TALLAHASSEE — What started as a plan to shield three disputed HCA trauma centers -- including Blake Medical Center in Bradenton -- from legal action, and later added limits on sky-high trauma access fees, collapsed entirely late Friday as legislators failed to pass any trauma measure.
One of the most high profile issues of the session fell prey to political maneuvering as the House attempted to amend it — and a bunch of unrelated issues — onto a bill that turned into such a train that House Speaker Will Weatherford chanted "choo-choo'' as it came up in his chamber. The House approved the measure, but the Senate would not take it up as session drew to a close.
"The bill got too heavy and was in trouble as soon as the House decided to use a train instead of a stand-alone bill,'' said Sen. Denise Grimsley, R-Sebring, the Senate sponsor.
The failure to grandfather Regional Medical Center Bayonet Point in Pasco County, Blake Medical Center in Manatee County and Ocala Regional Medical Center does not mean the facilities will be shut down anytime soon. But it almost guarantees that legal challenges from long-standing trauma centers that contend HCA was improperly granted state permission to open will continue. Safety net hospitals including Tampa General Hospital, Bayfront Health St. Petersburg, St. Joseph's Hospital in Tampa and UF Health Jacksonville have been embroiled in litigation that could eventually force HCA to shutter the three centers.
The warring hospitals had come up with a compromise that could have ended many of the legal challenges if it had been adopted by the Senate after the House had agreed.
Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, said no bill at all was preferable to the Senate version.
"We didn't like a lot of the options that were being considered, and compared to that we would rather have no trauma legislation," he said. "But we did agree to a trauma bill that put in an activation fee (limit), that grandfathered in three hospitals."
Lawmakers generally agreed on the basics: keeping the three centers open, creating a one-year $15,000 cap on access fees and instituting a one-year moratorium on new trauma centers.
The fee limits were added after a Tampa Bay Times investigation revealed hospitals across the state were charging huge fees to trauma patients even for minor injuries, and HCA was leading the pack.
The for-profit hospital chain is a formidable presence in Tallahassee with 25 registered lobbyists to influence legislators this session. It has made $1.3 million in campaign contributions, including $100,000 to the governor's re-election campaign, since November 2012.
The Senate wanted to create a trauma advisory council to come up with new rules for approving future centers, but wouldn't guarantee that safety net hospitals would be represented. The Senate also wanted to restrict safety net hospitals from pursuing legal challenges in the future.
Those hospitals instead brokered a compromise agreement with HCA that would have tightened the grandfathering provision to cover only the three existing trauma centers and required the Ocala facility, which is operating under provisional approval, to meet state standards for verified status in a year.
"All of the things the House tried to address the Senate failed to take up," said Rep. Jason Brodeur, R-Sanford, who sponsored trauma language in the House.
Protecting the three HCA centers became just one component of several omnibus health care trains with new proposals tacked on at nearly every opportunity in recent days.
"Anything that's in a train, sometimes it helps, sometimes it hurts," Carvalho said.
The House took its trauma center bill, HB 7113, and tacked on requirements that doctors consult the state's prescription drug monitoring database, independence for highly trained nurses, limits on the Miami-Dade Health Trust and regulations for virtual doctor visits.
HB 7113 sunk under the weight of competing House and Senate proposals, only to be replaced by HB 7105 as the preferred trauma vehicle.
Brodeur filed an amendment to HB 7105 late Friday, creating hope in the final hours that a deal had been struck. The measure was approved by the House 108-9, but the Senate never concurred. "When we're getting down to the last couple of hours we're trying to do the best job we can with all of the outstanding issues," Brodeur said.
Safety net hospitals vehemently opposed part of Brodeur's amendment that allowed post-operation surgical centers to keep patients for up to 24 hours.
Current law requires those facilities to discharge patients the same business day. Hospitals believe that patients needing care beyond that are best served in their facilities.
Safety net hospitals, which long have contended that opening additional trauma centers will only drive up costs while diluting quality of service, now will focus the state's authorization process.
But the HCA centers also enjoy support from people who live in the communities they serve, some of which came to Tallahassee to ask legislators to keep the centers open.