Senate Bill 2276
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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
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Florida Senate - 1999 SB 2276
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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.
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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.
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Florida Senate - 1999 SB 2276
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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.
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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
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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
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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
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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.
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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.
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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.
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