Florida legislators have put an end to a long squabble over trauma centers in Pinellas County, squashing a request by hospital operator HCA to open a center at Northside Hospital in St. Petersburg.
A bill passed by the Legislature overhauls regulations overseeing the state’s trauma system by setting new standards for what can be designated as a trauma center while grandfathering in some that have been subject to lawsuits.
The centers offer a specialized and expensive level of care for serious injuries like severe burns and gunshot wounds.
Under the bill, Pinellas County will keep Bayfront Health St. Petersburg and Johns Hopkins All Children’s Hospital as trauma centers, while Northside Hospital, an HCA facility, will be blocked from approval for a center.
HCA, however, will receive trauma center designations for three other facilities it owns and manages in the state, including one at Orange Park Medical Center in Clay County.
The bill calms a series of feuds over where trauma centers can be built and who should operate them. It’s the product of a compromise brokered by lawmakers and involving other area facilities, including Tampa General Hospital, the region’s only Level 1 Trauma Center. Such agreements are rare between for-profit hospital chains like HCA and "safety net" hospitals like Tampa General, which take on large amounts of indigent care.
"Of course, we are disappointed that this legislation effectively puts an end to our effort to designate Northside Hospital as another alternative for Pinellas County," said J.C. Sadler, a spokeswoman for HCA, which operates 46 hospitals in Florida including the Medical Center Hospital in Trinity and the Memorial Hospital of Tampa.
"Over the past several years," she said, "we have seen countless lives saved because trauma care has been more accessible across Florida through the HCA Trauma Network. We have advocated that patients benefit anytime they can be treated more expediently, especially in the often life or death situations associated with trauma."
Sadler said HCA will not be pursuing any other trauma centers in the Tampa Bay region.
The last time a bill regulating the trauma system passed the Legislature, according to a staff analysis, was in 2004. The new deal, signed by Gov. Rick Scott on Wednesday, ends most of the pending legal battles over trauma centers and adds a strict need formula that makes it unlikely the state will add more centers anytime soon.
"Trauma has been causing deep divisions in the hospital community for many, many years," said Bruce Ruben, president of the Florida Hospital Association. Until the compromise struck by Sen. Dana Young, R-Tampa, and Rep. Jay Trumbull, R-Panama City, a resolution felt "out of reach," he said.
Trauma centers are regulated by a series of laws and the Department of Health. Hospitals with more established trauma centers have contended that having too many of them would cut into the limited number of cases they see and lessen the amount of practice their providers get treating complicated injuries.
But HCA, whose plans to open new trauma centers have drawn some lawsuits, has argued that adding more facilities expands access to care for seriously injured patients. HCA has long wanted to open a trauma center in Pinellas County, but faced opposition from institutions like Bayfront Health and St. Joseph’s Hospital in Tampa, which both already operate Level 2 trauma centers. Both organizations said the centers are expensive to operate and it’s difficult to recruit and retain the highly-trained physicians needed to staff them. A trauma surgeon must be in the hospital at all times.
"Our primary concern related to a potential trauma program at Northside was patient safety. Study after study show that trauma patients get the best care when a community’s trauma-related resources are concentrated at specific hospitals, rather than diluting the specialized skill set across multiple settings," said Elena Paredes, spokeswoman with Bayfront Health. "Given its close proximity to Bayfront, the proposed center at Northside would have split resources and affected care for patients."
But trauma cases have also drawn contention because they can bring in more money for the hospital. They often require follow-up care and can be paid for from more sources, such as auto insurance or workers compensation coverage, in cases like workplace injuries or car crashes. They also draw funding from vehicle registration taxes and red light camera fines.
The system currently caps the number of trauma centers in the state at 44 across 19 "trauma service areas," though the legislation reduces the number of those areas to 18 and sets a new cap for the number of trauma centers at 35. (There is an exception for Memorial Hospital in Jacksonville, which might receive the 36th designation depending on ongoing litigation.)
"We do not feel that the need was demonstrated for the HCA center," said Dr. Mark Vaaler with Baycare’s St. Joseph’s Hospital. "The law that was put together is a really good compromise and puts trauma centers back into the realm that is based on high-quality care."
The bill also creates an advisory council, which must be established by Oct. 1, to meet quarterly and provide recommendations to the health department. The department would be required to analyze the state’s trauma system by August 2020 and repeat such an analysis every three years.
Contact Justine Griffin at [email protected] or (727) 893-8467. Follow @SunBizGriffin.