Nemours’ plans to establish

a pediatric heart-transplant program in Central Florida have again been denied, this time by a state administrative judge.

Nemours Children’s Hospital’s plans to establish a pediatric heart transplant program in Central Florida were quashed again, this time by a state administrative judge who said Nemours failed to show that there’s a need for the program.

In a 68-page ruling, Judge W. David Watkins wrote that there’s no evidence that a program at Nemours “would meaningfully and significantly enhance geographic access to transplant services.”

Watkins also expressed what critics of a new program in Florida have said: having too many programs for a highly specialized surgery dilutes the quality of care across the board.

Watkins’ ruling comes a year after Nemours challenged the state’s decision to deny the health system’s application for a pediatric heart transplant program through the Certificate of Need process.

“We are disappointed and surprised by the administrative law judge’s recommended order,” wrote a Nemours Children’s Health System Spokesperson in an email on Tuesday. “Nemours remains committed to bringing the most-advanced pediatric cardiac care to the region. We will further review the judge’s order, address all questions raised and continue to demonstrate why we are convinced the families of Central Florida deserve a program in their area.”

There are five pediatric heart transplant programs in Florida, including UF Health Shands Hospital in Gainesville; Johns Hopkins All Children’s Hospital in Tampa; Jackson Memorial Hospital in Miami; Joe DiMaggio Children’s Hospital in Hollywood; and Nicklaus Children’s Hospital in Miami.

Excluding Nicklaus Children’s Hospital, which received final approval for its program last year, the other four programs performed a total of 21 procedures between June 2016 to June 2017, according to state data.

In its application, Nemours had projected that it will perform at least 12 cases by the second year of its program.

Watkins said the projection “is not credible,” especially since the hospital admitted during the hearings that only two patients from the Central Florida region received pediatric heart transplants in 2016.

He said the hospital couldn’t achieve the number unless it took patients from other programs.

“Approval of Nemours’ [program] will not create transplant patients that do not exist or are not currently able to reasonably access services,” he wrote.

UF Health Shands Hospital, the closest pediatric heart transplant program to Orlando, was one of the strongest opponents of Nemours proposal with a “pervasive” presence at the final hearing, according to Watkins’ ruling.

Further, he rebuffed Nemours’ claim that creating a new program would increase the number of organ donors in Florida.

“These arguments are purely conjectural and are rejected. No record evidence exists which demonstrates that a Nemours program would increase the supply of organs in Florida,” Watkins wrote.

Nemours filed three Certificate of Need applications in 2016, for pediatric heart transplant, lung transplant, and heart and lung transplant programs. The state Agency for Health Care Administration only approved the lung transplant proposal and denied the other two, prompting the health system to challenge the denials via the state’s Division of Administrative Hearings.

Nemours has not implemented its lung transplant program yet.

Nemours isn’t the only health system in Orlando to apply for a pediatric heart transplant program.

Arnold Palmer Hospital for Children, which is part of Orlando Health, applied for the program last year and was denied by the state. The health system has also challenged the state decision and is going through a hearing process.