TALLAHASSEE -- Despite the objections of leading experts, members of the Florida House on Tuesday pressed forward with a last-minute campaign to loosen state restrictions on opening new hospital trauma centers.
Legislation approved by the House Health and Human Services Committee -- filed just hours before the vote, and retooled on the fly with amendments scribbled by hand -- comes amid a protracted fight among Florida hospitals over who should treat the most critically injured patients.
Their increasingly political debate centers on whether new trauma centers save lives or squander medical resources, raising the already steep cost of health care.
A companion Senate bill that could see its first public airing on Thursday is also being rushed through in the waning days of the session.
"This is a contentious issue, but it shouldn't be," said House sponsor Matt Gaetz, R-Fort Walton Beach, acknowledging the legislation aims to create more lenient standards for approving new trauma centers. "We have this protectionist system that punishes people in the greatest need of acute medical care."
The legislation appears to benefit the for-profit HCA hospital chain, whose entry into the trauma business sparked the current controversy. Gaetz is trying to help HCA's Fort Wal
ton Beach Medical Center, saying its prior attempts to open a trauma center were rejected by the state Department of Health.
In recent years, HCA has opened trauma centers statewide, including Regional Medical Center Bayonet Point in Hudson and Blake Medical Center in Bradenton. They are being run in partnership with the University of South Florida's medical school.
"When we see legislation that advances our mission of saving more lives, it is an easy decision for us to support the legislation. This is no different," HCA West Florida division spokeswoman J.C. Sadler said in a statement.
But HCA's trauma push has been opposed by long-standing trauma hospitals who argued they would be hurt not only financially, but because fewer patients would mean trauma teams wouldn't have enough patients to keep their skills at their peak. These hospitals -- including Tampa General and Bayfront Medical Center -- won at least a temporary victory late last year when Florida courts declared invalid a 20-year-old rule used to justify the new HCA programs.
A Tallahassee appeals court ruled that the Department of Health was out of bounds when it allowed several facilities -- including Blake Medical Center -- to start treating trauma patients.
The Blake trauma center has treated injury victims from Sarasota, Manatee and DeSoto counties since November 2011. Before Blake opened its $2.5 million trauma center, local trauma patients were flown to Bayfront Medical Center in St. Petersburg, which joined the lawsuit against the state.
State health officials are now rewriting the trauma rules -- efforts that could be undone by late-filed bills.
"There must be a transparent, scientific method that establishes the location and number of trauma centers needed to provide timely, efficient and cost-effective care based on the needs of the population," Tampa General trauma program manager Melissa Cole told the House committee Tuesday.
She called curtailing state oversight "a big mistake."
After some last-minute amendments, the House legislation was limited to hospitals in rural counties, although lawmakers acknowledged it likely will be amended again. It passed with support from Rep. Mike Fasano, R-New Port Richey, and Rep. Richard Corcoran, R-Land O'Lakes.
Under the bill, rural hospitals would no longer need state approval to open trauma centers. They would just need to be certified by the American College of Surgeons.
The college's Florida chapter opposed the change, as did the Florida Hospital Association and the Safety Net Hospital Alliance of Florida, which represents many trauma hospitals.
"In a perfect world, there would be a trauma center on every street corner. There would (also) be a heart transplant center on every street corner, but we can't afford that," said Dr. J.J. Tepas, chief of the division of pediatric surgery at Shands Jacksonville Medical Center.
The Senate may consider more sweeping legislation that would protect the new HCA trauma centers, whose legal status is the subject of an ongoing lawsuit by established trauma centers.
"We're all about good outcomes, with prudent use of resources," said Dr. Paul Danielson, director of pediatric trauma services at All Children's Hospital. "I don't know if this is the way to get there."