Walk-In Medical Clinics Pressed to Set Standards

“Emergency Medical & Surgical Services” sounds self-explanatory. Yet under that heading in the yellow pages for the Valley area, there are dozens of listings for medical clinics staffed by personnel who readily say they cannot treat a serious medical emergency.

This paradox is traced to a recent medical phenomenon: the rise of urgent-care centers.

These storefront medical offices are pitched as low-cost, no-wait alternatives to slow, expensive hospital emergency rooms for those with minor coughs, cuts or pains.

They have been remarkably effective, multiplying rapidly and forcing many hospitals to streamline emergency services and even start their own urgent-care centers.

Competing for Patients

But the fierce competition for the “walk-in” customer has created a confusing, some say potentially dangerous, situation.

Even though many of the centers emphasize in their ads that they treat only “minor emergencies” or “the walking sick and injured,” in a serious emergency, few people stop to read the fine print.

The danger, according to many doctors--including some who work at urgent-care centers--is that a person with a condition that threatens life or limb may waste precious time seeking help in the wrong place.

Here are two recent examples:

A man entered the Laurel Canyon Urgency Room and Medical Group office in North Hollywood last week with a finger “hanging just by a piece of skin,” said Dr. Aaron Ifekwunigwe, the owner and doctor on duty. He knew this was beyond his expertise and sent the man to a nearby hospital.

When the victim of a vicious fistfight was taken to Intercare Medical Center in Van Nuys last week with broken bones in his cheek and around his left eye, Dr. Mark L. Gordon said, he sent him directly across the street to the emergency room at Valley Hospital Medical Center.

Many centers have removed references to emergency service from their names and advertising, prompted by increased recognition within the medical community that the words can be misleading.

Even the centers’ national association changed its name, from the National Assn. of Free-standing Emergency Centers to the National Assn. for Ambulatory Care Centers.

Derivatives Stand

But a survey of urgent-care centers in the San Fernando Valley area still turns up a few with names such as Emergi-Center, Emergi-Office and Urgency Room. The phone-book listing for Calabasas Medical Group reads, “Efficient emergency care.”

Two medical associations are backing state legislation that would prohibit use of the word “emergency” or a derivative, such as “emergi-center,” by any medical facility that is not equipped to handle serious conditions 24 hours a day.

The California Medical Assn., which has more than 7,000 members in Los Angeles, is sponsoring a bill carried by Sen. Henry J. Mello (D-Watsonville) that would require a long list of required services and staffing for self-styled “emergency” centers.

The California chapter of the American College of Emergency Physicians is backing a similar bill, put forward by Sen. Ken Maddy (R-Fresno).

Bills Set Standards

Both bills, which are winding their way through committees toward a midsummer vote, list equipment and staffing that would be required of a center using the word “emergency.” There would be equipment, medication and staff sufficient to deal with a variety of crises, including X-ray and laboratory facilities, and at least one physician trained in emergency medicine.

Now, the urgent-care centers are treated as private doctors’ offices by the state and thus do not fall under regulations required of hospitals and medical clinics. Many of the doctors who run them are trained in family practice rather than emergency medicine, said Dr. Michael Jay Bresler, president of the California chapter of the American College of Emergency Physicians.

Some doctors say the legislation is an attempt by beleaguered hospitals to stifle the new competition.

“The average emergency room census has been going down for the last few years now,” said Dr. John Arterberry, director of emergency services for Northridge Hospital Medical Center. “The public is wising up to the fact that this is a very expensive form of care.”

The rate of growth of the urgent-care industry has been explosive. In 1982, there were 30 centers in California; now there are more than that just in the Valley area and Ventura County, and more than 200 statewide, according to the National Assn. for Ambulatory Care Centers. A representative of the association said more than 60 million Americans will spend a total $8 billion this year on medical care at urgent-care centers nationwide.

“The hospitals are fighting back by trying to get some state standards mandated,” Arterberry said. “If you deprive urgent-care centers of the ability to use the term ‘emergency,’ you deprive them of a major marketing tool.”

Arterberry said he supports standards for use of the word, but with some reservations. “I should be very much in favor of restrictive legislation,” he said. “But I can’t get that excited about protecting hospitals from competition. I look upon these guys like the Japanese, who kicked Detroit in the butt and kept the cost of a car down.”

Resolution Predicted

The problem of public confusion about where to go for emergency service may soon resolve itself, some staff members of urgent-care centers say, because of changes in the market.

“Four or five years ago there was a perception in the marketplace that opening an urgent-care center was somewhat akin to being handed the keys to King Solomon’s Mine,” said Robert Marks, president of North Star Medical Enterprises, which operates Emergi-Center in North Hollywood.

“Now there is so much competition for the walk-in portion of the business that many groups are turning back to more predictable sources of patients,” he said.

Emergi-Center may soon change its name to “Walk-in Center or something like that,” said Dr. Naum Rit, the center’s physician.

Marks said this center, like many of its competitors, is turning more toward repeat customers, trying to foster family practice and establish contracts to provide health care to local industries and health maintenance organizations. The regular business, he said, “allows you the freedom to spend time treating patients well rather than always beating the bushes for new patients.”

“Just depending on hit-and-run medicine--the person who walks in off the street--is not enough,” said Ifekwunigwe of the Urgency Center in North Hollywood.

Arterberry and others say there is room for both emergency care and urgent care.

Impromptu Referral

Linda Reskin, coordinator of the emergency department at Valley Hospital Medical Center, said the urgent-care center just across Sherman Circle from the emergency room entrance hasn’t noticeably changed things. “Actually, what’s happened most of the time is they get a patient in there with chest pain and they will send him over here,” she said.

One consequence of the new competition is that the hospital instituted a two-tiered pricing policy, with cheaper rates for routine services, she said.

Across the street at Intercare Medical Center, Dr. Mark Gordon said that Intercare, which operates three other urgent-care centers in the Valley and seven more around Los Angeles, makes no attempt to compete with emergency rooms. “We can’t do everything for everybody,” he said. “Otherwise, we’d have to be a little hospital.”

The center, like most, can stitch a cut, test for strep throat, even X-ray a bad back. It is open long hours, requires no appointment and is cheap, Gordon said. An X-ray of the lower back, for instance, would cost about half as much as it would across the street, he said.

But when a certain line is crossed--the line between, say, a stomach ache and the piercing pain of appendicitis--it is time to head to the hospital.

“We have a lot more capabilities and equipment than the average doctor’s office,” said Dr. Philip Fagan, chief executive officer and medical director of Intercare Medical Centers. “But, ultimately, we’re a doctor’s office, not a hospital.

“When you have chest pain, you should call the paramedics, not show up in your doctor’s office,” he said.