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Judge Tosses Out Trauma System Plan

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
US Army Medical Command
The Florida Channel
The Army Trauma Training Center at Jackson Memorial Hospital's Ryder Trauma Center in Miami.

As lawmakers debate revamping the trauma-care system, a judge Tuesday rejected a plan by the Florida Department of Health that likely would have led to an increase in trauma centers across the state.
Administrative Law Judge Garnett Chisenhall, in a 70-page ruling, tossed out a proposed rule that the department planned to use in determining whether trauma centers should be allowed to open. Chisenhall said the department's position "contravenes" at least two state laws.

The ruling was a victory for five major hospitals --- UF Health Jacksonville, Tampa General Hospital, Lee Memorial Hospital in Fort Myers, Bayfront Health-St. Petersburg and St. Joseph's Hospital in Tampa ---- that have long run trauma centers and filed challenges after the department proposed the rule last year.

It also was the latest development in six years of legal and regulatory battling about efforts to open new trauma centers in various parts of the state. Those battles have focused heavily on a law that limits the number of trauma centers statewide to 44 and also caps the numbers in 19 different regions of the state.

A House subcommittee on Monday approved a bill that would eliminate the limits on trauma centers, an approach supported by Gov. Rick Scott and the HCA health-care company, which has moved in recent years to open several trauma facilities. HCA has faced opposition from hospitals that already operate trauma centers.

The department's proposed rule, at least in part, dealt with a process of determining "need" for trauma centers in each of the 19 regions, known as trauma service areas. In the past, the numbers in each region have typically been viewed as a maximum number of trauma centers. But the proposed rule changed the interpretation to a minimum.

But Chisenhall wrote that the new interpretation conflicts with state law.

"While the undersigned (judge) cannot conclude that the department's new interpretation … is arbitrary and capricious, the outcome of the … case must turn on the Legislature's use of plain and unambiguous language that clearly establishes that the department is to calculate the maximum (rather than the minimum) number of trauma centers needed in the 19 TSAs," the ruling said.

Supporters of allowing more trauma centers argue that the facilities would provide greater access to care for patients who need care quickly after incidents such as traffic accidents. But opponents say trauma centers need highly trained staff members and significant numbers of patients and that allowing an influx of new trauma facilities would lead to a dilution that would affect quality of care.

Chisenhall appeared to try to straddle that argument.

"There are substantial benefits associated with reducing transport times and treating more severely injured patients in trauma centers," the ruling said. "Nevertheless, petitioners (the hospitals that challenged the proposed rule) presented compelling evidence indicating that the increased access to care could lead to decreased quality of care. For instance, given the specialized nature of the professionals that must continuously staff a trauma center, it is likely that all trauma centers in Florida would have more difficulty acquiring the necessary personnel if several new trauma centers were to open in rapid succession."