Senate Bill 2276

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



    Florida Senate - 1999                                  SB 2276

    By Senator Myers





    27-1346-99

  1                      A bill to be entitled

  2         An act relating to trauma care; creating s.

  3         395.40, F.S.; declaring legislative findings

  4         and intent with respect to creation of a

  5         statewide inclusive trauma system, as defined;

  6         amending s. 395.401, F.S.; deleting the

  7         definitions of the terms "local trauma agency"

  8         and "regional trauma agency"; defining the

  9         terms "trauma agency" and "trauma alert

10         victim"; prescribing duties of the Department

11         of Health with respect to implementation of

12         inclusive trauma systems and trauma agency

13         plans; amending s. 395.402, F.S.; prescribing

14         duties of the department with respect to

15         assignment of counties to trauma service areas;

16         providing an effective date.

17

18  Be It Enacted by the Legislature of the State of Florida:

19

20         Section 1.  Section 395.40, Florida Statutes, is

21  created to read:

22         395.40  Legislative findings and intent.--

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

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

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

26  Report on Timely Access to Trauma Care submitted by the

27  department in response to the request of the Legislature.

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

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

30  needs of trauma patients. An "inclusive trauma system" means a

31  system designed to meet the needs of all injured patients who

                                  1

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






    Florida Senate - 1999                                  SB 2276
    27-1346-99




  1  require care in an acute-care setting and into which every

  2  health care provider or facility with resources to care for

  3  the injured patient is incorporated. The Legislature deems the

  4  benefits of trauma care provided within an inclusive trauma

  5  system to be of vital significance to the outcome of a trauma

  6  patient.

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

  8  primary responsibility for the planning and establishment of a

  9  statewide inclusive trauma system with the department. The

10  department shall undertake the implementation of a statewide

11  inclusive trauma system as funding is available.

12         (4)  The Legislature finds that significant benefits

13  are to be obtained by directing the coordination of activities

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

15  and the provision of trauma care to all trauma patients. It is

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

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

18  Board of Nursing establish interagency teams and agreements

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

20  those portions of the inclusive state trauma system within the

21  statutory authority of each agency. This coordinated approach

22  will provide the necessary continuum of care for the trauma

23  patient from injury to final hospital discharge. The

24  department has the leadership responsibility for this

25  activity.

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

27  should undertake to:

28         (a)  Establish a coordinated methodology for

29  monitoring, evaluating, and enforcing the requirements of the

30  state's inclusive trauma system which recognizes the interests

31  of each agency.

                                  2

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






    Florida Senate - 1999                                  SB 2276
    27-1346-99




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

  2  assist in furthering the operation of trauma systems at the

  3  regional level. This should include issues of system

  4  evaluation as well as managed care.

  5         (c)  Develop and submit appropriate requests for

  6  waivers of federal requirements which will facilitate the

  7  delivery of trauma care.

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

  9  for mandatory consultation on the care of trauma patients and

10  mandatory transfer of appropriate trauma patients to trauma

11  centers.

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

13  trauma patient. This shall include the movement of the trauma

14  patient through the system of care and the identification of

15  medical responsibility for each phase of care for

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

17         (f)  Require the medical director of an emergency

18  medical services provider to have medical accountability for a

19  trauma patient during interfacility transfer.

20         (6)  Furthermore, the Legislature encourages the

21  department to actively foster the provision of trauma care and

22  serve as a catalyst for improvements in the process and

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

24  system. Among other considerations, the department is

25  encouraged to:

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

27  center in every trauma service area.

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

29  each trauma region.

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

31  2000 and at least every 5th year thereafter.

                                  3

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






    Florida Senate - 1999                                  SB 2276
    27-1346-99




  1         Section 2.  Subsection (1) and paragraphs (c) and (n)

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

  3  Supplement, are amended to read:

  4         395.401  Trauma services system plans; verification of

  5  trauma centers and pediatric trauma referral centers;

  6  procedures; renewal.--

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

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

  9  Administration.

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

11  means that portion of hospital charges reported to the agency

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

13  patient whose family income for the 12 months preceding the

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

15  federal poverty level, unless the amount of hospital charges

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

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

18  patient whose family income exceeds four times the federal

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

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

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

22  determined by the department to be in substantial compliance

23  with trauma center and pediatric trauma referral center

24  verification standards as established by rule of the

25  department, and which:

26         1.  Has formal research and education programs for the

27  enhancement of trauma care.

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

29  centers, pediatric trauma referral centers, and community

30  hospitals.

31         3.  Ensures an organized system of trauma care.

                                  4

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






    Florida Senate - 1999                                  SB 2276
    27-1346-99




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

  2  determined by the department to be in substantial compliance

  3  with trauma center verification standards as established by

  4  rule of the department, and which:

  5         1.  Serves as a resource facility to community

  6  hospitals.

  7         2.  Ensures an organized system of trauma care.

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

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

10  contracts for the purpose of administrative trauma services.

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

12  hospital that is determined to be in substantial compliance

13  with pediatric trauma referral center standards as established

14  by rule of the department.

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

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

17  two or more counties contract, for the purpose of

18  administering trauma services.

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

20  that has successfully completed the state-approved selection

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

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

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

24  state-approved trauma center that receives state funding for

25  trauma care services.

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

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

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

29  inclusive regional trauma system.

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

31  incurred a single or multisystem injury due to blunt or

                                  5

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






    Florida Senate - 1999                                  SB 2276
    27-1346-99




  1  penetrating means or burns; who requires immediate medical

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

  3  adult or pediatric scorecard criteria established by the

  4  department by rule.

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

  6  determined by the department to be in substantial compliance

  7  with trauma center verification standards.

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

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

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

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

12  as the basis for making destination decisions.

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

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

15  or penetrating means or burns and who requires immediate

16  medical intervention or treatment.

17         (2)

18         (c)  The department shall receive plans for the

19  implementation of inclusive trauma care systems from local and

20  regional trauma agencies.  The department may approve or not

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

22  conformance of the plan local or regional plans with this

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

24  adopted by the department pursuant to those sections.  The

25  department shall approve or disapprove the plans within 120

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

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

28  regional trauma care system plan, each local or regional

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

30  department  for approval an updated plan that which identifies

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

                                  6

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






    Florida Senate - 1999                                  SB 2276
    27-1346-99




  1  system. The department shall approve or disapprove the updated

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

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

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

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

  6  public hearing and give adequate notice of the public hearing

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

  8  local or regional trauma agency shall submit to the department

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

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

11  which the local or regional trauma agency will cease

12  operation.

13         Section 3.  Subsection (3) of section 395.402, Florida

14  Statutes, is amended to read:

15         395.402  Trauma service areas; number and location of

16  trauma centers.--

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

18  department shall periodically review the assignment of the 67

19  counties to trauma service areas. These assignments are made

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

21  Revisions made by the department should take into

22  consideration the recommendations made as part of the regional

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

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

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

26  and every 5 years thereafter. Until the department completes

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

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

29  following trauma service areas are to be utilized in

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

31  areas are subject to periodic revision by the Legislature

                                  7

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






    Florida Senate - 1999                                  SB 2276
    27-1346-99




  1  based on recommendations made as part of local or regional

  2  trauma plans approved by the department pursuant to s.

  3  395.401(2).  These areas shall, at a minimum, be reviewed by

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

  5  state-sponsored trauma centers.

  6         (a)  The following trauma service areas are hereby

  7  established:

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

  9  Okaloosa, Santa Rosa, and Walton Counties.

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

11  Holmes, and Washington Counties.

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

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

14  Taylor, and Wakulla Counties.

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

16  Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette,

17  Levy, Putnam, Suwannee, and Union Counties.

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

19  Duval, Nassau, and St. Johns Counties.

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

21  Hernando, and Marion Counties.

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

23  Volusia Counties.

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

25  Orange, Osceola, Seminole, and Sumter Counties.

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

27  Pinellas Counties.

28         10.  Trauma service area 10 shall consist of

29  Hillsborough County.

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

31  Highlands, and Polk Counties.

                                  8

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






    Florida Senate - 1999                                  SB 2276
    27-1346-99




  1         12.  Trauma service area 12 shall consist of Brevard

  2  and Indian River Counties.

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

  4  Manatee, and Sarasota Counties.

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

  6  Okeechobee, and St. Lucie Counties.

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

  8  Glades, Hendry, and Lee Counties.

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

10  County.

11         17.  Trauma service area 17 shall consist of Collier

12  County.

13         18.  Trauma service area 18 shall consist of Broward

14  County.

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

16  Monroe Counties.

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

18  Level I or Level II trauma center.

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

20  state-sponsored trauma centers in the state.

21         Section 4.  This act shall take effect July 1, 1999.

22

23            *****************************************

24                          SENATE SUMMARY

25    Provides legislative findings with respect to the current
      state of trauma care in the state and the need for a
26    statewide inclusive system. Provides duties of the
      Department of Health, as well as other agencies, to enter
27    into cooperative agreements for the provision of such a
      system and provides additional duties of the department
28    in implementing the system, reviewing plans for the
      system, and assigning the various counties to trauma
29    service areas.

30

31

                                  9