14-001022RP Shands Teaching Hospital And Clinics, Inc., D/B/A Uf Health Shands Hospital vs. Department Of Health
 Status: Closed
DOAH Final Order on Friday, June 20, 2014.


View Dockets  
Summary: The Proposed Rule is not an invalid exercise of the agency's delegated legislative authority.

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8SHANDS TEACHING HOSPITAL AND

12CLINICS, INC., d/b/a UF HEALTH

17SHANDS HOSPITAL,

19Petitioner,

20vs. Case No. 14 - 1022RP

26DEPARTMENT OF HEALTH,

29Respondent,

30and

31OSCEOLA REGIONAL HOSPITAL, INC.,

35d/b/a OSCEOLA REGIONA L MEDICAL

40CENTER,

41Intervenor.

42_______________________________/

43THE PUBLIC HEALTH TRUST OF

48MIAMI - DADE COUNTY,

52Petitioner,

53vs. Case No. 14 - 1027RP

59DEPARTMENT OF HEALTH,

62Respondent,

63and

64OSCEOLA REGIONAL HOSPITAL, INC.,

68d/b/a OSCEOLA REGIONAL MEDICAL

72CENTE R,

74Intervenor.

75_______________________________/

76ST. JOSEPH'S HOSPITAL, INC.,

80d/b/a ST. JOSEPH'S HOSPITAL,

84Petitioner,

85vs. Case No. 14 - 1028RP

91DEPARTMENT OF HEALTH,

94Respondent,

95and

96OSCEOLA REGIONAL HOSPITAL, INC.,

100d/b/a OSCEOLA REGIONAL MEDICAL

104CENTER ,

105Intervenor.

106_______________________________/

107FLORIDA HEALTH SCIENCES CENTER,

111INC., d/b/a TAMPA GENERAL

115HOSPITAL,

116Petitioner,

117vs. Case No. 14 - 1034RP

123DEPARTMENT OF HEALTH,

126Respondent,

127and

128OSCEOLA REGIONAL HOSPITAL, INC.,

132d/b/a OSCEOLA REGIONAL MEDICAL

136C ENTER,

138Intervenor.

139_______________________________/

140BAYFRONT HMA MEDICAL CENTER,

144LLC, d/b/a BAYFRONT MEDICAL

148CENTER,

149Petitioner,

150vs. Case No. 14 - 1035RP

156DEPARTMENT OF HEALTH,

159Respondent,

160and

161OSCEOLA REGIONAL HOSPITAL, INC.,

165d/b/a OSCEOLA REGION AL MEDICAL

170CENTER,

171Intervenor.

172_______________________________/

173FINAL ORDER

175Pursuant to notice, a formal hearing was held in this case

186before R. Bruce McKibben , Administrative Law Judge of the

195Division of Administrative Hearings, on April 28 - 30 and May 2,

2075 - 7 and 22 , 2014 , in Tallahassee, Florida.

216APPEARANCES

217For Petitioner Shands Teaching Hospital and Clinics, Inc. ,

225d/b/a UF Health Shands Hospital :

231Seann M. Frazier, Esquire

235Jonathan L. Rue, Esquire

239Parker, Hudson, Rainer and Dobbs, LLP

245215 South Monroe Street, Suite 750

251Tallahassee, Florida 32301

254For Petitioner The Public Health Trust of Miami - Dade

264County:

265Eugene Shy, Jr., Esquire

269Christopher C. Kokoruda, Esquire

273Office of Miami - Dade County, Florida

280Jackson Memorial Hospital

2831161 NW 12 th Avenue, Wes t Wing, Suite 109

293Miami, Florida 33136 - 1005

298For Petitioner St. JosephÓs Hospital, Inc. , d/b/a St.

306JosephÓs Hospital:

308Robert A. Weiss, Esquire

312Karen Ann Putnal, Esquire

316Moyle Law Firm

319118 North Gadsden St reet

324Tallahassee, Florida 32301

327For Petitioner s, Florida Health Sciences Center, Inc. ,

335d/b/a Tampa General Hospital (ÐTampa GeneralÑ) , and Bayfront HMA

344Medical Center, LLC , d/b/a Bayfront Medical Center (ÐBayfrontÑ) :

353Jeffr ey L. Frehn, Esquire

358Christoper Lunny, Esquire

361Radey, Thomas, Yon and Clark, P.A.

367301 South Bronough Street, Suite 200

373Tallahassee, Florida 32301

376Fo r Respondent Department of Health :

383Caryl Kilinski, Esquire

386Chadwick R. Stevens, Esquire

390Office of the General Counsel

395Department of Health

3982585 Merchants Row Boulevard

402Tallahassee, Florida 32399 - 1073

407For Intervenor Osceola Regional Hosp ital , Inc. , d/b/a

415Osceola Regional Medial Center :

420Stephen A. Ecenia, Esquire

424J. Stephen Menton, Esquire

428David Prescott, Esquire

431Rutledge, Ecenia and Purnell, P.A.

436119 South Monroe Street, Suite 202

442Tallahassee, Florida 32302 - 0551

447STATEMENT OF THE ISSUE

451Whether the Proposed R ule 64J - 2.010 enlarges, modifies or

462contravenes the specific provisions of law implemented, or is

471arbitrary or capricious, and thus constitutes an invalid

479exercise of delegated legislative authority.

484PRELIMINARY STATEMENT

486On March 6, 2014, Shands Teach ing Hospitals and Clinics ,

496Inc. , d/b/a UF Health Shands Hospital ("Shands") filed its

507Petition to Determin e Invalidity of Proposed R ule 64J - 2.010

519originated by the Florida Department of Health (the ÐDepartmentÑ

528or ÐDOHÑ) . The Shands petition was assigned DOAH Case No. 14 -

5411022 RP .

544On March 7, 201 4, The Public Health Trust of Miami - Dade

557County (which governs the Jackson Health System and will be

567referred to herein as ÐJackson Memorial Ñ), filed its Petition

577for Determination of Invalidity of Proposed Rule. The Jackson

586Memorial petition was assigned DOAH Case No. 14 - 1027 RP .

598St. JosephÓs Hospital, Inc. , d/b/a St. JosephÓs Hospital

606(ÐSt. JosephÑ) filed its Petition to Determine Invalidity of

615Proposed Rule on Ma rch 7, 2014. St. JosephÓs petition was

626assigned DOA H Case No. 14 - 1028 RP .

636Also filed on Mar ch 7, 2014, was the Petition for

647Determination of Invalidity of DOHÓs Proposed Trauma Center Need

656Rule . That petition, filed by Florida Health Sciences Center,

666Inc. , d/b/a Tampa General Hospital (ÐTampa GeneralÑ) was

674assigned DOAH Case No. 14 - 1034 RP .

683T he Petition for Determination of Invalidity of DOHÓs

692Proposed Trauma Center Need Rule filed by Bayfron t HMA Medical

703Center, LLC , d/b/a Bayfront Medical Center (ÐBayfrontÑ) was

711filed on March 7, 2014, and assigned DOAH Case No. 14 - 1035 RP .

726A Petition to Int ervene was filed by Osceola Regional

736Hospital, Inc. , d/b/a Osceola Regional Medical Center

743(ÐOsceolaÑ) on March 11, 2014, in each of the aforementioned

753cases. Intervention was granted by Order of the undersigned

762dated March 12, 2014. That Order also cons olidated all of the

774cases noted above.

777This matter was set for hearing on March 31 Î April 4, 10,

790and 11, 2014 by agreement of all parties . On March 21, 2014 , a

804motion hearing was held during which the parties asked to amend

815the proposed final hearing d ates. Upon agreement of the

825parties, the final hearing was rescheduled for April 10 - 11, 14,

83717, 21 - 22, and 25. An amended Notice of Hearing was issued that

851day . A status conference was held via telephone on March 31,

8632014. At that time, the parties agr eed to amend the final

875hearing schedule once again. On April 1, 2014, an Amended

885Notice of Hearing was entered setting the final hearing for

895April 28 - 30 and May 2, 5, and 6.

905The final hearing was ultimately held on April 28 - 30 and

917May 2 , 5 - 7, and 22 , 20 14 , in Tallahassee, Florida.

929At final hearing, Shands called five witnesses:

936Steve McCoy, Program Administrator for the DepartmentÓs Health

944Analysis Bureau; Jennifer Tschetter, Esquire, general counsel

951for the Department; Dr. David Ciesla, accepted as a n expert in

963trauma systems design and performance; Dr. Fred Moore, accepted

972as an expert in acute care surgery and trauma systems

982development; and Dr. Joseph Tepas, accepted as an expert in

992pediatric surgery, pediatric trauma surgery, and trauma systems

1000pl anning. ShandsÓ Exhibits 13, 22 - 25, 27, 31 - 35, 52 - 53 , and 64 -

101865 were admitted into evidence.

1023Jackson Memorial called one witness: Dr. Nicholas Namias,

1031accepted as an expert in trauma surgery and trauma systems.

1041Jackson Memorial Ós Exhibits 30 - 32, 34 - 35, and 46 were admitted

1055into evidence.

1057St. Joseph called no witnesses . St. JosephÓs Exhibits 1

1067and 2 were admitted into evidence.

1073Tampa General and Bayfront, collectively, called one

1080witness : Mark Richardson, accepted as an expert in health care

1091planning. Tampa General and Bayfront Ós Joint Exhibits 2 - 5, 8 -

110410, 12, 23, 35 - 38, 42 - 44, 46 - 47, 57 - 58, as well as pages 175 - 200

1126and Exhibits 8 - 10 and 12 - 15 of E xhibit 59 , were admitted into

1142evidence.

1143The Department called two witnesses: Steve McCoy and

1151Jennifer Tsche tter. DOHÓs Exhibits 1 - 10, 12 - 28, 30 - 31, and 34

1167were admitted into evidence.

1171Osceola called s ix witnesses: Gene Nelson, expert in

1180health planning, health policy, and trauma center feasibility

1188analysis; Dr. James Hurst, expert in trauma surgery, trauma

1197sy stems development, trauma surgery training and education , and

1206surgical critical care; Michael Heil, expert in trauma system

1215planning and development, trauma center planning and operation,

1223hospital administration , and pre - hospital transport; Dr. Eriq

1232Barqui st, expert in trauma surgery and trauma planning;

1241Anna Burrus; and Dr. Darwin Ang, expert in epidemiology, trauma

1251surgery and trauma planning. OsceolaÓs Exhibits 1 - 2, 15, 22 - 32,

126438 - 40, 131, 146, 148, 152, 158, 184, 186 - 189, 258, 263, 265,

1279293, 295, 345, a nd 346 were admitted into evidence.

1289A transcript of the proceeding was ordered by the parties .

1300Proposed final orders were to be filed no later than ten days

1312after the filing of the hearing transcript at DOAH. The

1322transcript was filed on May 30, 2014. Each party timely filed a

1334Proposed Final O rder, all of which have been carefully

1344considered in the preparation of this Final Order.

1352All citations are to Florida Statutes (201 3 ), unless

1362otherwise indicated.

1364FINDINGS OF FACT

1367The Parties

13691. Shands operates an 852 - bed hospital and Level I t rauma

1382c enter in Gainesville, Alachua County, Florida. Its business

1391address is 1600 S outhwest Arch er Road, Gainesville, Florida.

1401Shands treats about 2,500 trauma patients each year. Shands is

1412located within trauma service area (TSA) 4, which is comprised

1422of Alachua, Bradford, Columbia, Dixie, Gilchrist, Hamilton,

1429Lafayette, Levy, Putnam, Suwan n ee, and Union counties.

14382. St. JosephÓs is a regional tertiary hospital and has

1448served the Tampa area for 75 years and has appro ximately 800

1460licensed acute care beds. St. Joseph offers a broad array of

1471acute care services including tertiary health care, serves as a

1481comprehensive regional stroke center, and has been repeatedly

1489recognized as a Consumers Choice hospital. St. Joseph operates

1498a Level II t rauma c enter and a Level I pediatric trauma center .

1513St. Joseph is located in TSA 10, co nsisting of a single county,

1526Hillsborough.

15273. Tampa General is a major tertiary hospital that is

1537designated by the state as a Level I trauma cen ter. Tampa

1549General also serves as a teaching hospital for the University of

1560South Florida, College of Medicine ("USF"). Tampa General is

1571located in Tampa, Hillsborough County, Florida , TSA 10.

15794. Bayfront is a 480 - bed tertiary hospital located in

1590Pinell as County, Florida . In addition to serving as a teaching

1602hospital, Bayfront is designated as a Level II trauma center

1612pursuant to chapter 395, Part II, Florida Statutes. It is

1622located in TSA 9, comp osed of Pinellas and Pasco counties.

16335. The Public Hea lth Trust of Miami - Dade County, is an

1646entity which governs and operates the Jackson Health System,

1655including the Ryder Trauma Center at Jackson Memorial Hospital.

1664It is in TSA 19, consisting of Dade and Monroe counties.

16756. The Florida Department of Heal th is the state agency

1686authorized to verify and regulate trauma centers in the state of

1697Florida pursuant to chapter 395, Part II, Florida Statutes , and

1707Florida Administrative Code R ule 64J - 2.001 et seq . The Division

1720of Emergency Medical Operations, Office of Trauma, oversees the

1729Department's responsibilities with respect to the statewide

1736trauma system.

17387. Osceola is a licensed acute care general hospital,

1747located at 700 West Oak Street, Kissimmee, Florida. Osceola

1756provides a wide array of high quality he alth services to the

1768residents and visi tors within its service area. It is located

1779in TSA 8, c onsisting of Lake, Orange, Osceola, Seminole, and

1790Sumter counties.

1792T he Florida Trauma System

17978. For purposes of organizing a statewide network of

1806trauma servi ces, the Florida Legislat ure directed the Department

1816to undertake the implementation of a statewide inclusive trauma

1825system as funding is available. § 395.40(3), Fla. Stat.

18349. The need for a trauma system is premised on the basic

1846principle that a trauma victim who is timely transported and

1856triaged to receive specialized trauma care will have a better

1866clinical outcome. § 395.40(2), Fla. Stat. A trauma victim's

1875injuries are evaluated and assigned an Injury Severity Score

1884("ISS"). § 395.4001(5), Fla. Sta t. Patients with ISS scores of

1897nine or greater are considered trauma patients. § 395.402(1),

1906Fla. Stat.

190810. Trauma experts speak in terms of "a Golden Hour," a

1919clinical rule of thumb that postulates no more than 60 minutes

1930should elapse from the occur rence of an injury to the beginning

1942of definitive treatment. There is, however, no current

1950consensus on what constitutes the "Golden Hour" for transport

1959times. A 1990 Department study recommended travel time of 25 - 35

1971minutes as the outside range for opti mal outcomes. A 1999

1982Department study favored a goal of 30 minutes transport time by

1993ground, and a 50 - mile radius by helicopter. By contrast, a 2005

2006study conducted for the Department used 85 minutes "total

2015evacuation time" as "acceptable."

201911. A traum a center is a hospital that has a collection of

2032resources and personnel who are charged with taking care of

2042trauma patients. They are recognized by the community as a

2052resource for care of severely injured patients. The

2060International Classification Injury Severity Score (ÐICISSÑ)

2066methodology, considered with discharged patient data from the

2074Agency for Health Care Administration database, was used by DOH

2084to determine severely injured patients. An ICISS score is the

2094product of the survival risk ratios (i.e. , the probabilities of

2104survival) calculated for each traumatic injury a single patient

2113suffers.

211412. Level I trauma centers are generally larger and busier

2124and treat more patients than Level II centers. Level I trauma

2135centers are required to engage in edu cation and research.

214513. Trauma centers are required to have several types of

2155physician specialists at the ready at all times. For instance,

2165with respect to surgical services, a Level I trauma center must

2176have a minimum of five qualified trauma surgeons, assigned to

2186the trauma service, with at least two trauma surgeons available

2196to provide primary (in - hospital) and backup trauma coverage 24

2207hours a day at the trauma center when summoned.

221614. Further, in addition to having at least one

2225neurosurgeon to p rovide in - hospital trauma coverage 24 hours a

2237day at the trauma center , a Level I provider must also have

2249surgeons available to arrive promptly at the trauma center in 11

2260other specialties, including (but not limited to) hand surgery,

2269oral/maxillofacial su rgery, cardiac surgery, orthopedic surgery,

2276otorhinolaryngologic surgery and plastic surgery. Level II

2283trauma centers must comply with similar physician specialist

2291standards. Little if any credible evidence was presented in the

2301present case to suggest th at the ability to hire qualifie d

2313clinical staff, technicians, specialty physicians and other

2320personnel would be severely impacted if the Proposed Rule is

2330implemented . Rather, the existing trauma centers lamented the

2339possibility of reduced case loads which could make it more

2349difficult to retain proficiency.

2353Invalidation of Former Rule 64J - 2.010

236015. In 1992, the Department of Health and Rehabilitative

2369Services (HRS), the Department of Health's predecessor,

2376promulgated Florida Administrative Code Rule 64J - 2. 010, titled

"2386Apportionment of Trauma Centers within a Trauma Service Area,"

2395(hereinafter referred to as the Ð Former Rule Ñ ). The Department

2407of Health assumed administration of the Former Rule in 1996,

2417when the Legislature split HRS into two new agencies, the

2427Department of Health and the Department of Children and

2436Families.

243716. The Former Rule regulated the number of trauma centers

2447that could be established in Florida. The Former Rule di vided

2458the state into TSAs as set forth in section 395.402(4), and for

2470each TSA, announced the number of trauma center "positions"

2479available.

248017. In 2004, the Florida Legislature amended section

2488395.402 to require the Department to complete an assessment of

2498Florida's trauma system, and to provide a report to the Governor

2509a nd Legislature no later than February 1, 2005 (the 2005

2520Assessment). The scope of the assessment was defined in

2529paragraphs (2)(a) through (g) and subsection (3) of section

2538395.402.

253918. One objective of the assessment was to consider

2548aligning trauma servi ce areas within the trauma region

2557boundaries as established in section 395.4015(1) . It required

2566the Department to establish trauma regions that cover all

2575geographic areas of the state and have boundaries that are

2585coterminous with the boundaries of the Regional Domestic

2593Security T ask F orces (ÐR DSTF Ñ) established under s ection

2605943.0312.

260619. In a related 2004 amendment, the Legislature added a

2616provision that gave the Department the option to use something

2626other than the trauma service areas codified in s ecti on

2637395.402(4) upon completion of the 2005 Assessment. See

2645§ 395.402(2) , Fla. Stat. ("Trauma service areas as defined in

2656this section are to be utilized until the Department of Health

2667completes" the 2005 Assessment.) § 395.402(4) , Fla. Stat.

2675("Until the department completes the February 2005 assessment,

2684the assignment of counties shall remain as established in this

2694section.").

269620. As part of the 2004 amendments to the trauma statute,

2707the Legislature also required the Department to conduct

"2715subsequent annual reviews" of Florida's trauma system. In

2723conducting such annual assessments, the Legislature required the

2731Department to consider a non - exhaustive list of criteria set

2742forth in section 395.402(3)(a) - (k). Further, the Legislature

2751required the Departmen t to annually thereafter review the

2760assignment of FloridaÓs 67 counties to trauma service areas.

276921. The Department timely submitted its 2005 Assessment to

2778the Legislature on February 1, 2005.

278422. With respect to its review of the trauma service

2794areas, the 2005 Assessment recommended against the continued use

2803of the 19 trauma service areas. The 2005 Assessment instead

2813suggested that i t may be feasible for the existing trauma

2824service areas t o be modified to fit the seven RDSTF regions to

2837facilitate regional planning.

284023. Following receipt of the 2005 Assessment, the

2848Department took no action to amend the Former Rule and adopt the

2860recommendations of the 2005 Assessment. As a result, in

2869June 2011, several existing trauma centers challenged the

2877validity of the Former Rule pursuant to sections 120.56(1) and

2887(3). See Bayfront Med. Ctr., Inc. et al. v. Dep't of Health ,

2899DOAH Case Nos. 11 - 2602RX, 11 - 2603RX, 11 - 2746RX, 11 - 2796RX ( Fla.

2916Div. Adm in . H ear ., Sept. 23, 2011).

292624. On September 23, 2011, an administ rative law judge of

2937the Division of Administrative Hearings entered a final order

2946holding that the Former Rule was an invalid exercise of

2956delegated legislative authority. The administrative law judge

2963concluded that the Former Rule was invalid because it

2972contravened the laws it purportedly implemented, including

2979section 395.402. The judge found:

2984The authority granted by section 395.402 for

2991the use of the [nineteen] identified TSAs

2998existed only until February 2005. After

3004that time, the Department was requi red to

3012consider the findings of the 2005

3018Assessment, as well as the recommendations

3024made as part of the regional trauma system

3032plan. Thus, section 395.402 can no longer

3039service as a valid basis for the Rule.

304725. However, as set forth below , the author ity to utilize

3058the 19 TSAs was not rescinded; rather, the mandated requirement

3068to use only the TSAs was rescinded.

307526. T he Department was required to review the assignment

3085of FloridaÓs 67 counties to trauma service areas, taking into

3095consideration the fa ctors set forth in paragraphs (2)(b) - (g) and

3107subsection (3) of section 395.402. Having done so, it was

3117incumbent on the Department to amend its [Former] Rule to

3127allocate the number of trauma centers determined to be needed

3137within each designated area through systematic evaluation and

3145application of statutory criteria.

314927. On November 30, 2012, the First District Court of

3159Appeal affirmed the administrative law judge's determination

3166that the Former Rule was an invalid exercise of delegated

3176legislative auth ority. See Dep't of Health v. Bayfront Med.

3186Ctr., Inc. , 134 So. 3d 1017 (Fla. 1st DCA 2012).

319628. After noting that the Former Rule claimed to implement

3206sections 395.401, 395.4015, and 395.402, the appellate court

3214held that the Former Rule was invalid be cause it failed to

3226reflect the substantial amendments to those laws that were

3235enacted in 2004. The appellate court held:

3242Both the pre - and post - 2004 versions of the

3253statute require the Department to establish

3259trauma regions that "cover all geographic

3265area s of the state." However, the 2004

3273amendment requires that the trauma regions

3279both "cover all geographical areas of the

3286state and have boundaries that are

3292coterminous with the boundaries of the

3298regional domestic security task forces

3303established under s. 9 43.0312."

3308§ 395.4015(1), Fla. Stat. (2004).

3313Similarly, the rule fails to implement the

33202004 amendments to section 395.402. The

3326version of the statute in effect at the time

3335the rule was promulgated set forth the

3342nineteen trauma service areas reflecte d in

3349the rule. [T] he 2004 version of the statute

3358required the Department to complete an

3364assessment of Florida's trauma system no

3370later than February 1, 2005. It further

3377provides that the original nineteen trauma

3383service areas shall remain in effect until

3390the completion of the 2005 Assessment.

3396Bayfront , 134 So. 3d at 1019Ċ20 (Emphasis added) .

340529. It should be noted that the 20 0 4 version of the

3418statute does not specify at what point in time the 19 TSAs could

3431no longer be utilized , only that they would have to be used at

3444least until completion of the 200 5 Assessment .

3453Rule Development

345530. T he Department thereafter initiated rule development

3463workshops to commence construction of a new rule . The first

3474workshop concerning this rule was in Tallahassee, Florida , on

3483December 21, 2012. In January and Februar y 2013, w orkshops were

3495then held in Pensacola, Tampa, Ocala, Jacksonville, and Miami,

3504as DOH continue d working on a new rule. Each of the sessions

3517involved input from interested persons both live and by

3526telephone . Written comments and oral presentations by these

3535persons were considered by the Department. After these first

3544six workshops, held in various regions of the State to make them

3556more accessible to more citizens, DOH then scheduled three more

3566workshops in March 2013 , to be held in areas where there were no

3579existing trauma centers, specifically Ft. Walton Beach, Naples,

3587and Sebring.

358931. DOH also considered the recommendations of a report

3598issued by the American College of Surgeons (ÐACSÑ), the lead

3608professional group for trauma systems and trauma car e in the

3619United States. The ACS sent a consultation team to Tallahassee,

3629Florida , to conduct a three - day site visit and hold public

3641workshops in February 2013. The ACS ultimately issued a report

3651entitled ÐTrauma System Consultation Report: State of Flor ida,Ñ

3661in May 2013. The report included as one of its recommendations

3672the use of RDSTF regions as the TSA area s to be used in

3686determining need for additional trauma centers .

369332. In November 2013, DOH released a draft proposed rule

3703and a draft of its firs t TSA A ssessment (the January TSA

3716Assessment) . The Department then conducted three additional

3724workshops in Pensacola, Orlando, and Miami. Again, DOH

3732solicited comments from interested persons and entered into a

3741dialogue as to what the proposed rule shoul d look like upon

3753publication.

375433. On January 23, 2014, DOH conducted a Negotiated

3763Rulemaking Committee meeting at the DepartmentÓs headquarters in

3771Tallahassee, Florida. The committee consisted of seven persons:

3779Karen Putnal, Esq uire and Dr. Fred Moore - - representing existing

3791trauma centers; Steve Ecenia, Esq uire and Dr. Darwin Ang --

3802representing new trauma centers currently under challenge;

3809Dr. Patricia Byers -- representative of the EMS Advisory Council;

3819Jennifer Tschetter, Esq uire and Dr. Ernest Block -- re presenting

3830DOH. The public was invited to attend the session but w as not

3843afforded an opportunity to speak.

384834. The Department considered all the input from each of

3858the workshops , the ACS Report, and the negotiated session, as

3868well as all the applicable items enumerated in s ection

3878395.402(3)(a) - (k) .

3882The Proposed Rule

388535. On February 3, 2014, the Department published Notice

3894of Development of Proposed Rule 64J - 2.010 (the "Proposed Rule")

3906in Florida Administrative Register , Volume 40, Number 22.

391436. The D epartment's Notice cited s ection 395.405, as

3924rulemaking authority for the Proposed Rule. The Notice also

3933cited sections 395.401, 395.4015, 395.402 , and 395.405 as the

3942laws intended to be implemented by the Proposed Rule.

395137. The following day, February 4, 2014, the Department

3960published a Notice of Correction in Florida Administrative

3968Register, Volume 40 , No. 23, to correct the history notes of the

3980Proposed Rule. In the corrected Notice, the Department cited

3989section 395.402 as its rulemaking authority in addition to

3998section 395.405. The correction also removed reference to

4006sections 395.401, 395.4015, and 395.405 , as laws implemented by

4015the Proposed Rule. Following the Department's correction, the

4023Proposed Rule was intended only to implement section 395. 402.

40333 8 . T he Proposed Rule established 19 TSAs and determined

4045the number of trauma centers to be allocated within each TSA,

4056based upon a scoring system established in the Proposed Rule.

40663 9 . Under the scoring system, TSAs were awarded positive

4077or negative points based on data in an annual Trauma Service

4088Area Assessment relating to the following six criteria: (1)

4097population; (2) median transport times; (3) community support;

4105(4) severely injured patients not treated in trauma centers; (5)

4115Level 1 trauma ce nters; and (6) number of severely injured

4126patients (in each TSA) .

413140 . M s. Tschetter added the last two criteria (Level I

4143Trauma Centers and Number of Severely Injured Patients) in

4152response to comments received at the negotiated rulemaking

4160session.

41614 1 . Subsequent to a final public hearing held on

4172February 25, 2014, DOH revised its January TSA Assessment and

4182the earlier version of the Proposed Rule. The revised TSA

4192assessment (the ÐMarch TSA AssessmentÑ) reflected more

4199conservative calculations (as gl eaned from input and discussions

4208with stakeholders) and documents the statutory patient volumes

4216for the existing Level I and Level II trauma centers in each

4228TSA. The March TSA A ssessment further recalculated the Median

4238Transport times, including all trans ports from 0 - 10 minutes (as

4250opposed to only those transports greater than 10 minutes) and

4260only transports to trauma centers (as opposed to transports to

4270all hospitals).

42724 2 . O n March 25, 2014, a Notice of Change was published in

4287the Florida Administrativ e Register. The Proposed Rule, as

4296published on that date, is as follows :

4304Notice of Change/Withdrawal

4307DEPARTMENT OF HEALTH

4310Division of Emergency Medical Operations

4315RULE NO.: RULE TITLE:

431964J - 2.010 Apportionment of Trauma Centers within a Trauma

4329Service Are a (TSA)

4333NOTICE OF CHANGE

4336Notice is hereby given that the following changes have been made to

4348the proposed rule in accordance with subparagraph 120.54(3)(d)1.,

4356F.S., published in Vol. 40, No. 22, February 3, 2014 issue of the

4369Florida Administrative Register .

437364J - 2.010 Allocation of Trauma Centers A a mong the Trauma Service

4386Areas (TSAs).

4388(1) Level I and Level II trauma centers shall be allocated among the

4401trauma service areas (TSAs) based upon the following:

4409(a) The following criteria shall be used to determin e a total score

4422for each TSA. Points shall be determined based upon data in the

4434Trauma Service Area Assessment.

44381. Population

4440a. A total population of less than 0 to 600,000 receives 2 points.

4454b. A total population of 600,001 to 1,200,000 receives 4 points .

4469c. A total population of 1,200,001 to 1,800,000 1,700,000 receives 6

4486points.

4487d. A total population of 1,800,000 1,700,001 to 2,400,000 2,300,000

4505receives 8 points.

4508e. A total population greater than 2,400,000 2,300,000 receives 10

4522points.

45232. Median Trans port Times

4528a. Median transport time of less than 0 to 10 minutes receives 0

4541points.

4542b. Median transport time of 1 0 1 to 20 minutes receives 1 point.

4556c. Median transport time of 21 to 30 minutes receives 2 points.

4568d. Median transport time of 31 to 40 minut es receives 3 points.

4581e. Median transport time of greater than 41 minutes receives 4

4592points.

45933. Community Support

4596a. Letters of support for an additional trauma center from 25 0 to 50

4610percent of the city and county commissions located within the TSA

4621receive 1 point. Letters of support must be received by the

4632Department on or before April 1 annually.

4639b. Letters of support for an additional trauma center from more than

465150 percent of the city or county commissions located within the TSA

4663receive 2 points. Lette rs of support must be received by the

4675Department on or before April 1 annually.

46824. Severely I injured Patients Discharged from Acute Care Hospitals

4692Not Treated In Trauma Centers

4697a. Discharge of 0 to 200 patients with an International

4707Classification Injury Severity Score (ÐICISSÑ) score of less than

47160.85 (Ðseverely injured patientsÑ) from hospitals other than trauma

4725centers receives 0 points.

4729b. Discharge of 201 to 400 severely injured patients from hospitals

4740other than trauma centers receives 1 point.

4747c. Discharge of 401 to 600 severely injured patients from hospitals

4758other than trauma centers receives 2 points.

4765d. Discharge of 601 to 800 severely injured patients from hospitals

4776other than trauma centers receives 3 points.

4783e. Discharge of more than 800 seve rely injured patients from

4794hospitals other than trauma centers receives 4 points.

48025. Level I Trauma Centers

4807a. The existence of a verified Level I trauma center receives one

4819negative point.

4821b. The existence of two verified Level I trauma centers receives t wo

4834negative points.

4836c. The existence of three verified Level I trauma centers receives

4847three negative points.

48506. Number of Severely Injured Patients

4856a. If the annual number of severely injured patients exceeds the

4867statutory trauma center patient volumes identified in Section

4875395.402(1), F.S. , by more than 500 patients, the TSA receives 2

4886points.

4887b. If the annual number of severely injured patients exceeds the

4898statutory trauma center patient volumes identified in Section

4906395.402(1), F.S. , by 0 to 500 patient s, the TSA receives 1 point.

4919c. If the annual number of severely injured patients is less than

4931the statutory trauma center patient volumes identified in Section

4940395.402(1), F.S. , by 0 to 500 patients, the TSA receives one

4951negative point.

4953d. If the annual n umber of severely injured patients is less than

4966the statutory trauma center patient volumes identified in Section

4975395.402(1), F.S., by more than 500 patients, the TSA receives two

4986negative points.

4988(b) The following scoring system shall be used to allocate trauma

4999centers within the TSAs:

50031. TSAs with a score of 5 points or less shall be allocated 1 trauma

5018center.

50192. TSAs with a score of 6 to 10 points shall be allocated 2 trauma

5034cen ters.

50363. TSAs with a score of 11 to 15 points shall be allocated 3 trauma

5051cen ters.

50534. TSAs with a score of more than 15 points shall be allocated 4

5067trauma centers.

5069(2) An assessment and scoring shall be conducted by the Department

5080annually on or before August 30th, beginning August 30, 2015.

5090(3) The number of trauma centers allocat ed for each TSA based upon

5103the Amended Trauma Service Area Assessment, dated March 24, 2014

5113January 31, 2014 , which can be found at www.FLHealth.gov/ licensing -

5124and - regulation/trauma - system/_documents/trauma - area - service -

5134assessment.pdf , is as follows:

5138TSA Counties Trauma

5141Centers

51421 Escambia, Okaloosa, Santa Rosa, Walton 1

51492 Bay, Gulf, Holmes, Washington 1

51553 Calhoun, Franklin, Gadsden, Jackson, 1

5161Jefferson, Leon,

5163Liberty, Madison, Taylor, Wakulla

51674 Alachua, Bradford, Columbia, Dixie, 1

5173Gilchrist, Hamilt on, Lafayette, Levy,

5178Putnam, Suwannee, Union

51815 Baker, Clay, Duval, Nassau, St. Johns 1 2

51906 Citrus, Hernando, Marion 2

51957 Flagler, Volusia 1

51998 Lake, Orange, Osceola, Seminole, Sumter 3

52069 Pasco, Pinellas 2 3

521110 Hillsborough 1

521411 Hardee, Highlands, Polk 1

521912 Brevard, Indian River 1

522413 DeSoto, Manatee, Sarasota 2

522914 Martin, Okeechobee, St. Lucie 1

523515 Charlotte, Glades, Hendry, Lee 1 2

524216 Palm Beach 1

524617 Collier 1

524918 Broward 2

525219 Dade, Monroe 3

5256Rulemaking Authority 395.402, 395.405 FS. Law Impleme nted 395.402 FS.

5266History Î New 12 - 10 - 92, Formerly 10D - 66.1075, Amended 6 - 9 - 05, 12 - 18 -

528806,Formerly 64E - 2.022, Amended_________.

52944 3 . DOH did not incorporate the March TSA Assessment by

5306reference in the rule. After exchanges of communications with

5315the Joint Ad ministrative Procedures Committee (ÐJAPCÑ), wherein

5323DOH sought guidance concerning this matter, there was no

5332directive by JAPC that such adoption by reference would be

5342required.

53434 4 . DOH revised the population criterion in the Proposed

5354Rule to have even br eaks in intervals of 600,000 people. The

5367February proposed rule awarded 6 points in TSAs with a

5377population of 1,200,001 to 1,700,000 people (i.e., a 500,000

5391person interval), where all other measures were based upon a

5401600,000 person interval. This discre pancy is corrected in the

5412newly Proposed Rule.

54154 5 . DOH revised the community support criterion in the

5426Proposed Rule to no longer award a point to TSAs where 0 - 50% of

5441the city and county commissions send letters of support, because

5451this could have reflect ed the need for a trauma center (by

5463awarding points to the TSA) when no letters of support were

5474received. The Proposed Rule now awards a point to TSAs where

548525 - 50% of the county commissi ons send letters of support. DOH

5498chose twenty - five percent as the mi nimum necessary community

5509support because the smallest number of city and county

5518commissions in all of the TSAs is four, which ensures everyone

5529has a voice.

55324 6 . DOH revised the title of the fourth criterion from

5544Ðseverely injured patients not treated in t rauma centers Ñ to

5555Ðseverely injured patients discharged from acute care

5562hospitals ,Ñ which more accurately depicts the function of the

5572criterion.

55734 7 . DOH revised the sixth criterion to include citations

5584to the statutory minimum volumes for Level I and Leve l II trauma

5597centers in response to a request by the staff attorney for the

5609Joint Administrative Procedures Committee.

56134 8 . DOH also revised the rule to reference the March TSA

5626Assessment in place of the January TSA Assessment.

56344 9 . Finally, DOH revised the Proposed RuleÓs allocation

5644table based on the revisions to the rule and assessment. The

5655Proposed Rule as amended allocates a total of 27 trauma centers

5666throughout FloridaÓs 19 TSAs. Each TSA is still allocat ed at

5677least one trauma center.

568150 . The Propos ed Rule allocates only Level I and Level II

5694trauma centers, not pediatric trauma centers. The rulemaking

5702directive in section 395.402(4) is interpreted by DOH to be

5712limited to the allocation of Level I and Level II trauma

5723centers. In addition, the alloca tion of stand - alone pediatric

5734centers would not be feasible because pediatric trauma patients

5743make up such a small percentage of the population and all of the

5756Level I and II trauma centers have the ability to become

5767pediatric trauma centers. Currently, al l of the existing Level

5777I trauma centers provide pediatric care and there are only two

5788stand - alone pediatric centers in Florid a.

57965 1 . The Proposed RuleÓs allocation of 27 trauma centers is

5808conservative. There are currently 27 verified trauma centers in

5817th e state, including two verified trauma centers under

5826administrative challenge .

58295 2 . There are several elements of the Proposed Rule which

5841Petitioners have raised as evidence of the DepartmentÓs failure

5850to comply with its rulemaking authority. Petitioner s maintain

5859that DOH failed to consider all of the items enumerated in

5870section 395.402(3)(a) - (k) . Each of those criteria is addressed

5881below.

58825 3 . (a) T he recommendations made as part of the regional

5895trauma system plans submitted by regional trauma agencie s --

5905There is only one regional trauma agency in Florida. DOH

5915reviewed the regional agencyÓs plan, but it was devoid of any

5926recommendations related to trauma center allocation within the

5934TSAs. The regional agency did not amend its plan or submit any

5946sepa rate recommendations throughout the year - long, public

5955rulemaking process.

59575 4 . (b) S takeholder recommendations -- Petitioners complain

5967that DOH did not do enough to solicit input from everyone who

5979would be affected by the Proposed Rule. The Department,

5988ho wever, obtained stakeholder testimony from 171 individuals and

5997written comments from 166 stakeholders through the course of the

600712 rule development workshops conducted around the state. The

6016workshops were held in several cities to allow for geographic

6026access by more residents. Over 400 people attended the

6035workshops. The January TSA A ssessment was also modified prior

6045to its publication as a result of the stakeholder discussions at

6056the workshops and the negotiated rulemaking session. The March

6065TS A A ssessm ent was further amended after its publication as a

6078result of testimony at the public hearing for the Proposed Rule .

60905 5 . (c) T he geographical composition of an area to ensure

6103rapid access to trauma care by patients -- While Florida contains

6114no mountains, it s geography is unique to other states in that it

6127contains several inlets, bays, jetties, and swamplands. As

6135such, the DOH data unit examined the coastal areas versus non -

6147coastal areas. The unit also analyzed urban versus rural areas.

6157The unit also looke d at the communities surrounding Lake

6167Okeechobee. Ultimately, the analysis was not meaningful because

6175the effect geography has on access to trauma centers is captured

6186by FloridaÓs transport time records for emergency vehicles and

6195helicopters. Thus, by re viewing the Emergency Medical Services

6204Tracking and Reporting System (ÐEMSTARSÑ) database, DOH could

6212know the actual effects of FloridaÓs geography on access to

6222trauma centers.

62245 6 . (d) H istorical patterns of patient referral and

6235transfer -- This item was considered, but the January TSA

6245Assessment does not address it because it was neither measurable

6255nor meaningful. The data was not measurable because of

6264limitations of data quality in the Trauma Registry. Even if the

6275data were measureable it would not hav e been meaningful because

6286it would have only illustrated the catchment areas -- i.e., the

6297geographic distribution of patients served by existing trauma

6305centers. As recommended by the ACS, DOHÓs primary focus is on

6316the trauma system as a whole, not individua l trauma centers.

6327Moreover, transfer and referral history is not meaningful to an

6337assessment designed to inform an allocation rule because, again,

6346DOH does not have the authority to define where new trauma

6357centers are developed within a TSA. S ee § 402.39 5(4)(b), Fla.

6369Stat. (charging DOH with allocating by rule the number of trauma

6380centers in each TSA, not trauma center location within a trauma

6391service area).

63935 7 . (e) I nventories of available trauma care resources,

6404including professional medical staff -- Petitioners suggest that

6412DOH should have made a determination of existing professional

6421medical staff , but suggest no viable means of doing so. The

6432January TSA Assessment catalogues several trauma care resources

6440within TSAs, including financing, trauma center s, acute care

6449hospitals, and EMS response capabilities. The January TSA

6457Assessment does not catalogue available professional medical

6464staff. DOH is unaware of any database that compiles this

6474information. DOH sent a survey to the existing trauma centers

6484requesting information as to their resources and professional

6492staff, however it was not useful due to the limited responses

6503and potential for bias. The data unit also reviewed the DOH

6514Division of Medical Quality Assurance health professional

6521licensure data base (COMPASS), however , it was not helpful

6530because physician specialty reporting is voluntary. Similarly,

6537the data unit reviewed AH C AÓs inventory of licensed acute care

6549hospitals and the DOH annual physician workforce survey results,

6558but neither data sou rce provided trauma - specific information.

6568As such, the information was not complete and so was not

6579included in the January TSA A ssessment .

65875 8 . (f) P opulation growth characteristics -- In response to

6599this criterion, the DOH data unit analyzed the potential for

6609growth in all of the TSAs, but the January TSA A ssessment did

6622not include this analysis because it was not meaningful given

6632DOHÓs requirement to conduct the assessment annually. The

6640January TSA Assessment does however document the population in

6649each TSA. DOH decided that in light of the continuing change of

6661population in Florida, the best it could do would be to make a

6674finding as to the population in each TSA and use it -- year by

6688year -- to look at the potential need for additional (or

6699presumably fewer) trauma centers in an area. Obviously the

6708population of an area is not directly commensurate with the

6718number of severely injured patients that might be found. Not

6728all areas have equal percentages of severely injured patients;

6737urban areas would have highe r percentages than rural areas, in

6748general. Areas through which a major interstate highway runs

6757would expect a higher percentage. There are a number of factors

6768that could potentially affect an areaÓs expectation of trauma

6777services. Inasmuch as they coul d not all possibly be included

6788in an analysis, DOH defaulted to a more general view, i.e., the

6800total population. The total population figure became the first

6809measurement in the Proposed Rule.

68145 9 . (g) T ransportation capabilities ; and (h) M edically

6825appropriate ground and air travel times -- DOH considered these

6835two factors together and determined to cover them by way of a

6847determination of median transport time, which was to become the

6857second measurement in the Proposed Rule. The data unit gathered

6867transport capability data by reviewing the COMPASS licensure

6875database and archived paper applications to discern the number

6884of licensed emergency medical stations, helicopters, and

6891vehicles in each TSA. The data unit further calculated the

6901number of ground vehicle s per the population in each TSA and

6913every 100 square miles. The January TSA Assessment included

6922this information because it was meaningful and gathered from a

6932reliable database. DOH considered the testimony from a number

6941of trauma surgeons during the 12 workshops regarding transport

6950times and learned that the medically appropriate transport time

6959depends on the nature of injuries and individual patients, which

6969are not always discernable at the scene of an accident. Because

6980of this, the sooner a patient c an be transported to a trauma

6993center, the better it is for patient outcomes. In light of the

7005patient - specific realities of establishing a medically

7013appropriate transport time, the data team used EMSTARS to

7022calculate the median emergency transport times in each TSA for

7032the assessment . Granted the EMSTARS is a fairly new system

7043under development, and it reports all 911 calls voluntarily

7052reported (not just trauma patients), so it is not a completely

7063accurate measure. But it is a reasonable approach based up on

7074what is available. Also, the transport times do not reflect

7084whether pre - hospital resources are sufficient for the patient or

7095how far away the closest trauma center may be. It is not an

7108absolutely perfect measurement, but it is reasonable and based

7117on logic.

711960 . (i) R ecommendations of the Regional Domestic Security

7129Task Force -- Like FloridaÓs lone regional trauma agency, the

7139RDSTF did not offer any input throughout the year - long, public

7151rulemaking process. However , DOH considered the testimony of

7159nume rous emergency management and law enforcement officials

7167during the rule development process. For example, Chief Loren

7176Mock, the Clay County fire chief and also a member of the

7188Domestic Security Oversight Council, testified at the

7195Jacksonville workshop. T here is no evidence DOH directly

7204contacted a RDSTF representative to solicit input.

72116 1 . (j) T he actual number of trauma victims currently

7223being served by each trauma center -- The March TSA Assessment

7234included the annual trauma patient volume reported to th e Trauma

7245Registry by the existing trauma centers. When comparing the

7254average patient volume reported to trauma registry from 2010 -

72642012 to the data unitÓs calculation of the average number of

7275severely injured patients treated in trauma centers during this

7284same time span, the volumes reported by the trauma centers were

7295approximately 333% greater. This large disparity prompted DOH

7303to follow the example of many other states and use population as

7315a proxy for the number of potential trauma patients in each TSA

7327in its Proposed Rule. DOH found that : greater population means

7338a greater need for health care; population is a good indicator

7349of need for medical services; population is a reasonable proxy

7359for patient volume; and, more people in a given area results in

7371m ore trauma cases in a given area .

73806 2 . (k) O ther appropriate criteria : It was well

7392documented in literature presented to DOH during the rulemaking

7401process that there w ere a large percentage of severely injured

7412patients in Florida not being seen by trauma centers. The data

7423unit confirmed this by evaluating the AHCA administrative

7431database, which identifies the injuries suffered by patients as

7440well as the type of hospitals discharging those patients , i.e.,

7450comparing the total number of severely injured pati ents with the

7461number of severely injured patients discharged from acute care

7470hospitals in each TSA. This disparity was worrisome to DOH and

7481therefore included in the March TSA Assessment. As pointed out

7491by Petitioners, the DepartmentÓs figures include pa tients who

7500may have received treatment outside the TSA in which the injury

7511occurred. The figures may not have contained patients who

7520needed trauma care but could not access it for other reasons.

7531The Proposed Rule, however, makes as complete an evaluation of

7541the potential patient base for trauma centers as is possible.

75516 3 . Notwithstanding complaints about how the Department

7560addressed some of the criteria set forth in the statute, it is

7572clear that all criteria were considered and implemented into the

7582Proposed Rule to the extent feasible and possible. The most

7592credible testimony at final hearing supports the DepartmentÓs

7600process. Criticisms of the various elements within the Proposed

7609Rule expressed by Petitioners at final hearing seemed to be

7619based on the concept that the Proposed Rule may allow

7629competition to existing trauma centers rather than real

7637complaints about the elements themselves. All agree, for

7645example, that population, transportation times, number of

7652patients, and the existence of nearby traum a centers are

7662important factors that should be considered. Petitioners just

7670seemed to want those factors expressed in different (though

7679unspecified) terms.

76816 4 . Petitioners did enunciate certain shortcomings they

7690felt made the Proposed Rule less than com plete. St. Joseph

7701lamented the absence of all the DepartmentÓs analysis and

7710background for each of the proposed measurements contained in

7719the Proposed Rule. Jackson Memorial pointed out that pediatric

7728trauma centers were not specifically included in the Proposed

7737Rule. Shands showed that odd or unusual results could arise

7747from implementation of the Proposed Rule. For example, the

7756March TSA Assessment showed a total of 216 severely injured

7766patients in TSA 6, comprised of Marion, Citrus, and Hernando

7776count ies. The Proposed Rule called for two trauma centers in

7787that TSA. Although the number of patients necessary to maintain

7797a trauma centerÓs proficiency was disputed by various experts in

7807the field, it is clear that 108 patients per center would be

7819extremel y low. However, the figure appearing in the March

7829Assessment is not absolute or necessarily completely definitive

7837of need. There are other factors concerning population and

7846patients that may affect that figure.

7852The Six Measurement Criteria in the Propos ed Rule

78616 5 . Petitioners also took exception to the measurement

7871criteria in the Proposed Rule. Each of those six criterion is

7882discussed below .

7885Population

78866 6 . The Proposed Rule awards from two to ten points to a

7900TSA, depending on the TSA total population . Two poi nts are

7912awarded for a population of less than 600,000 and ten points are

7925awarded for a popu1 ation greater than 2.4 million.

79346 7 . T he Department used t otal p opulation as a "proxy" for

7949the actual number of trauma patients in the state rather than

7960u sing the actual number of trauma victims in the state. The

7972Proposed Rule does not define ÐpopulationÑ or ÐTotal

7980Population,Ñ nor are those terms defined in the trauma statute ,

7991but those words are subject to their normal definition .

80016 8 . The Proposed Rule does not re - state the source of the

8016summary Total Population data ; it is already contained in the

8026TSA Assessment. Neither the Proposed Rule nor the March TSA

8036Assessment contains any data or analysis reflecting population

8044by age cohort, population density, or incidence of trauma injury

8054in relation to these factors, and the Department did not

8064specifically conduct any analysis of the significance of any

8073aspect of population data as it relates to the need for new

8085trauma centers, other than determining the tota l population

8094growth rate in the TSAs. Rather, DOH decided upon total

8104population as the most reliable measure available.

81116 9 . Traumatic injury rates and the severity of traumatic

8122injury vary widely based on a number of factors, including

8132whether the area is urban or rural, the population age cohort,

8143and the infrastructure and physical characteristics or features

8151of the geographic area. Thus, the most reasonable way to

8161measure possible need was to look at the total population of an

8173area and extrapolate fro m that basis.

818070 . The Department presented no specific data or analysis

8190to support the incremental cutoff points for the Total

8199Population scale contained in the Proposed Rule. Rather, the

8208Department took population as a whole because it was the most

8219readily available, annually updateable, and understandable

8225factor it could access .

82307 1 . The use of population as a proxy is not without

8243problems, however. In TSA 19, for instance, the population has

8253increased by about thirty - eight percent in recent decades, but

8264the number of trauma victims has declined by approximately

8273twelve percent. As stated, the Proposed Rule as written is not

8284inerrant.

8285Median Transport Times

82887 2 . The Proposed Rule awards from zero to four points to a

8302TSA, depending on the Median Trans port Time within a TSA .

83147 3 . ÐMedian Transport TimeÑ is not defined in the Proposed

8326Rule, nor is the methodology for determining the summary ÐMedian

8336Transport TimeÑ statistics set forth in the TSA Assessment and

8346relied on in the Proposed Rule. Informatio n concerning

8355transport times is, however, contained within the TSA

8363Assessment .

83657 4 . T he Median Transport Time used in the Proposed Rule

8378represents the average transport time for all 911 transports

8387voluntarily reported to the state EMSTARS database. EMST ARS is

8397a database that is under development and that collects

8406information voluntarily provided by emergency medical transport

8413providers throughout the state. Although not all EMS providers

8422current ly report to EMSTARS (most notably, Miami - Dade County EMS

8434does not participate), the database is useful for research and

8444quality improvement initiatives.

84477 5 . T he Median Transport Time set forth in the March TSA

8461Assessment and used in the Proposed Rule includes transport time

8471for all patients, rega rdless of the n ature of the emergency,

8483whether the call involved trauma , other types of injury, or

8493illness , and regardless of whether the transport was conducted

8502with the regular flow of traffic or required Ðlights and siren.Ñ

85137 6 . T he Median Transport Time used in the Proposed Rule

8526includes all EMS transports of up to two hours in duration. T he

8539Median Transport Time excludes transports of patients to trauma

8548center s operating pursuant to the initial stage of trauma center

8559licensure known as Ðprovisional approval.Ñ

85647 7 . T he Department address ed Ðmedically appropriate air or

8576ground transport times,Ñ as required by section 395.402(3)(h),

8585by its generally accepted conclusion that "faster is better."

85947 8 . Not all injured patients, however, benefit from

8604receiving care at a trauma center. Thus, while an existing

8614trauma center is an appropriate destination for all patients

8623with any level of injury who live in the area of a trauma

8636center, the trauma centerÓs value beyond its immediate area is

8646as a resource for the most severe ly injured patients whose

8657problems exceed the capabilities of their nearest hospital.

86657 9 . The Department did not undertake any analysis to

8676balance its "faster is better" approach to trauma planning

8685against the reality that the resources necessary to prov ide high

8696quality trauma care are limited, as is the number of severely

8707injured patients.

870980 . There is a general (but not universal) consensus among

8720trauma experts that access to a trauma center within 30 - 50

8732minutes is an appropriate benchmark for access to trauma care.

8742Other than "faster is better," the Department did not determine

8752a medically appropriate travel time for any type of trauma or

8763any geographic area, but recognizes the general consensus as

8772appropriate.

87738 1 . The Proposed Rule awards from one to four points that

8786weigh in favor of approval of a new tra uma center within a TSA

8800if the Median Transport Time of patients transported in response

8810to any 911 c all is between 10 and 42 minutes, i.e., within but

8824faster than the generally accepted consensus.

8830Community Support

88328 2 . The Proposed Rule awards from one to two points to

8845each TSA depending on the number of letters of support written

8856by elected city or county commissioners .

88638 3 . T he Proposed Rule allows for consideration of

8874stakeholder recommendations by way of allowing letters of

8882support from local governments . ÐStakeholdersÑ in the state

8891trauma system include existing trauma centers, as well as all

8901acute care hospitals, and pre - and post - hospital care providers,

8913including emergency transport servi ces, air ambulances, and

8921emergency management planning agencies.

89258 4 . The Department could find no better way to acknowledge

8937support from those stakeholders, and citizens in general, than

8946to have their elected representatives listen to their

8954constituents a nd then reflect those peopleÓs desires and

8963comments.

8964Severely Injured Patients Discharged from Acute Care Hospitals

89728 5 . The Proposed Rule awards from zero to four points to a

8986T SA, depending on the number of severely injured patients

8996discharged from acu te care hospitals (non - trauma centers) .

90078 6 . T he Proposed Rule addresses the number of severely

9019injured patients , i.e., those with an ICISS score of < 0.85="">

9028discharged from hospitals other than trauma centers. The

9036Proposed Rule does not specifically defin e Ðseverely injured

9045patient,Ñ but it is obvious from the context in which that term

9058is used.

90608 7 . T he summary data in the TSA Assessment labeled "number

9073of severely injured patientsÑ within each TSA is intended to

9083reflect the number of severely injured p atients who ÐdidnÓt get

9094to trauma care.Ñ The Department's numbers may include patients

9103who received treatment at a trauma center outside of the TSA in

9115which the injury occurred. The Department did not conduct any

9125analysis of the "number of severely injur ed patients not treated

9136at a trauma center" to determine whether the patients not

9146treated at a trauma center received timely and appropriate care

9156at a non - trauma center hospital with the capability to treat the

9169patient's injuries. The number of Ðseverely injured patients

9177who did not get to trauma careÑ as reported by the Department is

9190unlikely to reflect the actual number of patients who required

9200care at a trauma center but did not have access, and suggests

9212that this number is far higher than it actually i s. The

9224Department, for example (and in response to discussion with

9233stakeholders), excluded from its analysis all patients with

9241isolated hip fractures as well as all patients who were released

9252from the hospital within 24 hours, which resulted in fewer

9262seve rely injured patients.

92668 8 . Neither the Proposed Rule nor the TSA Assessment

9277considers demographics or outcomes for "severely injured

9284patients" treated at general acute care hospitals or outcome

9293data for these patients.

92978 9 . The Proposed Rule does not inc lude any method for

9310projecting the actual demand for trauma services in the future ;

9320it is used to determine need at a single point in time (and will

9334be done so annually) . The Proposed Rule does not include any

9346criteria or method for evaluating whether the re are any capacity

9357problems at existing trauma centers, or other barriers that

9366impede access to trauma care.

937190 . The Department intended this criterion to show a

9381highly conservative estimate of patients who definitely need

9389trauma care.

9391Level I Trauma C enters

93969 1 . With respect to ÐLevel I Trauma Centers,Ñ the Proposed

9409Rule awards from negative one to negative three points to a TSA,

9421depending on whether the TSA already has one, two, or three

9432verified Level I trauma center(s) , respectively .

94399 2 . The Propos ed Rule creates the opportunity for

9450establishment of both additional Level I and also additional

9459Level II trauma centers, pursuant to the allocation of need, but

9470the Proposed Rule does not assign or subtract points for the

9481existence of Level II trauma cent ers.

94889 3 . This criterion reflects the recommendations of

9497stakeholders at the rule workshops. It was the consensus of

9507many stakeholders that Level I trauma centers should be

9516protected in order to safeguard the research and teaching

9525missions of those center s. The earlier proposal of a ÐhaloÑ

9536around existing centers, i.e., not approving a new trauma center

9546within a certain radius of existing centers, was not

9555incorporated into the Proposed Rule. This criterion, however,

9563offers some protection for existing ce nters.

9570Number of Severely Injured Patients

95759 4 . The Proposed Rule awards negative two to two points

9587based on the "number of severely injured patients" in a TSA.

9598The criterion awards points based on the number of Severely

9608Injured Patients which exceed the target trauma center patient

9617volumes as provided in section 395.402(1). If the annual number

9627of Severely Injured Patients exceeds the statutory volumes by

9636more than 500 patients, the TSA will receive two points; if it

9648exceeds it by less than 500 the TSA r eceives one point; if the

9662number of Severely Injured Patients is less than the statutory

9672volumes by zero to 500 patients, the TSA receives one negative

9683point; if it is less than the volumes by more than 500 patients,

9696the TSA receives two negative points.

97029 5 . T he Proposed Rule does not include any criterion

9714addressing the actual number of trauma victims currently being

9723served by each trauma center. Instead, Section 6 of the

9733Proposed Rule substitutes the "minimum statutory capacity" of

9741existing trauma cente rs for the actual capac ity of existing

9752trauma centers.

97549 6 . The Department could not find Ða meaningfulÑ way to

9766measure actual capacity of existing trauma centers . The most

9776accurate way to measure capacity was a contentious topic at rule

9787workshops, and t he Department spent a good deal of time working

9799with stakeholders on how to measure capacity in such a way that

9811it could be included as a factor in the Proposed Rule. One

9823suggestion as to how to measure trauma center capacity is by how

9835often existing trau ma centers actually divert trauma patients to

9845other facilities. However, trauma centers rarely admit that

9853they are not able to take any more patients, and this is not a

9867realistic method to evaluate capacity.

98729 7 . The capacity of an existing trauma center may be

9884measured by various means, including the number of beds at the

9895trauma center, the number of ICU beds, the number of trauma

9906bays, number of operating rooms, as well as the frequency of and

9918reasons for diversion. The trauma centerÓs clinical staff,

9926including medical and surgical specialists, and supporting

9933clinical personnel, are also indicator s of capacity. The

9942Department already routinely collects data reflecting trauma

9949center capacity as part of the quarterly and annual reports that

9960all existing t rauma centers are required to submit, and by way

9972of on - site licensure surveys. None of those means, however,

9983provided DOH with sufficiently reliable information and data.

99919 8 . The Proposed Rule comports with the DOH Mission to

10003protect, promote, and improv e the health of all Floridians

10013through integrated state, county, and community efforts. While

10021by no means perfect, the Proposed Rule is based upon logic and

10033reason derived from an extensive analysis of all relevant

10042factors.

10043History of the Rule

100479 9 . The ra tionale for DOHÓs inclusion of those particular

10059six criteria in the Proposed Rule can be better understood by

10070considering some more history of the trauma rule.

10078100 . As stated earlier herein, in 2004 the Legislature

10088made substantial revisions to the trauma statute and ordered the

10098Department to complete an assessment of FloridaÓs trauma system.

10107The scope of this assessment was defined in paragraphs (2)(a)

10117through (g) and subsection (3) of section 395.402 . An

10127appropriation of $300,000 was authorized for the Department to

10137contract with a state university to perform the actions required

10147under the amended statute. Ch. 2004 - 259, § 10, Laws of Florida.

1016010 1 . One proposal of the 2005 Assessment was to

"10171[c]onsider aligning trauma service areas within [sic] the

10179tra uma region boundaries as established in" s ection 395.4015(1).

10189§ 395.402(2)(a), Fla. Stat. In a related 2004 amendment, the

10199Legislature ended the statutory mandate to use the service areas

10209created in 1990.

1021210 2 . The obvious conclusion from the above sta tutory

10223change is that the section 395.402(4) service areas could be

10233replaced by the service areas DOH established or adopted once it

10244had the results of the 2005 Assessment. Unlike the prior

10254statute, there is no mandate for specific new service areas,

10264only the option not to use the prior service areas.

1027410 3 . The 2005 Assessment included five "Recommendations" :

102841. Trauma centers should be placed in

10291Tallahassee and in Bay County, which do not

10299currently have a trauma center . . . .

103082. It is reasonable to s et, as a system

10318goal, that 65 percent of trauma center

10325patients will be treated at a trauma

10332center. . . .

103363. Designation of additional trauma centers

10342should be based on the need as determined by

10351trauma region. Deployment of additional

10356trauma cente r s sh ould take place based, not

10366only on the number of patients served per

10374t raum a center, but according to the concept

10383of Ðtrauma center capacityÑ which should be

10390determined by the staffing levels of medical

10397specialists and other healthcare

10401professionals. . . .

104054. The data support the feasibility of

10412transforming the Florida Trauma Services

10417Areas so that these would coincide with the

10425Domestic Security Task Force Regions. . . .

104335. It is reasonable to fund trauma centers

10441with public funds, based on the

10447unrecoverable financial burden incurred by

10452trauma centers.

1045410 4 . The only legislative response to the 2005 Assessment

10465was an increase in funding to trauma centers. The Legislature

10475did not repeal the statute establishing the current 19 TSAs.

10485Likewise, the Depart ment has not amended the Rule to implement

10496the recommendations contained in the 2005 Assessment until the

10505present Proposed Rule .

1050910 5 . The Department, instead, reviewed existing statutes,

10518interpreted section 395.4015 to mandate the establishment of a

10527traum a system plan (which plan would include trauma regions that

10538have boundaries coterminous with those of the regional domestic

10547security task force boundaries). The development of the trauma

10556system plan is distinct from the determination of need for new

10567traum a systems addressed by the Proposed Rule.

10575CONCLUSIONS OF LAW

1057810 6 . The Division of Administrative Hearings has

10587jurisdiction over the parties and subject matter of this cause

10597pursuant to section 120.56, Florida Statutes.

1060310 7 . Section 395.402, is the st atutory authority for the

10615Proposed Rule and the law implemented. It states, in its

10625entirety:

10626395.402 Trauma service areas; number and

10632location of trauma centers . Ï

10638(1) The Legislature recognizes the need for

10645a statewide, cohesive, uniform, and

10650integrated trauma system. Within the trauma

10656service areas, Level I and Level II trauma

10664centers shall each be capable of annually

10671treating a minimum of 1,000 and 500

10679patients, respectively, with an injury

10684severity score (ISS) of 9 or greater. Level

10692II trauma centers in counties with a

10699population of more than 500,000 shall have

10707the capacity to care for 1,000 patients per

10716year.

10717(2) Trauma service areas as defined in this

10725section are to be utilized until the

10732Department of Health completes an assessment

10738of the trauma system and reports its finding

10746to the Governor, the President of the

10753Senate, the Speaker of the House of

10760Representativ es, and the substantive

10765legislative committees. The report shall be

10771submitted by February 1, 2005. The

10777department shall review the existing trauma

10783system and determine whether it is effective

10790in providing trauma care uniformly

10795throughout the state. The assessment shall:

10801(a) Consider aligning trauma service areas

10807within the trauma region boundaries as

10813established in July 2004.

10817(b) Review the number and level of trauma

10825centers needed for each trauma service area

10832to provide a s t atewide integrated trauma

10840system.

10841(c) Establi sh criteria for determining the

10848number and level of trauma centers needed to

10856serve the population in a defined trauma

10863service area or region.

10867(d) Consider including criteria within

10872trauma center approval standards based upon

10878the number of trauma victims served within a

10886service area.

10888(e) Review the Regional Domestic Security

10894Task Force structure and determine whether

10900integrating the trauma system planning with

10906interagency regional emergency and disaster

10911planning efforts is feasible and identify

10917any dupli cation of efforts between the two

10925entities.

10926(f) Make recommendations regarding a

10931continued revenue source which shall include

10937a local participation requirement.

10941(g) Make recommendations regarding a

10946formula for the distribution of funds

10952identified for t rauma centers which shall

10959address incentives for new centers where

10965needed and the need to maintain effective

10972trauma care in areas served by existing

10979centers, with consideration for the volume

10985of trauma patients served, and the amount of

10993charity care provid ed.

10997(3) In conducting such assessment and

11003subsequent annual reviews, the department

11008shall consider:

11010(a) The recommendations made as part of the

11018regional trauma system plans submitted by

11024regional trauma agencies.

11027(b) Stakeholder recommendations.

11030(c) The geo graphical composition of an area

11038to ensure rapid access to trauma care by

11046patients.

11047(d) Historical patterns of patient referral

11053and transfer in an area.

11058(e) Inventories of available trauma care

11064resources, including professional medical

11068staff.

11069(f) Population growth characteristics.

11073(g) Transportation capabilities, including

11077ground and air transport.

11081(h) Medically appropriate ground and air

11087travel times.

11089(i) Recommendations of the Regional

11094Domestic Security Task Force.

11098(j) The actual number of t rauma victims

11106currently being served by each trauma

11112center.

11113(k) Other appropriate criteria.

11117(4) Annually thereafter, the department

11122shall review the assignment of the 67

11129counties to trauma service areas, in

11135addition to the requirements of paragraphs

11141(2 )(b) - (g) and subsection (3). County

11149assignments are made for the purpose of

11156developing a system of trauma centers.

11162Revisions made by the department shall take

11169into consideration the recommendations made

11174as part of the regional trauma system plans

11182approved by the department and the

11188recommendations made as part of the state

11195trauma system plan. In cases where a trauma

11203service area is located within the

11209boundaries of more than one trauma region,

11216the trauma service areaÓs needs, response

11222capability, and system requirements shall be

11228considered by each trauma region served by

11235that trauma service area in its regional

11242system plan. Until the department completes

11248the February 2005 assessment, the assignment

11254of counties shall remain as established in

11261this section.

11263( a) The following trauma service areas are

11271hereby established:

112731. Trauma service area 1 shall consist of

11281Escambia, Okaloosa, Santa Rosa, and Walton

11287Counties.

112882. Trauma service area 2 shall consist of

11296Bay, Gulf, Holmes, and Washington Counties.

113023. Traum a service area 3 shall consist of

11311Calhoun, Franklin, Gadsden, Jackson,

11315Jefferson, Leon, Liberty, Madison, Taylor,

11320and Wakulla Counties.

113234. Trauma service area 4 shall consist of

11331Alachua, Bradford, Columbia, Dixie,

11335Gilchrist, Hamilton, Lafayette, Levy,

11339Pu tnam, Suwannee, and Union Counties.

113455. Trauma service area 5 shall consist of

11353Baker, Clay, Duval, Nassau, and St. Johns

11360Counties.

113616. Trauma service area 6 shall consist of

11369Citrus, Hernando, and Marion Counties.

113747. Trauma service area 7 shall consist of

11382Flagler and Volusia Counties.

113868. Trauma service area 8 shall consist of

11394Lake, Orange, Osceola, Seminole, and Sumter

11400Counties.

114019. Trauma service area 9 shall consist of

11409Pasco and Pinellas Counties.

1141310. Trauma service area 10 shall consist of

11421Hillsb orough County.

1142411. Trauma service area 11 shall consist of

11432Hardee, Highlands, and Polk Counties.

1143712. Trauma service area 12 shall consist of

11445Brevard and Indian River Counties.

1145013. Trauma service area 13 shall consist of

11458DeSoto, Manatee, and Sarasota C ounties.

1146414. Trauma service area 14 shall consist of

11472Martin, Okeechobee, and St. Lucie Counties.

1147815. Trauma service area 15 shall consist of

11486Charlotte, Glades, Hendry, and Lee Counties.

1149216. Trauma service area 16 shall consist of

11500Palm Beach County.

1150317. Trauma service area 17 shall consist of

11511Collier County.

1151318. Trauma service area 18 shall consist of

11521Broward County.

1152319. Trauma service area 19 shall consist of

11531Miami - Dade and Monroe Counties.

11537(b) Each trauma service area should have at

11545least one Level I or Level II trauma center.

11554The department shall allocate, by rule, the

11561number of trauma centers needed for each

11568trauma service area.

11571(c) There shall be no more than a total of

1158144 trauma centers in the state.

11587History. Ï ss. 5, 15, ch. 90 - 284; ss. 37, 98,

11599ch. 92 - 289; s. 195, ch. 99 - 397; s. 26, ch.

116122000 - 242; s. 6, ch. 2004 - 259; s. 100, ch.

116242008 - 4.

11627Note. Ï Former s. 395.033.

1163210 8 . Section 120.56(1)(a), provides that any person

11641substantially affected by Ða proposed rule may seek an

11650administrative determination of the invalidity of the rule on

11659the ground that the rule is an invalid exercise of delegated

11670legislative authority.Ñ

11672Standing

1167310 9 . As stipulated by the parties, all Petitioners and

11684Intervenor have standing under s ection 120.56(1), to participate

11693in this administrative hearing as persons substantially affected

11701by the Proposed Rule.

11705Burden of Proof

117081 10 . Petitioners seek a determination that the Proposed

11718Rule constitutes an invalid exercise of delegated legislative

11726authority and is arbitrary and ca pricious, in violation of

11736section 120.52(8) . Under section 120.56(2)(a), the petitioner

11744has a burden of going forward and only thereafter is the agency

11756required to demonstrate by a preponderance of evidence that the

11766proposed rule is not an invalid exercis e of legislative

11776authority. Petitioners met their burden in this proceeding.

117841 1 1. An invalid exercise of delegated legislative

11793authority means action that goes beyond the powers, functions,

11802and dutie s delegated by the Legislature. A proposed or existing

11813rule is an invalid exercise of delegated legislative authority

11822if :

11824(a ) The agency has materially failed to

11832follow the applicable rulemaking procedures

11837or requirement set forth in this chapter;

11844(b) The agency has exceeded its grant of

11852rulemaking authority, citation to which is

11858required by s. 120.54(3)(a)1.;

11862(c) The rule enlarges, modifies, or

11868contravenes the specific provisions of law

11874implemented, citation to which is required

11880by s. 120.54(3 )(a)1.;

11884(d) The rule is vague, fails to establish

11892adequate standards for agency decisions, or

11898vests unbridled discretion in the agency;

11904(e) The rule is arbitrary or capricious. A

11912rule is arbitrary if it is not supported by

11921logic or the necessary facts ; a rule is

11929capricious if it is adopted without thought

11936or reason or is irrational;

11941(f) A grant of rulemaking authority is

11948necessary but not sufficient to allow an

11955agency to adopt a rule; a specific law to be

11965implemented is also required. An agency may

11972adopt only rules that implement or interpret

11979the specific powers and duties granted by

11986the enabling statute. No agency shall have

11993authority to adopt a rule only because it is

12002reasonably related to the purpose of the

12009enabling legislation and is not arbitr ary

12016and capricious or is within the agencyÓs

12023class of powers and duties, nor shall an

12031agency have the authority to implement

12037statutory provisions setting forth general

12042legislative intent or policy. Statutory

12047language granting rulemaking authority or

12052gener ally describing the powers and

12058functions of an agency shall be construed to

12066extend no further than implementing or

12072interpreting the specific powers and duties

12078conferred by the enabling statute.

12083§ 120.52(8), Fla. Stat.

12087Standard of Review

1209011 2 . A propose d rule may be challenged pursuant to s ection

12104120.56, only on the ground that it is an invalid exercise of

12116delegated legislative authority. An Administrative Law Judge is

12124without authority to declare a proposed rule invalid on any

12134other ground. To do so w ould be an impermissible extension of

12146the judgeÓs authority beyond the boundaries established by the

12155legislature.

1215611 3 . ÐAn arbitrary decision is one not supported by facts

12168or logic, or despotic.Ñ Bd . of Tr s. of Int . Impust Fund v.

12183Levy , 656 So. 2d 13 59, 1362 (Fla. 1st DCA 1995) ( quoting Agrico

12197Chem. Co. v. DepÓt of Envtl. Reg. , 365 So. 2d 759, 763 (Fla. 1st

12211DCA 1978)). ÐA capricious action is one which is taken without

12222thought or reason or irrationally. Ñ Id. A determination is not

12233arbitrary or capr icious if it is justifiable Ðunder any analysis

12244that a reasonable person would use to reach a decision of

12255similar importance.Ñ Dravo Basic Materials Co., Inc. v. State

12264of Fla., Dep Ó t of Trans p . , 602 So . 2d 632 (Fla. 2nd DCA 1992).

1228211 4 . An administrative agencyÓs interpretation of the

12291statute it is charged with implementing is entitled to great

12301deference. See Level 3 Comm cÓns , LLC v. Jacobs , 841 So. 2d 447,

12314450 (Fla. 2003); PW Ventures, Inc. v. Nichols , 533 So. 2d 281,

12326283 (Fla. 1988); Fl a . Hosp . (Adventi st Health) v. Agency for

12340Health Care Admin . , 823 So. 2d 844, 847 (Fla. 1st DCA 2002).

12353The deference to agency interpretation of a statute it is

12363charged with enforcing applies even if other interpretations or

12372alternative rules exist. Atlantic Shores Resor t v. 507 S. St.

12383Corp. , 937 So. 2d 1239, 1245 (Fla. 3d DCA 2006); Miles v. FAMU ,

12396813 So. 2d 242, 245 (Fla. 1st DCA 2002); B d. of Tr s. , 656 So. 2d

12413at 1363. Similarly, Ð[a]gencies are accorded wide deference in

12422the exercise of lawful rulemaking authority whi ch is clearly

12432conferred or fairly implied and consistent with the agency's

12441general statutory duties. Charity v. FS U , 680 So. 2d 463, 466

12453(Fla. 1st DCA 1996).

1245711 5 . The challenger's burden to demonstrate an invalid

12467exercise of delegated legislative author ity Ðis a stringent one

12477indeed.Ñ Agrico , 365 So. 2d at 763.

1248411 6 . The Department drafted the proposed rule pursuant to

12495section 395.402(4) . It developed a scoring system to assess

12505need based upon six criteria and allocated between one and three

12516trauma centers per TSA. The Proposed Rule allocated a maximum

12526total of 27 positions for trauma centers , precisely the number

12536currently existing or approved and fewer than the 44 allowed by

12547statute .

1254911 7 . Petitioners claim that the Proposed Rule is invalid

12560because i t does not incorporate all of the criteria set forth in

12573section 395.402(3) . These criteria, however, are part of a

12583separate and distinct statutory requirement that the Department

12591conduct an annual assessment as to whe ther the existing trauma

12602system is effective in providing trauma care throughout the

12611state. The statutory requirement for rulemaking ( s ection

12620395.402(b) - (c)) does not specify the criteria the Department was

12631required to use in allocating trauma centers.

1263811 8 . Nonetheless, d uring the rulemaking process, the

12648Department did consider each of the criteria listed in s ection

12659395.402(3) . If particular criteria were not reflected in the

12669Proposed Rule it was because , after careful consideration, the

12678data could not be confidently used .

1268511 9 . The Proposed Rule was issued after a rule development

12697process over the course of more than one year. The Department

12708afforded every impacted constituency the opportunity to express

12716their views and conducted an extensive review of literature and

12726data related to trauma care. During this process, t he

12736Department carefully considered the views of Stakeholders,

12743including Petitioners (or their representative s ) and, where

12752appropriate, modified the Proposed Rule to t ake into account

12762their input.

127641 20 . The Legislature did not s pecify the criteria that the

12777Department was required to use in allocating TSAs but instead

12787delegated the Department a mandate to allocate Ðby ruleÑ the

12797number of trauma centers in each TSA. The Legislature

12806recognized that the Department, as a specialized administrative

12814body with expertise in public health, was in the best position

12825to make that determination. The allocation of trauma centers is

12835a complex process and there is no universally accepted

12844methodology. As the ACS has explained:

12850The optimal balanc e between these choices

12857and trade - offs will not yield a single

12866universal solution, but will depend upon

12872uniquely local factors, including geography,

12877resource availability, and regional social

12882elements. In the end, the decision is

12889inherently political rath er than purely

12895scientific. For that reason, it is a

12902decision that few regions have been able to

12910execute successfully.

12912Bayfront Exhibit 12.

1291512 1 . The DepartmentÓs Proposed Rule was the product of

12926thoughtful consideration by the DepartmentÓs experts durin g an

12935extensive rulemaking development process. Under these

12941circumstances, the DepartmentÓs determinations are accorded

12947deference. See, e.g. , Island Harbor Beach Club, Ltd. v. DepÓt

12957of Nat . Res . , 495 So. 2d 209, 223 (Fla. 1st DCA 1986) (ÐThe

12972complexity of the scientific and technical issues in this case

12982and the consequent deference necessarily given to [the

12990Department of Natural ResourceÓs] expertise vividly illustrate

12997the limited role an appellate court can play in resolving

13007disputes arising out of an adm inistrative agencyÓs exercise of

13017delegated discretion in respect to technical matters . . . .Ñ);

13028Rizov v. State, Bd. of Prof . Eng Órs , 979 So. 2d 979, 980 - 81

13044(Fla. 3d DCA 2008) (ÐAgencies generally have more expertise in a

13055specific area they are charged wit h overseeing. Thus, in

13065deferring to an agency's interpretation, courts benefit from the

13074agency's technical and/or practical experience in its field.Ñ);

13082see also Avatar Dev . Corp. v. State , 723 So. 2d 199, 207 (Fla.

130961998) (ÐUnder the complexities of our mo dern system of

13106government, the Legislature has recognized that [the Department

13114of Environmental Protection], as a specialized administrative

13121body, is in the best position to establish appropriate standards

13131and conditions . . . .Ñ)

1313712 2 . The rulemaking proc ess also refutes any claim that

13149the Proposed Rule was arbitrary or capricious. There was ample

13159testimony as to the facts and logic supporting each of the

13170criteria in the Proposed Rule -- negating any claim of

13180arbitrariness. The fact that the Department dev eloped the

13189Proposed Rule after a year of careful analysis as to the factors

13201that should be used to assess trauma center need negates any

13212claim that the Proposed Rule is ÐcapriciousÑ because it was one

13223allegedly Ðtaken without thoug ht or reason or irrationa lly.Ñ

13233123. The DepartmentÓs determination that the TSAs should

13241not be abolished and that their borders should not be realigned

13252should be accorded deference because there was no statutory

13261mandate to abolish or realign the TSAs. It is difficult to

13272reconcil e the continued existence of s ection 395.402 after the

13283recommendations in the 2005 Assessment, unless the Legislature

13291meant for DOH to have an option to use the 19 TSAs un til they

13306found a more effective and manageable way to allocate trauma

13316centers within the State. In this case, DOH adequately

13325described its analysis resulting in the decision to continue

13334(for the present) to use the 19 TSAs in lieu of the RDSTF

13347regions or any other system.

13352124. The Legislature has mandated that the Department

13360address two separate functions: trauma planning (for example,

13368in response to mass - casualty events) and the alloc ation of

13380trauma centers to TSAs.

13384125. Section 395.4015, is focused exclusively on trauma

13392planning -- not trauma center allocation -- as indicated by its

13403title : ÐState regional trauma planning; trauma regions.Ñ As

13412part of the LegislatureÓs 2004 amendments to the Trauma Statu t e,

13424the Legislature mandated that Ðthe department shall establish

13432trauma regions that cover all geographical areas of the state

13442and have b oundaries that are coterminous with the boundaries of

13453the regional domestic security task forces,Ñ which Ðmay serve as

13464the basis for the development of department - approved local or

13475regional trauma plans.Ñ § 395.4015(1) , Fla. Stat . While this

13485section mandated that the Department establish trauma regions

13493that were coterminous with the RDSTFs, it said nothing about

13503TSAs, the allocation of trauma centers, or the provision of

13513trauma care.

13515126. Section 395.402 , the section implemented by the

13523Proposed Rule, exp licitly recognizes the continued existence of

13532TSAs. Subsection (2)(a) states that in conducting its annual

13541assessment, the Department was required to Ð[c]onsider aligning

13549trauma service areas within the trauma region boundaries as

13558established in July 2004 .Ñ The meaning of the term ÐconsiderÑ

13569as a matter of plain English is permissive, not mandatory. See ,

13580e.g. , Merriam - Webster dictionary (defining ÐconsiderÑ as Ðto

13589think about (something or someone) carefully especially in order

13598to make a choice or decisi onÑ). In other words, the Department

13610was supposed to consider whether the boundaries of the TSAs

13620should be redrawn to fit neatly within the trauma regions; this

13631provision did not contemplate abolishing TSAs altogether.

13638Subsection ( 4 ) similarly required t he Department to conduct an

13650annual review [of] the assignment of the 67 counties to trauma

13661service areas and stated that Ð[i]n cases where a trauma service

13672area is located within the boundaries of more than one trauma

13683region, the trauma service areaÓs need s, response capability,

13692and system requirements shall be considered by each trauma

13701region served by that trauma service area in its regional system

13712plan.Ñ This subsection contemplated the ongoing existence for

13720TSAs -- creating the need for annual reviews -- a nd a clear

13733distinction between TSAs on the one hand and trauma regions or

13744RDSTFs on the other, including the fact that they are different

13755entities and could have overlapping geographical boundaries. It

13763is noteworthy that the above - cited provisions were al so added as

13776a result of the 2004 statutory a mendments. Unlike the

13786amendments to section 395.4015, which included a mandate to

13795establish trauma regions that were coterminous with the RDS TF s,

13806the Legislature did not include any similar mandates with

13815respect to TSAs.

13818127. As set forth above, the Department extensively

13826considered whether the boundaries of TSAs should be realigned

13835within the RDSTFs and reasonably concluded that the interests of

13845FloridaÓs public health was best served by maintaining the

13854status quo until such time as an appropriate regional trauma

13864planning structure was developed or the Department was given

13873clear authority to allocate trauma centers within RDSTFs.

13881128. Due to the size of the trauma planning regions, which

13892mirror the RDSTF bounda ries, regional trauma agencies are

13901necessary to aid in trauma center allocation and ensure trauma

13911centers are appropriately located throughout the regions. At

13919this time, there is only one regional trauma planning agency in

13930Florida.

13931129. In Citizens of Fl orida v. Mayo , 357 So. 2d 731, 733

13944(Fla. 1970), the Florida Supreme Court held that no court can

13955require an agency to adopt a specific rule, noting that Ðthe

13966agency rulemaking function involves the exercise of agency

13974discretion and this Court will not su bstitute its judgment for

13985that of the agency on an issue of discretion.Ñ The CourtÓs

13996analysis recognized that it is the statutory language which

14005controls the adoption of a rule, not the CourtÓs opinion as to

14017what a rule should include. In Bayonet Point H ospital, Inc. v.

14029Department of Health & Rehab ilitative Services , 490 So. 2d 1318,

140401320 (Fla. 1st DCA 1986), the First District adopted the

14050analysis in Mayo , supra , and confirmed that a court has no

14061authority to compel agency adoption of a rule which repres ents a

14073policy choice in the area of the agencyÓs statutory concern.

14083Id. ( citing FEA/United v. PERC , 346 So. 2d 551 (Fla. 1st DCA

140961977)). Prior decisions related to the 1992 Rule ( Bayfront Med .

14108C tr , Inc. et al. v. Dep Ó t of Health , Case Nos. 11 - 2602 RX , et al.

14127(Fla. D OAH , Sept. 23, 2013 ) ; and Dep Ó t of Health v. Bayfront

14142Med . Ctr . , Inc. , 134 So. 3d 1017 (Fla. 1 st DCA 2012)) , could not

14158dictate the results of the DepartmentÓs consideration over the

14167course of the rule development process for this Proposed Rule

14177a bout whether the TSAs should be aligned with the trauma

14188regions/RDSTFs, or mandate that the TSAs be abolished.

14196130. Contrary to the claim made by Petitioners, the

14205Proposed Rule is valid even though the Proposed Rule, on its

14216face, does not define the sourc es of data that would be used to

14230measure population, median transport time or hospital discharge

14238data.

14239131. In February 2014, the JAPC sent the Department a

14249letter stating that the Trauma Service Area Assessment, which

14258identifies the source data for crite ria used in the Proposed

14269Rule, was not specifically incorporated by reference into the

14278text of the Proposed Rule. The Department responded that the

14288assessment was prepared pursuant to a different statutory

14296requirement and that it did not have the force of law. The JAPC

14309has not objected to the Proposed Rule. The March TSA Assessment

14320does not constitute a rule as defined by section 120.52(16). It

14331is an informational reference only and therefore is not required

14341to be incorporated by reference. See ÐLookin g Glass Law:

14351Legislation by Reference in the States,Ñ F. Scott Boyd,

14361Louisiana L. Rev., Vol. 68, Number 4, Summer 2008.

14370132. Rules are valid even if they afford discretion to the

14381administrative agency in carrying them out. In Florida East

14390Coast Industri es , Inc. v. State Department of Community Affairs ,

14400677 So. 2d 357 (Fla. 1st DCA 1996), petitioners claimed that

14411proposed rules related to urban sprawl vested the agency with

14421unbridled discretion. The court agreed with the ALJÓs finding

14430that the rule in qu estion did not vest the agency with unbridled

14443discretion, relying upon testimony that determining what

14450constituted urban sprawl was so complex that it made a more

14461specific rule impossible. Id. at 361. The court concluded that

14471Ðexecutive agencies may exer cise some discretion witho ut

14480breaching their authority.Ñ Id.

14484133. Similarly , in Southwest Fl orida Water M anagement

14493District v. Charlotte County , 774 So. 2d 903, 911 (Fla. 2d DCA

145052001), the court upheld the ALJÓs finding that a rule that used

14517subjective terminology like Ðadverse impactÑ did not improperly

14525vest the agency with Ðunbridled discretion.Ñ It agreed with the

14535ALJÓs conclusion that Ð[i]t is appropriate and acceptable for

14544the rules to allow for the exercise of professional judgment.Ñ

14554Id. It stat ed that if determining what constitutes an adverse

14565impact to the environment requires professional judgment, then

14573determining what measures could be taken to prevent or lessen

14583the adverse impact also allow for the use of professional

14593judgment. Id.

14595134. The Proposed Rule affords the Department far less

14604discretion than the rules in the cases described above. It is

14615certainly well within the DepartmentÓs professional judgment to

14623identify appropriate sources of data to measure population,

14631median transport ti me and hospital discharge data. This is

14641particularly true since these criteria reflect data gathered by

14650the Department or other government entities. Further, the

14658Department is working to improve and expand data sources

14667available, and the absence of defin ed data sources gives the

14678Department flexibility to use improved data sources in the

14687future.

14688135. The reasonableness of the DepartmentÓs use of

14696criteria without specific definitions as a means for allocating

14705points is confirmed by other rules with similar characteristics.

14714See, e.g. , Fla. Admin. Code R. 5F - 14.003(6)(b)1 . (awarding

14725points if a Ð[p]roject results in significant bioenergy

14733production from Florida grown biomass resourcesÑ -- without

14741definitions for measurement of Ðbioenergy productionÑ or

14748Ðbiomas s resourcesÑ); Fla. Admin. Code R. 14 - 79.006(8)(a) 2.

14759(awarding points for bidding/estimates based on the criteria of :

14769Ð[d]emonstrates an understanding of all requisite steps in the

14778preparation of Department bidsÑ and Ðdemonstrates competence in

14786estimating project cost accuratelyÑ -- without defining either

14794criteria); Fla. Admin. Code R. 1T - 1.038(4) (awarding points for

14805Ðartistic excellence , Ñ Ðtradition and authenticity , Ñ and

14813Ðcommunity impact and engagementÑ -- without defining those

14821terms).

14822136. The crux of P etitionersÓ objection is that the

14832Proposed Rule is invalid because it will result in increased

14842competition, which will allegedly cause harm to PetitionersÓ

14850trauma centers. As discussed above, the Legislature delegated

14858to the Department the responsibility to allocate trauma centers -

14868- which meant the Department was required to balance a myriad of

14880interests including those of PetitionersÓ trauma centers, the

14888Intervenor, newly established trauma centers that have not yet

14897received final approval, EMS providers, elected representatives

14904and patient advocates. It would be impossible to develop a rule

14915that could simultaneously satisfy all of these interests --

14924although, as discussed above, the Department incorporated the

14932PetitionersÓ concerns into the Proposed Rule as the Department

14941believed appropriate. The DepartmentÓs determination of the

14948appropriate balance of conflicting interests is owed deference --

14957even if the result was a Proposed Rule with which Petitioners do

14969not agree.

14971137. In Board of Trustees , petitioner challenged the

14979decision of the Trustees (an administrative agency) to deny his

14989application to extend his existing 500 - foot dock to 600 feet,

15001based upon a rule that mandated that the maximum dock length as

15013500 feet. 656 So. 2d at 1361. The ALJ found that the decision

15026was not capricious because it reflected Ðthe thoughtful

15034balancing of varying factors , Ñ but found that the rule was

15045arbitrary because there was no evidence that the 500 foot limit

15056protected environmental interests. Id. at 1362. The appellate

15064court agreed with the ALJÓs finding with respect to

15073capriciousness but reversed with respect to arbitrariness. Id.

15081at 1363. The court found that in promulgating a predecessor

15091rule, the Trustees Ðattempted to balance competing interests

15099such as environmen tal, aesthetic, recreational, and private

15107commercial.Ñ Id. It concluded by stating: ÐThe issue before

15116the hearing officer . . . was not whether Trustees made the best

15129choice . . . or whether their choice is one that the appellee

15142finds desirable for his particular location. The issue is

15151whether the Trustees made a choice based upon facts, logic and

15162reason. It is clear they did.Ñ Id. at 1364. Here too, the

15174Department developed the allocation rule based upon facts, logic

15183and reason. The fact that the P roposed Rule may cause

15194Petitioners economic harm is not a basis to invalidate it.

15204ORDER

15205Based on the foregoing Findings of Fact and Conclusions of

15215Law, it is ORDERED that r ule 64J - 2.010 does not constitute an

15229invalid exercise of delegated legislative aut hority.

15236DONE AND ORDERED this 20th day of June , 2014 , in

15246Tallahassee, Leon County, Florida.

15250S

15251R. BRUCE MCKIBBEN

15254Administrative Law Judge

15257Division of Administrative Hearings

15261The DeSoto Building

152641230 Apalachee Parkway

15267Tall ahassee, Florida 32399 - 3060

15273(850) 488 - 9675

15277Fax Filing (850) 921 - 6847

15283www.doah.state.fl.us

15284Filed with the Clerk of the

15290Division of Administrative Hearings

15294this 20th day of June , 2014 .

15301COPIES FURNISHED:

15303Seann M. Frazier, Esquire

15307Parker, Hudson, Rainer a nd Dobbs, LLP

15314215 South Monroe Street , Suite 750

15320Tallahassee, Florida 32301

15323Chadwick R. Stevens, Esquire

15327Department of Health

153304052 Bald Cypress Way , Bin A02

15336Tallahassee, Florida 32399

15339Christopher Charles Kokoruda, Esquire

15343Miami - Dade County Attorney's O ffice

15350JMH, West Wing, Suite 109

153551611 Northwest 12th Avenue

15359Miami, Florida 33136

15362Karen Ann Putnal, Esquire

15366Moyle Law Firm, P.A.

15370118 North Gadsden Street

15374Tallahassee, Florida 32301

15377Jeffrey L. Frehn, Esquire

15381Radey, Thomas, Yon and Clark , P.A.

15387301 South Br onough Street , Suite 200

15394Tallahassee, Florida 32301

15397W. Robert Vezina, III, Esquire

15402Vezina, Lawrence and Piscitelli, P.A.

15407413 East Park Avenue

15411Tallahassee, Florida 32301

15414Jonathan L. Rue, Esquire

15418Parker, Hudson, Rainer and Dobbs, LLP

15424285 Peachtree Center Avenue , Suite 1500

15430Atlanta, Georgia 30303

15433J. Stephen Menton, Esquire

15437Rutledge Ecenia, P.A.

15440119 South Monroe Street, Suite 202

15446Tallahassee, Florida 32301

15449John H. Armstrong, M.D., F.A.C.S.

15454State Surgeon General

15457Department of Health

154604052 Bald Cypress Way, Bin A00

15466Tallahassee, Florida 32399 - 1701

15471Jennifer A. Tschetter, General Counsel

15476Department of Health

154794052 Bald Cypress Way, Bin A02

15485Tallahassee, Florida 32399 - 1701

15490Jamie Briggs, Agency Clerk

15494Department of Health

154974052 Bald Cypress Way, Bin A02

15503Tallahas see, Florida 32399 - 1701

15509Ken Plante, Coordinator

15512Joint Administrative Procedures Committee

15516Room 680, Pepper Building

15520111 West Madison Street

15524Tallahassee, Florida 32399 - 1400

15529Liz Cloud, Program Administrator

15533Administrative Code

15535Department of State

15538R. A. Gray Building, Suite 101

15544Tallahassee, Florida 32399

15547NOTICE OF RIGHT TO JUDICIAL REVIEW

15553A party who is adversely affected by this Final Order is

15564entitled to judicial review pursuant to section 120.68, Florida

15573Statutes. Review proceedings are gov erned by the Florida Rules

15583of Appellate Procedure. Such proceedings are commenced by

15591filing the original notice of administrative appeal with the

15600agency clerk of the Division of Administrative Hearings within

1560930 days of rendition of the order to be review ed, and a copy of

15624the notice, accompanied by any filing fees prescribed by law,

15634with the clerk of the District Court of Appeal in the appellate

15646district where the agency maintains its headquarters or where a

15656party resides or as otherwise provided by law.

Select the PDF icon to view the document.
PDF
Date
Proceedings
PDF:
Date: 01/20/2015
Proceedings: Transmittal letter from Claudia Llado forwarding Bayfront and Tampa General Exhibits numbered 1-5, 9, 10, 12, 23, 35-38, 42-44, 46, 47, 57, and 58 to the agency.
PDF:
Date: 01/20/2015
Proceedings: Transmittal letter from Claudia Llado forwarding fourteen-volume Transcript, along with six binders of Respondent?s Exhibits numbered 1-10, 12-31, and 34 to the agency.
PDF:
Date: 01/16/2015
Proceedings: Transmittal letter from Claudia Llado forwarding Public Health Exhibit?s numbered 30-32, 34, 35, and 46 to the agency.
PDF:
Date: 01/16/2015
Proceedings: Transmittal letter from Claudia Llado forwarding the Intervenor Osceola Regional Hospital?s five binders of Exhibits numbered 1, 2, 15, 22-32, 38-40, 131, 146, 148, 152, 158, 184, 186-189, 258, 263, 265, 295, 345, and 346 to the agency.
PDF:
Date: 01/16/2015
Proceedings: Transmittal letter from Claudia Llado forwarding the UF Health Shands Admitted Exhibits numbered 13, 22-25, 27, 31-35, 52, 53, 64, and 65 to the agency.
PDF:
Date: 01/16/2015
Proceedings: Transmittal letter from Claudia Llado forwarding one-volume Transcript (Deposition of Mark Richardson) along with St. Joseph?s Hospital Exhibit?s 1 and 29, to the agency.
PDF:
Date: 06/20/2014
Proceedings: DOAH Final Order
PDF:
Date: 06/20/2014
Proceedings: Final Order (hearing held April 28 through 30 and May 2, 5 through 7, and 22, 2014). CASE CLOSED.
PDF:
Date: 06/10/2014
Proceedings: Letter to Judge McKibben from Christopher Kokoruda enclosed portable electronic storage device regarding petitioner's proposed final order filed.
PDF:
Date: 06/09/2014
Proceedings: (Respondent's) Proposed Final Order filed.
PDF:
Date: 06/09/2014
Proceedings: The Tampa General and Bayfront Proposed Final Order filed.
PDF:
Date: 06/09/2014
Proceedings: (Intervenor's) Notice of Filing (Proposed Final Order) filed.
PDF:
Date: 06/09/2014
Proceedings: The Public Health Trust of Miami-Dade County, Florida?s Notice of Filing Proposed Final Order (filed in Case No. 14-001027RP).
PDF:
Date: 06/09/2014
Proceedings: The Public Health Trust of Miami-Dade County, Florida's Proposed Final Order (filed in Case No. 14-001027RP).
PDF:
Date: 06/09/2014
Proceedings: Shands Teaching Hospital and Clinics, Inc.'s Proposed Final Order filed.
PDF:
Date: 06/09/2014
Proceedings: SJH Notice of Filing Proposed Final Order (filed in Case No. 14-001028RP).
PDF:
Date: 06/09/2014
Proceedings: St. Joseph's Hospital, Inc.'s Proposed Final Order (filed in Case No. 14-001028RP).
Date: 05/30/2014
Proceedings: Transcript Volume I-XIV (not available for viewing) filed.
Date: 05/22/2014
Proceedings: CASE STATUS: Hearing Held.
PDF:
Date: 05/19/2014
Proceedings: St. Joseph's Hospital's Notice of Taking Telephonic Deposition of Anna Burrus (filed in Case No. 14-001028RP).
PDF:
Date: 05/08/2014
Proceedings: Notice of Continuation of Hearing (hearing set for May 22, 2014; 9:00 a.m.; Tallahassee, FL).
Date: 04/28/2014
Proceedings: CASE STATUS: Hearing Partially Held; continued to May 22, 2014; 09:00 a.m.; Tallahassee, FL.
PDF:
Date: 04/28/2014
Proceedings: The Public Health Trust's Notice of Joinder in Shand's Response in Opposition to Motion in Limine (filed in Case No. 14-001027RP).
PDF:
Date: 04/28/2014
Proceedings: Respondent's Notice of Filing Correction to Joint Prehearing Stipulation filed.
PDF:
Date: 04/28/2014
Proceedings: Respondent's Notice of Joinder in Intervenor's Motion in Limine filed.
PDF:
Date: 04/28/2014
Proceedings: Joint Pre-hearing Stipulation filed.
PDF:
Date: 04/25/2014
Proceedings: Intervenor's Motion in Limine filed.
PDF:
Date: 04/23/2014
Proceedings: Intervenor's Notice of Taking Deposition (of Commissioner Kathy Bryant) filed.
PDF:
Date: 04/22/2014
Proceedings: Notice of Filing Corrected Certificate of Service (filed in Case No. 14-001028RP).
PDF:
Date: 04/22/2014
Proceedings: Bayfront's and Tampa General's Notice of Taking Telephonic Deposition (of Eric Smith filed in Case No. 14-001034RP).
PDF:
Date: 04/22/2014
Proceedings: Bayfront's and Tampa General's Notice of Taking Deposition Duces Tecum (of Michael Heil filed in Case No. 14-001034RP).
PDF:
Date: 04/22/2014
Proceedings: Bayfront's and Tampa General's Joint Notice of Taking Deposition (of Dr. Hurst filed in Case No. 14-001034RP).
PDF:
Date: 04/21/2014
Proceedings: (Shands) Notice of Taking Deposition Duces Tecum (of Dr. James Hurst) filed.
PDF:
Date: 04/21/2014
Proceedings: (Shands) Amended Notice of Taking Deposition (of Michael Heil as to time only) filed.
PDF:
Date: 04/21/2014
Proceedings: Order Regarding Villereal Subpoena.
PDF:
Date: 04/21/2014
Proceedings: Department of Healths Response to Tampa General Hospital's Third Request for Production of Documents filed.
PDF:
Date: 04/18/2014
Proceedings: Intervenor's Notice of Taking Deposition (of Shari Hall) filed.
PDF:
Date: 04/18/2014
Proceedings: St. Joseph's Hospital's Response to Bayonet Point Motion to Quash, Motion to Compel, and Request for Hearing (filed in Case No. 14-001028RP).
PDF:
Date: 04/17/2014
Proceedings: Intervenor's Notice of Taking Deposition (of Lorin Mock) filed.
PDF:
Date: 04/17/2014
Proceedings: The Public Health Trust of Miami-Dade County, Florida?s Notice of Taking Depositions Duces Tecum (of Gene Nelson and Michael Heil; filed in Case No. 14-001027RP).
PDF:
Date: 04/17/2014
Proceedings: The Public Health Trust of Miami-Dade County, Florida?s Notice of Taking Depositions Duces Tecum (of Dr. Ang and Shari Hall; filed in Case No. 14-001027RP).
PDF:
Date: 04/16/2014
Proceedings: (Petitioner's) Motion to Quash Subpoena filed.
PDF:
Date: 04/16/2014
Proceedings: Order (granting amended motion for leave to amend petition to certify compliance with Rule 28-106.204, Fla. Admin. Code).
PDF:
Date: 04/16/2014
Proceedings: Notice of Taking Deposition Duces Tecum (Chief L. Mock) filed.
PDF:
Date: 04/15/2014
Proceedings: Amended Motion for Leave to Amend Petition to Certify Compliance with Rule 28-106.204, Fla. Admin. Code (filed in Case No. 14-001027RP).
PDF:
Date: 04/15/2014
Proceedings: Motion to Quash Subpoena filed.
PDF:
Date: 04/15/2014
Proceedings: Notice of Appearance (Luisette Gierbolini, filed in Case No. 14-001028RP).
PDF:
Date: 04/15/2014
Proceedings: Department of Health's Response to St. Joseph's Hospital, Inc.'s Third Request for Production filed.
PDF:
Date: 04/15/2014
Proceedings: Bayfront's and Tampa General's Joint Notice of Taking Deposition (of Dr. Ang) filed.
PDF:
Date: 04/15/2014
Proceedings: Bayfront's and Tampa General's Joint Notice of Taking Deposition Duces Tecum (of Gene Nelson) filed.
PDF:
Date: 04/15/2014
Proceedings: St. Joseph's Hospital's Amended Petition to Determine Invalidity of Proposed Rule 64J-2.010 (filed in Case No. 14-001028RP).
PDF:
Date: 04/15/2014
Proceedings: Notice of Filing Proof of Service (filed in Case No. 14-001028RP).
PDF:
Date: 04/15/2014
Proceedings: Order Granting Leave to Amend Petition(s).
PDF:
Date: 04/14/2014
Proceedings: SJH Motion for Leave to Amend Petition (filed in Case No. 14-001028RP).
PDF:
Date: 04/14/2014
Proceedings: Notice of Taking Depositions Duces Tecum (of Joseph Tepas) filed.
PDF:
Date: 04/14/2014
Proceedings: Notice of Taking Depositions Duces Tecum (of Frederick Moore) filed.
PDF:
Date: 04/14/2014
Proceedings: Notice of Taking Depositions Duces Tecum (of David Ciesla) filed.
PDF:
Date: 04/14/2014
Proceedings: Notice of Taking Depositions Duces Tecum (of Mark Ricardson) filed.
PDF:
Date: 04/14/2014
Proceedings: UF Health's Motion to Amend Petition by Interlineation filed.
PDF:
Date: 04/14/2014
Proceedings: (Petitioner's) Motion for Leave to Amend Petition (filed in Case No. 14-001027RP).
PDF:
Date: 04/14/2014
Proceedings: Bayfront's Unopposed Motion for Leave to Amend Petition for Determination of Invalidity of DOH's Proposed Trauma Center Need Rule (filed in Case No. 14-001035RP).
PDF:
Date: 04/14/2014
Proceedings: Tampa General's Unopposed Motion for Leave to Amend Petition for Determination of Invalidity of DOH's Proposed Trauma Center Need Rule (filed in Case No. 14-001034RP).
PDF:
Date: 04/14/2014
Proceedings: Osceola Regional Hospital, Inc.'s Response to Shands Teaching Hospital and Clinics, Inc.'s First Request for Production of Documents filed.
PDF:
Date: 04/14/2014
Proceedings: Osceola Regional Hospital, Inc.'s Notice of Service of Responses to Shands Teaching Hospital and Clinics, Inc.'s First Set of Interrogatories (filed in Case No. 14-001034RP).
PDF:
Date: 04/14/2014
Proceedings: Bayfront's and Tampa General's Joint Notice of Taking Deposition (of Steve Short) filed.
PDF:
Date: 04/14/2014
Proceedings: Bayfront's and Tampa General's Joint Notice of Taking Deposition (of Dr. James Hurst) filed.
PDF:
Date: 04/14/2014
Proceedings: Notice of Taking Depositions Duces Tecum (of Frederick Moore and Joseph Tepas) filed.
PDF:
Date: 04/14/2014
Proceedings: Notice of Taking Depositions Duces Tecum (of Steve Short, David Ciesla, and Mark Richardson) filed.
PDF:
Date: 04/14/2014
Proceedings: Petitioner Bayfront Medical Center, Inc.'s Motion to Compel Discovery from Intervenor Osceola Regional Hospital, Inc., (filed in Case No. 14-001035RP).
PDF:
Date: 04/11/2014
Proceedings: Tampa General's Third Request for Production of Documents to Department of Health (filed in Case No. 14-001034RP).
PDF:
Date: 04/11/2014
Proceedings: (Petitioner's) Notice of Taking Deposition (of Dr. Ang and Shari Hall) filed.
PDF:
Date: 04/11/2014
Proceedings: (Petitioner's) Notice of Taking Deposition (of Gene Nelson) filed.
PDF:
Date: 04/11/2014
Proceedings: (Petitioner's) Notice of Taking Deposition (of Michael Heil) filed.
PDF:
Date: 04/11/2014
Proceedings: (Petitioner's) Amended Petition for Determination of Invalidity of Proposed Rule (filed in Case No. 14-001027RP).
PDF:
Date: 04/09/2014
Proceedings: Shands Teaching Hospital and Clinics, Inc.'s First Request for Production of Documents to Osceola Regional Hospital, Inc filed.
PDF:
Date: 04/09/2014
Proceedings: Notice of Service of Shands Teaching Hospital and Clinics, Inc.'s First Interrogatories to Osceola Regional Hospital, Inc filed.
PDF:
Date: 04/08/2014
Proceedings: (Intervenors) Amended Notice of Taking Deposition Duces Tecum (Dr. Nick Namias) filed.
PDF:
Date: 04/08/2014
Proceedings: (Intervenors0 Amended Notice of Taking Deposition Duces Tecum (Robert Greene) filed.
PDF:
Date: 04/08/2014
Proceedings: (Intervenors) Notice of Taking Deposition Duces Tecum (Mark Knight) filed.
PDF:
Date: 04/08/2014
Proceedings: The Public Health Trust of Miami-Dade County's Response to Respondent's Second Request for Production (filed in Case No. 14-001027RP).
PDF:
Date: 04/08/2014
Proceedings: Notice of Service of the Public Health Trust's Responses to Respondent's Second Set of Interrogatories (filed in Case No. 14-001027RP).
PDF:
Date: 04/08/2014
Proceedings: St. Joseph's Hospital's Notice of Service of Ansnwers to Department of Health's Second Interrogatories and Second Request to Produce (filed in Case No. 14-001028RP).
PDF:
Date: 04/08/2014
Proceedings: Notice of Taking Deposition Duces Tecum (R. Greene) filed.
PDF:
Date: 04/08/2014
Proceedings: Notice of Taking Deposition Duces Tecum (Dr. Nick Namias) filed.
PDF:
Date: 04/08/2014
Proceedings: Bayfront's Response to Department of Health's Second Request for Production of Documents (filed in Case No. 14-001035RP).
PDF:
Date: 04/08/2014
Proceedings: Tampa General's Response to the Department of Health's Second Request for Production of Documents (filed in Case No. 14-001034RP).
PDF:
Date: 04/07/2014
Proceedings: Bayfront and Tampa General's Joint Notice of Taking Depositions (filed in Case No. 14-001034RP).
PDF:
Date: 04/07/2014
Proceedings: Bayfront and Tampa General's Joint Amended Notice of Taking Deposition of Agency Representative Duces Tecum (amended as to location only) (filed in Case No. 14-001034RP).
PDF:
Date: 04/04/2014
Proceedings: Notice of Appearance (Christopher Lunny, filed in Case No. 14-001034RP).
PDF:
Date: 04/04/2014
Proceedings: Order Overruling Objection to Subpoena.
PDF:
Date: 04/04/2014
Proceedings: Department of Health's Second Request for Production of Documents to Bayfront Medical Center filed.
PDF:
Date: 04/04/2014
Proceedings: Notice of Service of Department of Health's Second Set off Interrogatories to Public Health Trust of Miami-Dade County filed.
PDF:
Date: 04/04/2014
Proceedings: Notice of Service of Department of Health's Second Set of Interrogatoaries to Bayfront Medical Center filed.
PDF:
Date: 04/04/2014
Proceedings: Department of Health?s Second Request for Production of Documents to the Public Health Trust of Miami-Dade County filed.
PDF:
Date: 04/04/2014
Proceedings: Department of Health?s Second Request for Production of Documents to St. Joseph?s Hospital (filed in Case No. 14-001028RP).
PDF:
Date: 04/03/2014
Proceedings: Notice of Service of Department of Health's Second Set of Interrogatories to St. Joseph's Hospital (filed in Case No. 14-001028RP).
PDF:
Date: 04/03/2014
Proceedings: Department of Health's Second Request for Production of Documents to Tampa General Hospital filed.
PDF:
Date: 04/03/2014
Proceedings: Notice of Service of Department of Health's Second Set of Interrogatories to Tampa General Hospital filed.
PDF:
Date: 04/03/2014
Proceedings: St. Joseph's Hospital's Notice of Taking Deposition of Ahency Representative Duces Tecum (filed in Case No. 14-001028RP).
PDF:
Date: 04/03/2014
Proceedings: St. Joseph's Hosptial's Notice of Taking Deposition of Gail Lazenby Duces Tecum (filed in Case No. 14-001028RP).
PDF:
Date: 04/03/2014
Proceedings: Notice of Department of Health's Withdrawal of Objections to St. Joseph's Hospital's Rule 1.351 Subpoena for Documents and Update as to Status of SJH's Amended Motion (filed in Case No. 14-001028RP).
PDF:
Date: 04/02/2014
Proceedings: Intervenor's Cross-notice of Taking Depositions (of Chief Stuart McElhaney and Captain Gail Lazenby) filed.
PDF:
Date: 04/02/2014
Proceedings: Bayfront and Tampa General's Joint Notice of Taking Deposition of Agency Representative Duces Tecum (filed in Case No. 14-001034RP).
PDF:
Date: 04/02/2014
Proceedings: St. Joseph's Hospital's Amended Motion for Expedited Ruling on Objections to Rule 1.351 Subpoena for Documents (filed in Case No. 14-001028RP).
PDF:
Date: 04/01/2014
Proceedings: St. Joseph's Hospital's Motion for Expedited Ruling on DOH's Objections to Rule 1.351 Subpoena for Documents (filed in Case No. 14-001028RP).
PDF:
Date: 04/01/2014
Proceedings: Amended Notice of Hearing (hearing set for April 28 through May 2, 5, and 6, 2014; 9:00 a.m.; Tallahassee, FL; amended as to dates of hearing).
Date: 03/31/2014
Proceedings: CASE STATUS: Motion Hearing Held.
PDF:
Date: 03/31/2014
Proceedings: Notice of Telephone Status Conference (filed in Case No. 14-001028RP).
PDF:
Date: 03/27/2014
Proceedings: Intervenor's Response to Motion for Abeyance filed.
PDF:
Date: 03/27/2014
Proceedings: Intervenor's Response to Motion for Abeyance (filed in Case No. 14-001034RP).
PDF:
Date: 03/27/2014
Proceedings: Order (granting Tampa General and Bayfront's motion for leave to reply and SJH's motion for leave to file reply).
PDF:
Date: 03/26/2014
Proceedings: SJH's Motion for Leave to File Reply (filed in Case No. 14-001028RP).
PDF:
Date: 03/26/2014
Proceedings: Tampa General and Bayfronts Motion for Leave to Reply (filed in Case No. 14-001034RP).
PDF:
Date: 03/26/2014
Proceedings: Florida Department of Health's Response in Opposition to Joint Motion for Abeyance and Request for Immediate Scheduling Order filed.
PDF:
Date: 03/25/2014
Proceedings: Joint Motion for Abeyance Pending Expiration of New Point of Entry Created by 120.54(3)(d) Notice (filed in Case No. 14-001028RP).
PDF:
Date: 03/25/2014
Proceedings: The Public Health Trust of Miami-Dade County's Response to Respondent's First Request for Production (filed in Case No. 14-001027RP).
PDF:
Date: 03/25/2014
Proceedings: Notice of Service of the Public Health Trust of Miami-Dade County's Responses to Respondent's First Set of Interrogatories (filed in Case No. 14-001027RP).
PDF:
Date: 03/25/2014
Proceedings: St. Joseph's Hospital's Notice of Service of Answers to Department of Health's First Interrogatories and First Request to Produce (filed in Case No. 14-001028RP).
PDF:
Date: 03/24/2014
Proceedings: Shands Teaching Hospital and Clinics, Inc.'s Responses and Objections to Intervenor's Request for Production of Documents filed.
PDF:
Date: 03/24/2014
Proceedings: Shands Teaching Hospital and Clinics, Inc.'s Responses and Objections to Department of Health's Request for Production of Documents filed.
PDF:
Date: 03/24/2014
Proceedings: Notice of Service of Shands Teaching Hospital and Clinics, Inc.'s Response to Intervenor's Interrogatories filed.
PDF:
Date: 03/24/2014
Proceedings: Notice of Service of Shands Teaching Hospital and Clinics, Inc.'s Response to Department of Health's Interrogatories filed.
PDF:
Date: 03/24/2014
Proceedings: Bayfront's Response to the Department of Health's First Request for Production of Documents (filed in Case No. 14-001035RP).
PDF:
Date: 03/24/2014
Proceedings: Tampa General's Response to the Department of Health's First Request for Production of Documents (filed in Case No. 14-001034RP).
PDF:
Date: 03/24/2014
Proceedings: (Respondent's) Notice of Filing Notice of Change filed.
PDF:
Date: 03/24/2014
Proceedings: Notice of Voluntary Dismissal (filed in Case No. 14-001033RP).
PDF:
Date: 03/24/2014
Proceedings: (Joint) Stipulation (filed in Case No. 14-001033RP).
PDF:
Date: 03/24/2014
Proceedings: Bayfront and Tampa General's Joint Notice of Taking Deposition of Agency Representatives (filed in Case No. 14-001034RP).
PDF:
Date: 03/21/2014
Proceedings: Department of Health's Supplemental Response to Request for Production filed.
PDF:
Date: 03/21/2014
Proceedings: Order Granting Continuance and Re-scheduling Hearing (hearing set for April 10, 11, 14 through 17, 21, 22 and 25, 2014; 9:00 a.m.; Tallahassee, FL).
Date: 03/21/2014
Proceedings: CASE STATUS: Motion Hearing Held.
PDF:
Date: 03/21/2014
Proceedings: Deaprtment of Health's Response to Bayfront's Second Request for Production of Documents filed.
PDF:
Date: 03/21/2014
Proceedings: Department of Health's Response to Tampa General Hospital's Second Request for Production filed.
PDF:
Date: 03/21/2014
Proceedings: Deaprtment of Healths Response to St. Josephs Second Request for Production filed.
PDF:
Date: 03/21/2014
Proceedings: Department of Health's Response to Shands UF's First Request for Production of Documents filed.
PDF:
Date: 03/20/2014
Proceedings: Department of Health's Response to Memorial's First Request for Production of Documents filed.
PDF:
Date: 03/20/2014
Proceedings: Notice of Hearing on Motion for Brief Continuance (filed in Case No. 14-001028RP).
PDF:
Date: 03/20/2014
Proceedings: The Public Health Trust of Miami-Dade County's Response to Intervenor's First Request for Production (filed in Case No. 14-001027RP).
PDF:
Date: 03/20/2014
Proceedings: Bayfront and Tampa General's Joint Notice of Cancellation of Deposition of Agency Representative (filed in Case No. 14-001034RP).
PDF:
Date: 03/20/2014
Proceedings: (Petitioner's) Withdrawal of Motion for Protective Order (filed in Case No. 14-001028RP).
PDF:
Date: 03/20/2014
Proceedings: Osceola Regional Hospital, Inc.'s Notice of Service of Response to the Public Health Trust of Miami-Dade County's First Set of Interrogatories filed.
PDF:
Date: 03/20/2014
Proceedings: Osceola Regional, Inc.'s Response to Bayfront Medical Center's First Request for Production of Documents filed.
PDF:
Date: 03/20/2014
Proceedings: Osceola Regional Hospital, Inc.s Response to the Public Health Trust of Miami-Dade County's First Request for Production of Documents filed.
PDF:
Date: 03/20/2014
Proceedings: Bayfront and Tampa General's Joint Notice of Taking Deposition of Agency Representative (filed in Case No. 14-001034RP).
PDF:
Date: 03/20/2014
Proceedings: Notice of Making Expert Witness Available for Deposition filed.
PDF:
Date: 03/19/2014
Proceedings: Notice of Service of the Public Health Trust of Miami-Dade County?s Responses to Intervenor?s First Set of Interrogatories (filed in Case No. 14-001027RP).
PDF:
Date: 03/19/2014
Proceedings: St. Joseph's Hospital's Notice of Service of Answeres to Osceola Regionals First Interrogatories and First Request to Produce (filed in Case No. 14-001028RP).
PDF:
Date: 03/19/2014
Proceedings: Bayfront's Response to Intervenor's First Request for Production of Documents (filed in Case No. 14-001035RP).
PDF:
Date: 03/19/2014
Proceedings: Tampa General's Response to Intervenor's First Request for Production of Documents (filed in Case No. 14-001034RP).
PDF:
Date: 03/19/2014
Proceedings: Tampa General's Response to Intervenor's First Request for Production of Documents (filed in Case No. 14-001034RP).
PDF:
Date: 03/19/2014
Proceedings: Tampa General's Response to Intervenor's First Request for Production of Documents (filed in Case No. 14-001034RP).
PDF:
Date: 03/19/2014
Proceedings: (Petitioner's) Motion for Protective Order (filed in Case No. 14-001028RP).
PDF:
Date: 03/19/2014
Proceedings: (Petitioner's) Motion for Brief Continuance and Request for Motion Hearing (filed in Case No. 14-001028RP).
PDF:
Date: 03/19/2014
Proceedings: Department of Health's Response to Public Health Trust of Miami-Dade County's Request for Production of Documents filed.
PDF:
Date: 03/19/2014
Proceedings: Department of Health's Response to Bayfront Medical Center's First Request for Production filed.
PDF:
Date: 03/19/2014
Proceedings: Department of Health's Response to Tampa General Hospital's First Request for Production filed.
PDF:
Date: 03/19/2014
Proceedings: Notice of Service of Department of Health's Responses to Shand's First Set of Interrogatories filed.
PDF:
Date: 03/19/2014
Proceedings: Notice of Service of Department of Health's Responses to Shand's First Set of Interrogatories (filed in Case No. 14-001033RP).
PDF:
Date: 03/19/2014
Proceedings: Notice of Service of Department of Health's Responses to Shand's First Set of Interrogatories (filed in Case No. 14-001034RP).
PDF:
Date: 03/19/2014
Proceedings: Notice of Service of Department of Health's Responses to Shand's First Set of Interrogatories (filed in Case No. 14-001035RP).
PDF:
Date: 03/18/2014
Proceedings: Osceola Regional Hospital, Inc.'s Objection to Production Under Rule 1.351, Florida Rules of Civil Procedure filed.
PDF:
Date: 03/17/2014
Proceedings: Intervenor's First Request for Production of Documents to Shands Teaching Hospital and Clinics, Inc filed.
PDF:
Date: 03/17/2014
Proceedings: Intervenor's Notice of Service of First Set of Interrogatories (Nos. 1-11) to Petitioner, Shands Teaching Hospital and Clinics, Inc. d/b/a UF Health Shands Hospital filed.
PDF:
Date: 03/17/2014
Proceedings: Florida Department of Health's Request for Production to the Public Health Trust of Miami-Dade County (filed in Case No. 14-001027RP).
PDF:
Date: 03/17/2014
Proceedings: Notice of Serving of Department of Health's Interrogatories to Public Health Trust (filed in Case No. 14-001027RP).
PDF:
Date: 03/17/2014
Proceedings: Notice of Service on Departmnet of Health's First Interrogatories to Memorial Regional (filed in Case No. 14-001033RP).
PDF:
Date: 03/17/2014
Proceedings: Florida Department of Health's Request for Production of Documents to South Broward Hospital District d/b/a Memorial Regional Hospital (filed in Case No. 14-001033RP).
PDF:
Date: 03/17/2014
Proceedings: Department of Health's Response to St. Joseph's Hospitals, Inc.'s First Request for Production filed.
PDF:
Date: 03/17/2014
Proceedings: Florida Department of Health's Request For Production to Shands Teaching Hospital and Clinics, Inc., d/b/a UF Health Shands Hospital filed.
PDF:
Date: 03/17/2014
Proceedings: Notice of Service of Department of Health's First Interrogatories to Shands at UF filed.
PDF:
Date: 03/17/2014
Proceedings: Florida Department of Health's Request for Production of Documents to St. Joseph's Hospital, Inc., d/b/a St. Joseph's Hospital (filed in Case No. 14-001028RP).
PDF:
Date: 03/17/2014
Proceedings: Notice of Service on Department of Health's First Interrogatories to St. Joseph's Hospital (filed in Case No. 14-001028RP).
PDF:
Date: 03/17/2014
Proceedings: Florida Department of Health's Request for Production to Florida Health Sciences d/b/a Tampa General Hospital (filed in Case No. 14-001034RP).
PDF:
Date: 03/17/2014
Proceedings: Notice of Service on Department of Health's First Interrogatories to Tampa General (filed in Case No. 14-001034RP).
PDF:
Date: 03/17/2014
Proceedings: Memorial's First Request for Production of Documents to the Department of Health filed.
PDF:
Date: 03/17/2014
Proceedings: Respondent's Request for Production to Petitioner (filed in Case No. 14-001035RP).
PDF:
Date: 03/17/2014
Proceedings: Notice of Service on Department of Health's First Interrogatories to Bayfront (filed in Case No. 14-001035RP).
PDF:
Date: 03/17/2014
Proceedings: The Public Health Trust of Miami-Dade County's Notice of First Set of Interrogatories (Nos. 1-8) to Intervenor (filed in Case No. 14-001027RP).
PDF:
Date: 03/17/2014
Proceedings: The Public Health Trust of Miami-Dade County's First Request for Production of Documents to Osceola Regional Hospital, Inc. (filed in Case No. 14-001027RP).
PDF:
Date: 03/17/2014
Proceedings: The Public Health Trust of Miami-Dade County's First Request for Production of Documents to Department of Health (filed in Case No. 14-001027RP).
PDF:
Date: 03/17/2014
Proceedings: Bayfront's First Request for Production of Documents to Osceola Regional Medical Center (filed in Case No. 14-001035RP).
PDF:
Date: 03/17/2014
Proceedings: Intervenor's Notice of Service of First Set of Interrogatories (Nos. 1-11) to Petitioner South Broward Hospital District (filed in Case No. 14-001033RP).
PDF:
Date: 03/17/2014
Proceedings: Intervenor's First Request for Production of Documents (filed in Case No. 14-001033RP).
PDF:
Date: 03/14/2014
Proceedings: Notice of Appearance (J. Menton, filed in Case No. 14-001034RP).
PDF:
Date: 03/14/2014
Proceedings: Notice of Appearance (J. Menton, filed in Case No. 14-001033RP).
PDF:
Date: 03/14/2014
Proceedings: Intervenor's Notice of Service of First Set of Interrogatories (Nos. 1-11) to Petitioner, Bayfront HMA Medical Center, LLC (filed in Case No. 14-001035RP).
PDF:
Date: 03/14/2014
Proceedings: Intervenor's First Request for Production of Documents to Bayfront HMA Medical Center, LLC (filed in Case No. 14-001035RP).
PDF:
Date: 03/14/2014
Proceedings: Notice of Appearance (J. Menton, filed in Case No. 14-001035RP).
PDF:
Date: 03/14/2014
Proceedings: Intervenor's Notice of Service of First Set of Interrogatories (Nos. 1-11) to Petitioner, St. Joseph's Hospital, Inc (filed in Case No. 14-001028RP).
PDF:
Date: 03/14/2014
Proceedings: Intervenor's First Request for Production of Documents to St. Joseph's Hospital, Inc (filed in Case No. 14-001028RP).
PDF:
Date: 03/14/2014
Proceedings: Notice of Appearance (J. Menton, filed in Case No. 14-001028RP).
PDF:
Date: 03/14/2014
Proceedings: Intervenor's Notice of Service of First Set of Interrogatories (Nos. 1-11) to Petitioner, Public Health Trust of Miami-Dade County (filed in Case No. 14-001027RP).
PDF:
Date: 03/14/2014
Proceedings: Intervenor's First Request for Production of Documents to the Public Health Trust of Miami-Dade County (filed in Case No. 14-001027RP).
PDF:
Date: 03/14/2014
Proceedings: Notice of Appearance (J. Menton, filed in Case No. 14-001027RP).
PDF:
Date: 03/14/2014
Proceedings: Bayfront Medical Center's Second Request for Production to Department of Health (filed in Case No. 14-001035RP).
PDF:
Date: 03/14/2014
Proceedings: Tampa General's Second Request for Production of Documents to Department of Health (filed in Case No. 14-001034RP).
PDF:
Date: 03/14/2014
Proceedings: Intervenor's Notice of Service of First Set of Interrogatories to Petitioner, Florida Health Science Center filed.
PDF:
Date: 03/14/2014
Proceedings: Intervenor's First Request for Production of Documents to Florida Health Sciences Center filed.
PDF:
Date: 03/13/2014
Proceedings: Bayfront Medical Center's First Request for Production of Documents to Department of Health (filed in Case No. 14-001035RP).
PDF:
Date: 03/13/2014
Proceedings: Tampa General's First Request for Production of Documents to Department of Health (filed in Case No. 14-001034RP).
PDF:
Date: 03/13/2014
Proceedings: St. Joseph's Hospital, Inc.'s Second Request for Production to Department of Health (filed in Case No. 14-001028RP).
PDF:
Date: 03/13/2014
Proceedings: Notice of Service of Shands Teaching Hospital and Clinics, Inc.'s First Interrogatories to Department of Health filed.
PDF:
Date: 03/13/2014
Proceedings: Shands Teaching Hospital and Clinics, Inc.'s First Request for Production of Documents to Department of Health filed.
PDF:
Date: 03/13/2014
Proceedings: Notice of Appearance (Jonathan Rue) filed.
PDF:
Date: 03/12/2014
Proceedings: St. Joseph's Hospital, Inc.'s First Request for Production to Department of Health (filed in Case No. 14-001028RP).
PDF:
Date: 03/12/2014
Proceedings: Order of Pre-hearing Instructions.
PDF:
Date: 03/12/2014
Proceedings: Notice of Hearing (hearing set for March 31 through April 4, 10, and 11, 2014; 9:30 a.m.; Tallahassee, FL).
Date: 03/12/2014
Proceedings: CASE STATUS: Pre-Hearing Conference Held.
PDF:
Date: 03/12/2014
Proceedings: Order of Consolidation (DOAH Case Nos. 14-1022RP, 14-1027RP, 14-1028RP, 14-1033RP, 14-1034RP, and 14-1035RP)).
PDF:
Date: 03/12/2014
Proceedings: Amended Notice of Appearance (Eduardo S. Lombard) filed.
PDF:
Date: 03/11/2014
Proceedings: Notice of Appearance (W. Vezina) filed.
PDF:
Date: 03/11/2014
Proceedings: Notice of Appearance (Eduardo Lombard) filed.
PDF:
Date: 03/11/2014
Proceedings: Petition to Intervene (filed by Stephen Ecenia, R. David Prescott and J. Stephen Menton)
PDF:
Date: 03/11/2014
Proceedings: Department of Health's Unopposed Motion to Consolidate filed.
PDF:
Date: 03/11/2014
Proceedings: Notice of Appearance (Caryl Kilinski) filed.
PDF:
Date: 03/10/2014
Proceedings: Notice of Appearance (Chadwick Stevens) filed.
PDF:
Date: 03/10/2014
Proceedings: Order of Assignment.
PDF:
Date: 03/10/2014
Proceedings: Rule Challenge transmittal letter to Liz Cloud from Claudia Llado copying Ken Plante and the Agency General Counsel.
PDF:
Date: 03/06/2014
Proceedings: Shands Teaching Hospital and Clinics, Inc.'s Petition to Determine Invalidity of Proposed Rule 64J-2.010 filed.

Case Information

Judge:
R. BRUCE MCKIBBEN
Date Filed:
03/06/2014
Date Assignment:
03/10/2014
Last Docket Entry:
01/20/2015
Location:
Tallahassee, Florida
District:
Northern
Agency:
Department of Health
Suffix:
RP
 

Related Florida Statute(s) (8):