 million people, about one in every six Floridians. The decision whether to expand the system by a full third will be made by men and women in suits in Tallahassee’s mural-filled chambers this spring.

But the impact is elsewhere, in children’s hospitals in Tampa and Miami, in doctors’ offices in New Port Richey and in the home of a woman who recently lost her full-time teaching job. Here are some of the names and faces of people whose health care future is in the hands of Florida's lawmakers.

Photo: Nancy Fraze was making too much money waitressing to be eligible for Medicaid. So she quit her job. Her son, Dustin Rozwarski, 16, has severe allergies and asthma and requires expensive care. MAURICE RIVENBARK / TAMPA BAY TIMES

Read more here: http://www.miamiherald.com/2013/02/23/v-fullstory/3250065/the-faces-of-floridas-medicaid.html#storylink=cpy

Read more here: http://www.miamiherald.com/2013/02/23/v-fullstory/3250065/the-faces-of-floridas-medicaid.html#storylink=cpy

Hospitals a bit relieved by Scott's budget

Last year, Gov. Rick Scott delivered quite a shock to the state's medical establishment by proposing a cut of about $2 billion in public funding to hospitals.

So when his $74 billion budget was released Thursday, one of the more interested observers was the Florida Hospital Association. But compared to the previous year, Scott's proposed cut of $82 million, or 2 percent, wasn't so bad, said its president, Bruce Rueben.

"If you’re comparing it to last year, it’s clearly a better start," Rueben said Friday. "It indicates that he's taking a more thoughtful approach. We're still going to have a lot of discussion about the cuts in the coming months. It is time we stop making cuts to the elderly, poor and disabled. Hospitals have been cut by over $1 billion since 2005."

Rueben said Scott's overall message that he would take a hard look at how to implement the expansion of Medicaid through the Patient Protection and Affordable Care Act was encouraging. After all, he could have followed the lead of Texas Gov. Rick Perry, who has said his state won't implement it.

"(Scott) did not say, 'It’s not going to take place in Florida,'" Rueben said. "He should be commended for taking this seriously."