The politically charged business of saving Tampa Bay's most critically injured patients is set to take center stage this week in a Tallahassee appellate courtroom.
Lawyers for Tampa Bay's long-standing trauma programs at Bayfront Medical Center, St. Joseph's Hospital and Tampa General Hospital have argued that the state's approval of new trauma centers at HCA hospitals threatens the quality and financial viability of their services.
But so far, Bayfront alone has taken a major hit from trauma programs at Regional Medical Center Bayonet Point in Hudson and Blake Medical Center in Bradenton, which opened late last year.
From January to July, Bayfront treated 240 trauma patients from outside Pinellas County — a 68 percent decrease from the same period in 2011, according to hospital figures.
"That number definitely has a big financial impact," said Kanika Tomalin, Bayfront's vice president of strategic planning. The hospital still has the same expenses to run its trauma center even with fewer patients, she said.
But even though trauma has never been profitable, Bayfront remains committed to a service it has spent 25 years building, she stressed.
"It's a strong enough program that it isn't going to dissolve like sand in seven months," she said. "But it certainly is a very heavy consideration just logistically how we would run a trauma center if it got to a point where it couldn't financially sustain itself."
In court proceedings last year, Bayfront projected that it could lose more than $2.3 million from reduced trauma volume at a time when it already is struggling with razor-thin operating margins.
Bayfront, TGH and St. Joseph's are all not-for-profit institutions; HCA is the nation's largest for-profit hospital chain.
Just as important as finances, experts say, is keeping medical teams treating trauma patients sufficiently busy that they stay at the top of their game.
"It takes years of doing this to get the expertise necessary to really be a good trauma center," said Dr. Mark Vaaler, chief medical officer at Tampa's St. Joseph's.
He anticipated that trauma volume at St. Joseph's will hold steady this year. The hospital is seeing about 200 fewer trauma patients from Pasco, Hernando and Citrus counties — patients who likely now go to Bayonet Point. But at the same time, Vaaler noted, it has picked up about 100 patients from Bayfront's territory, due to changes in EMS transportation patterns.
Tampa General's trauma numbers also held steady during the first quarter of 2012, it reported.
"I'm very concerned that Bayfront has been the institution that has the most impact'' from the HCA hospitals, Vaaler said. "A very mature trauma center in the form of Bayfront could be really, really struggling."
And if it closed, he added, the only replacement would be new HCA programs that likely are seeing far lower patient volumes. And Bayfront is the only trauma center in Pinellas County.
Officials at Blake and Bayonet Point did not respond to requests for information about their trauma numbers. The Sarasota Herald-Tribune reported in July that Blake had treated more than 600 trauma patients from surrounding counties — cases that previously likely would have ended up at Bayfront.
The HCA centers opened in the midst of the ongoing legal battle. Late last year, Florida health officials granted preliminary approval to HCA, formerly headed by Gov. Rick Scott, to open four new trauma centers statewide. HCA is operating its new trauma centers in partnership with the University of South Florida.
Before that decision, Bayfront, TGH and St. Joseph's joined with another trauma hospital, Shands Jacksonville Medical Center, to challenge a 1992 state administrative rule used to approve the HCA plan.
They won a critical legal victory when a Tallahassee administrative judge declared the 1992 rule invalid. Judge W. David Watkins said the rule fails to take into account factors that make it safer to transport patients longer distances instead of opening greater numbers of costly facilities. Among them: more medical helicopters and advanced life support capabilities in ambulances.
HCA and the state appealed, and oral arguments in the case are scheduled for Thursday.
Letitia Stein can be reached at firstname.lastname@example.org or (727) 893-8330.