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Home / Featured / “I don’t know how he justifies it”: Kansas City emergency center can’t level up, says AG, court

“I don’t know how he justifies it”: Kansas City emergency center can’t level up, says AG, court

St. Joseph Medical Center

St. Joseph Medical Center in Kansas City, seen here on Aug. 18, 2022, was denied designation as a Level III trauma center under a state regulation that forbids such hospitals from being within 15 miles of higher-level trauma centers. Two Level I hospitals are less than 10 miles away. (Photo by Scott Lauck)

While the Missouri attorney general’s opposing counsel considers next steps, a regulation barring Level III trauma centers from existing within 15 miles of another Level I or II trauma center has won out in the Missouri Court of Appeals Western District.

St. Joseph Medical Center’s appeal of the regulation did not hold up in Judge Karen King Mitchell’s August 2 opinion. The center had claimed that the rule was arbitrary and capricious, that it should be based on “a needs-based assessment of trauma center designation that incorporates travel times,” and considered it a special regulation that violated Article III of the Missouri Constitution.

The center had applied to be a Level III trauma center in 2018, and the Missouri Department of Health and Social Services denied their application because it’s located about nine miles from St. Luke’s Hospital of Kansas City and less than 10 miles from Research Medical Center, which are both Level I trauma centers, which falls within the restrictions of the rule enacted in 1990.

Joe P. Bednar of Spencer Fane in Kansas City, who represented the center, contrasted the attorney general’s argument in the case with Schmitt’s campaign messaging in his bid for a U.S. Senate seat, in which he is often critical of government intrusion. 

“I don’t know how he justifies it,” Bednar said.

Missouri Attorney General Eric Schmitt represents DHSS. Chris Nuelle, a spokesman for the Missouri Attorney General’s office, said the office is not commenting at this time.

Bednar said that the application for a Level III designation was a business decision for the national corporation that owns St. Joseph Medical Center and other hospitals.

The case escalated to Cole County Circuit Court, where two witnesses testified during a bench trial. One said the state’s regulations are based on American College of Surgeons guidance, which allows patients in critical condition to receive care “in a reasonable amount of time,” while the other said unfettered building of trauma centers disturbs the balance of care for patients.

The court sided with DHSS, stating that the center failed to hold up its burden of proof for its arbitrary and capricious claim as well as the claim that it had violated the Missouri Constitution.

“The trial court found the testimony of Gamm and Dr. Coughenour credible, and we defer to the court’s credibility determinations,” Mitchell wrote. “Thus, the testimony provided ample evidence that the 15-mile rule is supported by a rational basis; St. Joseph failed to meet its burden to show otherwise.”

Mitchell also wrote that the center had misunderstood the trial court judgment when it claimed the rule was not rational. Judges Alok Ahuja and Janet Sutton concurred.

Bednar said that he didn’t bring forth witnesses, but argued the 1990 rule had no record or foundation to be based on what he called historical and geographic determinations. He also intends to file for a rehearing or motion to transfer to the Missouri Supreme Court. 

The case is Prime Healthcare Services-Kansas City doing business as St. Joseph Medical Center v. State of Missouri Department of Health and Senior Services, WD84723.