MANATEE -- Since Blake Medical Center's $2.5 million provisional trauma center debuted last November, its trauma doctors have treated more than 600 patients with severe injuries from car crashes, bad falls and stabbings.

Meanwhile, the controversial new center is still being challenged in court.

The Blake trauma center is a first for Manatee, Sarasota and DeSoto counties. Previously, people with life-threatening injuries in the three counties were airlifted to long-standing trauma centers in Tampa, St. Petersburg or Fort Myers.

Blake is one of at least three hospitals owned by for-profit hospital corporate giant HCA, where new provisional trauma centers are being opposed. Two other trauma centers were approved earlier this year.

Before the new centers even opened last year, hospitals with trauma centers initiated a legal challenge. They contend the new HCA trauma centers are too close to them and will siphon off patients, causing huge financial losses when they need every dollar.

Tampa General and St. Joseph's Hospital in Tampa and Bayfront Medical Center want to stop the trauma center at Blake. Bayfront also objects to the new provisional trauma center at Regional Medical Center Bayonet Point in Pasco County. Shands Jacksonville Medical Center is trying to halt the provisional trauma center at Orange Park Medical Center in Clay County.

The Department of Health and HCA have fought back. So far, the yearlong dispute has involved the state administrative hearing division, state health department and First and Second District Courts.

A new salvo is a now-pend

ing appeal filed in June at the First District Court. The opposing hospitals appealed a final order signed in May by Interim State Surgeon General Steven L. Harris. The order dismissed their petition for a formal administrative hearing at the Department of Health.

How the legal wrangling may -- or may not -- affect Blake remains to be seen.

Blake's trauma center medical director, Brian Kimbrell, said he doesn't focus on the court proceedings. "Our focus is on saving lives," he said about trauma care at Blake.

He is proceeding as planned to take the "provisional" center to fully approved status within the state's trauma center network.

A trauma surgeon, Kimbrell moved to Bradenton from California in 2010 with a mandate to build a new trauma center at Blake from the ground up. He and others at Blake achieved the first step by creating an extensive application required by state regulators.

The proposal needed to show Blake would have the staff, resources and protocols to operate an effective trauma center. In the end, Blake's application was more than 8,000 pages.

Their work paid off when state regulators approved the application last year, giving Blake permission to open a trauma center on a provisional basis.

The next hurdle will be passing a review by an out-of-state team of trauma-care experts who will put together an in-depth evaluation of how well the Blake center is functioning.

A positive evaluation will allow the Blake center to go from its current "provisional" status to being a verified trauma center. The designation is good for seven years.

"This will be a great accomplishment for us and one we're expecting to achieve soon," said Kimbrell.

He expects the review team will be on-site sometime between September and November.

The provisional trauma center reached the milestone of treating its 600th patient on July 12, said Blake spokeswoman Stephanie Petta.

Blake anticipated treating up to 750 trauma patients during the trauma center's first year. After the center opened, the number of cases was brisker than expected but has slowed in recent months, said Kimbrell.

The slowdown is probably due to the area's smaller population during the summer when winter visitors return north, he said.

The leading number of injuries being treated at Blake's trauma center has been caused by falls. Automobile and motorcycle accidents are in the next highest category. Penetration wounds, such as from gunshots or stabbings, have accounted for eight percent of total trauma injuries.

According to trauma specialists, severely injured patients have the best chance of survival if they receive trauma care within the "golden hour" or the first 60 minutes after a life-threatening injury.

Blake's opponents argue that trauma patients from Manatee, Sarasota and DeSoto counties can be airlifted to Tampa and St. Petersburg long before that window of time closes.

They also have contended that trauma care shouldn't be spread out because trauma surgeons need a large number of cases to maintain their skills.

The existing trauma centers already lose money and the hospitals predict they will lose millions more because of Blake and the other new provisional trauma centers owned by HCA.

Typically, trauma centers are a money-losing business for hospitals. They are expensive to run and treat uninsured patients.

According to the Department of Health's website, Level II trauma centers in Florida must be open 24 hours a day and have a minimum of five trauma surgeons on board for around-the-clock availability.

The Blake center now has four trauma surgeons, said Kimbrell, and anticipates hiring a fifth soon.

A large team of board-certified surgical specialists also must be on call around the clock, including doctors who specialize in obstetric/gynecologic surgery, eye surgery, orthopedic surgery and plastic surgery.

Non-surgical specialists must be available 24 hours a day, too. The specialties include cardiology, infectious disease, hematology and pulmonary medicine.

State regulations also specify medical equipment and treatment rooms.

Susan Hemmingway, Herald health correspondent, can be reached at shemmingway@hotmail.com.