Trauma Response fees questioned after auto crash

A $44,000 ER bill, then a helicopter ride

FORT PIERCE, Fla. - Eric Leonhard was out with his buddies in a rented limousine, celebrating his best friend's 50th birthday, when their driver ran a red light.

"I remember the crunch of the metal," said Leonhard. "That's all I really can remember."

Leonhard suffered head injuries, multiple cuts and broken bones from the 2012 motor vehicle crash. He was rushed by helicopter to the nearest trauma center, Lawnwood Regional Medical Center & Heart Institute.

The second he arrived at the Fort Pierce hospital, Leonhard was billed $32,767, an admission charge officially called a trauma response fee.

For more than a decade, trauma centers have been allowed to charge the fee to recoup their costs. But the Tampa Scripps station, WFTS-TV, partnered with the Tampa Bay Times and discovered those fees have ballooned in recent years to as much as $33,000.

The Times reviewed more than 10 million patient bills from Florida's 26 trauma centers. Since 2006, about 120,000 patients have been hit with the fees. In just the last three years, trauma-fee billings have topped $500 million in the state.

"Sometimes, they just see you as a dollar sign," said Leonhard, a charter boat captain.

Records show Leonhard was only at Lawnwood a matter of minutes before doctors determined his injuries were so severe he needed to be transferred to a different trauma center, 135 miles away.  With no insurance, Leonhard's total Lawnwood bill was almost $44,000 --- almost $1,000 a minute for his brief stay.

Leonhard was flown over six other trauma centers in four counties on the way to Kendall Regional Medical Center in Miami. The helicopter passed over three Level 1 trauma centers --- the state's highest emergency medical facility designation --- to get from Lawnwood's Level 2 center to another Level 2 center at Kendall. Both Lawnwood and Kendall are owned by Hospital Corp. of America.

"I 'coded' a couple of times coming into Miami," said Leonhard, using paramedic lingo for a cardiac patient who needs to be resuscitated immediately.

HCA, which used to be headed by Gov. Rick Scott, has a preferred-partner agreement with the air ambulance service that transported Leonhard from Fort Pierce to Miami.

"I think it's more of a business issue than it is an actual life-saving issue," Leonhard told the I-Team.

HCA declined to detail for the Times the expenses that factor into its charges.

“Providing trauma services requires highly specialized teams of caregivers, equipment and processes that have to be available 24/7,” J.C. Sadler, a HCA spokeswoman, noted in a written statement to the Times. “Our activation fees directly reflect the actual cost in each community of mobilizing these resources for patients who receive trauma care.”

Leonhard's attorney, J. Eric Romano of West Palm Beach, says the Lawnwood bill baffles him. "What are the trauma fees for?" Romano asked. "What do you get for that money?"

Mark Vaaler, chief medical officer at St. Joseph's Hospital in Tampa, says the fees fund things like specialized equipment, advanced training and on-call pay for emergency medical staff.
"The trauma activation fee is designed to help you respond within that golden hour for severely injured patients," Vaaler said. "So I think a reasonable fee is certainly justified in those circumstances."

At St. Joe's, that fee is $1,264, the second lowest in Florida. In recent years, the average trauma fee statewide has grown to $10,000.

"What has caught people's attention now is some of the trauma activation fees that are three, four and 10 and 20 times higher than some of the trauma activation fees that have been traditionally charged," said Vaaler.

Pat Palmer, a nationally recognized patient-billing advocate, says the fees often cannot be justified.

"It's like everybody's on the same computer and all the patients throughout the country are getting these kinds of charges," Palmer told WFTS-TV. "We're seeing in the investigation we're doing into a number of them that none of the documentation supports the charge for an entire team."

Since 2010, at least 7,000 patients who spent less than 24 hours in a Florida hospital were charged the fee, according to billing information reviewed by the Times.

Among the patients:

*A Pasco County woman with superficial cuts rang up a $36,179 bill at the Regional Medical Center Bayonet Point, including a $33,000 trauma fee;

*A Palm Beach County teen was billed $14,356 for treatment of minor burns at Delray Medical Center, including a $12,500 trauma fee;

*A 7-year-old Broward County boy, who hit his head playing sports, received a Broward Health Medical Center bill for $5,442, including a $4,473 trauma fee.

"Somebody's paying for that," said Vaaler. "So the cost of care certainly goes up."

Eric Leonhard spent 24 days in the hospital and is still recovering. "Right now, my bills are probably somewhere a little over $1 million," Leonhard said. "And that plays pretty hard on your psyche sometimes."

His situation has shown Leonhard how a trauma

case can impact anyone in the blink of an eye. "I didn't do anything wrong to deserve those bills, or the situation I'm in," Leonhard said. "And it's gonna affect me the rest of my life."

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