Wednesday, November 22, 2017
Editorials

Safeguard kids, not HCA's bottom line

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When the for-profit Hospital Corporation of America pushed to expand its Florida trauma center network five years ago, the conversation revolved around underserved communities and the claim that competition for patients would serve Floridians well. But in a textbook case of unintended consequences, it now appears children who are traumatically injured in the communities served by HCA's trauma centers can end up waiting much longer — hours, in fact — to get the treatment they need for life-threatening injuries. In a state that has invested so heavily in 13 pediatric trauma centers, critically injured children and their families should not be treated like profit centers. The medical system, from paramedics on the street to regulators in Tallahassee, should be looking out for these trauma patients and not a politically active hospital network's bottom line.

In 2010, just five children within a 50-mile radius of a pediatric trauma center were transported to a non-pediatric, non-HCA trauma center. Two years later, after HCA added five trauma centers in the state, 57 children within 50 miles of a pediatric facility had been transported to non-pediatric trauma centers, most of them HCA facilities. Once at HCA facilities, children often were transferred to pediatric facilities, but their stopover resulted in thousands of dollars in extra cost and greater risk to recovery.

Those trend lines are buried in reports that trauma centers must file with the Florida Department of Health — but if regulators noticed them, they kept quiet. It took the Tampa Bay Times' Kris Hundley and Alexandra Zayas, who have been investigating the state's trauma network, to reveal disturbing consequences of overexpansion. Earlier this year, the Times chronicled how HCA's five new trauma centers (including one that has since been closed by the state for an undisclosed reason) had been charging patients exorbitant fees of as much as $33,000 just for rolling in the door. That includes child trauma patients, regardless of their injuries or how long they stayed.

Now the Times has learned that the addition of HCA trauma centers, particularly in Marion, Clay and Pasco counties, has prompted local medical response systems to ignore medical protocol and state guidelines that recommend taking child trauma victims directly to a pediatric trauma center, even if an adult trauma center is closer, so they can receive the benefit of specialists trained to treat young, developing bodies. In these three counties, paramedics are transporting far more children than in the past to adult trauma centers for no obvious medical reasons. At least three children died after being taken first to an HCA adult trauma center despite meeting state criteria to go to a pediatric center — where they were eventually transferred. The children's injuries may have been fatal regardless, but it's unknown whether quicker attention by specialists at a pediatric center could have improved their odds.

No one accepts responsibility for this breach in medical protocol. Marion County's emergency medical officials, for example, contend hospitals advise where to take the patient. HCA hospitals contend it is up to paramedics to decide where patients are delivered. And state regulators are sitting on their hands. A health department spokesman told the Times his agency had no reason to look at how the proliferation of new trauma centers might impact the delivery of service to the youngest trauma patients — despite warnings from the pediatric medical community after the HCA trauma centers opened that they were seeing bad outcomes.

The health department now has every reason to investigate why children aren't being sent to directly to pediatric trauma centers and whether HCA has encouraged local emergency response agencies to favor them in violation of state guidelines. Local emergency response agencies need to double-down on educating their paramedics on how to handle child trauma patients. And everyone, instead of no one, should be looking out for child trauma patients.

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