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for hospitals to recoup costs for this special- ized care — was slightly more than $2,500 in 2006. When HCA entered the market, gaining state permission to open six trauma centers, the fees charged changed dramatically. HCA-operated trauma centers charge the highest trauma fees in the state — one hos- pital has a $33,000 fee — pushing the state average to almost $11,000. That increase exceeds inflation for the same period by nearly 2,000 percent. While nonprofit hospitals charge considerably less, on average, than HCA hospitals, their rates have crept up not because of increases in costs but because they want to keep up with "the market" … ironically now driven by the emergence of HCA-operated trauma centers. For example, two years ago, Lakeland Regional Medical Center doubled its trauma fee to $10,000 when it learned what a nearby HCA hospital charged. In just four years, trauma centers in the state have billed patients more than half a billion dollars in trauma fees. Aside from the price gouging engaged in by HCA hospitals, and the spillover effect on nonprofit trauma cen- ters trying to "keep up with the Joneses," the level of care might not be equal, either. That is because the state's nonprofit trauma centers are all accredited as Level 1 facilities, the highest designation for this type of spe- cialized care. That means all of the staff and facilities must be available 24/7 in the event of a trauma patient entering the hospital. All of the HCA trauma centers are rated at Level 2, which requires only that the staff must be "on call" but not physically located in the hos- pital at all times. Anyone who has driven in Bradenton traffic would have a difficult time imagining how Blake Medical Center could gather up all of its trauma personnel in an emergency in less time than a helicopter could fly the few extra miles to the Level 1 trauma center at Bayfront Medical Center in St. Petersburg, which used to be the trauma center assigned to Sarasota and Manatee counties. Yet, HCA officials have argued — as have their devotees in the Legislature — that hav- ing more trauma centers closer together improves potential care for Floridians, saving valuable minutes that can mean the differ- e n c e b e t w e e n l i f e and death. Three nonprofit hospi- tals that have operated Level 1 trauma centers for years, including Bayfront and Tampa HCA-operated trauma centers charge the highest trauma fees in the state — one hospital charges $33,000 — pushing the state average to almost $11,000. OPINION Sarasota News Leader March 21, 2014 Page 93