Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-10T13:17:18.455Z Has data issue: false hasContentIssue false
  • English
  • Français

The Emergicenter: Has its Time Arrived?

Published online by Cambridge University Press:  28 April 2021

Miles J. Zaremski  and
Darryl M. Fohrman
Get access Rights & Permissions [Opens in a new window]

Extract

Skyrocketing health care costs are endemic during inflationary periods, affecting not only health care consumers, but also health care providers. Virtually all governmental policymakers recognize spiraling health care costs, but hospital costs continue to escalate faster than the general rate of inflation. In response, alternatives to the traditional physician-patient and hospital-patient relationships have experienced a dramatic resurgence in the last decade, competing for the health care dollar. Two health care alternatives, the health maintenance organizstion (HMO) and the ambulatory surgical center (surgicenter) at which minor surgical procedures can be performed on an out-patient basis. have emerged to provide health care services in a more cost-efficient manner, thereby increasing price competition in the health care sector. The most recent alternative health care system on the health care horizon is the free standing emergency center or “emergicenter.” The growth of these emergicenters within the last few years has heen dramatic—500 in existence as of March 1982.

Type
Article
Information
Law, Medicine and Healthcare , Volume 11 , Issue 1 , February 1983 , pp. 4 - 44
Copyright
Copyright © 1983 American Society of Law, Medicine & Ethics

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Those Sky High Health Costs, Time Magazine 120(2): 54 (July 12, 1982). Nearly 10 percent of the United States gross national product is now spent on some sort of medical care, compared with 5.4 percent in 1960. Medical charges jumped a record 12.5 percent in 1981, the largest gain for any major consumer item. Id. at 55. The personal health care bill for the nation totaled $218 billion in 1980. Big Changes Ahead in How We Buy Health Care, Changing Times 36: 60 (March 1982) [hereinafter referred to as Big Changes].Google Scholar
National Health Planning and Resources Development Act of 1974, 42 U.S.C. §300K et seq. (1976); U.S. Code Cong. and Ad. News 1974: 7842, 7843, 7853.Google Scholar
Soaring Costs, Time Magazine 120(6): 42 (August 9, 1982). According to the federal Department of Health & Human Services, “the nation's health bill shot up 15.1 percent in 1981, outpacing the 8.9% inflation rate for the year.” The Department's statistics showed that over the past 10 years, expenditures for hospital care, a principal cause of the huge increase in 1981, quadrupled to $118 million. The costs of physician's services more than tripled to $54.8 billion. Id. See also Big Changes, supra note 1 (health care costs are outside the control of normal market forces).Google Scholar
The HMO is a prepaid health care organization plan composed of a health insurance plan, administrative level, and a care provider group. For a full description of the various types of HMOs, see Binford, G.C., Malpractice and the Prepaid Health Care Organization, Whittier Law Review 3:337 (1981). Under an HMO plan, a family pays a flat fee and in return is provided with comprehensive medical care. The plan attempts to reduce costs by making physicians and administrators accountable for health care expenditures. One Cap for Health Costs, Time Magazine 120(2): 55 (July 12, 1982).Google Scholar
Advocates of competition in health care contend that the present reimbursement system provides patients and physicians with little incentive to save on medical costs. Big Changes, supra note 1. See Koncel, J. A., Experts Examine Major Issues Facing Emergicenters, Hospitals 55(10): 83 (May 16, 1981) (overview of views on competition) [hereinafter referred to as Koncel]. See also, Michaels, J.L. Crouter, M.J., Emergicenters and the Need for a Competitive Regulatory Approach, Law, Medicine & Health Care 10(3): 108 (June 1982) [hereinafter referred to as Michaels & Crouter] (increased competition would encourage good managerial practices and improved cost efficiency). See generally Eisenberg, H., … And Other Competition You Will Face in 1983, Medical Economics 60(1): 239 (January 10, 1983).Google ScholarPubMed
The centers use various names and often do not use the term “emergi” or “emergency” in their titles, because these terms may create the impression that the center can handle life-or limb-threatening emergencies, when the center is staffed, equipped, and intended to offer only primary care services. Burns, L.A. Ferber, M.S., Freestanding Emergency Care Centers Create Public Policy Issues, Hospitals 55(10): 73 (May 16, 1981) [hereinafter referred to as Burns & Ferber].Google ScholarPubMed
The first emergicenter opened in 1973, and one estimate is that there are more than 500 freestanding emergicenters currently in existence. Emergency Centers Fill Medical Void; Twenty Operate in State, Miami Herald, March 15, 1982 [hereinafter referred to as Emergency Centers Fill Medical Void]. Rapid development has occurred in Texas, Florida, and the Midwest, and most recently in New York and California.Google Scholar
See Michaels, Crouter, , supra note 5, at 108.Google Scholar
For more detailed background information on emergicenters, see Burns, Ferber, , supra note 6; Seager, S. Barker, B., Hospital and its Freestanding Emergency Facilities Form Network, Hospitals 55(10): 79 (May 16, 1981); Koncel, , supra note 5.Google Scholar
Letter from Cripe, Michael J., NAFEC Managing Director, (September 17, 1982). NAFEC (formerly known as National Association of Centers for Urgent Treatment) is located at 404 Burton Park, 8700 N. Stemmons Freeway, Dallas, TX 75247.Google Scholar
The Doctor's In (NAFEC, Dallas, Tx.) (March 1981).Google Scholar
The independent, physician-owned emergicenter falls within this definition, which does not preclude the ongoing relation with a hospital through a separate contractual relation, for example, for the transfer of patients or use of laboratories. See Burns, Ferber, , supra note 6, at 73.Google Scholar
This would not preclude a contractual arrangement between the hospital and a group of physicians to provide services at the emergicenter as independent contractors. Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
The various types of medical treatment available from a NAFEC-member emergicenter include treatment for cuts, lacerations, sprains, fractures, chest pains, influenza, accidents, and job-related injuries. The Doctor's In, supra note 11. This brochure stresses that victims of life-threatening emergencies, such as automobile accidents, are encouraged to go directly to a hospital emergency room with full back-up medical services. Several emergicenters offer expanded services, including blood tests for marriages, physical checkups for employees of nearby businesses, and other occupational health services. See Background Information: The Doctors’ Emergency Officenter (Mercy Hospital and Medical Center, Chicago, Il.) (September 9, 1982).Google Scholar
See Dallas-Fort Worth Area is a Boom Area for Emergicenters, Hospitals 55 (10): 76 (May 16, 1981). See also Bums, Ferber, , supra note 6, at 74.Google Scholar
Members of the Congress of Delegates of the American Academy of Family Practices recently attacked the “for-profit primary care centers” because they offered episodic care rather than the continuing care basic to preventive medicine. Retail “Emergicenters” Take Off, Business Week, March 8, 1982, at 40 [hereinafter referred to as Retail “Emergicenters”].Google Scholar
Emergency Centers on Rise in U.S., Los Angeles Times, May 22, 1982, at 30 (hospital figures were compiled by Blue Cross of Southern California; figures for emergicenters developed from sampling charges at several southern California centers).Google Scholar
Emergency Centers Fill Medical Void, supra note 6.Google Scholar
Retail “Emergicenters,” supra note 19, at 40.Google Scholar
See Bums, Ferber, , supra note 6, at 74.Google Scholar
Emergency Centers on Rise in U.S., Los Angeles Times, May 22, 1982, at 33. This would be particularly true of independent, physicianowned emergicenters, as a hospital satellite emergicenter is an adjunct of the hospital and presumably offers the same payment plans as the sponsoring hospital. Of course, there may be individual differences in emergicenter structures.Google Scholar
Id. at 33.Google Scholar
See 42 U.S.C. §1395, et seq. (1981) (Medicare reimbursement policy).Google Scholar
See Koncel, , supra note 5, at 90 (quoting one advocate: “[C]ompetition in the health care area may achieve better patient care, the ultimate goal of any health care system”).Google Scholar
Apparently the only major problem facing both existing and prospective emergicenters is the risk of governmental regulation if the centers fail to police themselves. Retail “Emergicenters,” supra note 19, at 40.Google Scholar
Michaels, Crouter, , supra note 5.Google Scholar
Id. at 110. See Retail “Emergicenters,” supra note 19.Google Scholar
Michaels, Crouter, , supra note 5, at 109.Google Scholar
Id. See also Retail, “Emergicenters,” supra note 19, at 40.Google Scholar
Emergency Centers Fill Medical Void, supra note 6.Google Scholar
Florida has considered legislation regulating emergicenters but has not yet passed it; Colorado has CON requirements, yet their applicability to emergicenters is questionable; California has a growing interest in regulation, as does Tennessee, which has held public hearings on the regulation issues. Telephone interview with Roberts, James, NAFEC Managing Director (January 5, 1983). See also NAFEC to Issue Position Paper on Regulation, Industry Issues, Emercence 2(5): 2 (July 1982).Google Scholar
See Michaels, Crouter, , supra note 5, at 108. Rhode Island Department of Health, Rules and Regulations for the Licensing of Freestanding Emergency Care Facilities, R23-17-FECF §1.1 (December 30, 1981). Rhode Island legislation is currently being constitutionally challenged. Telephone interview with Roberts, James, NAFEC Managing Director (January 5, 1983).Google Scholar
Letter from Cripe, Michael J., NAFEC Managing Director (September 17, 1982).Google Scholar
See National Association of Freestanding Emergency Centers, Bylaws (NAFEC, Dallas, Tx.) (September 1981) [hereinafter referred to as NAFEC Bylaws].Google Scholar
Letter from Cripe, Michael J., NAFEC Managing Director (September 17, 1982).Google Scholar
See NAFEC Bylaws, supra note 37.Google Scholar
Tougher Membership Standards Adopted, Emergence 2(5): 3 (July 1982).Google Scholar
American College of Emergency Physicians, Emergency Care Guidelines (ACEP, Dallas, Tx.) (1982) [hereinafter referred to as Guidelines]. They were approved by the Board of Directors of ACEP on December 4, 1981, and by the Board of Directors of the Emergency Department Nurses Association on February 5, 1982.Google Scholar
See, e.g., Darling v. Charleston Memorial Hosp., 211 N.E.2d 253 (III. 1965), cert. denied, 383 U.S. 946 (1966).Google Scholar
See Guidelines, , supra note 41, at Introduction.Google Scholar
Id. This guideline is especially important when one considers that permanent medical records are not always kept by emergicenters. Retail, “Emergicenters,” supra note 19.Google Scholar
See Guidelines, , supra note 41.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Joint Commission on Accreditation of Hospitals, Accreditation Manual for Ambulatory Health Care 1982 (JCAH, Chicago) (1981).Google Scholar
Joint Commission on Accreditation of Hospitals, Accreditation Manual for Hospitals 1982 (JCAH, Chicago) (1981) at 63–70.Google Scholar
Retail, “Emergicenters,” supra note 19.Google Scholar
At the June 13-17, 1981, Interim Meeting of the American Medical Association in Chicago, the House of Delegates referred the subject to the Board of Trustees. Report of the Board of Trustees, Freestanding Emergency Medical Care Centers (Resolutions 27, 641-81). The Report was not adopted, but was returned to the House of Delegates for further consideration at its December 1982 meeting. Telephone interview with Brievogel, Jean, Assistant Director, Media Relations, Office of Public Relations, American Medical Association (September 9, 1982). The Association has not adopted any formal policy regarding emergicenters.Google Scholar
Cook County Jury Verdict Report, September 24, 1982. Malpractice suits filed in Cook County, Illinois, through September 1982 increased by 9.4 percent over the same period in 1981. From January through September 1982, more than 1,175 suits were filed.Google Scholar
See What Price Health? Chicago Suntimes, November 8, 1982, §1, at 1.Google Scholar
Binford, G.C., Malpractice and the Prepaid Health Organization, Whittier Law Review 3:337 (1981). Causes of action have sounded in breach of contract, negligent selection or control of physicians, and breach of fiduciary duty. See, e.g., Amago v. Cuban Clinic Ass'n of Health, 345 So.2d 1091 (Fla. App. 1977) (issue of fact as to whether the HMO was liable to the subscriber for the cost of providing medical care to wife at a nonparticipating hospital); Pulvers v. Kaiser Foundation Health Plan, 160 Cal. Rptr. 392 (Cal. App. 1979) (health maintenance organization, by representing in its literature that it would provide “high standards” of medical services, did not thereby warrant a standard higher than non-negligence).Google Scholar
Prosser, Law of Torts (4th ed. 1971) at 685–86.Google Scholar
Emergency Centers on Rise in U.S., Los Angeles Times, May 22, 1982, at 30.Google Scholar
Id.Google Scholar
Designations of emergency facilities vary regionally. Guidelines, , supra note 41.Google Scholar
Id.Google Scholar
For example, NAFEC informs the public of the functions of emergicenters through brochures and leaflets. Mercy Hospital and Medical Center in Chicago also promotes public awareness of the emergicenters’ function and capability by distribution of a packet of information. Background Information: The Doctor's Emergency Officenter (Mercy Hospital and Medical Center, Chicago, II.) (September 9, 1982).Google Scholar
For example, an emergicenter may be called ABC Hospital and XYZ Physicians Freestanding Emergency Center. XYZ physicians may only be leasing space from the hospital, and the hospital may have no daily control of the facility's operations. Yet, the name of the facility may plausibly be interpreted to mean that the ABC hospital owns or somehow manages the emergicenter; that the physicians from the emergicenter are on staff at the hospital; or that if further emergency care is needed, the patient will “automatically” be taken to the affiliating hospital.Google Scholar
For example, the hospital and emergicenter may have a contract for rental space, transfer of patients, referral of patients, and use of laboratories and other equipment.Google Scholar
One estimate is that only ½ of 1 percent of patients coming to the emergicenter for treatment will need subsequent emergency medical treatment. Telephone interview with Marcia Bingham, Director of Public Relations, Mercy Hospital and Medical Center, Chicago, III. (September 9, 1982).Google Scholar
See Guidelines, , supra note 41.Google Scholar
Id.Google Scholar
Michaels, Crouter, , supra note 5, at 111. As noted previously, many emergicenters refuse to treat Medicare patients; it is unknown whether this extends to other indigent patients. See Emergency Centers on Rise in U.S., Los Angeles Times, May 22, 1982, at 33.Google Scholar
Hiser v. Randolph, 617 P.2d 774 (Ariz. App. 1980) (physician generally free to contract for services, although he has duty to see patients while on call). See also Hill v. Ohio County, 468 S.W.2d 306 (Ky. App. 1971) (county hospital had no duty to admit the decedent for obstetrical care in absence of order from physician).Google Scholar
See generally Good Samaritans and Hospital Emergencies, Southern California Law Review 54:417 (1981).Google Scholar
Id. See, e.g., Ill. Rev. Stat. ch. 111 §4404 (1978) (emergency care of injured persons; exemption from civil liability); Ind. Stat. Ann. §§34-4-12-1 et seq. (1981) (immunity; rendering emergency first aid); Mich. Comp. Laws Ann. 35: §691.1501 (1981) (physicians’ and nurses’ emergency care; civil liability). See also Matts v. Hornsi, 308 N.W.2d 284 (1981) (statute provides partial immunity to physicians whose actual duty does not require response to emergency but who respond in good faith to life-threatening emergency within a hospital or other licensed medical care facility; statute does not require that person providing emergency care be affiliated with facility where care is rendered). But see Hamburger v. Henry Ford Hosp., 284 N.W.2d 155 (Mich. App. 1979) (due to absence of express language in good samaritan statute, it is unreasonable to conclude legislature intended to protect hospitals where hospital-patient relationship existed at time of negligent act).Google Scholar
See McKenna v. Cedars of Lebanon Hosp., 155 Cal. Rptr. 631 (Cal. App. 1979) (hospital physician responding to “code blue” was essentially a medical volunteer called to a scene of emergency; hospital patient not his patient).Google Scholar
Compare Hamburger, supra note 70 (hospital-patient relationship established hospital liability for negligence of employees responding to emergency); with Matts, supra note 70 (no physician-patient relationship before emergency; good samaritan act applicable), and Colby v. Schwartz, 144 Cal. Rptr. 624 (Cal. App. 1978) (good samaritan immunity not available to physicians on hospital emergency call panel who treat patients requiring immediate medical care, as this is part of normal course of practice).Google Scholar
Hamburger, supra note 70. The court held that the good samaritan statute excused only physicians, nurses, and specified hospital personnel from civil liability where volunteer assistance is performed in an emergency, without gross negligence or wilful or wanton misconduct. However, a hospital, due to the high standard of care it is required to provide patients, may be liable for ordinary negligence in the treatment of a patient by employees where a hospital-patient relationship exists at the time of the negligent act. In this case, a nurse's aide assisted patient in distress, although it was not the ordinary responsibility of the aide to do so.Google Scholar
One who represents that another is his servant or other agent and thereby causes a third person to justifiably rely upon the care or skill of such apparent agent is subject to liability to the third person for harm caused by the lack of care or skill of one appearing to be a servant or other agent as if he were such. Restatement (Second) of Agency (1968) §267.Google Scholar
A hospital can be derivatively liable for the negligent acts of its employees committed in the course of their employment. See, e.g., Musso v. Westfield Memorial Hosp., 407 N.Y.S.2d 605 (N.Y. App. Div. 1978) (hospital liable for alleged act or omission of emergency room employee in failing to discover and treat plaintiff for frostbite and subsequent gangrene).Google Scholar
See, e.g., Hannola v. City of Lakewood, 426 N.E.2d 1187 (Ohio App. 1980).Google Scholar
Id. at 1187.Google Scholar
Id. at 1188.Google Scholar
Id. at 1190.Google Scholar
Id. at 1191.Google Scholar
Id. at 1190.Google Scholar
Adamski v. Tacoma Gen. Hosp., 579 P.2d 970, 977 (Wash. App. 1978).Google Scholar
Id. at 977.Google Scholar
Gasbarra v. St. James Hosp., 406 N.E.2d 544, 555 (Ill. App. 1980).Google Scholar
Id. See Wallace v. Garden City Osteopathic Hosp., 314 N.W.2d 557, 561 (Mich. App. 1981).Google Scholar
See Zaremski, M.J. Spitz, M.M., Liability of a Hospital as an Institution: Are the Walls of Jericho Tumbling? Forum 16(2): 225 (Fall 1980); Zaremski, M.J., Hospital Corporate Liability: The Walls Continue to Tumble, Medicolegal News 9(2): 13 (April 1981).Google Scholar
See, e.g., Darling v. Charleston Memorial Hosp., 211 N.E.2d 253 (Ill. 1965), cert. denied, 383 U.S. 946 (1966); Edmonds v. Chamberlain Memorial Hosp., 629 S.W.2d 28 (Tenn. App. 1981); Johnson v. Misericordia Community Hosp., 301 N.W.2d 156 (Wisc. 1981): Elam v. College Park Hosp., 183 Cal. Rptr. 159 (Cal. App. 1982); Pickle v. Curns, 435 N.E.2d 877 (Ill. App. 1982).Google Scholar
286 S.E.2d 374 (N.C. Ct. of App. 1982).Google Scholar
Id. at 376.Google Scholar