Florida Senate - 2014 SB 1276
By Senator Grimsley
1 A bill to be entitled
2 An act relating to trauma service areas; amending s.
3 395.402, F.S.; requiring the Department of Health to
4 provide an annual report assessing the trauma system;
5 revising factors for the department to consider when
6 conducting the assessment; limiting the total number
7 of trauma centers for each trauma service area;
8 deleting a provision that limits the total trauma
9 areas allowed in the state; reconfiguring certain
10 trauma service areas; amending s. 395.4025, F.S.;
11 revising application requirements for the department
12 to consider when selecting a hospital to be recognized
13 as a trauma center; deleting a provision relating to
14 the procedure for protesting an application decision
15 by the department; conforming cross-references;
16 requiring the department to redesignate certain
17 hospitals as Level II trauma centers; providing an
18 exception; providing an effective date.
20 Be It Enacted by the Legislature of the State of Florida:
22 Section 1. Section 395.402, Florida Statutes, is amended to
24 395.402 Trauma service areas; number and location of trauma
26 (1) The Legislature recognizes the need for a statewide,
27 cohesive, uniform, and integrated trauma system. Within the
28 trauma service areas, Level I and Level II trauma centers shall
29 each be capable of annually treating a minimum of 1,000 and 500
30 patients, respectively, with an injury severity score (ISS) of 9
31 or greater. Level II trauma centers in counties with a
32 population of more than 500,000 shall have the capacity to care
33 for 1,000 patients per year.
34 (2) Trauma service areas as defined in this section are to
35 be used by
utilized until the Department of Health to complete
36 completes an annual assessment of the trauma system. This
37 assessment shall be reported and reports its finding to the
38 Governor, the President of the Senate, the Speaker of the House
39 of Representatives, and the substantive legislative committees .
40 The report shall be submitted by February 1 of each year , 2005.
41 The department shall review the existing trauma system and
42 determine whether it is effective in providing trauma care
43 uniformly throughout the state. The assessment shall:
44 (a) Consider aligning trauma service areas within the
45 trauma region boundaries as established in July 2004.
46 (a) (b) Review the number and level of trauma centers needed
47 for each trauma service area to provide a statewide integrated
48 trauma system.
49 (b) (c) Identify Establish criteria used for determining the
50 number and level of trauma centers needed to serve the
51 population in a defined trauma service area or region.
52 (d) Consider including criteria within trauma center
53 approval standards based upon the number of trauma victims
54 served within a service area.
55 (c) (e) Evaluate the level of integration of Review the
56 Regional Domestic Security Task Force structure and determine
57 whether integrating the trauma system planning with interagency
58 regional emergency and disaster planning efforts is feasible and
59 identify any action needed to reduce duplication of planning
60 efforts and to promote effective response to mass casualty
61 events between the two entities.
62 (d) (f) Report the amounts, sources, and uses of financial
63 support for the trauma system Make recommendations regarding a
64 continued revenue source which shall include a local
65 participation requirement.
66 (e) (g) Make recommendations regarding the a formula for the
67 distribution of state funds identified for trauma centers which
68 shall address incentives for new centers where needed and the
69 need to maintain effective trauma care in areas served by
70 existing centers, with consideration for the volume of trauma
71 patients served, and the amount of charity care provided.
72 (3) In conducting the annual such assessment and subsequent
73 annual reviews, the department shall consider:
74 (a) The Recommendations made as part of the regional trauma
75 system plans submitted by regional trauma agencies.
76 (b) Stakeholder recommendations.
77 (c) The performance of the trauma system compared to
78 specific standards for access and quality geographical
79 composition of an area to ensure rapid access to trauma care by
81 (d) Historical patterns of patient referral and transfer in
82 an area.
83 (e) Inventories of available trauma care resources,
84 including professional medical staff.
85 (f) Population growth characteristics.
86 (g) Transportation capabilities, including ground and air
88 (h) Medically appropriate ground and air travel times.
89 (i) Recommendations of the Regional Domestic Security Task
91 (j) The actual number of trauma victims currently being
92 served by each trauma center.
93 (k) Other appropriate criteria.
94 (4) Annually thereafter, the department shall review the
95 assignment of the 67 counties to trauma service areas, in
96 addition to the requirements of paragraphs (2)(b)-(g) and
97 subsection (3). County assignments are made for the purpose of
98 developing a system of trauma centers. Revisions made by the
99 department shall take into consideration the recommendations
100 made as part of the regional trauma system plans approved by the
101 department and the recommendations made as part of the state
102 trauma system plan. In cases where a trauma service area is
103 located within the boundaries of more than one trauma region,
104 the trauma service area’s needs, response capability, and system
105 requirements shall be considered by each trauma region served by
106 that trauma service area in its regional system plan. Until the
107 department completes the February 2005 assessment, the
108 assignment of counties shall remain as established in this
110 (4) (a) The following trauma service areas are hereby
112 (a) 1. Trauma service area 1 shall consist of Escambia,
113 Okaloosa, Santa Rosa, and Walton Counties.
114 (b) 2. Trauma service area 2 shall consist of Bay, Gulf,
115 Holmes, and Washington Counties.
116 (c) 3. Trauma service area 3 shall consist of Calhoun,
117 Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,
118 Taylor, and Wakulla Counties.
119 (d) 4. Trauma service area 4 shall consist of Alachua,
120 Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy,
121 Putnam, Suwannee, and Union Counties.
122 (e) 5. Trauma service area 5 shall consist of Baker, Clay,
123 Duval, Nassau, and St. Johns Counties.
124 (f) 6. Trauma service area 6 shall consist of Citrus,
125 Hernando, and Marion Counties.
126 (g) 7. Trauma service area 7 shall consist of Flagler and
127 Volusia Counties.
128 (h) 8. Trauma service area 8 shall consist of Lake, Orange,
129 Osceola, Seminole, and Sumter Counties.
130 (i) 9. Trauma service area 9 shall consist of Pasco and
131 Pinellas Counties.
132 (j) 10. Trauma service area 10 shall consist of Hillsborough
134 (k) 11. Trauma service area 11 shall consist of Hardee,
135 Highlands, and Polk Counties.
136 (l) 12. Trauma service area 12 shall consist of Brevard and
137 Indian River Counties.
138 (m) 13. Trauma service area 13 shall consist of Charlotte,
139 DeSoto, Manatee, and Sarasota Counties.
140 (n) 14. Trauma service area 14 shall consist of Martin,
141 Okeechobee, and St. Lucie Counties.
142 (o) 15. Trauma service area 15 shall consist of Collier,
143 Charlotte, Glades, Hendry, and Lee Counties.
144 (p) 16. Trauma service area 16 shall consist of Palm Beach
146 17. Trauma service area 17 shall consist of Collier County.
147 (q) 18. Trauma service area 17 18 shall consist of Broward
149 (r) 19. Trauma service area 18 19 shall consist of Miami
150 Dade and Monroe Counties.
151 (5) (b) Each trauma service area should have at least one
152 Level I or Level II trauma center. The department shall
153 allocate, by rule, The total number of trauma centers, including
154 both Level I and Level II trauma centers, permitted in needed
155 for each trauma service area is limited as follows: one center
156 in areas 2, 3, 4, 7, 11, 12, 14, and 15; two centers in areas 5,
157 6, 10, 13, and 16; and three centers in areas 1, 8, 9, 17, and
158 18. An area may not have more than 3 centers. An additional
159 Level I or Level II center may not be approved if located less
160 than 10 miles from an existing Level I or Level II center.
161 (c) There shall be no more than a total of 44 trauma
162 centers in the state.
163 Section 2. Present subsections (8) through (12) of section
164 395.4025, Florida Statutes, are redesignated as subsections (7)
165 through (11), respectively, subsection (1), paragraphs (c) and
166 (d) of subsection (2), and present subsection (7) of that
167 section are amended, present subsections (13) and (14) of that
168 section are redesignated as subsections (12) and (13),
169 respectively, and amended, and a new subsection (14) is added to
170 that section, to read:
171 395.4025 Trauma centers; selection; quality assurance;
173 (1) For purposes of developing a system of trauma centers,
174 the department shall use the 19 trauma service areas established
175 in s. 395.402. Within each service area and based on the state
176 trauma system plan, the local or regional trauma services system
177 plan, and recommendations of the local or regional trauma
178 agency, the department shall establish the approximate number of
179 trauma centers needed to ensure reasonable access to high
180 quality trauma services. The department shall select those
181 hospitals that are to be recognized as trauma centers, based on
182 documentation of the hospital’s ability to meet established
183 quality standards.
185 (c) In order to be considered by the department,
186 applications from those hospitals seeking selection as trauma
187 centers, including those current verified trauma centers that
188 seek a change or redesignation in approval status as a trauma
189 center, must be received by the department no later than the
190 close of business on April 1. The department shall conduct a
191 provisional review of each application for the purpose of
192 determining that the hospital’s application is complete and that
193 the hospital has the critical elements required for a trauma
194 center. This critical review will be based on trauma center
195 standards and shall determine include, but not be limited to, a
196 review of whether the hospital has:
197 1. Equipment and physical facilities necessary to provide
198 trauma services.
199 2. Personnel in sufficient numbers and with proper
200 qualifications to provide trauma services.
201 3. An effective quality assurance process.
202 4. Submitted written confirmation by the local or regional
203 trauma agency that the hospital applying to become a trauma
204 center is consistent with the plan of the local or regional
205 trauma agency, as approved by the department, if such agency
207 (d)1. Notwithstanding other provisions in this section, the
208 department may grant up to an additional 18 months to a hospital
209 applicant that is unable to meet all requirements as provided in
210 paragraph (c) at the time of application if the number of
211 applicants in the service area in which the applicant is located
212 is equal to or less than the service area allocation, under s.
213 395.402(4) as provided by rule of the department. An applicant
214 that is granted additional time under pursuant to this paragraph
215 shall submit a plan for departmental approval which includes
216 timelines and activities that the applicant proposes to complete
217 in order to meet application requirements. An Any applicant that
218 demonstrates an ongoing effort to complete the activities within
219 the timelines outlined in the plan shall be included in the
220 number of trauma centers at such time that the department has
221 conducted a provisional review of the application and has
222 determined that the application is complete and that the
223 hospital has the critical elements required for a trauma center.
224 2. Timeframes provided in subsections (1)-(7) (8) shall be
225 stayed until the department determines that the application is
226 complete and that the hospital has the critical elements
227 required for a trauma center.
228 (7) Any hospital that wishes to protest a decision made by
229 the department based on the department’s preliminary or in-depth
230 review of applications or on the recommendations of the site
231 visit review team pursuant to this section shall proceed as
232 provided in chapter 120. Hearings held under this subsection
233 shall be conducted in the same manner as provided in ss. 120.569
234 and 120.57. Cases filed under chapter 120 may combine all
235 disputes between parties.
236 (12) (13) The department may adopt, by rule, the procedures
237 and process by which it will select trauma centers. Such
238 procedures and process must be used in annually selecting trauma
239 centers and must be consistent with subsections (1)-(7) (8)
240 except in those situations in which it is in the best interest
241 of, and mutually agreed to by, all applicants within a service
242 area and the department to reduce the timeframes.
243 (13) (14) Notwithstanding the procedures established
244 pursuant to subsections (1)-(12) through (13), hospitals located
245 in areas with limited access to trauma center services shall be
246 designated by the department as Level II trauma centers based on
247 documentation of a valid certificate of trauma center
248 verification from the American College of Surgeons. Areas with
249 limited access to trauma center services are defined by the
250 following criteria:
251 (a) The hospital is located in a trauma service area with a
252 population greater than 600,000 persons but a population density
253 of less than 225 persons per square mile;
254 (b) The hospital is located in a county with no verified
255 trauma center; and
256 (c) The hospital is located at least 15 miles or 20 minutes
257 travel time by ground transport from the nearest verified trauma
259 (14) If a hospital has operated continuously as a Level II
260 trauma center for a consecutive 12-month period and is in
261 operation on July 1, 2014, the department shall within 30 days
262 after a request by the hospital, redesignate such a hospital as
263 a Level II trauma center if such hospital has met the
264 requirements of subsections (5) and (6) with regard to quality
265 of care and patient outcomes. The department shall designate any
266 such hospital as a Level II trauma center if the redesignation
267 of the hospital does not cause the total number of trauma
268 centers in the trauma service area to exceed the number
269 specified in s. 395.402(5). A hospital that meets the
270 requirements of this section shall be eligible for renewal of
271 the 7-year approval period as provided in subsection (6).
272 Section 3. This act shall take effect July 1, 2014.