(1) For purposes of developing a system of trauma centers, the department shall use the 18 trauma service areas established in s. 395.402. The department shall designate those hospitals that are to be recognized as trauma centers.
(2)(a) The department shall prepare an analysis of the Florida trauma system by August 31, 2020, and every 3 years thereafter, using the hospital discharge database described in s. 408.061 for the most current year and the most recent 5 years of population data for the state available from the American Community Survey 5-Year Estimates by the United States Census Bureau. The department’s report must, at a minimum, include all of the following:
1. The population growth for each trauma service area and for the state.
2. The number of high-risk patients treated at each trauma center within each trauma service area, including pediatric trauma centers.
3. The total number of high-risk patients treated at all acute care hospitals, including nontrauma centers, in each trauma service area.
4. The percentage of each trauma center’s sufficient volume of trauma patients, as described in subparagraph (3)(d)2., in accordance with the International Classification Injury Severity Score for the trauma center’s designation, inclusive of the additional caseload volume required for those trauma centers with graduate medical education programs.
(b) The department shall make available all data, formulas, methodologies, calculations, and risk adjustment tools used in preparing the report.
(3)(a) The department shall notify each acute care general hospital and each local and each regional trauma agency in a trauma service area with an identified need for an additional trauma center that the department is accepting letters of intent from hospitals that are interested in becoming trauma centers. The department may accept a letter of intent only if there is statutory capacity for an additional trauma center in accordance with subsection (2), paragraph (d), and s. 395.402. Letters of intent must be postmarked no later than midnight October 1 of the year in which the department notifies hospitals that it plans to accept letters of intent.
(b) By October 15, the department shall send to all hospitals that submitted a letter of intent an application package that will provide the hospitals with instructions for submitting information to the department for selection as a trauma center. The standards for trauma centers provided for in s. 395.401(2), as adopted by rule of the department, shall serve as the basis for these instructions.
(c) In order to be considered by the department, applications from those hospitals seeking selection as trauma centers, including those current verified trauma centers that seek a change or redesignation in approval status as a trauma center, must be received by the department no later than the close of business on April 1 of the year following submission of the letter of intent. The department shall conduct an initial review of each application for the purpose of determining whether the hospital’s application is complete and the hospital is capable of constructing and operating a trauma center that includes the critical elements required for a trauma center. This critical review must be based on trauma center standards and must include, but need not be limited to, a review as to whether the hospital is prepared to attain and operate with all of the following components before April 30 of the following year:
1. Equipment and physical facilities necessary to provide trauma services.
2. Personnel in sufficient numbers and with proper qualifications to provide trauma services.
3. An effective quality assurance process.
(d) Except as otherwise provided in this part, the department may not approve an application for a Level I trauma center, Level II trauma center, Level II trauma center with a pediatric trauma center, jointly certified pediatric trauma center, or stand-alone pediatric trauma center if approval of the application would exceed the limits on the numbers of Level I trauma centers, Level II trauma centers, Level II trauma centers with a pediatric trauma center, jointly certified pediatric trauma centers, or stand-alone pediatric trauma centers set forth in s. 395.402(1). However, the department shall review and may approve an application for a trauma center when approval of the application would result in a total number of trauma centers which exceeds the limit on the number of trauma centers in a trauma service area as set forth in s. 395.402(1), if the applicant demonstrates and the department determines that:
1. The existing trauma center’s actual caseload volume of high-risk patients exceeds the minimum caseload volume capabilities, including the additional caseload volume for graduate medical education critical care and trauma surgical subspecialty residents or fellows, by more than two times the statutory minimums listed in sub-subparagraphs 2.a.-d. or three times the statutory minimum listed in sub-subparagraph 2.e., and the population growth for the trauma service area exceeds the statewide population growth by more than 15 percent based on the American Community Survey 5-Year Estimates by the United States Census Bureau for the 5-year period before the date the applicant files its letter of intent; and
2. A sufficient caseload volume of potential trauma patients exists within the trauma service area to ensure that existing trauma centers caseload volumes are at the following levels:
a. For Level I trauma centers in trauma service areas with a population of greater than 1.5 million, a minimum caseload volume of the greater of 1,200 high-risk patients admitted per year or, for a trauma center with a trauma or critical care residency or fellowship program, 1,200 high-risk patients admitted plus 40 cases per year for each accredited critical care and trauma surgical subspecialty medical resident or fellow.
b. For Level I trauma centers in trauma service areas with a population of less than 1.5 million, a minimum caseload volume of the greater of 1,000 high-risk patients admitted per year or, for a trauma center with a critical care or trauma residency or fellowship program, 1,000 high-risk patients admitted plus 40 cases per year for each accredited critical care and trauma surgical subspecialty medical resident or fellow.
c. For Level II trauma centers and Level II trauma centers with a pediatric trauma center in trauma service areas with a population of greater than 1.25 million, a minimum caseload volume of the greater of 1,000 high-risk patients admitted or, for a trauma center with a critical care or trauma residency or fellowship program, 1,000 high-risk patients admitted plus 40 cases per year for each accredited critical care and trauma surgical subspecialty medical resident or fellow.
d. For Level II trauma centers and Level II trauma centers with a pediatric trauma center in trauma service areas with a population of less than 1.25 million, a minimum caseload volume of the greater of 500 high-risk patients admitted per year or, for a trauma center with a critical care or trauma residency or fellowship program, 500 high-risk patients admitted plus 40 cases per year for each accredited critical care and trauma surgical subspecialty medical resident or fellow.
e. For pediatric trauma centers, a minimum caseload volume of the greater of 500 high-risk patients admitted per year or, for a trauma center with a critical care or trauma residency or fellowship program, 500 high-risk patients admitted per year plus 40 cases per year for each accredited critical care and trauma surgical subspecialty medical resident or fellow.
The International Classification Injury Severity Score calculations and caseload volume must be calculated using the most recent available hospital discharge data collected by the agency from all acute care hospitals pursuant to s. 408.061. The agency, in consultation with the department, shall adopt rules, for trauma centers and acute care hospitals for the submission of data required for the department to perform its duties under this chapter.
(e) If the department determines that the hospital is capable of attaining and operating with the components required in paragraph (c), the applicant must be ready to operate in compliance with state trauma center standards no later than April 30 of the year following the department’s initial review and approval of the hospital’s application to proceed with preparation to operate as a trauma center. A hospital that fails to comply with this subsection may not be designated as a trauma center.
(4) By May 1, the department shall select one or more hospitals that submitted an application found acceptable by the department based on initial review for approval to prepare to operate with the components required in paragraph (3)(c). If the department receives more applications than may be approved, the department must select the best applicant or applicants from the available pool based on the department’s determination of the capability of an applicant to provide the highest quality patient care using the most recent technological, medical, and staffing resources available and which is located the farthest away from an existing trauma center in the applicant’s trauma service area to maximize access. The number of applicants selected is limited to available statutory need in the specified trauma service area as designated in paragraph (3)(d) or s. 395.402(1).
(5) Following its initial review, the department shall conduct an in-depth evaluation of all applications found acceptable in the initial review. The applications shall be evaluated against criteria enumerated in the application packages as provided to the hospitals by the department. An applicant may not operate as a provisional trauma center until the department completes the initial and in-depth reviews and approves the application through those review stages.
(6) Within 1 year after the hospital begins operating as a provisional trauma center, a review team of out-of-state experts assembled by the department shall make onsite visits to all provisional trauma centers. The department shall develop a survey instrument to be used by the expert team of reviewers. The instrument must include objective criteria and guidelines for reviewers based on existing trauma center standards such that all trauma centers are assessed equally. The survey instrument must also include a uniform rating system that reviewers must use to indicate the degree of compliance of each trauma center with specific standards, and to indicate the quality of care provided by each trauma center as determined through an audit of patient charts. In addition, hospitals being considered as provisional trauma centers must meet all the requirements of a trauma center and must be located in a trauma service area that has a need for such a trauma center.
(7) Based on recommendations from the review team, the department shall approve for designation a trauma center that is in compliance with trauma center standards, as established by department rule, and with this section. Each trauma center shall be granted a 7-year approval period during which time it must continue to maintain trauma center standards and acceptable patient outcomes as determined by department rule. An approval, unless sooner suspended or revoked, automatically expires 7 years after the date of issuance and is renewable upon application for renewal as prescribed by rule of the department.
(8) Only an applicant or hospital with an existing trauma center in the same trauma service area or in a trauma service area contiguous to the trauma service area where the applicant has applied to operate a trauma center may protest a decision made by the department with regard to whether the application should be approved, or whether a need has been established pursuant to the criteria in paragraph (3)(d). Hearings held under this subsection shall be conducted in the same manner as provided in ss. 120.569 and 120.57. Cases filed under chapter 120 may combine all disputes between parties.
(9) Notwithstanding any provision of chapter 381, a hospital licensed under ss. 395.001-395.3025 that operates a trauma center may not terminate or substantially reduce the availability of trauma service without providing at least 180 days’ notice of its intent to terminate such service. Such notice shall be given to the department, to all affected local or regional trauma agencies, and to all trauma centers, hospitals, and emergency medical service providers in the trauma service area. The department shall adopt by rule the procedures and process for notification, duration, and explanation of the termination of trauma services.
(10) Except as otherwise provided in this subsection, the department or its agent may collect trauma care and registry data, as prescribed by rule of the department, from trauma centers, hospitals, emergency medical service providers, local or regional trauma agencies, or medical examiners for the purposes of evaluating trauma system effectiveness, ensuring compliance with the standards, and monitoring patient outcomes. A trauma center, hospital, emergency medical service provider, medical examiner, or local trauma agency or regional trauma agency, or a panel or committee assembled by such an agency under s. 395.50(1) may, but is not required to, disclose to the department patient care quality assurance proceedings, records, or reports. However, the department may require a local trauma agency or a regional trauma agency, or a panel or committee assembled by such an agency to disclose to the department patient care quality assurance proceedings, records, or reports that the department needs solely to conduct quality assurance activities under s. 395.4015, or to ensure compliance with the quality assurance component of the trauma agency’s plan approved under s. 395.401. The patient care quality assurance proceedings, records, or reports that the department may require for these purposes include, but are not limited to, the structure, processes, and procedures of the agency’s quality assurance activities, and any recommendation for improving or modifying the overall trauma system, if the identity of a trauma center, hospital, emergency medical service provider, medical examiner, or an individual who provides trauma services is not disclosed.
(11) Out-of-state experts assembled by the department to conduct onsite visits are agents of the department for the purposes of s. 395.3025. An out-of-state expert who acts as an agent of the department under this subsection is not liable for any civil damages as a result of actions taken by him or her, unless he or she is found to be operating outside the scope of the authority and responsibility assigned by the department.
(12) Onsite visits by the department or its agent may be conducted at any reasonable time and may include but not be limited to a review of records in the possession of trauma centers, hospitals, emergency medical service providers, local or regional trauma agencies, or medical examiners regarding the care, transport, treatment, or examination of trauma patients.
(13) Patient care, transport, or treatment records or reports, or patient care quality assurance proceedings, records, or reports obtained or made pursuant to this section, s. 395.3025(4)(f), s. 395.401, s. 395.4015, s. 395.402, s. 395.403, s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s. 395.51 must be held confidential by the department or its agent and are exempt from the provisions of s. 119.07(1). Patient care quality assurance proceedings, records, or reports obtained or made pursuant to these sections are not subject to discovery or introduction into evidence in any civil or administrative action.
(14) The department may adopt, by rule, the procedures and process by which it will select trauma centers. Such procedures and process must be used in selecting trauma centers and must be consistent with subsections (1)-(9) except in those situations in which it is in the best interest of, and mutually agreed to by, all applicants within a service area and the department to reduce the timeframes.
(15) Notwithstanding the procedures established pursuant to subsections (1)-(14), hospitals located in areas with limited access to trauma center services shall be designated by the department as Level II trauma centers based on documentation of a valid certificate of trauma center verification from the American College of Surgeons. Areas with limited access to trauma center services are defined by the following criteria:
(a) The hospital is located in a trauma service area with a population greater than 600,000 persons but a population density of less than 225 persons per square mile;
(b) The hospital is located in a county with no verified trauma center; and
(c) The hospital is located at least 15 miles or 20 minutes travel time by ground transport from the nearest verified trauma center.
(16)(a) Notwithstanding the statutory capacity limits established in s. 395.402(1), the provisions of subsection (8), or any other provision of this part, an adult Level I trauma center, an adult Level II trauma center, a Level II trauma center with a pediatric trauma center, a jointly certified pediatric trauma center, or a stand-alone pediatric trauma center that was verified by the department before December 15, 2017, is deemed to have met the trauma center application and operational requirements of this section and must be verified and designated as a trauma center.
(b) Notwithstanding the statutory capacity limits established in s. 395.402(1), the provisions of subsection (8), or any other provision of this part, a trauma center that was not verified by the department before December 15, 2017, but that was provisionally approved by the department to be in substantial compliance with Level II trauma standards before January 1, 2017, and is operating as a Level II trauma center, is deemed to have met the application and operational requirements of this section for a trauma center and must be verified and designated as a Level II trauma center.
(c) Notwithstanding the statutory capacity limits established in s. 395.402(1), the provisions of subsection (8), or any other provision of this part, a trauma center that was not verified by the department before December 15, 2017, as a Level I trauma center but that was provisionally approved by the department to be in substantial compliance with Level I trauma standards before January 1, 2017, and is operating as a Level I trauma center is deemed to have met the application and operational requirements of this section for a trauma center and must be verified and designated as a Level I trauma center.
(d) Notwithstanding the statutory capacity limits established in s. 395.402(1), the provisions of subsection (8), or any other provision of this part, a trauma center that was not verified by the department before December 15, 2017, as a pediatric trauma center but was provisionally approved by the department to be in substantial compliance with the pediatric trauma standards established by rule before January 1, 2018, and is operating as a pediatric trauma center is deemed to have met the application and operational requirements of this section for a pediatric trauma center and, upon successful completion of the in-depth and site review process, shall be verified and designated as a pediatric trauma center. Notwithstanding subsection (8), no existing trauma center in the same trauma service area or in a trauma service area contiguous to the trauma service area where the applicant is located may protest the in-depth review, site survey, or verification decision of the department regarding an applicant that meets the requirements of this paragraph.
(e) Notwithstanding the statutory capacity limits established in s. 395.402(1) or any other provision of this part, a hospital operating as a Level II trauma center after January 1, 2017, must be designated and verified by the department as a Level II trauma center if all of the following apply:
1. The hospital was provisionally approved after January 1, 2017, to operate as a Level II trauma center, and was in operation on or before June 1, 2017;
2. The department’s decision to approve the hospital to operate a provisional Level II trauma center was in litigation on or before January 1, 2018;
3. The hospital receives a recommended order from the Division of Administrative Hearings, a final order from the department, or an order from a court of competent jurisdiction that it was entitled to be designated and verified as a Level II trauma center; and
4. The department determines that the hospital is in substantial compliance with the Level II trauma center standards, including the in-depth and site reviews.
Any provisional trauma center operating under this paragraph may not be required to cease trauma operations unless a court of competent jurisdiction or the department determines that it has failed to meet the trauma center standards, as established by department rule.
(f) Notwithstanding the statutory capacity limits established in s. 395.402(1), or any other provision of this act, a joint pediatric trauma center involving a Level II trauma center and a specialty licensed children’s hospital which was verified by the department before December 15, 2017, is deemed to have met the application and operational requirements of this section for a pediatric trauma center and shall be verified and designated as a pediatric trauma center even if the joint program is dissolved upon the expiration of the existing certificate and the pediatric trauma center continues operations independently through the specialty licensed children’s hospital, provided that the pediatric trauma center meets all requirements for verification by the department.
(g) Nothing in this subsection shall limit the department’s authority to review and approve trauma center applications.
1Note.—Section 14, ch. 2018-66, provides that “[i]f the provisions of this act relating to s. 395.4025(16), Florida Statutes, are held to be invalid or inoperative for any reason, the remaining provisions of this act shall be deemed to be void and of no effect, it being the legislative intent that this act as a whole would not have been adopted had any provision of the act not been included.”
Cited 2 times | Published | Florida 1st District Court of Appeal
...l of 44 trauma
centers in the state.” § 395.402(4), Fla. Stat. Florida
Administrative Code Rule 64J-2.010 sets forth the criteria to be
used in allocating trauma centers among the TSAs and allocates
two trauma centers for TSA 9.
Section 395.4025, Florida Statutes (2016), governs the trauma
center application and selection process. First, the Department
“shall annually notify each acute care general hospital . . . that the
department is accepting letters of intent from hospitals that are
interested in becoming trauma centers.” § 395.4025(2)(a), Fla.
Stat....
...“By October 15, the department shall send to all hospitals
that submitted a letter of intent an application package that will
provide the hospitals with instructions for submitting information
to the department for selection as a trauma center.” §
395.4025(2)(b), Fla. Stat. “In order to be considered by the
department, applications . . . must be received by the department
no later than the close of business on April 1.” § 395.4025(2)(c),
Fla....
...s the
critical elements required for a trauma center.” Id. “After April
30, any hospital that submitted an application found acceptable by
the department based on provisional review shall be eligible to
operate as a provisional trauma center.” § 395.4025(3), Fla. Stat.
After a hospital is approved as a provisional trauma center,
“[b]etween May 1 and October 1, the department shall conduct an
in-depth evaluation of all applications found acceptable in the
provisional review.” § 395.4025(4), Fla. Stat. Finally, based on the
recommendations from a review team, the Department shall select
verified trauma centers by July 1 of the second year following the
filing of the letter of intent. § 395.4025(6), Fla....
...to make the final
selection(s). Upon final verification, a trauma center is granted
approval to operate for seven years, provided it continues to
maintain trauma center standards and acceptable patient
outcomes, and may thereafter apply for renewal. § 395.4025(6),
Fla....
...2d at 753, approved sub
nom. Naegele Outdoor Advert. Co., Inc. v. City of Jacksonville, 659
So. 2d 1046 (Fla. 1995); see also Heslop v. Moore, 716 So. 2d 276,
279 (Fla. 3d DCA 1998).
Bayfront argued, and the trial court ruled, that pursuant to
section 395.4025(5), the Department may not accept a LOI or
accept, review, and/or provisionally grant a trauma center
application when there is no need (i.e., an open slot) for a trauma
center in the TSA. This matter necessitates a brief review of the
statutory scheme. Section 395.4025(2) governs the submission of
a LOI and application and the ensuing provisional review of the
application, and in pertinent part it requires the Department to
notify each hospital that it is accepting LOIs, to send an
application pack...
...trauma center. The
provisions of subsection (2) do not confer discretion on the
Department and require it to invite and accept a LOI and to accept,
provisionally review, and provisionally grant an application
without regard to need. Notably, section 395.4025(2)(d)1.
9
authorizes the Department to grant an extension of time to an
applicant if the number of applicants in the TSA is equal to or less
than the service area allocation, not if the number of applicants is
equal to or less than the number of open slots, which further
evinces that the Legislature considers need irrelevant at the
provisional review stage of the application process. Section
395.4025(3) provides that after April 30, any hospital whose
application has been provisionally approved shall be eligible to
operate as a provisional trauma center. Section 395.4025(4)
governs the in-depth review of applications.
Section 395.4025(5), Florida Statutes, governs the onsite visit
by a review team of out-of-state experts and contains the following
provision, which is at the heart of the issue: “In addition, hospitals
being considered as provisional trauma center...
...that
sentence in interpreting the statute as prohibiting the Department
from processing and approving an application at the provisional
review stage when there is not an open trauma center slot in the
TSA.
The statutory context indicates that section 395.4025(5) is not
intended to make need a criteria at or before the provisional review
stage....
...a timely and complete application and have the critical elements
required for a trauma center. The Legislature’s definition of
“provisional trauma center” as “a hospital that has been verified
by the department to be in substantial compliance with the
requirements in s. 395.4025 and has been approved by the
department to operate as a provisional Level I trauma center,
Level II trauma center, or pediatric trauma center” supports this
10
interpretation....
...allow need to enter into consideration. See, e.g., Searcy, Denney,
Scarola, Barnhart & Shipley, 209 So. 3d at 1189 (explaining that
all parts of a statute must be given effect and must be read
together to achieve a consistent whole). For all these reasons,
section 395.4025 is clear and does not require or permit the
Department to consider need until the onsite review stage of the
application process.
Florida Administrative Code Rule 64J-2.012(1)(a) does not
compel a different conclusion as it req...
...As such, Bayfront
failed to demonstrate a substantial likelihood of success on the
merits of its claim relating to need.
Bayfront also argued, and the trial court found, that
Northside cannot begin operations as a provisional trauma center
until the conclusion of all administrative proceedings. Section
395.4025 provides that “[a]fter April 30, any hospital that
submitted an application found acceptable by the department
based on provisional review shall be eligible to operate as a
11
provisional trauma center.” § 395.4025(3), Fla. Stat.; see also Fla.
Admin. Code R. 64J-2.012(1)(g)1. (providing that the Department
shall notify each hospital that passed the provisional review
process that “the hospital shall operate as a Provisional trauma
center beginning May 1”). Section 395.4025(7), Florida Statutes,
provides that “[a]ny hospital that wishes to protest a decision made
by the department based on the department’s preliminary or in-
depth review of applications or on the recommendations of the site
visit re...
...ll proceed as
provided in chapter 120,” but it does not state what effect an
administrative challenge has on a provisional trauma center
beginning operation. The parties cited and we found no statute,
rule, or appellate decision directly on point. Section 395.4025 sets
forth a definite timeline for the trauma center application process
and requires a hospital to establish a trauma center prior to
submitting an application....
Cited 1 times | Published | Florida 1st District Court of Appeal
...§ 395.402(4)(c), Fla. Stat. (2016).
1 The appeals at issue were consolidated for travel and are
now consolidated for disposition.
2 The Legislature substantially amended the applicable
statutes in this case, in particular sections 395.402 and 395.4025,
after oral argument....
...r capricious, the rules
contravened the laws being implemented and vested unbridled
discretion in the Department.
MOOTNESS
After oral argument in this case, the Legislature substantially
amended sections 395.402 and 395.4025....
...d/b/a Orange Park Medical Center (“Orange Park”). JFK and
Public Health Trust submitted letters of intent to apply to operate
as a trauma center; Orange Park already operates a provisional
trauma center.
5
(2016). See also § 395.4025(1), Fla....
...However, under these statutes as revised in 2018, the
Legislature itself now provides the maximum number of trauma
centers for each service area. § 395.402(1)(c), Fla. Stat. (2018). No
longer does the Department have the authority to select or
establish the appropriate number of trauma centers. § 395.4025(1),
Fla. Stat. (2018). The new statutes prohibit the Department from
approving trauma centers—or even accepting letters of intent—for
service areas that have already met the new statutory maximums,
absent certain extenuating circumstances. § 395.4025(3) & (4), Fla.
Stat....
...3d at 654.
The ALJ determined that the Proposed Rules were an invalid
exercise of delegated legislative authority because (1) it would
render superfluous the requirement that trauma centers be
located in a TSA with a need under the prior version of section
395.4025(5) where all TSAs would always have a need; (2) the rule
minimums would implicitly supersede the statutory minimum
provided by the prior version of section 395.402(4); and (3) it vests
the Department with unbridled discretion to perm...
...er subsection (5) are
wholly conditional. We find this distinction to be relevant here, so
that the request for fees under section 120.595(2) allows us to
decide this moot appeal.
7
First, the prior version of section 395.4025(5) provided that
provisional trauma centers “shall be located in a trauma service
area that has a need for such a trauma center.” (emphasis added).
The ALJ held that because the Department’s allocation of
minimum need would mean all TSAs would “always” have a need,
the Proposed Rules render the prior version of section 395.4025(5)
superfluous. The ALJ’s holding is not accurate under the statute
or the Proposed Rules.
There is nothing in the prior version of section 395.4025(5)
that bars multiple TSAs from having needs at the same time....
...would foreclose the opportunity for another TSA to meet its rule
minimum.
This is all within its authority, as the Department was tasked
with establishing “the approximate number of trauma centers
needed to ensure reasonable access to high-quality trauma
services.” See § 395.4025(1), Fla. Stat. (2016) (emphasis added).
The Legislature’s use of the words “approximate” and “reasonable”
makes unlikely that it intended “need” to refer to a defined and
limited maximum. The former section 395.4025(5) was not
rendered superfluous or contravened by the Proposed Rules.
Second, the prior version of section 395.402(4) provided both
a floor for the individual TSAs (one) and a ceiling for the state (44).
8
§ 395.402(4)(b) & (c), Fla....
...actual or approximate need. Between the floor and the ceiling, the
Department was tasked with allocating (distributing or
designating) the remaining 25 available trauma centers slots
amongst the TSAs based upon their approximate need.
§§ 395.402(4)(b), 395.4025(1), Fla....
Cited 1 times | Published | Florida 1st District Court of Appeal
...Application and Selection Process
The trauma center application and selection process is a lengthy, multistage
process that begins each year with the Department notifying acute care hospitals and
trauma agencies that it is accepting letters of intent from those hospitals interested
in becoming trauma centers. § 395.4025(2)(a), Fla. Stat. (2015). Letters of intent are
due by October 1, and the Department thereafter distributes an application package
to each hospital that timely submitted a letter of intent. § 395.4025(2)(a)-(b), Fla.
Stat. (2015). The completed application is due by April 1 of the following year. §
395.4025(2)(c), Fla....
...complete and that the hospital has the critical elements required for a trauma center.”
Id. If the Department finds the hospital’s application acceptable based on the
provisional review, the hospital is “eligible to operate as a provisional trauma
center.” § 395.4025(3), Fla. Stat. (2015).
3
Between May 1 and October 1, the process entails an “in-depth evaluation”
by the Department of all applications found acceptable in the provisional review. §
395.4025(4), Fla. Stat. (2015). And between October 1 and June 1, a review team of
out-of-state experts assembled by the Department conducts onsite visits of all
provisionally approved trauma centers. § 395.4025(5), Fla. Stat. (2015). Based on
the recommendations from the review team, the Department selects verified trauma
centers by July 1 of the second year following the filing of the letter of intent. §
395.4025(6), Fla....
...Admin. Code R. 64J-2.016(11). Upon final verification, the
trauma center is granted approval to operate for seven years, provided it continues
to maintain trauma center standards and acceptable patient outcomes, and may
thereafter apply for renewal. § 395.4025(6), Fla....
...Van Laningham entered an order rejecting the Department’s decision and
recommending that the Department enter a final order (1) deeming Jackson South’s
2015 Application acceptable, (2) verifying that Jackson South was in substantial
compliance with the requirements of section 395.4025, and (3) approving Jackson
South to operate as a provisional Level II trauma center until the 2014-2016
application cycle concluded for TSA 19....
...ile challenging the denial of
a previous application. The statutory scheme provides several points of entry for a
hospital to challenge an adverse decision made by the Department, including the
decision to deny an applicant a provisional license. § 395.4025(7), Fla....
...on may ultimately be
denied due to a lack of authorized need. Even if a hospital successfully completes
the rigorous application process to become a verified trauma center, there still must
be a need for a trauma center in the relevant TSA. 2 See § 395.4025(5), Fla....
Published | Florida 1st District Court of Appeal | 2013 WL 4859092
...ea would have at least one trauma center, with not more than forty-four centers statewide. See Ch. 90-284, § 5, Laws of Fla.; § 395.033, Fla. Stat. (1991) (renumbered as § 395.402 by ch. 92-289, Laws of Fla.). A related statute, later codified as section 395.4025, directed DOH’s predecessor to establish an “approximate number of state-sponsored trauma centers needed to ensure reasonable access to high quality services” within each trauma service area. See Ch. 90-284, § 6(1), Laws of Fla.; § 395.0335(1), Fla. Stat. (1991) (renumbered as § 395.4025 by ch....
...This section also set forth a list of some of the criteria to be considered in reviewing trauma center applications, including whether the hospital had sufficient facilities and personnel. See Ch. 90-284, § 6(2)(d), Laws of Fla.; § 395.0335(2)(d), Fla. Stat. (1991) (renumbered as § 395.4025 by ch....
...92-989, Laws of Fla.) (emphasis added). Further, this section required that new facilities “shall be located in a trauma service area which has a need for such a center.” Ch. 90-284, § 6(5), Laws of Fla.; § 395.0335(5), Fla. Stat. (1991) (renumbered as § 395.4025 by ch....
...l domestic security task forces established under s. 943.0312.” § 395.4015, Fla. Stat. (2004). Section 395.402(4) clarified that the existing nineteen service areas would remain in place until DOH completed the February 2005 assessment. Moreover, section 395.4025 was also amended in 2004 to state that “until [DOH] has conducted the review provided under s. 395.402, only hospitals located in trauma service areas where there is no existing trauma center may apply.” § 395.4025(14), Fla. Stat. (2004). Section 395.4025 also required that DOH “shall annually notify” existing trauma care centers “that [DOH] is accepting letters of intent from hospitals that are interested in becoming trauma centers.” § 395.4025(2)(a), Fla. Stat. (2004). Further, section 395.4025 continued to require, as it did in 1991, that applicant hospitals have sufficient facilities and personnel and “be located in a trauma service area that has a need for such a trauma center.” § 395.4025(2)(c), (5), Fla....
...rsuant to this section shall proceed as provided in chapter 120. Hearings held under this subsection shall be conducted in the same manner as provided in ss. 120.569 and 120.57. Cases filed under chapter 120 may combine all disputes between parties. § 395.4025(7), Fla....
...The ALJ found the approval of appellees’ new trauma centers would “result in an immediate reduction in trauma patient volumes as well as increased staffing challenges” for appellants’ centers which is the type of injury that sections 395.402 and 395.4025 were designed to protect....
...within a given region arising from the establishment of a new trauma center.” Id. Additionally, the ALJ found the Legislature expressly recognized that the substantial interests of hospitals may be affected by the granting of new trauma centers in section 395.4025(7), which states that “[a]ny hospital that wishes to protest a decision made by the department based on the department’s preliminary or in-depth review of applications” may do so through a chapter 120 hearing. Whether or not section 395.4025 provides an independent basis for standing by “provision of statute” as contemplated by section 120.52(13) we need not decide here. The ALJ was correct that appellants’ injuries of economic loss and shortage of available specialists and other *92 service providers are within the zone of interest protected by sections 895.402 and 395.4025....
...njured trauma victim is incorporated. The Legislature deems the benefits of trauma care provided within an inclusive trauma system to be of vital significance to the outcome of a trauma victim. *93 Further, at oral argument, appellee DOH argued that section 395.4025, which pertains to the submission and review of trauma center applications, did not permit DOH to consider need for additional trauma centers when it reviewed applications. Instead, DOH argued this section required it to grant any application that met the statutory criteria. However, section 395.4025(1) specifically requires DOH to “establish the approximate number of trauma centers needed to ensure reasonable access to high-quality trauma services.” § 395.4025(1), Fla....
...r 2005. See § 395.402(4), Fla. Stat. (2004). Finally, the rule also states that it implements section 395.405. That section merely provides, “The department shall adopt and enforce all rules necessary to administer ss. 395.401, 395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045.” This is no more than a general grant of authority to adopt and enforce necessary rules....
This Florida statute resource is curated by Graham W. Syfert, Esq., a Jacksonville, Florida personal injury and workers' compensation attorney. Attorney Syfert regularly works with Chapter 395 in the context of hospital liability and represents clients throughout Northeast Florida. For legal consultation, call 904-383-7448.
