Judge: Orange Park Medical Center's trauma unit shouldn't have opened

As Gov. Rick Scott seeks to eliminate a cap on the number of trauma centers in the state, an administrative law judge has ruled that the Florida Department of Health improperly allowed a Clay County hospital to open a trauma center last year.

The 57-page ruling, issued Friday by Judge W. David Watkins, backed the arguments of UF Health Jacksonville hospital, which challenged the department's decision to allow Orange Park Medical Center to begin operating a trauma center in May.

The dispute is part of years of legal and political battles across the state about whether new trauma centers should be allowed to open, with the battles involving the department and major players in the hospital industry.

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A key issue in the Orange Park case is a law that caps the number of trauma centers in the state at 44 and a related rule that allocates trauma centers in 19 different regions. Watkins said the five-county Northeast Florida region, which includes Orange Park Medical Center and UF Health Jacksonville, is only allocated one trauma center --- a slot that has long been filled by UF Health Jacksonville's trauma center.

Watkins wrote that the Department of Health failed to follow the Northeast Florida limit when it gave what is known as "provisional" approval for Orange Park Medical Center to open the trauma center and that UF Health Jacksonville has sustained a loss of patients and money because of the new facility. Trauma centers that receive provisional approval then can seek a more-permanent status.

"During the first three months after Orange Park opened its trauma center in 2016, UF Health Jacksonville's volume of its most severely injured patients decreased by 17 percent," Watkins wrote. "Overall, UF Health Jacksonville projects an annual loss of 320 to 540 trauma cases caused by Orange Park's operation of a trauma center."

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Watkins' ruling does not mean Orange Park Medical Center's trauma center will have to close. Under administrative law, the ruling is considered a recommended order that will go back to the Department of Health for final action. That action could be challenged at the 1st District Court of Appeal.

But Watkins also wrote that UF Health Jacksonville "lacks an available, adequate administrative remedy" because of the economic harm and potential damage to its quality of care stemming from the department's decision to allow the Orange Park trauma center to operate. As a result, Watkins wrote that UF Health Jacksonville should be able to go to circuit court to challenge the operation of the Orange Park facility.

"It is also well-established that when an agency engages in conduct for which there is no colorable legal authority --- -i.e., the agency's action is illegal --- exhaustion (of administrative remedies) is not required and the aggrieved party should be able to invoke the circuit court's jurisdiction for redress from that illegality," Watkins wrote.

"Pursuant to the authority discussed above, the department lacks colorable legal authority to permit Orange Park to operate as a provisional trauma center while this proceeding is pending. Accordingly, here, UF Health Jacksonville should not be required to exhaust administrative remedies."

Watkins' ruling came three days after Scott called for eliminating the cap of 44 trauma centers, with the governor's office saying it would lead to a "free market approach" that would ensure access to high-quality care throughout the state.

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"Capping trauma centers, which is currently done in Florida, adds barriers for Floridians that are in need immediate care due to severe injury," an email from Scott's office said.

Along with the Northeast Florida battle, disputes about new trauma centers have taken in place in the Tampa Bay region, Central Florida and South Florida. The HCA hospital chain, which includes Orange Park Medical Center, has sought to open trauma centers at several of its hospitals and has run into opposition from longstanding trauma providers, such as UF Health Jacksonville.

Proponents of more trauma centers, such as Scott, argue that the facilities can help save lives by reducing the amounts of time and distance needed to transport injured people for care.

But critics of easing the limits on trauma centers say the facilities are costly to operate and require highly trained medical staffs. They contend that adding new facilities can siphon patients and staff from existing trauma centers.