Florida Senate - 2013                          SENATOR AMENDMENT
       Bill No. CS for CS for SB 966
                                Barcode 806986                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       Senator Bean moved the following:
    1         Senate Substitute for Amendment (495738) (with title
    2  amendment)
    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.—
   10         (1)
   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.
   26         4. The number and location of needed trauma centers based
   27  on local needs, population, and location and distribution of
   28  resources.
   29         4.5. Data collection regarding system operation and patient
   30  outcome.
   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
   36  system.
   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
   49  centers.—
   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
  104  transport.
  105         (h) Medically appropriate ground and air travel times.
  106         (i) Recommendations of the Regional Domestic Security Task
  107  Force.
  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
  126  section.
  127         (2)(a) The following trauma service areas are hereby
  128  established:
  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
  150  County.
  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
  162  County.
  163         (q)17. Trauma service area 17 shall consist of Collier
  164  County.
  165         (r)18. Trauma service area 18 shall consist of Broward
  166  County.
  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;
  188  records.—
  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