Lawmakers Look At Revamping Trauma System

A House health-care panel on Monday approved a bill that would clear a path for increasing the number of trauma centers in the state’s biggest cities and changing rules that allow hospitals to challenge the designation of new trauma centers.

The trauma-center issue has been controversial for years, but the bill (HB 1165), sponsored by Rep. Jay Trumbull, R-Panama City, cleared the House Health Quality Subcommittee unanimously.

Though his clients have concerns with the bill, Mark Delegal, a lobbyist and lawyer for the Safety Net Hospital Alliance of Florida, told House members that Trumbull and Senate Health Policy Chairwoman Dana Young, R-Tampa, have worked earnestly on making changes to the current trauma-center designation system. Young is sponsoring a Senate bill on the issue.

The Safety Net Hospital Alliance, which includes public, teaching and children’s hospitals, wants to continue to work on the bills, Delegal said.

“We don’t wish to see the bill killed here,” Delegal says, “but we have serious concerns with it.”

Delegal says members of the Safety Net Hospital Alliance believe the state needs to manage the trauma centers to ensure quality. To that end, volume of services is important to maintaining quality of care.

Delegal says that the House bill would allow the Department of Health to grant seven trauma-center designations that currently are being litigated or contested and said that some of them could be controversial, including a trauma center at Northside Hospital in St. Petersburg and Kendall Medical Center’s move to operate a pediatric trauma center.

The Senate bill would place a moratorium on new trauma-center designations in areas where existing trauma facilities are located, and Delegal suggested that the House take the same approach.

The Legislature for the last several years has wrangled with the state’s trauma system and whether to continue with current regulations or to allow a more competitive environment that would increase the number of trauma facilities in the state.

The regulation of trauma centers in Florida is governed by laws regulating hospitals as well as rules by the Department of Health. A hospital can receive a designation as a Level I, Level II, pediatric, or provisional trauma center.

Current law caps the number of trauma centers at 44. Under the current rules, the state is divided into 19 “trauma service areas,” and each area is authorized to have least one trauma center.

The House bill would change current trauma laws to eliminate the statewide cap and define need based on population. The bill would make clear that there is a minimum need of two level I or level II adult trauma centers where population is greater than 1.25 million, which, for now, would impact trauma service areas in the Tampa Bay and Jacksonville areas.

The House bill would allow a minimum of four level I or level II trauma centers in areas where the population is greater than 2.5 million, which would impact the Miami-Dade County and greater Orlando areas.

The House bill also would make clear that the department must allocate by rule the number of trauma centers needed for each trauma service area. That was worrisome to Delegal, who suggested that the Legislature should either tightly define or follow the path of the Senate and establish an advisory council and require it to define the need.

The Senate bill (SB 1876) would require the Department of Health to create the Florida Trauma System Advisory Council by Oct. 1 and require it to submit a biennial report, beginning in January 2020 to the governor and the Legislature on whether an increase of the number of trauma centers within each trauma service area is recommended.

The House version also would make changes to the trauma-approval process by limiting the facilities that can challenge state decisions. While current law allows any hospital with a trauma center to appeal a state decision, the House bill would limit the challenge process only to hospitals that are located in the same trauma areas or in contiguous trauma areas to applicants. Those changes are not in the Senate proposal.

While Delegal encouraged the House to consider some of the options in the Senate bill, Steve Ecenia, a lawyer and lobbyist who represents hospitals owned by the HCA health-care company, suggested the House is taking the better approach than the Senate.

Ecenia says the state’s population was just 13 million when the statewide cap of 44 trauma centers was put into law, and more facilities are need as the population approaches 21 million.

“It’s important to recognize that access in this state is not where we want it to be,” says Ecenia, whose client operates nine trauma centers.

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