Munroe Regional Medical Center, Shands at the University of Florida and Shands Jacksonville Medical Center are asking the Circuit Court in Leon County to overturn the Florida Department of Health's decision that allowed Ocala Regional Medical Center to open the trauma unit.
The lawsuit claims the FDOH didn't have the authority to grant the trauma center application. Ocala Regional counters that it followed the rules and should be allowed to continue operating.
Ocala Health System encompasses the Ocala Regional Medical Center and West Marion Community Hospital in west Marion County. Munroe is a not-for-profit, 421-bed facility. Ocala Regional is a for-profit hospital.
ORMC's trauma center serves patients in Marion, Lake, Sumter and Citrus counties. The trauma center's director, Dr. Darwin Noel Ang, said this is one of the least-served trauma areas.
The lawsuit by Munroe isn't an isolated move. It is just the latest in a complex array of court and legislative actions challenging the state's process of permitting new trauma centers.
The First District Court of Appeal in Florida decided last month that the Department of Health's rules for granting new trauma centers was outdated. That ruling came after the Florida Legislature in 2004 required the FDOH to update those rules, which had not changed since 1992.
Munroe contends in its Leon County court petition that the FDOH didn't have the authority to approve new trauma centers until new rules were put into effect. The hospital was asking that Ocala Regional's FDOH “provisional” approval be blocked.
“Without this court halting these actions, the (FDOH's) rogue and outrageous conduct will be unchecked, the directive (by the Legislature) for a uniform and integrated state and local trauma system will continue to be disregarded and petitioners (Munroe and Shands hospitals), their staff and their patients will be irreparably injured,” says the Leon County court lawsuit .
Munroe CEO Steve Purves wrote to his hospital board in explaining his actions that “Trauma centers are extraordinarily expensive, require scarce medical and surgical expertise and can have significant negative consequences for injured patients if not done well.”
Purves wrote his board, “As you also know, Munroe and Shands have been working collaboratively over the last year to explore a more coordinated approach to trauma services given the significant investment in the Shands Level I trauma program and our longstanding referral relationship with them.”
He said that strategy was “a better alternative and a more coordinated approach for our region rather than the development of another costly and duplicative trauma center ...”
Purves also said that the FDOH's trauma application process did not provide for a venue for other area hospitals to lodge objections to applications.
Greg Bishop is a California-based trauma center consultant who worked with Munroe and Shands on this trauma center issue. He said Florida's current rules never took into account whether Ocala Regional's new trauma facility was needed, but rather focused only on the procedures to establish the facility.
“Florida has been a convoluted mess compared to any other (system) in the country,” Bishop said. “They never made any sense.”
Bishop said that many trauma centers throughout Florida often don't justify their existence. He said many are built to bring their hospitals prestige and improve their ability to compete.
On Friday, the FDOH began a series of meetings in Tallahassee taking public input about drawing up new rules. The FDOH also sent notifications on Dec. 13 to at least two other hospitals — Munroe Regional and Jackson North Medical Center in Miami-Dade County — that it would not approve their requests for trauma centers until the rule-making process was completed.
Munroe also said in its lawsuit that FDOH was unfair because its request to provide similar trauma service was nearly identical to Ocala Regional's petition for a trauma center.
It remains to be seen whether the courts will order Ocala Regional to close its trauma center now that the hospital has invested about $12 million into it.
“That's a very tough set of circumstances,” Bishop said.
Ocala Health System CEO Randy McVay said he feels confident in the service his hospital is providing.
“We are very confident in the quality of health care that's being rendered,” McVay said. “I think the Department of Health will determine that, too.”
McVay said many of the issues will have to be hashed out and argued by lawyers, but some issues are glaring.
McVay said his hospital began the trauma application process more than a year ago, but he is only now hearing about Munroe's objections.
He also doesn't understand why Shands and Jacksonville are part of the lawsuit, citing their distance from Marion County.
McVay also said that given Munroe's complaints that for-profit hospitals focus too much on the financial bottom line, it is now doing just that.
“It appears they are acting in their best interest rather than the best interest of the trauma patients,” McVay said.