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TALLAHASSEE (CBSMiami/NSF) – In a hospital industry battle, the Florida Department of Health faces legal challenges about decisions that could revamp trauma care in Miami-Dade County.

The three challenges, filed Wednesday in the state Division of Administrative Hearings, involve the Jackson Health System, the HCA health-care chain and Nicklaus Children’s Hospital, all prominent players in the industry.

HCA’s Kendall Regional Medical Center is involved in each of the cases, as it challenges a newly approved trauma center at Jackson South Community Hospital — and tries to help the Department of Health fend off challenges to a newly upgraded status for Kendall’s trauma center.

All three cases stem from decisions the department made in late April and come after years of legal and regulatory wrangling by hospitals in various parts of Florida about operating trauma centers. Those disputes have repeatedly played out in administrative cases and have spilled into the Legislature.

In one of the new cases, Kendall is challenging a decision by the Department of Health to give what is known as “provisional” approval to a trauma center at Jackson South Community Hospital. That approval allowed the hospital, part of the Jackson system, to open a trauma facility in May.

The state regulates the number and types of trauma centers, at least in part, because the facilities are expensive and require specialized staff. Kendall raised objections about such issues in its challenge to the Jackson South trauma center, which poses competition in southern Miami-Dade County.

“The opening of the trauma center at Jackson South has decreased trauma patient volume at Kendall and has resulted in a loss of revenue,” Kendall attorneys wrote in the challenge, filed last month with the department and forwarded Wednesday to the Division of Administrative Hearings. “Upon information and belief, trauma patients have already been transported to Jackson South that otherwise would have received life-saving care at Kendall. Kendall has experienced substantial and material reductions in the volume of trauma patients it has traditionally treated. Decreased patient volumes could also adversely impact Kendall’s ability to maintain sufficient patient volumes to meet the trauma standards. A trauma center at Jackson South could also create shortages of the highly trained trauma physicians and staff required to operate a trauma center, as well as increased competition for those personnel, which would require Kendall to expend additional resources in the recruitment, retention, and replacement of such personnel.”

But in announcing the opening of the Jackson South facility last month, Carlos Migoya, president and CEO of Jackson Health System, said the new trauma center would improve access to care for patients. The system’s Jackson Memorial Hospital has also long operated Ryder Trauma Center.

“For more than two decades, Jackson has been synonymous with providing unmatched trauma care — and now we are expanding our footprint into south Miami-Dade, an area that has seen tremendous growth,” Migoya said in a prepared statement May 3. “More lives will undoubtedly be saved because of the new trauma center at Jackson South.”

But while Kendall Regional and the Jackson system battle about the new Jackson South trauma center, they — along with Nicklaus Children’s Hospital — also are tangling about a Department of Health decision to upgrade Kendall’s facility to what is known as a Level 1 trauma center.

Florida’s trauma system includes Level 1, Level 2 and pediatric trauma centers. Level 1 facilities are required by law to meet pediatric-trauma center standards and also have formal research and education programs.

Kendall’s new upgrade from a Level 2 trauma center to a “provisional” Level 1 center could create competition from Jackson Memorial’s Ryder Trauma Center and for Nicklaus Children’s Hospital. Documents in the challenge filed by Nicklaus Children’s Hospital indicate a large part of the debate focuses on how Kendall’s upgrade would affect pediatric trauma patients.

Nicklaus Children’s Hospital, which was formerly known as Miami Children’s Hospital, said a Level 1 trauma center at Kendall would have a “devastating impact.”

“Generally speaking, the adverse impact of approval of Kendall Regional as a Level 1 trauma center will include: NCH’s (Nicklaus Children Hospital’s) ability to continue to provide high quality health care services to pediatric patients; the unnecessary duplication of pediatric health care services; and a decrease in the volume of pediatric patients served by NCH, resulting in a material loss of revenue,” the challenge said.

But in another document, Kendall Regional attorneys disputed legal issues raised in Nicklaus Children’s Hospital’s challenge.

“The bulk of NCH’s petition is premised upon the faulty assumption that the department must make an assessment of ‘need’ for a Level II trauma center seeking to become a Level I trauma center,” the Kendall attorneys argued. “No statute or rule supports such an assumption.”

The News Service of Florida’s Jim Saunders contributed to this report.

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