Fight over Florida trauma centers appears to be near an end

Published July 22, 2014

TALLAHASSEE — Florida's trauma drama could be almost finished.

With an appeal deadline passing Monday, the Florida Department of Health and hospitals owned by the HCA health-care chain appear to have prevailed after a three-year legal and political battle about approving new trauma centers.

The key point came last month when an administrative law judge upheld a rule that the department proposed for determining where trauma centers could be allowed across the state. Hospitals in the Tampa Bay and Gainesville areas unsuccessfully fought the proposed rule and had until Monday to appeal.

Spokespeople for two of the hospitals challenging the proposed rule — Tampa General and St. Joseph's Hospital in Tampa — said they would not appeal. UF Health Shands in Gainesville signaled earlier this month it would drop the case. A spokeswoman for Bayfront Medical Center in St. Petersburg could not be reached. But no appeals had been posted to an online case docket as of early Monday evening.

Though some legal issues remain to be resolved, the bottom line is that it appears disputed trauma centers at Blake Medical Center in Manatee County, Regional Medical Center Bayonet Point in Pasco County and Ocala Regional Medical Center in Marion County can shed lingering uncertainty about whether they will remain open. Those hospitals are all part of the HCA chain, which also now could move forward with a renewed proposal to open a trauma center at Osceola Regional Medical Center in Kissimmee.

Stephen Ecenia, an HCA attorney, said he and his clients are relieved that the litigation appears to be nearly finished.

"Things certainly appear to be heading toward resolution, and that's very satisfying,'' Ecenia said.

The legal battling began in 2011 when opponents of the new trauma centers challenged a longstanding state rule for approving trauma facilities. Ultimately, an administrative law judge and the 1st District Court of Appeal found the old rule invalid, but the Department of Health allowed the Manatee, Pasco and Marion trauma centers to open — and remain open.

That spurred several more legal challenges and political fights in the Legislature about changing the state's trauma-care law. Meanwhile, the Department of Health early this year unveiled a new proposed rule, which was supported by HCA, that drew a fight in the state Division of Administrative Hearings.

Last month, Administrative Law Judge R. Bruce McKibben upheld the proposed rule, which includes a scoring system that takes into account several factors in determining whether new trauma centers should be approved in different parts of the state. McKibben pointed to the department's lengthy process of developing the rule.

"The department's proposed rule was the product of thoughtful consideration by the department's experts during an extensive rulemaking development process,'' he wrote in a 71-page order. "Under these circumstances, the department's determinations are accorded deference."

The hospitals that challenged the proposed rule all have run trauma centers for years. They have repeatedly raised concerns about the new trauma facilities draining patients and highly trained specialists from their centers.

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Cases remained pending Monday in the Division of Administrative Hearings that challenge the continued operation of the trauma centers at Blake Medical Center and Regional Medical Center Bayonet Point. But with the rule upheld, it likely would be difficult for opponents to win those cases, attorneys said. UF Health Shands this month dismissed a similar challenge to Ocala Regional Medical Center's trauma facility.

Lisa Patterson, a spokeswoman for St. Joseph's in Tampa, said her hospital hopes the new rule will be an improvement over the old, invalid rule and that it will properly assess community need before new trauma centers open.