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Trauma center fight moves to Legislature with proposed fix

From the News Service of Florida:

After more than two years of legal and political wrangling in the hospital industry, a Senate proposal would overhaul the way Florida approves trauma centers and could ensure that three disputed trauma facilities remain open.

The proposal, filed this week by Sen. Denise Grimsley, R-Sebring, could short-circuit a debate about how the Florida Department of Health determines where new trauma centers should be allowed to open.

It also would allow trauma centers in operation on July 1 to remain open --- a proposal that likely would ensure the continued operation of trauma facilities at Blake Medical Center in Manatee County, Regional Medical Center Bayonet Point in Pasco County and Ocala Regional Medical Center in Marion County. Those hospitals have been at the center of the ongoing legal battles.

The proposal (SB 1276), filed a week before the start of the annual legislative session, could touch off a fierce lobbying battle.

The changes would help the HCA health-care chain, which has opened the trauma facilities at Blake Medical Center, Regional Medical Center Bayonet Point and Ocala Regional Medical Center and has sought to open trauma centers elsewhere. But the proposal likely will draw opposition from major hospitals in the Tampa Bay, Jacksonville and Gainesville areas that have battled HCA and the Department of Health about new trauma approvals.

HCA attorney Stephen Ecenia said Wednesday the company would support Grimsley's bill. HCA has argued, in part, that allowing more trauma centers would better meet the needs of injured patients in various parts of the state.

"I think it (the bill) presents a clear path to moving forward,'' Ecenia said.

But Mark Delegal, general counsel for the Safety Net Hospital Alliance of Florida, which represents public and teaching hospitals that have long operated trauma centers, said his group thinks current laws offer a proper balance for determining whether needs exist for new trauma centers.

Delegal described the part of the bill that would ensure the continued operation of the disputed HCA trauma facilities as the "big enchilada." Also, he said a "proliferation" of trauma centers would reduce the volume of patients going to the highly specialized facilities, which could ultimately affect quality of care.

Grimsley's bill became public Tuesday afternoon, just hours after the Department of Health finished a hearing about a proposed rule that would determine how many trauma centers would be allowed in 19 separate areas of the state. It was apparent during the hearing that the hospital industry was divided about the proposal, raising the specter of additional litigation if the department ultimately adopts the rule.

A major part of the trauma debate stems from court decisions in 2011 and 2012 that the department used an invalid rule in approving the trauma centers at Blake Medical Center, Regional Medical Center Bayonet Point and Orange Park Medical Center in Clay County. The Orange Park trauma facility later closed for other reasons, but the department also allowed Ocala Regional to open a trauma facility.

The HCA trauma centers have been challenged by Tampa General Hospital, St. Joseph's Hospital in Tampa, Bayfront Medical Center in St. Petersburg, UF Health Shands Hospital in Gainesville and UF Health Jacksonville. Ongoing litigation poses a threat to the continued operation of the trauma facilities at Blake Medical Center, Regional Medical Center Bayonet Point and Ocala Regional Medical Center.

Grimsley, who was out of her office Wednesday and also could not be reached by email, is an influential lawmaker on health-care issues, serving as chairwoman of the Senate Health and Human Services Appropriations Subcommittee. A trauma bill has not been filed in the House, though a proposal is expected to emerge.

The Grimsley proposal would designate varying numbers of potential trauma centers in 18 separate areas of the state, a slight variation from the Department of Health's proposed 19 areas. The divvying up of trauma centers is a key part of the legal challenges in recent years, with the Tampa Bay, Jacksonville and Gainesville hospitals arguing that decisions should made based on seven domestic-security task force regions --- rather than the 19 areas.

The bill makes numerous other legal changes, including the provision that trauma centers would be able to remain open if they operated continuously for a 12-month period and if they are in operation July 1, the date the measure would take effect.