Even though 69-year-old Margaret King was in misery after she fell off a kitchen stool last month and broke her wrist, she refused to be taken to a hospital emergency room.
Instead of calling paramedics, King telephoned a neighbor to ask for a ride to an urgent health care clinic that she had driven past many times while running errands.
The ride to the emergency room at Glendale Adventist Medical Center would have been much shorter, but King's wrist needed immediate attention, and, the Eagle Rock resident said, she "didn't want to wait forever in a hospital."
It is situations like this that have prompted Glendale Adventist Medical Center to jump into the rapidly growing field of urgent health care, where patients are treated for illnesses or injuries that are not life-threatening but require speedy medical attention.
Second Local Hospital to Act
The medical center next month will become the second large hospital in Glendale to offer an urgent care program in an attempt to compete with the area's small private clinics, which offer cheaper and quicker service to people who five years ago would have taken their business to hospital emergency rooms, said Dr. Barry Staum, medical director of Glendale Adventist's emergency department.
"In recent years, many of our patients have begun to seek service at these urgent care clinics, and I think that means they're trying to tell us something," Staum said. "I think it's time for us to respond to that."
Plans call for people entering the hospital's emergency department to be examined by a triage nurse, who will determine whether the patient's injuries are serious enough--such as heart attacks or gunshot wounds--to require emergency attention.
Treatment Less Expensive
If the situation is not life-threatening, the person will be treated as an urgent care patient--for about half the price of regular emergency treatment.
Previously, anyone entering the emergency room had to pay an average of about $90, compared to the urgent care price of $39. Memorial Hospital of Glendale charges the same amount for its urgent care program, which was established last summer.
In addition, urgent care patients should be in and out of the hospital in about one hour, instead of longer waits sometimes encountered when the emergency room is busy, nursing unit coordinator Peggy Daly said.
In opening its urgent care center, Glendale Adventist "is keeping up with the times and is taking the necessary step in an age when medical care is a consumer's market," said Jim Roberts, executive director of the National Assn. of Freestanding Emergency Centers.
"Health care costs are out of sight if you don't pay attention to what you're doing," said Roberts, whose Dallas-based association promotes the growth of urgent care clinics. "People are now shopping around for good, cheap health care, and you don't have to look hard to find it. Hospitals are beginning to catch on to that."
Competition for the health care dollar has intensified in recent years as three urgent care clinics in Glendale have opened to lure business from hospitals. Doctors at the clinics have long expected Glendale Adventist to enter the market.
The competition was too intense for one clinic, Glendale Urgency Medical Clinic, which went out of business last year. Two other clinics under the same ownership in Silver Lake and Echo Park are doing a "solid business," said spokeswoman Judy Seymour. Another clinic that primarily treated Hispanics has closed.
"It's a growing market, and it's very competitive," said Dr. Larry Vigilia, owner of the 13-month-old Colorado Family Health Center in Glendale. "Most hospitals are trying to compete and I've been anticipating that Adventist would join in."
Although doctors at urgent care centers in the area acknowledge that Glendale Adventist's entry into the market may cut slightly into their business, none expects to be looking elsewhere for work.
Industry experts said that, although the majority of private urgent care clinics go out of business during the first year of operation, the ones that survive the crucial 12 months manage to stay open.
"We feel it's a matter of how good your service is," said Dr. Richard Foullon, owner of Verdugo Hills Urgent Medical Care, which opened in February. "If you treat your patients well, they'll keep coming back to you rather than going to a hospital. To many people, big hospitals are sort of intimidating, and we offer an alternative to that.
Urgent heath care clinics began opening up about four years ago as a reaction to the escalating costs of medical care, especially emergency treatment.
Most of the clinics are open 12 hours a day, including weekends, and at least one licensed physician is on duty at all times. Although none boasts the resources of a hospital, most have basic medical equipment, such as X-ray and electrocardiogram machines, and a laboratory.
In the past 2 1/2 years, the number of urgent care clinics in California has grown from about 30 to more than 120, said Carole Gallien, spokeswoman for the California Assn. of Freestanding Ambulatory Centers. Last year, the number of clinics nationwide doubled to about 2,500.
"Have you ever seen fireworks? Well, that's what's happening in this field, and hospitals are beginning to notice," Gallien said.
Medical experts in the past have criticized urgent care clinics, sometimes referred to pejoratively as "doc-in-the-boxes," although much of the opposition has died down.
Critics had often argued that use of the word "urgent" implies that the clinics are prepared for emergencies, such as heart attacks and other severe trauma. Such labeling could mislead the public, and patients might lose valuable time by going to an urgent care clinic for an emergency that only a hospital could handle, said Dr. Joe Corless of Children's Hospital of Orange County, who has written about the clinics in the medical journal California Health Review.
Urgent care clinics, on the other hand, have criticized hospitals that establish such clinics in the emergency room, claiming that doctors are not assigned solely to handle cases of urgent treatment, but are part of the regular emergency staff.
"If you establish urgent care treatment, you had better have a staff that does nothing but handle the urgent patients," said Foullon. "If you don't, you defeat the whole purpose of urgent care because our main claim is quick service."
Neither the urgent care facility at Memorial Hospital of Glendale nor the one planned at Glendale Adventist has a doctor assigned full-time to handle the program.
Glendale Adventist's Staum, however, claims that, because of the hospital's resources, it can assign a doctor to treat urgent care patients if the workload demands it.
"I think people who run these private centers like to believe hospital centers will fail," Staum said. "The bottom line is, if we need an extra physician, we'll get one."
For example, an urgent care center established in July, 1983, at St. Joseph Medical Center in Burbank has proved so successful that hospital officials will assign a doctor permanently to the program by April, said spokesman Scott Tibbits. About 20 people a day are treated as urgent care patients, he said.
20 Patients Daily Expected
Staum said that when the urgent care clinic goes into operation he expects about 20 people a day will receive treatment. At Memorial Hospital of Glendale, the number is considerably less, with about five to 10 patients receiving urgent treatment every day.
By contrast, most successful private urgent care clinics average 20 to 40 patients a day, but owners said it takes time, effort and word of mouth to hit that level.
"I tried virtually everything to get going--ads in newspapers, magazines and radio, flyers, public appearances," Foullon said.
To spread the word about his clinic, he even entered Glendale's Days of the Verdugos parade in October. The clinic's entry consisted of a team of doctors and nurses walking alongside a pickup truck on which was written the clinic's name and location. In the bed of the pickup truck, another team of physicians "treated" a man impersonating a patient.
Foullon's clinic on North Glendale Avenue and another he owns in Sunland are almost breaking even and will soon become profitable when his start-up costs, primarily for equipment, are paid off, he said.
But other clinics are still struggling.
Vigilia said his Colorado Family Health Center is "getting by, but that's about all," and his advertising consists of an occasional stack of flyers put through the mail and a half-page advertisement in the phone book.
But, although urgent care centers come and go, hospital officials and clinic owners agree that competition is good for the industry.
"If urgent health care centers never got started, prices would still be high and there would still be long waits for treatment," Vigilia said. "With Glendale Adventist coming in, it might affect us, but it's healthy in the long run, and you need that when you're talking about personal health."