Florida Senate - 2013 SENATOR AMENDMENT
Bill No. CS for CS for SB 966
Senate . House
Senator Bean moved the following:
1 Senate Substitute for Amendment (495738) (with title
4 Delete lines 834 - 1073
5 and insert:
6 Section 15. Paragraphs (b) and (k) of subsection (1) of
7 section 395.401, Florida Statutes, are amended to read:
8 395.401 Trauma services system plans; approval of trauma
9 centers and pediatric trauma centers; procedures; renewal.—
11 (b) The local and regional trauma agencies shall develop
12 and submit to the department plans for local and regional trauma
13 services systems. The plans must include, at a minimum, the
14 following components:
15 1. The organizational structure of the trauma system.
16 2. Prehospital care management guidelines for triage and
17 transportation of trauma cases.
18 3. Flow patterns of trauma cases and transportation system
19 design and resources, including air transportation services,
20 provision for interfacility trauma transfer, and the prehospital
21 transportation of trauma victims. The trauma agency shall plan
22 for the development of a system of transportation of trauma
23 alert victims to trauma centers where the distance or time to a
24 trauma center or transportation resources diminish access by
25 trauma alert victims.
4. The number and location of needed trauma centers based
27 on local needs, population, and location and distribution of
29 4. 5. Data collection regarding system operation and patient
31 5. 6. Periodic performance evaluation of the trauma system
32 and its components.
33 6. 7. The use of air transport services within the
34 jurisdiction of the local trauma agency.
35 7. 8. Public information and education about the trauma
37 8. 9. Emergency medical services communication system usage
38 and dispatching.
39 9. 10 . The coordination and integration between the trauma
40 center and other acute care hospitals.
41 10. 11 . Medical control and accountability.
42 11. 12 . Quality control and system evaluation.
43 (k) It is unlawful for any hospital or other facility to
44 hold itself out as a trauma center unless it has been so
45 verified or designated pursuant to s. 395.4025(14).
46 Section 16. Section 395.402, Florida Statutes, is amended
47 to read:
48 395.402 Trauma service areas; number and location of trauma
50 (1) The Legislature recognizes the need for a statewide,
51 cohesive, uniform, and integrated trauma system. Within the
52 trauma service areas, Level I and Level II trauma centers shall
53 each be capable of annually treating a minimum of 1,000 and 500
54 patients, respectively, with an injury severity score (ISS) of 9
55 or greater. Level II trauma centers in counties with a
56 population of more than 500,000 shall have the capacity to care
57 for 1,000 patients per year.
58 (2) Trauma service areas as defined in this section are to
59 be utilized until the Department of Health completes an
60 assessment of the trauma system and reports its finding to the
61 Governor, the President of the Senate, the Speaker of the House
62 of Representatives, and the substantive legislative committees.
63 The report shall be submitted by February 1, 2005. The
64 department shall review the existing trauma system and determine
65 whether it is effective in providing trauma care uniformly
66 throughout the state. The assessment shall:
67 (a) Consider aligning trauma service areas within the
68 trauma region boundaries as established in July 2004.
69 (b) Review the number and level of trauma centers needed
70 for each trauma service area to provide a statewide integrated
71 trauma system.
72 (c) Establish criteria for determining the number and level
73 of trauma centers needed to serve the population in a defined
74 trauma service area or region.
75 (d) Consider including criteria within trauma center
76 approval standards based upon the number of trauma victims
77 served within a service area.
78 (e) Review the Regional Domestic Security Task Force
79 structure and determine whether integrating the trauma system
80 planning with interagency regional emergency and disaster
81 planning efforts is feasible and identify any duplication of
82 efforts between the two entities.
83 (f) Make recommendations regarding a continued revenue
84 source which shall include a local participation requirement.
85 (g) Make recommendations regarding a formula for the
86 distribution of funds identified for trauma centers which shall
87 address incentives for new centers where needed and the need to
88 maintain effective trauma care in areas served by existing
89 centers, with consideration for the volume of trauma patients
90 served, and the amount of charity care provided.
91 (3) In conducting such assessment and subsequent annual
92 reviews, the department shall consider:
93 (a) The recommendations made as part of the regional trauma
94 system plans submitted by regional trauma agencies.
95 (b) Stakeholder recommendations.
96 (c) The geographical composition of an area to ensure rapid
97 access to trauma care by patients.
98 (d) Historical patterns of patient referral and transfer in
99 an area.
100 (e) Inventories of available trauma care resources,
101 including professional medical staff.
102 (f) Population growth characteristics.
103 (g) Transportation capabilities, including ground and air
105 (h) Medically appropriate ground and air travel times.
106 (i) Recommendations of the Regional Domestic Security Task
108 (j) The actual number of trauma victims currently being
109 served by each trauma center.
110 (k) Other appropriate criteria.
111 (4) Annually thereafter, the department shall review the
112 assignment of the 67 counties to trauma service areas, in
113 addition to the requirements of paragraphs (2)(b)-(g) and
114 subsection (3). County assignments are made for the purpose of
115 developing a system of trauma centers. Revisions made by the
116 department shall take into consideration the recommendations
117 made as part of the regional trauma system plans approved by the
118 department and the recommendations made as part of the state
119 trauma system plan. In cases where a trauma service area is
120 located within the boundaries of more than one trauma region,
121 the trauma service area’s needs, response capability, and system
122 requirements shall be considered by each trauma region served by
123 that trauma service area in its regional system plan. Until the
124 department completes the February 2005 assessment, the
125 assignment of counties shall remain as established in this
127 (2) (a) The following trauma service areas are hereby
129 (a) 1. Trauma service area 1 shall consist of Escambia,
130 Okaloosa, Santa Rosa, and Walton Counties.
131 (b) 2. Trauma service area 2 shall consist of Bay, Gulf,
132 Holmes, and Washington Counties.
133 (c) 3. Trauma service area 3 shall consist of Calhoun,
134 Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,
135 Taylor, and Wakulla Counties.
136 (d) 4. Trauma service area 4 shall consist of Alachua,
137 Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy,
138 Putnam, Suwannee, and Union Counties.
139 (e) 5. Trauma service area 5 shall consist of Baker, Clay,
140 Duval, Nassau, and St. Johns Counties.
141 (f) 6. Trauma service area 6 shall consist of Citrus,
142 Hernando, and Marion Counties.
143 (g) 7. Trauma service area 7 shall consist of Flagler and
144 Volusia Counties.
145 (h) 8. Trauma service area 8 shall consist of Lake, Orange,
146 Osceola, Seminole, and Sumter Counties.
147 (i) 9. Trauma service area 9 shall consist of Pasco and
148 Pinellas Counties.
149 (j) 10. Trauma service area 10 shall consist of Hillsborough
151 (k) 11. Trauma service area 11 shall consist of Hardee,
152 Highlands, and Polk Counties.
153 (l) 12. Trauma service area 12 shall consist of Brevard and
154 Indian River Counties.
155 (m) 13. Trauma service area 13 shall consist of DeSoto,
156 Manatee, and Sarasota Counties.
157 (n) 14. Trauma service area 14 shall consist of Martin,
158 Okeechobee, and St. Lucie Counties.
159 (o) 15. Trauma service area 15 shall consist of Charlotte,
160 Glades, Hendry, and Lee Counties.
161 (p) 16. Trauma service area 16 shall consist of Palm Beach
163 (q) 17. Trauma service area 17 shall consist of Collier
165 (r) 18. Trauma service area 18 shall consist of Broward
167 (s) 19. Trauma service area 19 shall consist of Miami-Dade
168 and Monroe Counties.
169 (3) (b) Each trauma service area should have at least one
170 Level I or Level II trauma center. To assess additional trauma
171 services needs in each area, the department shall:
172 (a) Define access standards based on time and distance to
173 Level I and Level II centers by both ground and air transport;
174 (b) Consider trauma services system plans, inventories of
175 available trauma care resources including professional medical
176 staff, as well as other factors; and
177 (c) Define quality standards for trauma centers, including,
178 but not limited to, minimum volume standards for Level I and
179 Level II trauma centers which may exceed the minimum levels in
180 subsection (1). allocate, by rule, the number of trauma centers
181 needed for each trauma service area.
182 (c) There shall be no more than a total of 44 trauma
183 centers in the state.
184 Section 17. Subsection (14) of section 395.4025, Florida
185 Statutes, is amended and subsection (15) is added to that
186 section to read:
187 395.4025 Trauma centers; selection; quality assurance;
189 (14) Notwithstanding the procedures established pursuant to
190 subsections (1) through (13) in this section, hospitals located
191 in areas with limited access to trauma center services shall be
192 designated by the department as a Level II trauma center based
193 on documentation of a valid certificate of trauma center
194 verification from the American College of Surgeons. Areas with
195 limited access to trauma center services are defined by the
196 following criteria:
197 (a) The hospital is located in a trauma service area with:
198 1. A population greater than 600,000 persons but a
199 population density of less than 225 persons per square mile or
200 2. A population greater than 2 million persons but with
201 only one trauma center; and,
202 (b) The hospital is located in a county with no designated
203 or provisional trauma center; and,
204 (c) The hospital is located at least 15 miles or 20 minutes
205 travel time by ground transport from the nearest trauma center.
206 any other provisions of this section and rules adopted
207 pursuant to this section, until the department has conducted the
208 review provided under s. 395.402 , only hospitals located in
209 trauma services areas where there is no existing trauma center
210 may apply.
211 (15) Trauma centers designated as Level I, Level II, or
212 pediatric trauma centers as of July 1, 2013 shall retain such
213 designation unless the department determines the hospital is no
214 longer able to comply with the adopted standards for such
215 centers. A trauma center provisionally approved as a Level II
216 trauma center as of July 1, 2013 may complete the application
217 process through verification by the department as a Level II
218 Trauma Center.
221 ================= T I T L E A M E N D M E N T ================
222 And the title is amended as follows:
223 Delete lines 62 - 82
224 and insert:
225 center”; amending s. 395.401, F.S.; revising the
226 components of plans for local and regional trauma
227 services systems; revising a prohibited act to
228 recognize that a hospital or other facility may be
229 either verified or designated as a trauma center;
230 amending s. 395.402, F.S., repealing provisions
231 relating to the Department of Health’s assignment of
232 counties to trauma service areas; repealing outdated
233 provisions requiring the Department of Health to
234 conduct a study; repealing provisions requiring the
235 Department of Health to annually review the assignment
236 of counties to trauma service centers; repealing
237 provisions regarding the number of trauma centers in
238 each trauma service area and in the state; providing
239 criteria for assessing additional trauma services
240 needs in each trauma service area; amending s.
241 395.4025, F.S.; establishing criteria for designating
242 Level II trauma centers in areas with limited access
243 to trauma center services; retaining trauma center
244 designation for centers designated or provisionally
245 approved as of July 1, 2013; amending s. 395.701,
246 F.S.; revising the