Over the objections of long-established Florida hospitals, a judge has upheld a state proposal that paves the way for a costly expansion of the trauma care system.
The order by Judge R. Bruce McKibben is the latest chapter in a contentious battle for seriously injured patients who can generate high payouts from health and auto insurers.
A group of longstanding trauma centers, including Bayfront Health St. Petersburg and Tampa General and St. Joseph's hospitals in Tampa, had challenged the state's trauma center expansion plans, saying regulators overstepped their authority and the rule is "arbitrary and capricious."
But McKibben, a judge with the state's Division of Administrative Hearings, rejected that argument in a 71-page order issued Friday that concluded the state's rule is based on "facts, logic and reason."
McKibben heard from 15 witnesses during Tallahassee hearings in March, April and May. Representatives from established trauma centers spoke of declining patient volume as a result of new trauma centers opening.
That argument did not sway the judge.
"The fact that the proposed rule may cause petitioners economic harm is not a basis to invalidate it," he said.
Florida has 27 hospitals designated to operate special medical units for traumatically injured patients who need fast specialized care.
McKibben affirmed a rule that would allow new centers to open in areas of the state that meet certain criteria for population, transport times and volume of severely injured patients.
The new rule also gives an applicant credit if the hospital has "community support" from local officials. Existing trauma centers said they feared these criteria would further politicize the site approval process.
The judge's decision is a blow to hospitals that have argued that increasing the number of trauma centers means each center will see fewer seriously injured patients, meaning doctors and nurses won't get experience they need to give the best care. Especially at a time when competition is keen for the best medical talent, duplicating services will also drive up costs, they argued.
Representatives of Tampa General and University of Florida Health Shands Hospital said the petitioners are evaluating their next step. The parties have 30 days to file an appeal with the 1st District Court of Appeal in Tallahassee.
The ruling is a victory for HCA Healthcare, the for-profit hospital chain that has opened six trauma centers in the state since 2009 and wants to add more.
J.C. Sadler, a spokeswoman for HCA, said the company, which is operating its trauma centers in Florida in partnership with the University of South Florida, is pleased with McKibben's order.
"Since we began the USF/HCA partnership in 2010, we have been committed to increasing life-saving access to high-quality trauma care for all Floridians and have made significant contributions to the communities we serve," she said.
HCA has come under criticism since a Tampa Bay Times investigation in March showed that the company's trauma centers charge far more for their services than other trauma centers in the state.
Last year's data shows that the average total bill for hospitalized HCA trauma patients was $132,307 — $45,000 more than the average at other trauma centers. But HCA's patients were no more severely injured than patients treated elsewhere.
The Times investigation also found that a special "trauma response" fee as high as $34,000 often is billed by HCA in addition to treatment. The rest of the state's trauma centers had an average response fee of about $7,000.
After the stories were published, HCA announced it would waive trauma response fees for the uninsured.
Over the past five years, HCA has opened trauma centers in Bradenton, Hudson, Ocala, Fort Pierce, Miami and outside Jacksonville in Orange Park.
The trauma center at Orange Park Medical Center lost its trauma designation in 2013 when the Florida Department of Health found undisclosed deficiencies. The hospital is challenging that decision in a pending case.
Established trauma centers have also challenged the legality of HCA's trauma centers in Bradenton, Hudson and Ocala. Those legal cases were put on hold pending McKibben's decision on the rule challenge.
Hearings will be held in late July regarding the challenge to HCA's Ocala Regional Medical Center. September hearings are scheduled on cases concerning HCA's Blake Medical Center and Regional Medical Center Bayonet Point in Hudson.