The Florida Senate

395.401  Trauma services system plans; verification of trauma centers and pediatric trauma referral centers; procedures; renewal.--

(1)  As used in this part, the term:

(a)  "Agency" means the Agency for Health Care Administration.

(b)  "Charity care" or "uncompensated charity care" means that portion of hospital charges reported to the agency for which there is no compensation for care provided to a patient whose family income for the 12 months preceding the determination is less than or equal to 150 percent of the federal poverty level, unless the amount of hospital charges due from the patient exceeds 25 percent of the annual family income. However, in no case shall the hospital charges for a patient whose family income exceeds four times the federal poverty level for a family of four be considered charity.

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

(d)  "Level I trauma center" means a hospital that is determined by the department to be in substantial compliance with trauma center and pediatric trauma referral center verification standards as established by rule of the department, and which:

1.  Has formal research and education programs for the enhancement of trauma care.

2.  Serves as a resource facility to Level II trauma centers, pediatric trauma referral centers, and community hospitals.

3.  Ensures an organized system of trauma care.

(e)  "Level II trauma center" means a hospital that is determined by the department to be in substantial compliance with trauma center verification standards as established by rule of the department, and which:

1.  Serves as a resource facility to community hospitals.

2.  Ensures an organized system of trauma care.

(f)  "Local trauma agency" means an agency established and operated by a county or an entity with which the county contracts for the purpose of administrative trauma services.

(g)  "Pediatric trauma referral center" means a hospital that is determined to be in substantial compliance with pediatric trauma referral center standards as established by rule of the department.

(h)  "Regional trauma agency" means an agency created and operated by two or more counties, or an entity with which two or more counties contract, for the purpose of administering trauma services.

(i)  "State-approved trauma center" means a hospital that has successfully completed the state-approved selection process pursuant to s. 395.4025 and has been approved by the department to operate as a trauma center in the state.

(j)  "State-sponsored trauma center" means a state-approved trauma center that receives state funding for trauma care services.

(k)  "Trauma center" means any hospital that has been determined by the department to be in substantial compliance with trauma center verification standards.

(l)  "Trauma scorecard" means a statewide methodology adopted by the department by rule under which a person who has incurred a traumatic injury is graded as to the severity of his or her injuries or illness and which methodology is used as the basis for making destination decisions.

(m)  "Trauma victim" means any person who has incurred a single or multisystem life-threatening injury due to blunt or penetrating means and who requires immediate medical intervention or treatment.

(2)(a)  The local and regional trauma agencies shall plan, implement, and evaluate trauma services systems, in accordance with this section and ss. 395.4015, 395.404, and 395.4045, which consist of organized patterns of readiness and response services based on public and private agreements and operational procedures.

(b)  The local and regional trauma agencies shall develop and submit to the department plans for local and regional trauma services systems. The plans must include, at a minimum, the following components:

1.  The organizational structure of the trauma system.

2.  Prehospital care management guidelines for triage and transportation of trauma cases.

3.  Flow patterns of trauma cases and transportation system design and resources, including air transportation services, and provision for interfacility transfer.

4.  The number and location of needed state-approved trauma centers based on local needs, population, and location and distribution of resources.

5.  Data collection regarding system operation and patient outcome.

6.  Periodic performance evaluation of the trauma system and its components.

7.  The use of air transport services within the jurisdiction of the local trauma agency.

8.  Public information and education about the trauma system.

9.  Emergency medical services communication system usage and dispatching.

10.  The coordination and integration between the verified trauma care facility and the nonverified health care facilities.

11.  Medical control and accountability.

12.  Quality control and system evaluation.

(c)  The department shall receive plans for the implementation of trauma care systems from local and regional trauma agencies. The department may approve or not approve the local or regional trauma agency plans based on the conformance of the local or regional plans with this section and ss. 395.4015, 395.404, and 395.4045 and the rules adopted by the department pursuant to those sections. The department shall approve or disapprove the plans within 120 days after the date the plans are submitted to the department.

(d)  A trauma agency shall not operate unless the department has approved the local or regional trauma services system plan of the agency.

(e)  The department may grant an exception to a portion of the rules adopted pursuant to this section or s. 395.4015 if the local or regional trauma agency proves that, as defined in the rules, compliance with that requirement would not be in the best interest of the persons served within the affected local or regional trauma area.

(f)  A local or regional trauma agency may implement a trauma care system only if the system meets the minimum standards set forth in the rules for implementation established by the department and if the plan has been submitted to, and approved by, the department. At least 60 days before the local or regional trauma agency submits the plan for the trauma care system to the department, the local or regional trauma agency shall hold a public hearing and give adequate notice of the public hearing to all hospitals and other interested parties in the area to be included in the proposed system.

(g)  Local or regional trauma agencies may enter into contracts for the purpose of implementing the local or regional plan. If local or regional agencies contract with hospitals for trauma services, such agencies must contract only with hospitals which are verified trauma centers.

(h)  Local or regional trauma agencies providing service for more than one county shall, as part of their formation, establish interlocal agreements between or among the several counties in the regional system.

(i)  This section does not restrict the authority of a health care facility to provide service for which it has received a license pursuant to this chapter.

(j)  Any hospital which is verified as a trauma center shall accept all trauma victims that are appropriate for the facility regardless of race, sex, creed, or ability to pay.

(k)  It is unlawful for any hospital or other facility to hold itself out as a trauma center unless it has been so verified.

(l)  A county, upon the recommendations of the local or regional trauma agency, may adopt ordinances governing the transport of a patient who is receiving care in the field from prehospital emergency medical personnel when the patient meets specific criteria for trauma, burn, or pediatric centers adopted by the local or regional trauma agency. These ordinances must be consistent with s. 395.4045, ordinances adopted under s. 401.25(6), and the local or regional trauma system plan and, to the furthest possible extent, must ensure that individual patients receive appropriate medical care while protecting the interests of the community at large by making maximum use of available emergency medical care resources.

(m)  The local or regional trauma agency shall, consistent with the regional trauma system plan, coordinate and otherwise facilitate arrangements necessary to develop a trauma services system.

(n)  After the submission of the initial local or regional trauma care system plan, each local or regional trauma agency shall annually submit to the department for approval an updated plan which identifies the changes, if any, to be made in the trauma care system. The department shall approve or disapprove the updated plan within 120 days after the date the plan is submitted to the department. At least 60 days before the local or regional trauma agency submits a plan for a trauma care system to the department, the local or regional trauma agency shall hold a public hearing and give adequate notice of the public hearing to all hospitals and other interested parties in the area. A local or regional trauma agency shall submit to the department written notice of its intent to cease operation of the local or regional trauma agency at least 90 days before the date on which the local or regional trauma agency will cease operation.

(o)  This section does not preclude a local or regional trauma agency from adopting trauma care system standards.

(3)  The department shall adopt, by rule, standards for verification of trauma centers based on national guidelines, including those established by the American College of Surgeons entitled "Hospital and Prehospital Resources for Optimal Care of the Injured Patient" and published appendices thereto. Standards specific to pediatric trauma referral centers shall be developed in conjunction with Children's Medical Services and adopted by rule of the department.

(4)  The department may withdraw local or regional agency authority, prescribe corrective actions, or use the administrative remedies as provided in s. 395.1065 for the violation of any provision of this section and ss. 395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045 or rules adopted thereunder. All amounts collected pursuant to this subsection shall be deposited into the Emergency Medical Services Trust Fund provided in s. 401.34.

History.--s. 1, ch. 82-60; s. 1, ch. 84-317; s. 1, ch. 85-65; s. 4, ch. 87-399; s. 1, ch. 88-186; s. 4, ch. 89-275; s. 5, ch. 89-283; s. 4, ch. 90-284; s. 36, ch. 92-78; ss. 35, 98, ch. 92-289; s. 730, ch. 95-148; s. 38, ch. 97-237; s. 8, ch. 98-89.

Note.--Former s. 395.031.