Item B1
Meeting Date:
BOARD OF COUNTY COMMISSIONERS
AGF.NT1A TTF.M SUMMARY
Allg 17. /.001 Division: Bore
Bulk Item:
No
x
Department: DiRt.ri~t Pivp-
AGENDA ITEM WORDING: Consideration of a referendum to disband the Upper
Keys Health Care Taxing District (Trauma District)
ITEM BACKGROUND: The BOCC, in a conflict resolution meeting with the city of
Islamorada, agreed to refund $440,000.00 of the Trauma District funds. This
brought into question how the Trauma District could survive as its income is
derived from interest earned on a capital fund of 3.7 million dollars.
The function of the Trauma District has also been questioned. Because
of its very existence, it is stopping the payment by other Florida counties
to their county residents because their trauma funding is based on payer of
last resort. This results in a Miami-Dade resident who is injured in the
Trauma District and who is indigent, or medically poor, having his bill
paid for by the Trauma District taxpayers. Another issue is the high cost
of administration versus the expenditures of medical care.
PREVIOUS RELEVANT BOCC ACTION:
CONTRACT/AGREEMENT CHANGES:
STAFF RECOMMENDATION:
TOTAL COST:
BUDGETED: Yes
No
COST TO COUNTY:
REVENUE PRODUCING: Yes
No
AMOUNT PER MONTH
YEAR
APPROVED BY: County Attorney
OMB/Purchasing
Risk Mgt.
DIVISION DIRECTOR APPROVAL:
.~ (,~......, I e<.t-
MURRAY F.. NF.T,SON. rommi RRi onp-r
DOCUMENTATION: Included:
x
To Follow:
Not Required:
DISPOSITION:
AGF.NT1A TTF.M #
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.l(IJ.~1 STATE OF FLORIDA . .
~ DEPARTMENT OF HEt\LTH AND REHABIUTATIVE SERVICES
February 17, 1989
'.' I..,'
....John' C'~ Stormont, Commissioner
District Five, Monroe County
Board of County Commissioners
Key West, Florida 33040
Dear Commissioner Stormont:
This letter is to follow-up our phone conversation of January 26
and your January 30 letter regarding the proposed agreement
between the Upper Keys Health Care Taxing Distric"C and Baptist
Hospital of Miami.
As.I stated on the telephoner my. review of the proposed agreement
focused only on the prehospital section identified as II 5.
Transfer from On-Scene." I would recommend that this section and
any' references to prehospital care be deleted. Prehospital care
and the triage of trauma patients must be addressed in each
individual emergency medical services provider's trauma transport
protocols (TTPs). I will be contacting Key Largo volunteer
Ambulance Squad and Ocean Reef Volunteer Fire Department
individually to "discuss revisions to their TTPs. Accordingly, it
is unnecessary to include language relating to trauma .transport
protocols in your agreement, even to cover remote transport
possibilities.
In follow-up of your conversation with Terry Meek regarding the
provisions of the agreement related to access to emergency carer
I would like to clarify in writing that no agreement between
Monroe County and any hospital will negate or modify that
hospi tal I s responsibility to comply with the Florida Statutes,
(F.S.)r particularly with reference to section 395.0142. I would.
also like to clarify that we do not necessarily agree with your
statement "although statutory access requirements exist, only
dollar assurances would suffice at this time to prohibit 'no beds
available I. reasons for denial of access." We commend your
proactive efforts to resolve the emergency care access problems,
however the state is also committed to enforcing the access to
care legislation. The Department of Health and Rehabilitative
Services I Office of Emergency Medical Services and Office of
Licensure and Certification will vigorously pursue any complaints
filed against hospitals which refuse to provide emergency medical
care to persons in need of such care.
:..,!:.~';:!V E rj
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FEB 2 2 1989
COUN';'{ h,jM!N1STRAiOH
(f)
1317WINEWOOD BLVD. · TALLAHASSEE. FL 32399-0700
ROB MARTINE?. GOVERNOR
GREGORY l. COLER. SECRETARY
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JUN - 8 2001
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I~i 91500 o,,~'" Highw"
Tavernier, Florida 33070
-rRAurn
Phone: 305-852-4418
June 6, 2001
Commission Murray E. Nelson
County Commissioner
District 5
Damaron Building - Suite 2
Key Largo, FL 33037
Dear Murray:
I appreciate you taking the time to meet with me both last week and this week concerning the
Upper Keys Trauma District. As I related to you, this is a very important issue for our board of
directors since it is their objective to provide only the best care for the residents of the Upper
Keys. Consequently, any diminished care concerning trauma patients would be unacceptable to
them.
As I understand your plan, it is your objective to take what we have in place in the Upper Keys
and provide that same level of care throughout Monroe County, I am quite confident that our
board, our physicians and the administrative staff at Mariners Hospital would be in support of
such a plan. Our concerns have always been that, first, we do not want to regress in the care we
render to our patients in the Upper Keys and, second, we do not want to be placed in the position
of arranging interfC'lcility transfers which would, at a minimum, delay timely care to the patient and
potentially have trauma care provided to the patient at a non-trauma designated facility.
In summary, if our model program that has been in place for over 10 years can be expanded
County-wide, we would be in support of such a program. The caveat to the implementation of
such a program would be that I would want to be assured that all necessary agreements to
implement your program are signed and in place before existing agreements in place with the
Upper Keys Health Care Taxing District were terminated.
It certainly appears that your plan would go a long ways to assuring that most timely and effective
management of trauma patients throughout Monroe County. If there is any way that I can help
you in implementing such a system, please do not hesitate to give me a call.
Sincerely,
~~
. '
Robert H. Luse
Chief Executive Officer
RHUgs
cc:
Joanne Mahoney. Chairman of Trauma Advisory Board
Jay Hershoff,Chairman, Mariners Hospital' .
(j)
An Affiliate of Baptist Health Systems of South Florida
YishermenJ < 7fospita(
3301 Ovcrscas Hwy. Marathon, FL 33050
(305) 743-5533 Fax (305) 743-3962
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Rick Rice, Administrator
---
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- -
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=---- - ~
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May 25, 2001
Murray E. Nelson
County Commissioner
District 5
Damaron Building Suite II
Key Largo, FL 33037
Dear Commissioner Nelson:
I would like to thank you for taking time out of your busy schedule to meet with the
Administrative Staff on May 22,2001 to discuss the County's effort in dealing with
trauma patients.
The Physicians and Administrative Staff of Fishermen's Hospital are all in favor of your
plan and efforts to manage the care oftrauma patients. The care oftrauma patients at the
closest Emergency Department is clearly in the patient's best interest. We feel very
strongly that the Emergency Department Physicians, Surgeons, Anesthesiologist, and
other supp011 staff at this hospital have managed trauma patients in a very effective
marmer. In the management of patient who have been involved in a traumatic event, and
need a level of care beyond our ability, we welcome your proposed arrangement with the
Ryder Trauma Center at Jackson Memorial Hospital in Miami. Although, historically we
have not experienced difficulty in airlifting those patients to Jackson Memorial Hospital,
a definitive agreement ensuring rapid transport, bed availability and a receiving physician
would secure a seamless system approach to treating those patients.
Thank you once again in taking time out of yOur busy schedule. If I can be of further
assistance in your efrorts, please let me know.
Sincerely;
eL/ 1/
.' f /
..//. ~~
Rick Rice .
Administrator
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0-\\ It" MAY' 5 2001 iu ill
~L ~ ~ MEDICAU CENTER
~
Lower Keys
-__--I
May 10,2001
Murray E. Nelson
County Commissioner
. District 5
Damaron Building Suite II
Key Largo, Florida 33037
Dear Commissioner Nelson:
I want to Thank you for taking time out of your busy schedule to meet with some of our
Physicians and Administrative Staff on May 2, 2001 to discuss the County's effort in
dealing with trauma patients. .
The Physicians and Administrative Staff of the Lower Keys Medical Center are all in
favor of your plan and efforts to manage the care of trauma patients. The care of trauma
patients at the clQsest Emergency Department is clearly in the patients' best interest. We
feel very strongly that the Emergency Department Physicians, Surgeons,
Anesthesiologists, and other support staff at this facility have managed trauma patients in
a very effective manner. In the management of patients who have been involved in a
traumatic event, and need a level of care beyond our ability, we welcome your proposed
arrangement with the Ryder Trauma Center at Jackson Memorial Hospital in Miami.
Although, historically we have not experienced difficulty in airlifting those patients to
Jackson Memorial Hospital, a definitive agreement ensuring rapid transport, bed
availability, and a receiving physician would secure a seamless system approach to
treating those patients.
Once again, thank you for your time and assistance.
f1....s spepeccttful~IY, (\.. . .' .....
~~ (,~d .~.
, Ronald L. Bierman,
President/CEO
RB/ga
5900 College Road
P.O.Box 9107
Key West. FL 33041-9107
Ph. 305-294-5531
Fax 305-294-8065
@
dePoo Building
1200 Kennedy Drive
Key West, FL 33040
Ph. 305-294-5531
Fax 305-294-8844
O,l!~J,Y ~o~~~E
, (305) 294-4641
,.
Social Services Department
5100 College Road, Wing III
Key West, FL 33040
(305) 292-4573
(305) 292-4517 FAX
(~.,~
BOARD OF COUNTY COMMISSIONERS
Dixie Spehar, District 1
MAYOR George Neugent, District 2
Charles "Sonny" McCoy, District 3
Mayor Pro Tem Nora Williams, District 4
Murray E. Nelson, District 5
. MEMORANDUM
TO:
FROM:
James L. Roberts
County Administrator
Louis LaTorre, Di~ector.. ~~~~
Social Services ~~1Y.
~ "1
, .
DATE:
May 2, 2001
RE: Breakdown of HCRA Cases
The attached breakdown is being.
request, based on your inquiry
District issue.
furnished to you at your
pertaining to the Trauma
i '
,..,...:; -.'.
1". ....
In'reference to the Trauma District cases, those were cases
denied under HCRA because they were being handled through
the Trauma District. They were a HCRA case and also a
t~9uma case, so we denied the case under HCRA so the Count~
would not pay twice. In reference to the total number of
HCRA cases per year, it does not. reflect as to how many were
approved or denied, it only reflects the number of cases
referred and handled by us.
Attachment
Cc: James E. Malloch
cD
12/28/01
UNO - 001 - .GENERAL FUND
UNCTION - 5600 - HUMAN SERVICES
~TIVITY - 5610 - HOSPITALS
,CCOUNT ------.---TITLE-..-------
30508 INPATIENT HOSPITAL SVCS
'OTAL **OPERATING EXPEND/EXPENS
'OTAL HEALTH CARE RESP ACT
'O~AL COMMUNITY SERVICES
'OTAL HOSPITALS
.:.".............
.'
.
MONROE. COUNTY
DEPARTMENT EXPENDITURE BUDGET ~ORKSHEET
~
ELECT OFCL - 1016 - COMMUNITY.SERVICES
COST CTR - 61503 - HEALTH CARE RESP ACT
- - - - - - -- -- CURRENT' YEAR -- -- -- ----
2000 BUDGET 2000 ACTUAL BUDGET YTD ACTUAL TO COMPLETE
100,000 129,570 100,000 100,000
100,000 129 , 570 100,000 100,000
100,000 129,570 100,000
100,000
100,000 129,570 100,000 100,000
100,000 129,570 100,000
100 , 000 .
NOTE: _Monroe County is obligated to fund the Health..Care
Responsibility Act by Florida Statute. Monroe
~o~nty's (HCRA) liability is $353,840 for FY2001.
SEE ATTACH~D DOCDrlENTATION
/
/
./
RUN DATE 02/28/01 TIME 11:14:31
TRESUN/PEI , BUDGET ANALYST V5.0
(( PAGE 76
100,000
100,000
100,000
100,000
100,000
cv
--- REQUESTED --__
BASE NE~ PROGRAMS
-.
.... "0..: OUNTY 3MONROE
KEY WEST FLORIDA 330'0
(305) 294.4641
PUBLIC SAFETY DIVISION
James R. "Reggie" Parosl Director
490 63rd Street, Suite 140
Marathon, Fl. 33050
BOARD OFCOUNTY COMMISSIONERS
MAYOR, George Neugent, District 2
Mayor Pro Tern, Nora Williams, District 4
Dixie M. Spehar, District 1
Charles "Sonny" McCoy, District 3
Murray E. Nelson, DistrictS
.\
MEMORANDUM
TO:
Karie McDonald, Director
Upper Keys Health Care District (UKHCD)
FROM:
James R. "Reggie" Paros, Director
Public Safety Division
SUBJECT:
"
Information concerning trauma patients for whom the
UKHCD has paid their trauma care costs
DATE:
May 30,2001
Please provide the following details for each of the subject patients for the last five years.
Date of Service I
Name
Total costs paid by UKHCD for trauma-related transportation and care'
City and State of Patient's Residence
State in which Driver's License is issued.
Geographical location of where accident/injury occurred.
Your efforts to provide this information within the next week will be appreciated.
\.
'\,
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TRAUMA PATIENTS, 1996
-.- ---
Date Name City ST Location Drivers License ST TOTALS
-- --.- ~------
02/14/96 ! Homestead FL MM 103 unk. $624.63
i -- -
02/24/96 I Miami FL MM 84 unk.
02/24/96 I Key Largo FL MM 84 unk.
02/29/96 ~ Key Largo FL MM 109 FL
03/10/96 ! unk. unk. MM 91 unk.
. 03/10/96 ! I Plantation FL MM 91 unk.
I
04/06/96 i. t Carpentersville IL MM 103 IL
.
04/09/96 ; Plantation FL na/14 yrs. Old
04/22/96 ~ ; Key Largo FL MM 100 FL $53,109.14
"
04/28/96 i Hialeah FL MM 101 unk. $17,543.13
,
! --
05/03/96 : Key Largo FL MM94 FL
----
05/18/96 . i Key Largo FL MM 100 FL
05/18/96 i i West Palm Beach FL OR unk,
OS/26/96 i i Miami FL OR na/4 yrs. Old
i
06/04/96 I : Tavernier FL Tavernier unk.
I
! r T . --.--.
06/29/96 : avernler FL Tavernier na/9 yrs, Old
.
07/02/96 i ! Florida City FL MM 84 unk.
I
,
07/06/96 , ! Kendall FL MM89 na/14 yrs. Old
I
,
07/22/96 1 i Plantation Key FL MM 91 FI
08/09/96 I ; Bokee la FL MM 97 FL
I
08/18/96 i i Sunrise FL OR unk.
! --
08/21/96 . ~ Key Largo FL MM 99 FL
I
12/07/96 ~ i Miami FL MM 105 FL $190.00
12/13/96 ; i Islamorada FL MM88 FL
12/19/96 .' I , Key Largo FL MM97 FL
~
12/19/96 I · Key Largo FL MM89 unk.
12/20/96 I
. . Key Largo FL MM 102 unk.
I I
TOTALS $71,466,90
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TRAUMA PATIENTS, 1997. .
Date Name City ST Location Drivers License ST Totals
01/22/97 I-- I Key Largo FL MM 100 unk. $5,850.67
I
02/09/97 ' i Indianapolis IN MM 102 IN
04/06/97 . I Tavernier FL MM96 unk. $2,638.00
04/28/97 i ! unk,(OR patient)
06/08/97 i i Homestead FL MM 93 FL
07/25/98 ' I Miami FL MM 106 FL $261.01
07/25/98 : I Miami FL MM 106 FL $190.00
07/30/97 I ! . Key Largo FL MM95 na/7 yrs. Old
I
07/31/97 : ; . Hialeah FL MM 111 FL
I
08/03/97 : \: Miami FL MM85 unk.
08/08/97 : 1M, . FL MM83 unk.
:: laml
09/16/97 : ,. unk. ship unk,
;' unk,
09/24/97 : I' FL MM77 FL $1,906.20
I: Marathon,
10/11/97 l' Plantation FL MM 99 unk.
11/01/97 i Key Largo FL MM 105 unk. $190.00
11/01/97 i Key Largo FL MM 102 unk. $190.00
11/27/97 :. Key Largo FL MM 104 FL
12/25/97 ; Islamorada FL MM85 FL $1,394.02
TOTALS r $12,619,90
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TRAUMA PATIENTS, 1998.
Date Name City ST Location Driver License St. . Total'
01/21/98 I Tavernier FL MM 91 FL
01/22/98 I Key Largo FL MM 106 FL
01/31/98 i Ontario Cana MM92 Canada
01/31/98 ! Ontario
I Cana MM92 Canada
02/01/98 --
Temple NH MM75 NH
02/05/98 f Orlando FL MM82. FL $31,589.12
02/14/98 ! Miami FL MM 110 unk.
02/14/98 l Key Largo FL MM 110 FL
,
,
02/15/98 i Key Largo FL MM 106 FL $4,459.68
,
03/11/98 I Epsom NH MM 100 NH
I
"
04/27/98 , Key Largo FL MM 91 FL
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I
05/31/98 I Key Largo FL MM95 FL $7,823.47
,
!
06/01/98 I Leisure City FL MM 110 unk. $190.00
06/01/98 I Florida City FL MM 110 unk. $10,333.82
I
06/01/98 I Miami FL MM 100 FL
,
06/01/98 I Florida City FL MM 100 FL
I
06/11/98 I Pensacola FL MM 98 unk.
06/11/98 I unk. MM 98 unk.
06/17/98 ! Florida City FL MM 109 unk.
06/17/98 I Florida City FI MM 109 FL $2,626.71
!
06/17198 ! Homestead FL MM 109 unk.
06/20/98 Ft. Myers FL Tav unk.
07/29/98 . ! Miami FL MM 79 FL $9,022.24
. I
08/07/98 i Plantation FL MM74 unk.
08/20/98 Longview WA MM101.5 WA.
08/23/98 i Ft. Lauderdale FL MM 81.7 FL
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08/28/98 1 Key Largo FL MM98.5 unk.
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09/19/98 , . Mayo FL MM 84.5 unk.
..-......... - '\
10/21/98 . \ Miami FL MM 102 unk. $1,924.36
12/31/98 ! Miami FL MM 93 FL
1998 Totals $67,969.40
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TRAUMA PATIENTS, 1999
.. Dale Name City ST. Location Driver License St. Total
01/20/99 ; Sugarloaf FL MM110 FL
om 8/99 IslamoradalLavonia FL,MI Islamorad unk.
03/01/99 . --
1 : Tavernier FL MM 103 FL $1,215.26
03/10/99 I ! Tavernier FL MM90 FL
03/21/99 l Miami FL Islamorad unk.
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I
04/11/99 I : Miami FL MM109 FL
_n_.____
04/21/99 Key Largo FL MM92 FL
-
04/23/99 ! : Plantation FL MM86 FL
05/06/99 Baltimore MD MM99 unk. $190.00
,
05/06/99 I Miami FL MM 109 FL
05/06/99 . : Marathon FL MM 109 FL
1
05/06/99 I : Marathon FL MM 109 FL
05/06/99 I Fl. Lauderdale FL MM 78.5 FL
OS/23/00 I Key Largo FL MM 107 unk. $2,075.91
05/30/99 I West Palm Beach FL MM112 na/6 years old
06/12/99 i Tavernier FL MM104 FL
06/27/99 , Coral Gables FL Islamorad unk.
I
07/23/99 I Key Largo FL MM102.5 unk.
I
07/24/99 I Key Largo FL MM 103 unk.
07/29/99 Pembroke Pines FL MM 75? unk. $145.07
I
07/31/99 i Seminole FL MM 106 unk.
08/03/99 I IKey Largo FL MM84 FL
08/07/99 , Augusta GA MM 80 na/14 years old
I
08/11/99 I Key Largo FL MM 103 unk.
08/12/99 i Key Largo FL MM 102 FL $66,182.42
1
09/18/99 ............. .. I Tavernier . FL MM90 unk. $22,935.7 4
I .
10/05/99 . Hollywood FL MM 105 unk.
10/18/99 ; Key Largo FL MM 105 unk.
10/23/99 j ; Key Largo FL MM 100 na/age 7
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11/04/99 I i Key Largo FL MM97 FL
11/15/99 I : Allendalle MI MM unk. $1,782.59
11/18/99 Islamorada FL MM82 unk.
11/20/99 . Key Largo FL Rl. 905 FL
11/21/99 Key Largo FL MM 113 unk. $24,132.18
11/23/99 I Homestead FL MM 91 FL
11/23/99 i Key Largo FL MM 91 FL
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11/29/99 I Key Largo FL MM 106 unk. $3,313.84
12/03/99 ! Key Largo FL MM 103 unk.
12/10/99 I National Park NJ MM 107 unk.
!
12/10/99 ; ; Englewood FL MM 107 FL
12/29/99 I : Key Largo FL MM 103 FL
12/30/99 I ' Sagmorehills OH MM74 unk. $4,718.06
1.2/30/99 I ' Key West FL MM 107 FL $190.00
12/30/99 Key Largo FL MM 110 FL
I
TOTALS $126,881.07
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TRAUMA PATIENTS, 2000
Date Name
01/01/00
01/05/00
01/15/00
01/20/00
01/22/00
01/22/00
01/23/00
02/13/00
02/18/00
02/21/00
02/21/00
02/21/00
03/01/00
03/01/00
03/04/00
03/04/00
03/04/00
03/04/00
03/15/00
03/17/00
03/26/00
03/26/00
03/26/00
03/29/00
03/31/00
03/31/00
04/07/00
04/10/00 . ............-
04/18/00 \
04/21/00,11
04/21/00
04/22/00! !
04/30/00 I
04/30/00 \
05/07/00 I
05/14/00 I
OS/21/00 I
OS/21/00 !
06/05100 \
06/14/00 i
07/01/00 I
07/01/00 I
07/14/00 I
07/28/00 \
07/31/00 I
08/03/00 I
08/04/00 I
08/18/00
09/04/00
09/09/00 I
09/09/00 I
10/01/00.1
City
I i Key Largo
I i Marathon
Key Largo
, Key Largo
! . unknown
I i Homestead
I
I ' England
I ~ Three River Falls
: . Key Largo
, -
i Key Largo
I , Marathon
I Marathon
I . Tavernier
" _ Key Largo
, Key West
; : Miami
! i Homestead
j ~ Key Largo
I ,Key Largo
j : Key Largo
i I Miami
I ' Hialeah
I I Islamorada
; .
1 i Key Largo
! i Miami
i .
.' I' Islamorada
I : Tavernier
. I . Islamorada
Newborgh
Miami
Key Largo
Key Largo
Key Largo
, Plantation
Tavernier
Tampa
Key West
Key West
Tavernier
Ft. Myers
Key Largo
Miami
. Matlacha
Homestead
; Miami
. Islamorada
I Islamorada
Islamorada
l Key Largo
; Layetteville
. Tavernier
, Tavernier
ST~ Location Driver License St.
FL MM 106 FL
FL MM 102 FL
FL MM 103.5 FL
__~__ _0-
FL MM 98.2 na/age 15
___0_-
MM 88.5
FL MM 88.5 unk.
----
MM 102
------
MN MM 86.5 MN
--- ---
FL MM 91.5 FL
.----
FL SR 905 FL
FL SR 905 FL
FL SR 905 unk.
FL MM 106 FL
FL MM 106 FL
FL MM 89 FL
FL MM 89 na/age 7
FL MM 89 FL
--
FL MM106 FL
FL MM 99 FL
FL MM 106 FL
FL MM 77 unk.
FL MM 77 FL
FL MM 103 FL
Fl MM 99.5 FL
FL SR 905 Fl
FL MM 77.5 FL
FL MM 97.5 unk.
Fl MM 86.5 Fl
NY MM 107 NY
FL MM 110 FL
FL MM 91.5 FL
FL MM 104 na/age 6
Fl MM 91 Fl
Fl MM 100 unk.
FL on water unk.
FL Crd.Snd. FL
FL Crd.Snd. FL
FL Crd.Snd. unk.
FL MM 89.9 FL
Fl on water unk,
Fl MM 101 Fl
FL MM 101 Fl
FL MM 87 unk.
FL MM 107 Fl
Fl PKCC unk.
FL MM 110 Fl
FL MM 80.5 unk.
FL MM 104
FL MM 99 unk.
NC MM 81 unk.
FL MM 81 FL
Fl MM 86 unk.
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TOTALS
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$3,049.39 V
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$2,350.64 ../
$7,288.96 t.-
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$2,773.16
$1,231.28
$190.00 V-
$190.00
$2,160.18 v/
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$27,956.46
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$1,644.18
$74,515.79 ~
$10,507.04
$37,882.26 ~
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10/16/00 -, . . .. Tavernier FL MM 81 unk. $1,457.01
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10/16/00 ( . Islamorada FL MM 81 FL $73,271.82
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10/24/00 I I Key Largo FL MM 101.5 unk. $190,00
11/03/00 I . Canada MM 82 unk.
!
11/03/00 ' Key Largo FL MM 99.5 FL
11/08/00 Homestead FL MM90 unk.
12/08/00 . Key Largo FL MM 99.5 unk.
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12/10/00 , Ashland KY MM 100 unk.
..- -.--- !-.
12/13/00 ! Tavernier FL MM94 FL $1,551.25
-
12/28/00 L Key Largo FL MM 102 unk. $284.24
12/31/00 i Islamorada FL MM82 unk.
TOTALS $250,520.34
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Monroe County Property ApprnIsers Office
ErvIn A.HJggs, CFA
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MONROE- COUNTY TAXING DISTRICTS'
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DISTRICT lOOA (I-A) Stock Island Municipal Service District (SIMUNTED) Stock Island
to Boca Chic_a Channel - includes Stock Island South of U.S. Highway 1 and Raccoon Key
(Key Haven)..
DISTRICT 100B (I-B) Big Coppitt Municipal Service District (BCMUNTD) Boca Chica
Channel to Shark Key Channel - includes Boca Chica Key, Rockland Key, East Rockland
Key, Big Coppitt Key, Geiger Key and Shark Key.
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,DISTRICT.,lOOC (I-C) Sugarloaf Municipal Service District (SLMUNTD) Shark Key
Channel to Kemp Channel - includes Saddlebunch Key, Upper and Lower Sugarloaf Key,
Park Key and Cudjoe Key.
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DISTRICT lOOH (I-D) Big Pine Key Municipal Service District (BPMUNTD) located
between Kemp Channel and the Seven Mile Bridge ':"".includes Summerland Key, Ramrod
Key, Big Torch Key, Middle Torch Key, Little Torch Key, Big Pine Key, No Name Key,
West Summerland Key a!kJa Spanish Harbor Key, Bahia Honda Key, Little Duck Key a!kJa
Ohio Key and Missouri Key a!kJa Little Grassy Key.
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DISTRICT SOOD (3) Duck Key Municipal Service District (DKKEYTD) West end of
Tom's Harbor Bridge to Long Key.Bridge - includes Tom's Harbor Key, Duck Key and
Conch Key.
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DISTRICT. SOOL, (4A) Long Key' Municipal 'Service District. (LKMUNTD) Long Key
Bridge North up to Craig Key (does not include Craig Key) - including City of Layton
(SOLA).
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PIS'!'RICTSOOI(4B) IslamoradaMunicipal Service District (ISLATD) Craig Key.'
DISTRICT SOOP (S) Plantation Municipal Service District (PLTNTD) West end Tavernier
Creek Bridge to South Bay Harbor Drive and Lobster Lane - Tavernier and the southwest
part of Key Largo.
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DISTRICT SOOK (6) (SKLGOTD) That part of Key Largo from South Bay Harbor Drive
and Lobster Lane to the Southern Boundary of the intersection of the right of way County
Roads 905 and 905A, plus Cross Key.
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DISTRICT SOOR (7) (NKLTD) That. part of Key Largo North of the boundaryof District 6
..:: Ocean Reef. . . . .'. . . .
DISTRICT 5000 (Part of District 8) All other properties situated in the unincorporated areas
of Monroe County, Florida, not included within any of the above delineated seven (7)
districts, including in said District 8 all of these prop~rties situated on the mainland of the
State of Florida between Dade and Collier Counties and including all keys not connected to
U.S. 1. (excluding those Islands in the boundary of the City of Marathon).
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~ISTRICT SOOF - (Part of District 8) - Everglades.
DISTRICT SOOC - A small part of the Everglades area that has Big Cypress Basin Fund /f0
levy i.nstead of Okeechobee Basin Fund levy.' \.LV
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JEB8USH,GQVERNOR
RUBEN J. KING-5HAW. JR., EXECUTive OIRECTOR
fM mfM @ mill&] [f) & fM
To: All Counties
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From:
Hazel Greenberg, CPM',
Bureau of Managed Health Gare'
Data Analysis Unit' .
Subject:
Health Care Responsibility Act (HCRA)
County Estimated Popul~tion and HeRA Liability
Datc:
January 3,2001
Enclosed are the most current population estimates provided to the Agency by the Bureau of
Economic & Business Research and published by the Governor's office.
The 2000 - 2001 poverty level guidelines are expected to be published in mid to late February.
As soon as the Federal Register publishes the guidelines. the HCRA income limitations will be
sent to all county and hospital contacts.
If you have any questions concerning this mailing or any aspect of the HCRA, I can be rcached
via email at ~reenbeh@fdhc,state.n.us by anyone who wishes to use email, or you may call me at
(850) 414-9444, correspond by fax at (850) 414-2875 or mail to:
Hazel Greenberg, CPM
Medical Health Care Program Analyst
Agency for Health Care Administration
Bureau of Managed 'Health Care, Data Analysis Unit
2727 Mahan Drive, Stop Mail Code 26 .
Tallahassee, FL 32308
Visit AHeA Onlin~ I1t
www.ldhc.stat~.II.us
2727 M;1h;1n Drive: . Mail Stop It
TalLlhasscc. FL 32308
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Agency for Health Core Administration
Health Care Responsibility Act
1001 County Population Liability
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Henlth CII~C Responsibility Act
2001 Count)' Population Liability
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Upper Keys Health Care Taxing District
January 19, 1988 - Monroe County Board of County Commissioners (BOCC) declared
that an emergency exists, waived the requirements of advertising under the provisions of
Florida Statutes, and adopted three Emergency Ordinances creating the Lower Keys, the
Middle Keys and the Upper Keys Municipal Service Taxing Districts for health care and
facilities enhancement.
January 19, 1988 - BOCC adopted three Resolutions requesting the Supervisor of
Elections to conduct a Referendum Election on March 8, 1988 concerning each of the
aforementioned Health Care Taxing Districts.
March 8, 1988 - All three Referendums passed thus creating the Lower Keys, Middle
Keys, and Upper Keys Health Care Districts for a period not to exceed five years and
providing for said districts to be funded by the imposition of one-half of one mill per year
per $1,000.00 of assessed taxable value of real property.
July 1, 1988- Chapter 88-186, Laws of Florida, relating to Trauma Systems and
Emergency Hospital Care was approved by the Governor, with an effective date of
October 1, 1988.
$ubsequently, the BOCC rescinded the trauma tax in the Lower Keys and Middle Keys
Districts under the assumption the new Florida Law solved the problem concerning
trauma care. The Upper Keys Taxing District kept the trauma tax in place.
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Karie McDonald, RN, EMT-P
Emergency Management Director-Trauma
Upper Keys Health Care Taxing District
OKl!~rY ~o~~~E
(305) 294-4641
Advisory Board
98600 Overseas Highway
Key Largo, FL 33037
(305) 451-2766
Fax (305) 451-6211
Joanne Mahoney, MD, Chairperson
Robert Luse, PresidenVCEO, Mariners
Donald Sock, EMT-P
Penny Mason, VP, TIS Bank
Sylvia Murphy
Judith Cooley, CPA
Rayme Suarez, Atty.
.../'
MEMORANDUM
FROM:
Karie McDonald, Trauma Director
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TO:
Commissioner Nelson
DATE: June 29, 200_
SUBJECT: Information request
Please find the information you requested below. I apologize for the delay and not getting this to
you in a timely fashion. Please call if you have any questions.
At the time of the initial transport, patient care is of utmost importance and the method of
payment is not of concern. Once the patient is admitted to the trauma hospital, the trauma office
begins to check with various hospital officials (social workers, trauma registry office and patient
families) to determine financial resources. Various sources of payment may include auto
insurance, health insurance, Medicare, Medicaid, VA coverage. Should the patient be covered by
any of the above, no payment will be made from the health care district.
The trauma office is in constant contact with the supervisor of the programs department in the
financial service office at Jackson Memorial Hospital. Through our work with Jackson Memorial
Hospital, we were able to obtain funding from a special program specific to a Russian citizen who
was a trauma district patient. We also work with Florida Highway Patrol and receive information
from the accident reports (when appropriate).
f.s the director, I also do patient follow-up visits at the trauma center. I visit the patients and their
h-milies and work with the case managers and social services. We provide information back and
forth that may be helpful in determining financial sources.
AIJ;n.Q.YgD this is not a complicated procedure it is very time consuming requiring travel and phone
.tjme with many different people. Unlike many of the government programs, we do not have many
~trictions other than no other source of payment and having been iniured within the district
boundaries.
~
Karie McDonald, RN, EMT.P
Emergency Management Director-Trauma
Upper Keys Health Care Taxing District
O~~~~~~E
(305) 294-4641
Advisory Board
98600 Overseas Highway
Key Largo, FL 33037
(305) 451-2766
Fax (305) 451-6211
Joanne Mahoney, MD, Chairperson
Robert Luse, President/CEO, Mariners
Donald Bock, EMT-P
Penny Mason, VP, TIB Bank
Sylvia Murphy
Judith Cooley, CPA
Rayme Suarez, Atty.
Facts About the Upper Keys Health Care Taxing District - Trauma Care Fund
1. What is the Upper Keys Health Care Taxing District? Commonly referred to as the
Trauma District, it reaches from the DadeIMonroe County line to the north end of Long Key
Bridge. It was established in 1988 to ensure that rapid access is available to transfer trauma
victims to the appropriate state certified trauma centers - Jackson Memorial Hospital's Ryder
Trauma Center and Miami Children's Hospital- via Miami-Dade Air-Rescue.
2. Why does the Trauma District exist? Voters overwhelmingly supported the referendum
that established three separate trauma districts in Monroe County and the associated tax. The
plan was only implemented in the Upper Keys. A half-cent tax was collected from 1988 until
1992. In 1992, voters again ~upported the tax, which was cut to a quarter-cent. The tax hasn't
been collected since 1995.
3. How does the Trauma District work? The Trauma District has written agreements with
Jackson, Miami Children's and Miami-Dade Air-Rescue that guarantee immediate
acceptance and transfer of trauma victims from the Upper Keys. When an accident occurs,
paramedics respond, evaluate and call a "trauma alert." The trauma transport officer responds
to the scene. Working with the paramedic, the trauma officer coordinates the rapid transfer of
the trauma victim, Air-Rescue responds and the trauma center is notified that a trauma victim
is on the way.
4. What is a trauma alert victim? A person who has sustained injury due to blunt or
penetrating means or burns is considered a trauma alert victim. To qualify for transfer to a
trauma center, the victim must meet the minimum trauma transport criteria established by the
Florida Department of Health's Division of Emergency Medical Services. Life threatening
injuries include severe head injury; penetrating wounds to the head, chest or abdomen; severe
hemorrhaging; amputation or critical burns.
5. What is the "Golden Hour"? This is the all-important first hour after injury when lives can
be saved and serious disability can be lessened if the proper specialists, such as
neurosurgeons or thoracic surgeons, treat trauma victims. Air-Rescue is crucial to meeting
the golden hour since they transport trauma victims from the scene or meet the trauma
victims as they are brought to the Mariners Hospital Emergency Center.
--over--
(jJ)
6. Who has benefited from the Trauma District? Every Monroe County citizen and visitor in
the Upper Keys benefits by knowing the most essential care is available to them if needed.
Additionally, ambulances and other appropriate medical equipment have been purchased,
including the Jaws of Life. In the district's twelve years, 349 trauma victims were served. In
2000, 63 trauma victims were treated, 22 of which were in Is1amorada.
7. Isn't all this expensive? The cost of trauma care is extremely expensive. The Trauma
District is the payer of last resort so the staff uses every means possible to secure funding for
care, such as auto or boat, disability, workers compensation, Medicare or Medicaid
insurance. When the district does have to pay for care, per the agreement, the charge is a
Medicaid rate, which is much lower than the actual cost of care. In the district's 12 years, it
has paid $1.6 million in trauma victim care due to the diligence of the staff. The operating
budget for the Trauma Office is approximately $134,000 per year, which includes salary and
benefits for two paid employees and routine office expenses. The self-sustaining fund, which
is $3.7 million, primarily uses interest from the account for operating costs, patient care and
equipment purchases.
8. But now the COBRA law is in place. Why do we need the district? COBRA has other
common names such as anti-dumping law and Emergency Medical Treatment and Labor Act
(EMTALA). Congress enacted EMTALA in 1986 as part of the Consolidated Omnibus
Budget Reconciliation Act (COBRA) of 1985. It was designed to prevent hospitals from
refusing to treat patients or from transferring patients to charity or county hospitals when the
patients couldn't pay. According to the federal law, if any person goes to an emergency
department and requests examination or treatment, the emergency staff must provide
appropriate medical screening to determine whether or not an emergency medical condition
exists. If the medical condition is beyond the capabilities of that emergency department to
treat the patient, a patient may not be transferred unless 1) the patient or family has been
informed of the risk of transfer and 2) a physician determines the medical benefits of transfer
reasonably outweigh the risk. The hospital receiving the transfer must first agree to accept
the patient, have available space, and have an accepting physician or surgeon. This can be
an extremely time-consuming process.
9, What would happen without the Trauma District? Without the Trauma District, the
agreement between the trauma centers and the district would no longer be valid. Trauma
victims would be transported to Mariners where the staff would stabilize the trauma victim to
the best of their ability and begin the arduous process of getting the trauma victim transferred
(as outlined above) as quickly as possible. This process can take many hours during which
the "golden hour" is lost.
For more information about the Trauma District, call 451-2766.
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. (305) 294-4641
Murray E. Nelson
Commissioner, District Five
Damaron Building, Suite II
99 I 98 Overseas Highway
Key Largo, FL 33037
PHONE (305) 852-7175
FAX (305) 852-7162
Email: boccdis5@mail.state.fl.us
July 9, 2001
David V. Shatz, M.D.
P.O. 016960 (D-40)
Miami FL 33101
Dear Dr. Shatz:
(~.~ ----
BOARD OF COUNTY COMMISSIONERS
MAYOR George Neugent, District 2
Mayor Pro-Tern Nora Williams, District 4
Dixie Spehar, District 1
Charles "Sonny" McCoy, District 3
Murray Nelson, District 5
At our meeting on April 12, Dr. Schwemmer and I outlined a trauma
plan for Monroe County. At this meeting you agreed that the Trauma
District should not be responsible for out-of-county and out-of-the-state
trauma victims. You also agreed that the taxpayers of the Trauma District
should not be responsible for the residents of the other 66 Florida counties
! including the 2.3 million residents of Miami-Dade County.
As you know, any resident of any Florida county'who would qualify
for H.C.R.A. or HB 509 payments are denied payment if they are injured in
the UPl?er Keys Health Care Taxing District (Trauma District).
There is also the issue of the Trauma District guaranteeing acceptance
and transfer of trauma victims to Ryder Trauma Hospital based on ability to
pay rather than the medical needs of the patient. As this arrangement clearly
violates State Statute 395, the current agreement with the Trauma District
does not meet the needs of all the Monroe or Miami-Dade County citizens,
or other areas.
@
Dr. David Shatz
- 2-
July 9, 2001
As it is the responsibility of the District 19 trauma hospital (Jackson
Ryder) to provide for a comprehensive ground and air transport system for
all trauma victims, I have asked that you give all of the Monroe County
hospitals and all of the EMS departments the same agreement that you
currently have with the Trauma District. This will allow for the rapid
transport and acceptance to the Ryder Trauma Center that all of the citizens
and visitors to Monroe County deserve!
As no county resident or visitor can choose where they will receive
trauma injuries, it is imperative that these agreements be concluded as soon
as possible. As the designated trauma hospital director for District 19, you
would be remiss if you did anything less than has been requested.
Yours truly,
':"~ E /~/dL
Murray E. Nelson
Commissioner
District Five
MEN/dh
C: Monroe County Administrator Jim Roberts
Monroe County Attorney Jim Hendrick
Monroe County BOCC
Monroe Co. Health Dept. Interim Administrator Steve Mason
Robert Luse, Mariner's Hospital
Rick Rice, Fishernlan's Hospital
Ronald Biennan, Lower Keys Medical Center
Steven Cohn, Director, Ryder Trauma Center
Miami-Dade Conunissioner Katy Sorenson
f: Shatz ltr 7 -9-0 I
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SCHOOL OF MEDICINE
July 25,2001
Murray E. Nelson
Commissioner, District Five
Damaron Building, Suite II
99198 Overseas Highway
Key Largo, FL 33037
Dear Mr. Nelson:
I was a bit dismayed at the tone of your letter to me dated July 9,2001. I realize your political standing,
and your desire to accomplish what you think is best for the people, but allow me to assist you in
understanding a few points.
I have always agreed and attempted to provide optimal care for the severely injured patient, including
those in Monroe County. In an agreement written long before the tenure of you or me, our respective
organizations established a plan that has proven very effective in optimizing that care. Until recently, it
has functioned nearly seamlessly. Not only has it not collected any money from the citizens of the Upper
Keys in many years, but it has in fact purchased emergency medical equipment to maintain a high level of
service to the citizens and its visitors. And at the same time, it has provided fmancial reimbursement to a
hospital that has extended its arms to the Taxing District and its citizens. The arrangement has not
burdened Mariner's Hospital nor Jackson Memorial Medical Center.
And now, because of political wrangling in Monroe County, that agreement, and trawna care in general, is
threatened. The result is potentially devastating. While caring for a severely injured patient is my
foremost interest, I must also be cognitive of the fmancial status of the hospital and Miami Dade County.
You have repeatedly stated that you will take responsibility only for Monroe County residents, and have
nothing to do with the tourists and visitors who bring large amounts of revenue to your county every year.
Instead, you want Jackson to have to pursue alternate means of recouping the fmanciallosses. You have
also repeatedly stated that the Health Care Responsibility Act (HCRA) (Chapter 154, Sections .301-.331,
Florida Statutes) will be responsible for covering those losses. The fact is, HCRA has several very
important limitations. First, it covers only a very select group of people (those at or below the federal
poverty level), which is only approximately 10% of the population of Monroe County, and which only
covers the State of Florida, excluding all out of state and foreign tourists. Secondly, it does not cover any
transportation. All patients are transported to the JMH Ryder Trawna Center from Monroe County by
helicopter. If the Miami Dade Fire Rescue Air Rescue helicopter is used, the taxpayers of Miami Dade
County will be paying that bill. And lastly, HCRA does not cover any physician charges. That means that
the trawna surgeons, radiologists, and anesthesiologists, who live day and night in the hospital to provide
the immediate level of trawna care we all desire, will do so with no hope of compensation. Is that fair?
'1 ~
At one of our recent meetings, I provided you with a copy of an agreement that was acceptable to the JMH
The Daughtry Family Department of Surgery
Division of Trauma/Surgical Critical Care and Burns
P.O. Box 016960 (D-40)
Miami, Florida 33101
Phone: 305-585-1178
Fax: 305-326-7065
@
administration and was essentially nothing more than a revision of the long-ago established agreement
between JMH and the Upper Keys Taxing District. The revision simply extended that agreement to
include all of Monroe County. Apparently that was not acceptable to you.
Allow me to clarify a couple of issues that seem to be misunderstood. The Trauma Service Area
designations were made by the state to detennine the number of trauma centers necessmy for a given
region. The District 19 that you refer to has nothing to do with the obligation of the trauma center to take
patients from all areas surrounding its county. Nor does the trauma center have any obligation to provide
transportation by any means. Additionally. EMT ALA laws never reference trauma centers. Baptist
Hospital has surgical capabilities. and in fact, is closer to Monroe County and Mariner's Hospital. than is
Jackson Memorial Hospital. Therefore. only by the agreement between the County and Jackson is there
any obligation on the part of the trauma center to receive any Monroe County trauma victims. Nor is there
any obligation on the part of Miami Dade Air Rescue to transport victims from Monroe County.
I hope you can understand my concerns. and understand the very real threat to the trauma system as it
stands. It works very well. and has been for quite some time. I am not a resident of Monroe County and
will not participate in its politics. My desire is to extend to all of the citizens (and visitors) of Monroe
County what is currently in place with the Upper Keys, a proven and effective system. without
jeopardizing the fmancial status of the Miami Dade County trauma center and its system.
.Re'P~ _
David V. Shatz. M.D.
Associate Professor of Surgery
Director, Prehospital Services, Ryder Trauma Center
Deputy Medical Director
Miami Dade Fire Rescue
cc: Monroe County Administrator Jim Roberts
Monroe County Attorney Jim Hendrick
Monroe County BOCCaMonroe Co. Health Dept. Interim Administrator Steve Mason
Robert Luse, Mariner's Hospital
Rick Rice, Fishennan's Hospital
Ronald Bierman, Lower Keys Medical Center
Miami Dade Commissioner Katy Sorenson
Miami Dade Fire Chief R. David Paulison
~
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SCHOOL OF MEOrClNE
Patrice Tavcrni~r
Administrator
Fisherman's HospitaJ
;301 Overseas Highway
Mar1ldaoa. PI. 33050
Dear Ms. Tavernier'
Thank you for IlITIJ'JglDg 1IDeeMS b~n myself and your adtninistr.bW staff lur wed:
regardiDs trauma patiCllt tr1uufar from your facihty to Jackson Memorial Hospital (JMH). AJ 1
meDtioACd in our Idcpboru: cooversattoa. my aoaa was 10 change the cwtent practice of an
intcrfaciJi1y traoJfi:r betweeD our instjtuCions. to olle ideGtlcaJ to what oc::.curs within Dade
County IUd the Upper Ke)'l. That cbIDF U lIS (OUOW3: UlY patient .arriviu& It yoUl' Emcqcacy .
Room meetin8 sta~ trawu criteria caD. be tnLn${emd to ~ directly, witbout the Deed for
ap~ow.I of our TnDsCC'J' wter DOt of the anm!iog numa SUlpIl Oil "Iia[ thatbme. . Your
"p~ysiciaDs or llurstSMed simply to call B.PtiSt.lfeat~ S;Uelns" AerolllCd ~rNiuiu~DadcF~
.Rescue Ai.rRoscue (or hcJiCiOpter IrNlSport A coutt.csy caJl from your physician CO ours would be
appreciated but is by no means a pcereqwsite for sending a patient
I have informed the ll'Iuma SurgtODS and the staft" of the Trawna Resu,scimtion UDit al JMH of
the challi<; which is effective immediat.ety. I trust that this is .t positive move iu minimi7i", the
wos:k ud fnLQtions your physic:;ilm aDd uurses face in att.emptior to get trawna violimJ to .
trauma ~tet_ CertainlY. if lUly problema or questions arise. please contact me:.
Res
David V. S1ua~ MD.. F.ACS.
Associate Professor of Swgcry
OifecCOr, Prcbospital Setvi~es
c<;: K.arie McDonald. Johnny DelSado. Lynn Maud
J-~Ato( t... ~,/~ -----.. 'il; 0/';
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Pt1EMORAHOUM
TO~
Orian Haft. Chid, KeV We~l Rescue
Kim Bassett. DON, lower FJQiida Keys Medical Cenler
FROM:
Johnny O~~~do. Program Manager, Bl!pli!ll Medic31 Tr;msport Services.
AoroMe~
Trauma Aler1s
SUBJECT:
DATE:
M8Irch t, 2001
Pursuant to our conversations Of' TlIl!'sday, FQbruary, 29, 2G01
Prior to han6port from (he scene of. trauma vic(lm who meets Flollda's Trau~~
Criteria 'he Rescue Chief o/his designee will call th~ AeroMed Communications Center
and request a "TRAUMA STANDBY-. This actIon will place It'le AeroMed helicppt~r in 8
prQ.ta\Jnch mode for immediate responsQ
Upon arrival in the ED at Lower FlorIda KeY::f Medical Cente! the Nursing Supervisor will
inittale II calllc the AeroMed Communications Center. A requeSllo dispalch the aircraft
will be made ,f In Ifle opinion of the Emergency Physlcian/Slllg~(Jn the patient will
reqUlfe the services or ltle Ryder Trauma Center or another {acillty fOf their ,oJuties
The aircraft will respofld to L!=KMC regardless 01 acceplance: ::Jtlhe Ryder irauma
Cenl~( and stand-by .tt~ere'(or' aCee'PlanCe .
r,,;5o let16( also authori2:e~ NEXTCL to add Key Wesl Rescue to our (roquenc:y.
This process: will be reviewed. semi-annually for effectiveness
~'f~A~
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(305) 294-4641
Murray E. Nelson
Commissioner, District Five
Damaron Building, Suite 2
99198 Overseas Highway
Key Largo, FL 33037
PHONE (305) 852-7175
FAX (305) 852-7162
Email: boccdis5@mail.state.fl.us
(' .,.....-.....-
BOARD OF COUNTY COMMISSIONERS
MAYOR George Neugent, District 2
Mayor Pro-Tern Nora Williams, District 4
Dixie Spehar, District I
Charles "Sonny" McCoy, District 3
Murray E Nelson, District 5
FACTS ABOUT THE UPPER KEYS HEALTH CARE DISTRICT
TRAUMA CARE FUND
1. What is the Upper Keys Health Care Taxing District? Referred to as the
Trauma District, it reaches from the Dade-Monroe County line to the north end of
the Long Key Bridge. It was established in 1988 in spite of the fact that the
Florida Department of Health and Rehabilitative Services stated in a letter dated
Feb. 17, 1989 that no agreement between Monroe County and any hospital will
negate or modify that hospital's responsibility to comply with Florida Statutes
(FS), particularly with reference to section 395.0142. The Upper Keys chose to
adopt a Trauma District while the Middle and Lower Keys did not.
2. Why does the Trauma District exist? The Trauma District was created during a
time of great uncertainty in the medical field. Most of these issues have been
resolved with the adoption and amending of the Emergency Medical Treatment
and Labor Act (EMT ALA), the Consolidated Omnibus Budget Reconciliation Act
(COBRA), Health Care Responsibility Act (HCRA), Hospital and Trauma Surtax,
and the adoption of State Statute 395.00.
3. How Does the Trauma District Work? The Trauma District has written
agreements with Jackson, Miami Children's, and Miami-Dade Rescue that
implies that a trauma victim is guaranteed immediate acceptance and transfer
from the Upper Keys. This agreement may be based on ability to pay rather than
the medical needs of the patient. It is also impossible to guarantee consistent
transfer or acceptance because helicopters cannot fly in bad weather, when they
have mechanical problems, or there are multiple accidents in Miami-Dade. If
three trauma patients arrived at Jackson Trauma Center at the same time, one each
from the Trauma District, Miami-Dade or Broward County, the patient receiving
medical care first would not be the patient from the Trauma District but the
patient with the highest medical need.
(~j
4. What is a trauma alert victim? A person who has sustained injury due to blunt
or penetrating means or significant body burns is considered a trauma alert victim.
To qualify for transport, the paramedic on the scene must establish that the victim
meets trauma criteria. Then the paramedic determines how the victim is
transported and to where (FS 409), according to Statute and protocols.
5. Who has benefited from the Trauma District? Mostly Jackson Ryder Trauma
Hospital. Because the Trauma District exists, trauma victims from all 67 Florida
counties who are hurt in the Trauma District and would qualify for payments
under HCRA or Hospital and Trauma Surtax in their home county, are denied
payment because HRCA and Hospital and Trauma Surtax are payers of last resort.
This means that a Miami-Dade resident who is a trauma victim in the Trauma
District and qualifies for HCRA or Hospital and Trauma Surtax in Miami-Dade
County will be denied payment and the Trauma District will pay the bill. A large
part of trauma funds were paid for victims from Miami-Dade or other Florida
counties-35% (over the last 5 years). Also, there were 44% of trauma victims
who were hurt in the Trauma District and lived in the Trauma District that may
have been denied HRCA because the Trauma District exists (last 5 years).
6. Isn't all this expensive? Yes! In the last 12 years 1989-2000, the Trauma
District has spent $1,225,978.00 on administration and $1,472,443.00 on transport
and treatment. The Trauma District has spent $4,700,037.00 of taxpayers' money
in the last 12 years.
7. What is HCRA? The Health Care Responsibility Act pays for indigent trauma
victims who are treated at an out-of-county hospital. Monroe County must fund
up to $353,840.00 for FY 2001. All counties in Florida must fund
$62,892,264.00 for FY 2001. Qualification for utilization of these funds are that a
family of four in Monroe County can earn up to $2,206 per month, own their own
home, one automobile of any value, their clothing, tools of trade, cemetery plots
and $6,500 of other assets.
8. What is Hospital and Trauma Surtax? Some counties have adopted Hospital
and Trauma Surtax that will pay for trauma patients from their county who are
indigent or medically poor. Medically poor means a person has insufficient
income, resources, and assets to provide needed medical care without using
resources required to meet basic needs for shelter, food, clothing and personal
expenses.
9. Why do we still need the District? We don't. The Middle and Lower Keys
have equally good records and a positive history of savings lives of trauma
victims. The Trauma Officer now only duplicates services already provided by
the paramedic, EMS provider, emergency hospital room and the trauma hospital.
@)
10. What would happen without the Trauma District? The Upper Keys hospital
(Mariners) and all the EMS providers would secure agreements with Jackson
Ryder Trauma Center, Miami Children's Hospital and Miami-Dade Rescue to
continue to provide the same service as is being currently provided. Providing
trauma service is required of a designated trauma hospital under State Statute 395.
All trauma patients would qualify for HCRA and Hospital and Trauma Surtax
payments from their home county and all taxing counties. All taxing districts
would receive a portion of the 3.7 million dollars trauma fund. Key Largo would
receive approximately 1.1 million dollars and other areas would receive rebates
based on total taxes paid in.
11. Who is covered for trauma care in Monroe County? All federal, state and
county employees. All military personnel, all Medicare and Medicaid patients, all
veterans (23,000), all children under age 18, all employees of major employers
(FKEC, FKAA, City Electric, Bell South) and anyone with auto insurance. All
indigent residents meeting HCRA or Hospital surtax requirements.
12. How often is the Trauma Officer called? In the last 12 years, 349 trauma
victims were served. That is an average of one call every 35 days. The
administrative cost for each call was $3,512.83.
August, 2001
~3'--O'\
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IVIUllUctYI "U~U:;:'l UV. LUV I ::J..JL "'YI
'-'''Iyl.......... L-. \\JIIYI) IYIML..L.VVI I \...JV.,J/ L..:7..::..-.......... I I
fJ.VI
Attention:
COMMISSIONER NELSON
Date:
8/6/01
Company:
DISTRICT 5
Number of Pages:
3
Fax Number: 7162
Voice Number: 7175
From: JAMES E. (JIM) MALLOCH
Company: MONROE COUNTY
Fax Number:
(305) 292-4417
Voice Number:
(305)292-4500/4510
Subject:
HCRA INFORMATION REQUESTED
Comments:
COMMISSIONER:
BASED ON THE CENSUS WEBSITE FOR 1990 CENSUS
INFORMATION BY INTERPOLATION, I COME UP WITH ABOUT
22% MAKING LESS THAN $2,200 PER MONTH. CENSUS
INCOMES BY FAMILIES FOR CENSUS 2000 HAVE NOT BEEN
RELEASED ON THEIR WEBSITE YET.
HOPE THIS WILL ASSIST YOU.
REGARDS, JIM MALLOCH
(ij)
U S Census Bureall .. ~ ;'~~,;;:;~.'i":"''liif'd .
. . ~ . 't.:;:~:~~~!.~l.~~~""
Basic Facts · Quick Tables
DP-4. Income and Poverty Status in 1989: 1990
Data Set: 1990 Summary Tape File 3 (STF 3l - Sample data
Geographic Area: Monroe County, Frorida
NOTE: For information on confidentiality, sampling error, nonsampling error, and definitions, see
hltP..;!lfil~J11ng~U;gm~_y'~~9QY1b9.mel~_nj.tf~jM.Q.~$(~~P~U.~13._0~htm.
ub'ect
NCOME IN 1989
Households
Less Ihan $5,000
$5,000 to $9 999
$10,000 to $14,999
$15000 to $24,999
$25.000 to $34,999
$35 000 10 $49 999
$50,000 to $74,999
$75,000 0 $99,999
$100,000 to $149,999
$150 000 or more
Famll households
less than $5,000
$5000 to $9,999
$10000 to $14 999
$15,000 to $24 999
$25 ODD to $34.999
$35,000 to $49 999
$50.000 to $74,999
$75,000 to $99,999
5100.000 to $149 999
$150,000 or more
Nontaml households
less than $5 000
$5 000 to $9 999
$10,000 to $14,999
$15.00010524.999
$25 000 to $34 999
$35.000 to $49 999
$50.000 to $74,999
$75,000 to $99,999
$100000 to $149,999
$150000 or more
OVERTY STATUS IN 1989
. .___ _ person.s .~r w~om pove~ status is deiennlned
American Fact
Main I Search I Feedback I FAC
_:nt:t,..
1~.;1Id.OC)
1\ \. '2-
-'f~~1 Lfl2..
Numbe
oC
(tlC,l.i
33,611
24,77
609
36
1487
9.164
138
5,78
@
__ !6.12
American FactFinder
Page 2 0:
-"' Below Doverty level - -_. --. -- --- -.. "-- .- - -- -'-- .- .- - . . 8,202
Persons 18 vears and over .-- 1--- 6~
- Below poverty level ... E?~~
Persons 65 years and over 12,047
Below DOverty level -~
- Relaled children under 18 years -. 12,98~
Below poverty level 1,81
Related children under 5 years __4,251
Below poverty level 61
Relaled ch.~ldren 5 to 17 years 8,72
Below poverty level 1,20
Unrelated individuals 19,~~
Below poverty I~vel - ~IL
-.--.---
Families .
20,78
Below poverty level 1,45
With related children under 18 years 783
Below poverty level 86
With related children under 5 years 3,351
Below poverty level 441
Female householder, no husband present 2,07
Below R~:)Verty level _. 53
_.. Wilh.!ela1cd children under 18 year_~_.________.._.n____ 1,25
BelowE_overty level --- 4f8
WIth related children under 5 years 40
Below poverty level -. 251
(X) Not applicable
Source: U.S. Bureau of the Census, 1990 Census of Population and Housing. Summary Tape File 3 (Sample Data)
MatricesP4. P5, P19, PBD, P8DA, Poo, P91, P92, P93, P94, P95, P96, P107, P107A, P110, P110A. P114A.
P117, P122, P123, P126.
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Rug 13 01 05:17p
Commissioner Williams
(305) 289-6306
p.2
'. .. A ~
PDr
~hfol
. ..,,__r.
SCHOOL OF MEDICINE
~~
July 25, 200 I
.4.\
.~,~
JUl 3 1 2001
Murray E. Nelson
Commissioner, District Five
Damaron Building, Suite II
99198 Overseas Highway
Key Largo: FL 33037
Dear Mr. Nelson:
I was a bit dismayed at the tone of your letter to me dated July 9,2001. I realize your political standing,
and your desire to accomplish what you think is best for the people. but allow me to assist you in
understanding a few points.
I have always agreed and attempted to provide optimal care for the severely injured patient, including
those in Monroe County. In an agreement written long before the tenure of you or me. our respective
organizations established a plan that has proven Vety effective in optimhing that care. Until recently. it
has ~ctioned nearly seamlessly. Not only has it not collected any money from the citizens of the Upper
Keys in many years, but it has in fact purchased emergency medical equipment to maintain a high level of
service to Che citizens and its visitors. And at the same time, it has provided financial reimbursement to a
hospital that has extended its anns to the Taxing District and its citizens. The arrangement has not
burdened Mariner's Hospital nor Jackson Memorial Medical Center.
And now, because of political wrangling in Monroe County, that agreement, and trauma care in general, is
threatened. The result is potentially devastating. While caring for a severely injured patient is my
foremost interest, 1 must also be cognitive of the financial status of the hospital and Miami Dade County.
You have repeatedly stated that you will take responsibility only for Monroe County residents, and have
nothing to do with the tourists and visitors who bring large amounts of revenue to your county eveI)' year.
Instead, you want Jackson to have to pursue alternate means of recouping the financial losses. You have
also repeatedly stated that the Health Care Responsibility Act (HCRA) (Chapter 154, Sections .301-.331,
Florida Statutes) will be responsible for covering those losses. The fact is, HCRA has several very
important limitations. First, it covers only a very select group of people (those at or below the federal
poverty level), which is only approximately I ()o1o of the population of Monroe County, and which only
covers the State of Florida, excluding all out of state and foreign tourists. Secondly, it does not cover any
transportation. All patients are transported to the JMH Ryder Trauma Center from Monroe County by
helicopter. If the Miami Dade Fire Rescue Air Rescue helicopter is used, the taxpayers -Olttiami Dade
County will be paying that bill. And lastly, HCRA does not cover any physician charges. That means that
the trauma surgeons, radiologists, and anesthesiologists, who live day and night in the hospital to provide
the immediate level of trauma care we all desire, will do so with no hope of compensation. Is that fair?
At one of our recent meetings, I provided you with a copy of an agreement that was acceptable to the JMH
The Daughtry Family Department of Surgery
Division of Traum:vSurgical Critical Care and Burns
P.O. Box 016960 (1).40)
Miami, Florida 33101
Phone: 305.585-1178
Fax: 305-326-7065
Rug 13 01 05:17p
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1.;.._~..{~,)~y}r.
r
i~
,~.,
Commission@r Williams
(305) 289-6306
p.3
administration and was essentially no~g more than a revision of the long-ago established agreement
between JMH and the Upper Keys Taxitl'g District. The revision simply extended that agreement to
include all of Monroe County. Apparently that was not acceptable to you.
Allow me to clarify a couple of issues that seem to be misunderstood. The Trauma Service Area
designations were made by the state to determine the number of trauma centers necessary for a given
region. The District 19 that you refer to has nothing to do with the obligation of the trauma center to take
patients from all areas surrounding its county. Nor does the trauma center have any obligation to provide
transportation by any means. Additionally, EMTALA laws never reference trauma centers. Baptist
Hospital has surgical capabilities, and in fact, is closer to Monroe County and Mariner's Hospital, than is
Jackson Memorial Hospital. Therefore, only by the agreement between the County and Jackson is there
any obligation on the pan of the tramna center to receive any Monroe County trauma victims. Nor is there
any obligation on the part of Miami Dade Air Rescue to transpon victims from Monroe County.
I hope you can understand my concerns, and understand the very real threat to the trauma system as it
stands. It works very wen. and has been for quite some time. I am not a resident of MODlae County and
will not participate in its politics. My desire is to extend to aU of the citizens (and visitors) of Monroe
County what is currently in place with the Upper Keys, a proven and effective system, without
jeopardizing the financial status of the Miami Dade County trauma center and its system.
R1l:tHt-
David V, Shatz, M.D.
Associate Professor of SurgeIy
Director, Prehospital ServiCC$, Ryder Trauma Center
Deputy Medical Director
Miami Dade Fire Rescue
cc: Monroe County Administrator Jim Roberts
Monroe County Attorney Jim Hendrick
Monroe County BOCC
Monroe Co. Health Dept Interim Administrator Steve Mason
Roben Luse, Mariner's Hospital
Rick Rice, Fisherman's Hospital
Ronald Bierman, Lower Keys Medical Center
Miami Dade Commissioner Katy Sorenson
Miami Dade Fire ChiefR David Paulison
Au~ 13 01 05:18p Commissioner Williams
0B{01/2001 15:42 3054516211
(305) 289-6306
p.4
PAGE 01
M,"rra)' E. Nelson
Conunililiioner. DiMel five
Damaron Building. Suite 11
99 J 9S Owluas Hishw3.}'
Key Largo, FL 33037
PHONE (3US) 852.7175
FAX (3u5) 852.7162
Email 'bOccdis5@mailsl3te.n.U&
,-~--
WJID or COUNTY &OMMJSSIO~RS
w. YOl(. Gcot'&e Ne'ltlll. . Met 2
~....yor Pro-Tern NGI'lI WiU:uu. Diatn.:t <4
Dixie Spehat. J>iM.:l \
CUt"c "SCIIl..'\y" MoCo)', Di,lrict)
M\lIlI'Y Nc:bon. Dislricl S
O. O~,~lY ~2~~E
1l3S1 Z'J4._1
.
AUG - 1 2001
July 9.200 I
David V. Shatz, M.D.
P.O. 016960 (0-40)
Miami FL 33101
Dear Dr. Shatz:
At our meeting on April 12. Dr. Schwemmer and I outlined a trauma
plan for Monroe County. At this meeting you 3gJ'eed that the Trauma
District should not be responsible for out-of-county and out-of-the-state .
trauma victims. You also agreed that the taxpayers oftlle Trauma District
should not be responsible for the residents of the other f6 Florida counties
. including th.e 2.3 million residents of Miami-Dade COllllty.
As you know. any resident of allY Florida county,\Yho would qualify
for H.C.R.A. or HB 509 payments are denied payment if they arc injured ir.
the Upper Keys Health Caxe Taxing District (Traum.a District).
There is also the issue. of the Trauma District guarallteeing acceptance
and transfer of trauma victims to Ryder Trauma Hospit~ll:>ased on abihty to
pay rather than the medical needs oftbe patient. As tbi~ n.lTan~ment clearly
violates State Statute 395. the current agreement with the Trauma District
does not mee\ the needs of all the Monroe or Miami-Daile County citizens.
or other areas.
Rug 13 01 05:18p Commissione~ Williams
~tl/~lIL~~l l~:ql 3~~q510211
(305) 289-S30S p.5
PAGE 82
Dr. David Shatz
- 2-
July 9. 2001
As it is tbe responSibility of the Distnct 19 trauma hospital (Jackson
R~'der) to provide for a comprehensive ground and air bansport system for
all trauma victi.ms, I have asked that you give all of the :Monroe County
hospitals and all of the EMS departments the same agre.~ment that you
cWTently have with the Trauma DistJict. This will allow for the rapid
transport and acceptance to the Ryder Trauma Center th~t all of the citizens
and visitors to Monroe County deserve!
As 110 county resident or visitor c.an choose when; they will receive
trauma injuries, it is imperative that these agreements be: concluded as soon
as possible. As the designated trauma hospital director for District 19, you
would be remiss if you did anything les~ than h~ been lcquc:sted.
Yours truly,
\oo~.E /'.~/
. ,~
Murray E. elsolt
Commissioner
District Five
MEN/dh
I
c~ Mouoe County Adminiscn.cor JimRobclts
MolU"OC County ^tIOm~' Jim.llcndricl:
Moar~CoWlI:1 BOCC
Monroe ('.0. Reallh Dept. Interim Adn1inistr.llor Steve Mason
Robe.t.1 Lll&c; Mariner's HO!lpil:.1
Rid.: R.icc.-fisllmlWl.'$ H05,l)itill
Ro.lald mmaun,.Lower Keys Medical Center
SIC'iCn Cuhn, Direcotor. R~'der T(aWlla Cemet
~li-l)ilde Commissioner KiltY Sorenson
C: Sha~ II.r 1-9-01
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