Florida Senate - 2013                        COMMITTEE AMENDMENT
       Bill No. CS for SB 966
                                Barcode 185148                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/22/2013           .                                

       The Committee on Appropriations (Bean) recommended the
    1         Senate Amendment to Amendment (342762) (with title
    2  amendment)
    4         Delete lines 458 - 535
    5  and insert:
    6         Section 14. Paragraph (a) of subsection (7) and subsection
    7  (14) of section 395.4001, Florida Statutes, are amended to read:
    8         395.4001 Definitions.—As used in this part, the term:
    9         (7) “Level II trauma center” means a trauma center that:
   10         (a) Is verified by the department to be in substantial
   11  compliance with Level II trauma center standards and has been
   12  approved by the department to operate as a Level II trauma
   13  center or is designated pursuant to s. 395.4025(14).
   14         (14) “Trauma center” means a hospital that has been
   15  verified by the department to be in substantial compliance with
   16  the requirements in s. 395.4025 and has been approved by the
   17  department to operate as a Level I trauma center, Level II
   18  trauma center, or pediatric trauma center, or is designated by
   19  the department as a Level II trauma center pursuant to
   20  s. 395.4025(14).
   21         Section 15. Paragraph (b) of subsection (1) and paragraph
   22  (3) of section 395.401, Florida Statutes, are amended to read:
   23         395.401 Trauma services system plans; approval of trauma
   24  centers and pediatric trauma centers; procedures; renewal.—
   25         (1)
   26         (b) The local and regional trauma agencies shall develop
   27  and submit to the department plans for local and regional trauma
   28  services systems. The plans must include, at a minimum, the
   29  following components:
   30         1. The organizational structure of the trauma system.
   31         2. Prehospital care management guidelines for triage and
   32  transportation of trauma cases.
   33         3. Flow patterns of trauma cases and transportation system
   34  design and resources, including air transportation services,
   35  provision for interfacility trauma transfer, and the prehospital
   36  transportation of trauma victims. The trauma agency shall plan
   37  for the development of a system of transportation of trauma
   38  alert victims to trauma centers where the distance or time to a
   39  trauma center or transportation resources diminish access by
   40  trauma alert victims.
   41         4. The number and location of needed trauma centers based
   42  on local needs, population, and location and distribution of
   43  resources.
   44         4.5. Data collection regarding system operation and patient
   45  outcome.
   46         5.6. Periodic performance evaluation of the trauma system
   47  and its components.
   48         6.7. The use of air transport services within the
   49  jurisdiction of the local trauma agency.
   50         7.8. Public information and education about the trauma
   51  system.
   52         8.9. Emergency medical services communication system usage
   53  and dispatching.
   54         9.10. The coordination and integration between the trauma
   55  center and other acute care hospitals.
   56         10.11. Medical control and accountability.
   57         11.12. Quality control and system evaluation.
   58         (3) The department may withdraw local or regional agency
   59  authority, prescribe corrective actions, or use the
   60  administrative remedies as provided in s. 395.1065 for the
   61  violation of any provision of this section and ss. 395.4015,
   62  395.402, 395.4025, 395.403, 395.404, and 395.4045 or rules
   63  adopted thereunder. All amounts collected pursuant to this
   64  subsection shall be deposited into the Emergency Medical
   65  Services Trust Fund provided in s. 401.34.
   66         Section 16. Subsection (1) of section 395.4015, Florida
   67  Statutes, is amended to read:
   68         395.4015 State regional trauma planning; trauma regions.—
   69         (1) The department shall establish a state trauma system
   70  plan. As part of the state trauma system plan, the department
   71  shall establish trauma regions that cover all geographical areas
   72  of the state and have boundaries that are coterminous with the
   73  boundaries of the regional domestic security task forces
   74  established under s. 943.0312. These regions may serve as the
   75  basis for the development of department-approved local or
   76  regional trauma plans. However, such regional plans shall
   77  recognize trauma service areas that reflect well established
   78  patient flow patterns. The delivery of trauma services by or in
   79  coordination with a trauma agency established before July 1,
   80  2004, may continue in accordance with public and private
   81  agreements and operational procedures entered into as provided
   82  in s. 395.401.
   83         Section 17. Section 395.402, Florida Statutes, is amended
   84  to read:
   85         395.402 Trauma service areas; number and location of trauma
   86  centers.—
   87         (1) The Legislature recognizes the need for a statewide,
   88  cohesive, uniform, and integrated trauma system. Within the
   89  trauma service areas, Level I and Level II trauma centers shall
   90  each be capable of annually treating a minimum of 1,000 and 500
   91  patients, respectively, with an injury severity score (ISS) of 9
   92  or greater. Level II trauma centers in counties with a
   93  population of more than 500,000 shall have the capacity to care
   94  for 1,000 patients per year.
   95         (2) Trauma service areas as defined in this section are to
   96  be utilized until the Department of Health completes an
   97  assessment of the trauma system and reports its finding to the
   98  Governor, the President of the Senate, the Speaker of the House
   99  of Representatives, and the substantive legislative committees.
  100  The report shall be submitted by February 1, 2005. The
  101  department shall review the existing trauma system and determine
  102  whether it is effective in providing trauma care uniformly
  103  throughout the state. The assessment shall:
  104         (a) Consider aligning trauma service areas within the
  105  trauma region boundaries as established in July 2004.
  106         (b) Review the number and level of trauma centers needed
  107  for each trauma service area to provide a statewide integrated
  108  trauma system.
  109         (c) Establish criteria for determining the number and level
  110  of trauma centers needed to serve the population in a defined
  111  trauma service area or region.
  112         (d) Consider including criteria within trauma center
  113  approval standards based upon the number of trauma victims
  114  served within a service area.
  115         (e) Review the Regional Domestic Security Task Force
  116  structure and determine whether integrating the trauma system
  117  planning with interagency regional emergency and disaster
  118  planning efforts is feasible and identify any duplication of
  119  efforts between the two entities.
  120         (f) Make recommendations regarding a continued revenue
  121  source which shall include a local participation requirement.
  122         (g) Make recommendations regarding a formula for the
  123  distribution of funds identified for trauma centers which shall
  124  address incentives for new centers where needed and the need to
  125  maintain effective trauma care in areas served by existing
  126  centers, with consideration for the volume of trauma patients
  127  served, and the amount of charity care provided.
  128         (3) In conducting such assessment and subsequent annual
  129  reviews, the department shall consider:
  130         (a) The recommendations made as part of the regional trauma
  131  system plans submitted by regional trauma agencies.
  132         (b) Stakeholder recommendations.
  133         (c) The geographical composition of an area to ensure rapid
  134  access to trauma care by patients.
  135         (d) Historical patterns of patient referral and transfer in
  136  an area.
  137         (e) Inventories of available trauma care resources,
  138  including professional medical staff.
  139         (f) Population growth characteristics.
  140         (g) Transportation capabilities, including ground and air
  141  transport.
  142         (h) Medically appropriate ground and air travel times.
  143         (i) Recommendations of the Regional Domestic Security Task
  144  Force.
  145         (j) The actual number of trauma victims currently being
  146  served by each trauma center.
  147         (k) Other appropriate criteria.
  148         (4) Annually thereafter, the department shall review the
  149  assignment of the 67 counties to trauma service areas, in
  150  addition to the requirements of paragraphs (2)(b)-(g) and
  151  subsection (3). County assignments are made for the purpose of
  152  developing a system of trauma centers. Revisions made by the
  153  department shall take into consideration the recommendations
  154  made as part of the regional trauma system plans approved by the
  155  department and the recommendations made as part of the state
  156  trauma system plan. In cases where a trauma service area is
  157  located within the boundaries of more than one trauma region,
  158  the trauma service area’s needs, response capability, and system
  159  requirements shall be considered by each trauma region served by
  160  that trauma service area in its regional system plan. Until the
  161  department completes the February 2005 assessment, the
  162  assignment of counties shall remain as established in this
  163  section.
  164         (a) The following trauma service areas are hereby
  165  established:
  166         (1)1. Trauma service area 1 shall consist of Escambia,
  167  Okaloosa, Santa Rosa, and Walton Counties.
  168         (2)2. Trauma service area 2 shall consist of Bay, Gulf,
  169  Holmes, and Washington Counties.
  170         (3)3. Trauma service area 3 shall consist of Calhoun,
  171  Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,
  172  Taylor, and Wakulla Counties.
  173         (4)4. Trauma service area 4 shall consist of Alachua,
  174  Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy,
  175  Putnam, Suwannee, and Union Counties.
  176         (5)5. Trauma service area 5 shall consist of Baker, Clay,
  177  Duval, Nassau, and St. Johns Counties.
  178         (6)6. Trauma service area 6 shall consist of Citrus,
  179  Hernando, and Marion Counties.
  180         (7)7. Trauma service area 7 shall consist of Flagler and
  181  Volusia Counties.
  182         (8)8. Trauma service area 8 shall consist of Lake, Orange,
  183  Osceola, Seminole, and Sumter Counties.
  184         (9)9. Trauma service area 9 shall consist of Pasco and
  185  Pinellas Counties.
  186         (10)10. Trauma service area 10 shall consist of
  187  Hillsborough County.
  188         (11)11. Trauma service area 11 shall consist of Hardee,
  189  Highlands, and Polk Counties.
  190         (12)12. Trauma service area 12 shall consist of Brevard and
  191  Indian River Counties.
  192         (13)13. Trauma service area 13 shall consist of DeSoto,
  193  Manatee, and Sarasota Counties.
  194         (14)14. Trauma service area 14 shall consist of Martin,
  195  Okeechobee, and St. Lucie Counties.
  196         (15)15. Trauma service area 15 shall consist of Charlotte,
  197  Glades, Hendry, and Lee Counties.
  198         (16)16. Trauma service area 16 shall consist of Palm Beach
  199  County.
  200         (17)17. Trauma service area 17 shall consist of Collier
  201  County.
  202         (18)18. Trauma service area 18 shall consist of Broward
  203  County.
  204         (19)19. Trauma service area 19 shall consist of Miami-Dade
  205  and Monroe Counties.
  206         (b) Each trauma service area should have at least one Level
  207  I or Level II trauma center. The department shall allocate, by
  208  rule, the number of trauma centers needed for each trauma
  209  service area.
  210         (c) There shall be no more than a total of 44 trauma
  211  centers in the state.
  214  ================= T I T L E  A M E N D M E N T ================
  215         And the title is amended as follows:
  216         Delete lines 3392 - 3395
  217  and insert:
  218         flow patterns; amending s. 395.402, F.S., repealing
  219         provisions relating to the Department of Health's
  220         assignment of counties to trauma service areas;
  221         repealing outdated provisions requiring the Department
  222         of Health to conduct a study; repealing provisions
  223         requiring the Department of Health to annually review
  224         the assignment of counties to trauma service centers;
  225         repealing provisions regarding the number of trauma
  226         centers in each trauma service area and in the state;
  227         amending s. 395.4025, F.S.; establishing criteria for
  228         designating Level II trauma centers in areas with
  229         limited access to trauma center services; amending
  230         s. 395.405, F.S., removing rulemaking authority for
  231         s. 395.402, F.S.; amending s.