Witnesses Relate Medical Horror Stories at Hearing on Outpatient Clinic Industry : Health: “It’s like Dodge City before the marshals,” one physician testifies. Congressional panel urges tighter regulations.

After hearing a distraught Texas father describe the death of his 4-year-old daughter at an emergency medical clinic, a congressional panel Monday decried what it said is an alarming increase in medical horror stories in the fast-growing clinic industry.

The industry has mushroomed at such a pace that currently nearly half of all surgeries are performed in clinics, yet they remain largely unregulated.

“It’s like Dodge City before the marshals,” Dr. Dennis O’Leary, president of the Joint Committee on Accreditation of HealthCare Organizations, said in testimony before a regulation subcommittee of the House Committee on Small Business. O’Leary’s group is a nonprofit organization that develops performance standards.

Rep. Ron Wyden (D-Ore.), subcommittee chairman, said the lack of regulations for outpatient care “provides a fertile environment for medical entrepreneurs who are undertrained, unscrupulous or unethical.” He said evidence indicates that “millions of procedures are performed each year in unlicensed or substantially under-regulated facilities.”

Even though 41 states require outpatient clinics to be licensed, “most states’ requirements are no more than fire and building code requirements” and do not examine the qualifications of the doctor or support staff, said Steve Jenning, the subcommittee’s staff director.

In addition, the subcommittee found no state with sufficient minimum standards for staff, equipment or accurateness of advertising at outpatient clinics.

Over the past 20 years, the number of outpatient clinics has increased to more than 23,000. While offering cheaper care and more convenience than many hospitals, such centers are often home to malpractice, false advertising and insufficient regulation, the subcommittee said in a report.

The report noted that by 1995, 65% of all surgeries will be performed outside of hospitals.

At the hearing, Raymond Portlock of Duncanville, Tex., explained how his 4-year-old daughter died after receiving a massive overdose of a sedative from an unqualified technician at a diagnostic clinic in 1989.

Many doctors who perform specialty surgeries, such as cosmetic surgery, at an outpatient center are not qualified to do so, Dr. Gustavo Colon, president of the American Assn. for Accreditation of Ambulatory Plastic Surgery Facilities, said in a statement.

“Even tattoo artists, hairdressers and manicurists need licensing and/or health board examination to practice their specific art, while a physician who decides to perform surgery in his office currently does not need licensing for any specific procedure,” he added.

Kenneth Wagstaff, executive director of the Medical Board of California, said that most ambulatory surgery centers and outpatient clinics in the state are not regulated.

He cited one case in Los Angeles where an ear, nose and throat doctor falsely advertised himself as specializing in plastic surgery and his inexperience in the field led to the death of one patient and the disfiguring of several others.

Doctors at some of the centers have been accused of overbilling patients for needless, or even unperformed, surgery. “The centers are usually skimming away the cream of the crop in terms of the high-margin procedure, the most profitable procedures,” Jenning said, adding that doctors at such clinics will try to reduce the cost of their operation by cutting back on equipment and staff.

Unlike those practicing at an outpatient clinic, doctors working at a hospital are subject to peer review and must submit their credentials for review and can perform specialized procedures only if they have adequate training and experience in that area, Wagstaff noted.

Less than 7% of all state-licensed surgical, diagnostic and emergency care units have hospital affiliation, the subcommittee report found.

Jenning said the subcommittee recommends enforcing minimum standards for equipment and personnel training as well as peer review for doctors working at outpatient clinics.