Emergency medicine has become an important profit center for hospitals. Not only does emergency care itself produce income for hospitals, but dedicated emergency departments are critical magnets for patients who will be admitted for lucrative testing and treatments. As with other areas of medicine, the profit motive in emergency care can lead to dangerous decisionmaking. In this regard, care providers now vie for a share healthcare dollars by proliferating emergency rooms and urgent care centers. This trend puts patient safety at risk.
At Mishkind Kulwicki Law, we have seen firsthand the dangers of stand-alone ERs. These facilities attract seriously ill patients, but lack specialty consultants, ICUs and other needed services and personnel that are available to ER patients at fully appointed hospitals. Now, urgent care centers or “urgi-cares” are getting in on the act in record numbers. The facilities are turning up at pharmacies, strip malls and even inside Target and Wal-Mart stores.
Urgent care facilities offer even less care than stand-alone ERS. Urgicares are meant for patients who have a nonemergency medical condition. A recent report on MedPage Plus indicates that urgent care centers are “booming.” According to the article, about 3 million patients visit urgent cares each week. The trend is expected to continue, with one urgent care executive calling it “the next gold rush.”
There are a number of problems with this trend. First, the personnel who staff urgent cares may not have the training of board-certified emergency medicine specialists and, thus, the facilities “are not equipped to deal with life-threatening emergencies.” Second, they do not offer continuity of care that exists with a family physician who may require repeat visits to identify the nature of a problem. Finally, these facilities rely on the patient to determine whether their medical condition requires urgent or emergent care.
The risk of delays in treatment due to patient confusion about the type of care offered at an urgent care center is made worse by centers that advertise without noting limitations in their services. For instance, one urgent care’s website answers the question “What kind of patients go to … Urgent Care?” with the proclamation “Everyone!….”
There is little guidance under Ohio law as to what standard of care applies in an urgent care setting. Further, the Urgent Care Association of America publishes some practice guidelines that cover lifethreatening conditions, like heart attack, but not others, like stroke. As these facilities multiply in number, the number of medical malpractice claims arising out of urgent care will likely rise.
