Amid a wide-ranging controversy about the state’s trauma system, the Florida Department of Health on Thursday ordered the closure of a Clay County hospital trauma center — while a judge heard arguments about whether another trauma facility should have been allowed to open in Marion County.
The department sent a notice to Orange Park Medical Center near Jacksonville denying approval to continue operating a trauma center that opened in late 2011. The original approval was given on what is known as a "provisional" basis, but the department said the Clay County hospital had not met standards needed to receive a more-permanent approval.
"This denial means that Orange Park Medical Center cannot continue to operate as a provisional trauma center,” the notice said. "Please adjust your services accordingly.”
Orange Park Medical Center issued a statement that said it plans to appeal the decision and will suspend trauma-center operations pending the appeal. The statement said the hospital was "disappointed and surprised" to receive the notification and said it has served more than 1,000 trauma patients since the center opened.
"As we all know, this decision impacts not just our hospital community, but it will negatively impact the lives of all those in the Orange Park area,” trauma/critical care surgeon Anthony Udekwu said in the statement. "We will continue to work with the Florida department to provide high quality care to our patients."
The department’s consideration, and ultimate approval, of provisional status in 2011 for Orange Park Medical Center and two other hospitals touched off a series of-industry legal battles that have spread to other facilities. Those battles have largely pitted hospitals in the HCA health-care chain — such as Orange Park Medical Center — that want to run trauma centers against other nearby hospitals.
One of those fights played out Thursday in a Leon County courtroom, as Circuit Judge Terry Lewis listened to arguments about whether the department improperly gave provisional approval in December to open a trauma center at Ocala Regional Medical Center. Nearby Munroe Regional Medical Center in Ocala, Shands Hospital at the University of Florida and Shands Jacksonville Medical Center filed the challenge.
Lewis listened to arguments for more than three hours about sometimes-esoteric issues such as how the department has carried out laws about the trauma system. Attorneys for Munroe and the Shands hospitals argued that the department overstepped its legal authority to approve the Ocala Regional trauma center, a position that stems at least in part from court fights during the past two years about other hospitals.
"We’re here because they are acting without authority,” said Seann Frazier, an attorney for the Shands hospitals.
But attorneys for the department and Ocala Regional, which also is part of HCA, said the agency followed state laws in approving the trauma center. J. Stephen Menton, an attorney for Ocala Regional, told Lewis that the case is motivated by Shands trying to retain control of the trauma market for patients who come from nearby Marion County.
"What we’ve got here is a turf battle,” Menton said. "It’s as simple as that."
Lewis, who repeatedly questioned attorneys on both sides, said he would rule as quickly as possible but did not give a specific timetable.
The series of legal battles began in 2011 as Orange Park Medical Center, Blake Medical Center in Manatee County and Regional Medical Center Bayonet Point in Pasco County sought approval to open trauma centers. Four hospitals that have long operated trauma centers — Shands Jacksonville, Tampa General Hospital, St. Joseph’s Hospital in Tampa and Bayfront Medical Center in St. Petersburg — challenged the approvals.
An administrative law judge sided with the challengers, which argued that a 1992 rule used by the department to approve trauma centers was invalid. The department appealed that decision and, amid the appeal, allowed the three trauma centers to open on a provisional basis.
The 1st District Court of Appeal in November 2012 upheld the administrative law judge’s decision. The appeals court found that the department had not updated the 1992 rule to take into account changes made in state law in 2004, with one of the most heavily debated issues centering on how trauma centers should be spread geographically through the state.
Department officials approved the Ocala Regional trauma proposal after the appeals court ruling. While saying it properly followed the law in granting that approval, the department also has started the process of drawing up new rules for reviewing trauma-center proposals.
In still another legal issue, The Miami Herald reported Thursday that Jackson Health System has decided to voluntarily dismiss petitions related to the department’s denial in December of trauma-center applications for Jackson North Medical Center and Jackson South Community Hospital. The petitions had sought a hearing before an administrative law judge.
Meanwhile, the department’s announcement that it would close down the Orange Park Medical Center trauma center added a new wrinkle to the debate. Earlier this month, the department approved more-permanent status — known as becoming a "verified trauma center" — for Blake Medical Center and Regional Medical Center Bayonet Point.
But in a news release, the department said Orange Park Medical Center had not received a similar approval because of deficiencies in meeting four types of standards. The department said that it had notified other hospitals and emergency-medical services providers in northeast Florida about the decision.
"Verified trauma centers across the state must meet the defined standards for trauma care,” the department said in the release. "The Department of Health remains committed to maintaining those standards on behalf of injured patients."