CODING: Words stricken are deletions; words underlined are additions.





                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    

                            CHAMBER ACTION
              Senate                               House
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10                                                                

11  Senator Myers moved the following amendment:

12

13         Senate Amendment (with title amendment) 

14         On page 69, between lines 9 and 10,

15

16  insert:

17         Section 56.  Section 395.40, Florida Statutes, is

18  created to read:

19         395.40  Legislative findings and intent.--

20         (1)  The Legislature finds that there has been a lack

21  of timely access to trauma care due to the state's fragmented

22  trauma system. This finding is based on the 1999 Trauma System

23  Report on Timely Access to Trauma Care submitted by the

24  department in response to the request of the Legislature.

25         (2)  The Legislature finds that it is necessary to plan

26  for and to establish an inclusive trauma system to meet the

27  needs of trauma victims. An "inclusive trauma system" means a

28  system designed to meet the needs of all injured trauma

29  victims who require care in an acute-care setting and into

30  which every health care provider or facility with resources to

31  care for the injured trauma victim is incorporated. The

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Legislature deems the benefits of trauma care provided within

 2  an inclusive trauma system to be of vital significance to the

 3  outcome of a trauma victim.

 4         (3)  It is the intent of the Legislature to place

 5  primary responsibility for the planning and establishment of a

 6  statewide inclusive trauma system with the department. The

 7  department shall undertake the implementation of a statewide

 8  inclusive trauma system as funding is available.

 9         (4)  The Legislature finds that significant benefits

10  are to be obtained by directing the coordination of activities

11  by several state agencies, relative to access to trauma care

12  and the provision of trauma care to all trauma victims. It is

13  the intent of the Legislature that the department, the Agency

14  for Health Care Administration, the Board of Medicine, and the

15  Board of Nursing establish interagency teams and agreements

16  for the development of guidelines, standards, and rules for

17  those portions of the inclusive state trauma system within the

18  statutory authority of each agency. This coordinated approach

19  will provide the necessary continuum of care for the trauma

20  victim from injury to final hospital discharge. The department

21  has the leadership responsibility for this activity.

22         (5)  In addition, the agencies listed in subsection (4)

23  should undertake to:

24         (a)  Establish a coordinated methodology for

25  monitoring, evaluating, and enforcing the requirements of the

26  state's inclusive trauma system which recognizes the interests

27  of each agency.

28         (b)  Develop appropriate roles for trauma agencies, to

29  assist in furthering the operation of trauma systems at the

30  regional level. This should include issues of system

31  evaluation as well as managed care.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (c)  Develop and submit appropriate requests for

 2  waivers of federal requirements which will facilitate the

 3  delivery of trauma care.

 4         (d)  Develop criteria that will become the future basis

 5  for mandatory consultation on the care of trauma victims and

 6  mandatory transfer of appropriate trauma victims to trauma

 7  centers.

 8         (e)  Develop a coordinated approach to the care of the

 9  trauma victim. This shall include the movement of the trauma

10  victim through the system of care and the identification of

11  medical responsibility for each phase of care for

12  out-of-hospital and in-hospital trauma care.

13         (f)  Require the medical director of an emergency

14  medical services provider to have medical accountability for a

15  trauma victim during interfacility transfer.

16         (6)  Furthermore, the Legislature encourages the

17  department to actively foster the provision of trauma care and

18  serve as a catalyst for improvements in the process and

19  outcome of the provision of trauma care in an inclusive trauma

20  system. Among other considerations, the department is

21  encouraged to:

22         (a)  Promote the development of at least one trauma

23  center in every trauma service area.

24         (b)  Promote the development of a trauma agency for

25  each trauma region.

26         (c)  Update the state trauma system plan by December

27  2000 and at least every 5th year thereafter.

28         Section 57.  Subsection (1) and paragraphs (c) and (n)

29  of subsection (2) of section 395.401, Florida Statutes, 1998

30  Supplement, are amended to read:

31         395.401  Trauma services system plans; verification of

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  trauma centers and pediatric trauma referral centers;

 2  procedures; renewal.--

 3         (1)  As used in this part, the term:

 4         (a)  "Agency" means the Agency for Health Care

 5  Administration.

 6         (b)  "Charity care" or "uncompensated charity care"

 7  means that portion of hospital charges reported to the agency

 8  for which there is no compensation for care provided to a

 9  patient whose family income for the 12 months preceding the

10  determination is less than or equal to 150 percent of the

11  federal poverty level, unless the amount of hospital charges

12  due from the patient exceeds 25 percent of the annual family

13  income. However, in no case shall the hospital charges for a

14  patient whose family income exceeds four times the federal

15  poverty level for a family of four be considered charity.

16         (c)  "Department" means the Department of Health.

17         (d)  "Level I trauma center" means a hospital that is

18  determined by the department to be in substantial compliance

19  with trauma center and pediatric trauma referral center

20  verification standards as established by rule of the

21  department, and which:

22         1.  Has formal research and education programs for the

23  enhancement of trauma care.

24         2.  Serves as a resource facility to Level II trauma

25  centers, pediatric trauma referral centers, and community

26  hospitals.

27         3.  Ensures an organized system of trauma care.

28         (e)  "Level II trauma center" means a hospital that is

29  determined by the department to be in substantial compliance

30  with trauma center verification standards as established by

31  rule of the department, and which:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         1.  Serves as a resource facility to community

 2  hospitals.

 3         2.  Ensures an organized system of trauma care.

 4         (f)  "Local trauma agency" means an agency established

 5  and operated by a county or an entity with which the county

 6  contracts for the purpose of administrative trauma services.

 7         (f)(g)  "Pediatric trauma referral center" means a

 8  hospital that is determined to be in substantial compliance

 9  with pediatric trauma referral center standards as established

10  by rule of the department.

11         (h)  "Regional trauma agency" means an agency created

12  and operated by two or more counties, or an entity with which

13  two or more counties contract, for the purpose of

14  administering trauma services.

15         (g)(i)  "State-approved trauma center" means a hospital

16  that has successfully completed the state-approved selection

17  process pursuant to s. 395.4025 and has been approved by the

18  department to operate as a trauma center in the state.

19         (h)(j)  "State-sponsored trauma center" means a

20  state-approved trauma center that receives state funding for

21  trauma care services.

22         (i)  "Trauma agency" means an agency established and

23  operated by one or more counties, or an entity with which one

24  or more counties contract, for the purpose of administering an

25  inclusive regional trauma system.

26         (j)  "Trauma alert victim" means a person who has

27  incurred a single or multisystem injury due to blunt or

28  penetrating means or burns; who requires immediate medical

29  intervention or treatment; and who meets one or more of the

30  adult or pediatric scorecard criteria established by the

31  department by rule.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (k)  "Trauma center" means any hospital that has been

 2  determined by the department to be in substantial compliance

 3  with trauma center verification standards.

 4         (l)  "Trauma scorecard" means a statewide methodology

 5  adopted by the department by rule under which a person who has

 6  incurred a traumatic injury is graded as to the severity of

 7  his or her injuries or illness and which methodology is used

 8  as the basis for making destination decisions.

 9         (m)  "Trauma victim" means any person who has incurred

10  a single or multisystem life-threatening injury due to blunt

11  or penetrating means or burns and who requires immediate

12  medical intervention or treatment.

13         (2)

14         (c)  The department shall receive plans for the

15  implementation of inclusive trauma care systems from local and

16  regional trauma agencies.  The department may approve or not

17  approve the local or regional trauma agency plans based on the

18  conformance of the plan local or regional plans with this

19  section and ss. 395.4015, 395.404, and 395.4045 and the rules

20  adopted by the department pursuant to those sections.  The

21  department shall approve or disapprove the plans within 120

22  days after the date the plans are submitted to the department.

23         (n)  After the submission of the initial local or

24  regional trauma care system plan, each local or regional

25  trauma agency shall, every 5th year, annually submit to the

26  department  for approval an updated plan that which identifies

27  the changes, if any, to be made in the regional trauma care

28  system. The department shall approve or disapprove the updated

29  plan within 120 days after the date the plan is submitted to

30  the department.  At least 60 days before the local or regional

31  trauma agency submits a plan for a trauma care system to the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  department, the local or regional trauma agency shall hold a

 2  public hearing and give adequate notice of the public hearing

 3  to all hospitals and other interested parties in the area. A

 4  local or regional trauma agency shall submit to the department

 5  written notice of its intent to cease operation of the local

 6  or regional trauma agency at least 90 days before the date on

 7  which the local or regional trauma agency will cease

 8  operation.

 9         Section 58.  Subsections (1) and (3) of section

10  395.402, Florida Statutes, are amended to read:

11         395.402  Trauma service areas; number and location of

12  trauma centers.--

13         (1)  The Legislature finds that it is appropriate to

14  recognize as a trauma patient someone with an injury severity

15  score (ISS) of 9 or greater.  The Legislature also recognizes

16  that Level I and Level II trauma centers should each be

17  capable of annually treating a minimum of 1,000 and 500

18  patients, respectively, with an injury severity score (ISS) of

19  9 or greater. Further, the Legislature finds that, based on

20  the numbers and locations of trauma victims with these injury

21  severity scores, there should be 19 trauma service areas in

22  the state, and, at a minimum, there should be at least one

23  trauma center in each service area.

24         (3)  Trauma service areas are to be used. The

25  department shall periodically review the assignment of the 67

26  counties to trauma service areas. These assignments are made

27  for the purpose of developing a system of trauma centers.

28  Revisions made by the department should take into

29  consideration the recommendations made as part of the regional

30  trauma system plans approved by the department, as well as the

31  recommendations made as part of the state trauma system plan.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  These areas must, at a minimum, be reviewed in the year 2000

 2  and every 5 years thereafter. Until the department completes

 3  its initial review, the assignment of counties shall remain as

 4  established pursuant to chapter 90-284, Laws of Florida. The

 5  following trauma service areas are to be utilized in

 6  developing a system of state-sponsored trauma centers. These

 7  areas are subject to periodic revision by the Legislature

 8  based on recommendations made as part of local or regional

 9  trauma plans approved by the department pursuant to s.

10  395.401(2).  These areas shall, at a minimum, be reviewed by

11  the Legislature prior to the next 7-year verification cycle of

12  state-sponsored trauma centers.

13         (a)  The following trauma service areas are hereby

14  established:

15         1.  Trauma service area 1 shall consist of Escambia,

16  Okaloosa, Santa Rosa, and Walton Counties.

17         2.  Trauma service area 2 shall consist of Bay, Gulf,

18  Holmes, and Washington Counties.

19         3.  Trauma service area 3 shall consist of Calhoun,

20  Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,

21  Taylor, and Wakulla Counties.

22         4.  Trauma service area 4 shall consist of Alachua,

23  Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette,

24  Levy, Putnam, Suwannee, and Union Counties.

25         5.  Trauma service area 5 shall consist of Baker, Clay,

26  Duval, Nassau, and St. Johns Counties.

27         6.  Trauma service area 6 shall consist of Citrus,

28  Hernando, and Marion Counties.

29         7.  Trauma service area 7 shall consist of Flagler and

30  Volusia Counties.

31         8.  Trauma service area 8 shall consist of Lake,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Orange, Osceola, Seminole, and Sumter Counties.

 2         9.  Trauma service area 9 shall consist of Pasco and

 3  Pinellas Counties.

 4         10.  Trauma service area 10 shall consist of

 5  Hillsborough County.

 6         11.  Trauma service area 11 shall consist of Hardee,

 7  Highlands, and Polk Counties.

 8         12.  Trauma service area 12 shall consist of Brevard

 9  and Indian River Counties.

10         13.  Trauma service area 13 shall consist of DeSoto,

11  Manatee, and Sarasota Counties.

12         14.  Trauma service area 14 shall consist of Martin,

13  Okeechobee, and St. Lucie Counties.

14         15.  Trauma service area 15 shall consist of Charlotte,

15  Glades, Hendry, and Lee Counties.

16         16.  Trauma service area 16 shall consist of Palm Beach

17  County.

18         17.  Trauma service area 17 shall consist of Collier

19  County.

20         18.  Trauma service area 18 shall consist of Broward

21  County.

22         19.  Trauma service area 19 shall consist of Dade and

23  Monroe Counties.

24         (b)  Each trauma service area should have at least one

25  Level I or Level II trauma center.

26         (c)  There shall be no more than a total of 44

27  state-sponsored trauma centers in the state.

28         Section 59.  Subsection (1) of section 395.4045,

29  Florida Statutes, is amended to read:

30         395.4045  Emergency medical service providers;

31  transport of trauma victims to trauma centers.--

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (1)  Each emergency medical services provider licensed

 2  under chapter 401 shall transport trauma alert victims to

 3  hospitals approved as trauma centers, except as may be

 4  provided for either in department-approved local or regional

 5  trauma transport protocol or, if no local or regional trauma

 6  transport protocol is in effect, as provided for in a

 7  department-approved provider's trauma transport protocol.

 8  Development of regional trauma protocols shall be through

 9  consultation with interested parties, including, but not

10  limited to, each approved trauma center; physicians

11  specializing in trauma care, emergency care, and surgery in

12  the region; each trauma system administrator in the region;

13  and each emergency medical service provider in the region

14  licensed under chapter 401. Trauma alert victims shall be

15  identified through the use of a trauma scoring system.  The

16  department shall specify by rule the subjects to be included

17  in an emergency medical service provider's trauma transport

18  protocol and shall approve or disapprove each such protocol.

19

20  (Redesignate subsequent sections.)

21

22

23  ================ T I T L E   A M E N D M E N T ===============

24  And the title is amended as follows:

25         On page 5, line 14, after the semicolon

26

27  insert:

28         creating s. 395.40, F.S.; declaring legislative

29         findings and intent with respect to creation of

30         a statewide inclusive trauma system, as

31         defined; amending s. 395.401, F.S.; deleting

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         the definitions of the terms "local trauma

 2         agency" and "regional trauma agency"; defining

 3         the terms "trauma agency" and "trauma alert

 4         victim"; prescribing duties of the Department

 5         of Health with respect to implementation of

 6         inclusive trauma systems and trauma agency

 7         plans; amending s. 395.402, F.S.; removing

 8         legislative findings; prescribing duties of the

 9         department with respect to assignment of

10         counties to trauma service areas; amending s.

11         395.4045, F.S.; prescribing transport

12         requirements for emergency medical services

13         providers;

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