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New Trauma Proposal Draws Challenges

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.

Broward County and major hospital systems in Jacksonville and Miami are challenging the Florida Department of Health about a proposed change in the way trauma centers are divvied up among various parts of the state.

Broward, UF Health Jacksonville and the Public Health Trust of Miami-Dade County, which operates the Jackson Health System, filed challenges Friday and Monday in the state Division of Administrative Hearings. They argue that the Department of Health overstepped its legal authority in proposing a new rule for the state trauma system.

That proposed rule would set numbers of trauma centers that would be allowed in 19 different areas --- an issue that has been highly controversial in the hospital industry in recent years.

The challengers raise a series of objections to the proposed rule, which was published last month. Broward and the Public Health Trust of Miami-Dade object to a possible reduction in the number of allowed trauma centers in their regions; UF Health Jacksonville objects to a potential increase in the number of trauma centers allowed in its five-county area.

An administrative law judge in 2014 upheld a department trauma-system rule after three years of legal and legislative battling about the issue. Much of that battling focused on trauma centers that opened in Pasco, Manatee and Marion counties.

Florida has limited the numbers of trauma centers in different regions of the state because of issues such as the relatively high costs of running the facilities. Also, existing trauma centers have raised concerns about additional facilities draining away staff and patients. But supporters of opening trauma centers have contended that they can improve access to potentially life-saving care.

The state takes into account several factors in determining how many trauma centers should be allowed in each area, such as population, transportation times and community support. But the newly filed challenges take issue with the way the proposed rule ends up calculating the need for trauma centers in some regions.

"The petitioner (the Public Health Trust of Miami-Dade), or any other party besides the department, has no way of verifying the accuracy, completeness, or suitability of the data that the department uses in the trauma service area assessments,'' the health trust's challenge says. "This is because either the department claims the data is confidential and exempt from disclosure, or the formulas used to calculate the data is unknown and not disclosed by the department. And more importantly, if the data and methodology … are flawed, then the reported number of trauma centers allocated to each TSA (Trauma Service Area region) would also be flawed, thus rendering the proposed rule arbitrary and capricious."

In Northeast Florida, UF Health Jacksonville operates the only trauma center, but the proposed rule would allow another trauma facility in the region. In Broward County, the number of authorized trauma centers would go from two to one, while in the region that includes Miami-Dade and Monroe counties, the number would go from three to two.

Broward already has three trauma centers, while Jackson Health System has been in a legal battle to get approval to open a trauma facility at Jackson South Community Hospital.

In the challenge, the Public Health Trust of Miami-Dade said the Department of Health has given assurances that existing trauma centers would be "grandfathered," meaning they would be able to remain open despite the changes in the proposed rule. The health trust, however, said the text of the proposed rule does not include a "grandfathering" provision.