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Trauma Care Fight Flares In South FL

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Florida's trauma care battles are back.

Two major health care systems in South Florida have launched legal challenges against a state Department of Health decision that allowed Aventura Hospital and Medical Center to open a trauma center this spring. Meanwhile, another Miami-Dade County hospital, Jackson South Community Hospital, is fighting a state denial of its plan for a trauma center.

The challenges, filed this week in the state Division of Administrative Hearings, came about a year after a judge upheld a Department of Health rule for determining where additional trauma centers would be allowed. The approval of that rule effectively ended three years of legal battling in the hospital industry about trauma center plans.

The new South Florida disputes stem from applications submitted under the rule, which specifies how many trauma centers are allowed in 19 different areas of the state. With one slot available in Miami-Dade and Monroe counties, the Department of Health on April 30 gave notice that it would approve the Aventura trauma center while turning down the Jackson South proposal.

The challenges, which are intertwined, involve three of the most-powerful players in Florida's hospital industry: Miami-Dade's Jackson Health System, the South Broward Hospital District and the HCA health care chain, which includes the Aventura hospital.

In one of the cases, Jackson South, which is part of the Jackson Health System, wants an administrative law judge to reverse the Department of Health's denial of its proposed trauma center. In a 15-page filing, Jackson South contended that the Department of Health used an arbitrary process in reviewing the hospital's application.

"In certain instances, the department applied standards that were inescapably flawed, by requiring specific documentation that was not set forth in the trauma standards,'' the filing said. "As a result, the application process became a 'guessing game,' with JSCH (Jackson South) having no way to know how to successfully navigate the application process."

Aventura Hospital and Medical Center filed a petition Tuesday to intervene in the case, as the outcome of Jackson South's challenge ultimately could affect the ability of the Aventura trauma center to continue operating. Aventura quickly opened the center May 1 under what is known as "provisional" status.

"For more than two years and continuing through the present, Aventura has been developing its Level II trauma services program and application, and in the process has expended substantial human and financial resources in the recruitment and retention of highly skilled surgical and non-surgical physician specialists. as well as other personnel, and has also expended substantial resources on trauma service related hospital physical plant improvements,'' Aventura's petition to intervene said. "The financial expenditures alone to date amount to several million dollars."

In the two other challenges, which are highly similar, Jackson Memorial Hospital and the South Broward Hospital District are contesting the department's decision to approve the Aventura trauma center.

Jackson and Memorial Regional Hospital, which is part of the South Broward Hospital District, operate trauma centers that they contend will be hurt by the Aventura facility. In part, those arguments focus on the Aventura facility drawing away patients and specially trained staff members.

"The new trauma center at Aventura will disrupt and substantially alter existing patient flows to Jackson Ryder, and will compromise Jackson Ryder's ability to continue to meet the needs of the trauma patients it serves,'' Jackson attorneys wrote, referring to Jackson's Ryder Trauma Center. "Trauma patients that would otherwise receive trauma care at Jackson Ryder are being diverted to Aventura for trauma care. The re-distribution of trauma patients and reduction in trauma patient volume at Jackson Ryder is detrimental to the inclusive trauma system and to Jackson Ryder in particular."

But Aventura Hospital and Medical Center quickly filed motions to dismiss those cases, arguing that the Department of Health rule had already established a need for an additional trauma center in Miami-Dade and Monroe counties, a region designated by the state as Trauma Service Area 19. Along with Jackson's Ryder Trauma Center, another trauma facility operates at Kendall Regional Medical Center.

"Prior to Aventura's provisional approval, there were only two trauma centers in TSA 19,'' Aventura's attorneys wrote in a document filed Tuesday. "The existence of an unmet slot prior to Aventura's provisional approval means that by the terms of the rule there was a per se 'need' for an additional trauma center in TSA 19. By granting Aventura's trauma center provisional status, the department assigned the third slot in TSA 19 to Aventura."