MANATEE -- In a corner of Blake Medical Center’s emergency room, patients are seeing doctors and nurses in two new treatment rooms. They probably have no idea they are in the heart of what could be the region’s first trauma center -- and the core of a legal battle playing out in Tallahassee.
Blake is one of four Florida hospitals owned by the national Hospital Corporation of America that applied for state approval to open trauma centers. It has committed some $2.5 million to the project, including the new treatment bays.
But in May, three Tampa Bay hospitals challenged the state Health Department over its approval process. Bayfront Medical Center, St. Joseph’s Hospital and Tampa General Hospital said the HCA centers would be unfair competition and handicap their existing trauma centers.
“A reduction in patient volume would also increase the losses resulting from the operation of Bayfront’s trauma center,” Bayfront said in its initial filing.
As summer heated up, so did the case. HCA jumped in on the Health Department’s side. Shands Jacksonville Medical Center, a University of Florida affiliate, joined the Tampa Bay hospitals. All six parties sent lawyers into a four-day hearing in late June.
Later this month, after 89 court filings (and counting), Administrative Law Judge W. David Watkins is expected to reach a decision. Only one thing is certain: One side will be out millions of dollars a year.
Two sides square off
At the core of the dispute is some common sense.
By state law, once paramedics designate someone as a trauma patient, the person must be taken to the nearest trauma center.
For most of Manatee, Sarasota and DeSoto counties, that means Bayfront in St. Petersburg. But a trauma center at Blake would capture those patients, estimated at more than 500 a year. Similarly, the planned center at HCA’s Bayonet Point hospital would siphon off patients coming from north of Tampa. Shands says a planned HCA trauma center could take 25 percent of its patients.
The Tampa Bay hospitals and Shands argue that the HCA trauma centers were approved under outdated rules, dating to 1992, which did not consider current populations and needs. They also pointed to a 2004 law where state legislators mandated updated state trauma management plans.
HCA countered that the rules have been continually revised, and that the longtime approval system should be the authority.
Moreover, they noted, the 2004 mandate from lawmakers said that each of the state-designated trauma regions should have at least one trauma center -- and the Manatee-Sarasota-DeSoto region has none.
Why a battle over turf?
One question is why everyone seems to want an operation that, by all accounts, loses money.
Trauma centers are a bit like sports arenas -- prestigious, but fabulously expensive. Traditionally, they lose money, even though they provide a vital service with hefty medical bills. They must be prepared for every contingency: Doctors specializing in cardiac, orthopedic, neurologic and plastic surgery, among many others, must be on hand, and the hospital must be stocked with the equipment for each one -- all costly investments.
A 2002 Florida Department of Health study found it costs hospitals from $300,000 to $4 million a year to keep all the specialized physicians on staff for trauma cases.
In 2005, the University of South Florida studied outcomes and costs of Florida’s trauma center. It found that trauma patients’ charges are almost twice those of other patients, and their hospital stays 50 percent longer. Hospitals typically lose money on long patient stays, as they perform most of the money-making procedures at the beginning.
It all added up. The state’s 20 trauma centers operating in 2003 lost some $92.6 million that year, the USF study found. So why would the profit-conscious HCA want to operate money-losing services?
Studies indicate that HCA may be recognizing changes in health-care economics.
In recent years, hospitals have had to start paying independent specialist surgeons to be on call -- often costing $1 million a year or more. Having a trauma center means most of those surgeons would be paid employees, which would reduce overall operating costs. Those doctors also could bring patients into the HCA system, meaning more long-term income.
The HCA hospitals also are planning Level Two trauma centers, which can handle virtually all trauma cases but have fewer expenses than Level 1 centers, which must have research and teaching programs. Trauma centers also get a slice of state funding dedicated to trauma centers.
Open question on life saving
The answer to the core question -- will the closer trauma center save lives -- is still unclear. Medical literature often refers to the “golden hour,” the importance of starting treatment in the first 60 minutes. At helicopter cruising speed, a flight across Tampa Bay to Bayfront takes just seven minutes. But poor weather can ground helicopters, forcing a long drive across bridges.
The 2005 USF study found that location made some difference. When a county has a trauma center, its mortality rate is half that of a county with no trauma center.
But the same study found several counties with no trauma center that have mortality rates lower than those with a trauma center. And even in counties with no trauma center, most trauma patients were treated at a trauma center, a sign of how effective the transport system can be.
Blake officials, though, are adamant that the trauma center will mean better results.
“For victims of traumatic injuries in Manatee, Sarasota and DeSoto counties, care is delayed because of long travel times to the nearest trauma center,” Blake’s chief executive Dan Friedrich said as the hospital announced its plans.
“Having a trauma center here in Manatee County will save time and lives.”