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GAO Says Unregulated Clinics Pose ‘Deadly’ Risks

April 29, 1991

WASHINGTON (AP) _ Outpatient surgical centers and walk-in clinics independent of hospitals are largely unregulated, leaving an unsuspecting public at risk of shoddy care, according to congressional investigators.

A General Accounting Office study of immediate-care facilities found ″a deadly medical triangle″ - untrained doctors performing high-risk procedures, misleading advertising and unlicensed, uninspected facilities, investigator Frank Papineau told a House subcommittee.

While outpatient centers can offer cheaper care and more convenience and privacy, ″we have found that too often, procedures performed in these clinics are conducted in spartan settings with skeleton crews that are never inspected,″ Papineau said.

″Under such conditions, they are a refuge for the unqualified, the unscrupulous and the undertrained,″ he testified to the House Small Business subcommittee on regulation.

He called the currently unregulated landscape for ambulatory care facilities ″an open invitation to bad medicine.″

Twenty years ago, few ambulatory care facilities existed. Today, there are an estimated 23,000 state-licensed ambulatory surgical, diagnostic and immediate-care facilities, according to subcommittee staff. Forty-one states have licensing programs, and their regulations vary.

Fewer than 7 percent of these state-licensed units are affiliated with a hospital. The rest are independent, for-profit enterprises.

Hospitals have to meet certain requirements to be accredited, including peer review committees that monitor conditions in the facility and can intervene if problems are found. Physicians have to present their credentials for review to get hospital privileges. Hospitals also can monitor physicians until they demonstrate competence.

Absent these requirements, ambulatory clinics are a ″fertile environment″ for unethical entrepreneurs, said Rep. Ron Wyden, D-Ore., subcommittee chairman.

″In the words of one anonymous physician interviewed by subcommittee staff, outpatient service is an area of care favored by the ’medical buccaneer,″ he said.

Wyden said he wants to find a way to adequately regulate these facilities, allow their continued growth and at the same time assure high quality care.

Raymond Portlock of Duncanville, Texas, told panel members about the death of his 4-year-old daughter, Erica, after being given an overdose of chloral hydrate as a sedative for a radiological test at a local diagnostic center.

″We never saw a doctor″ at the Duncanville Diagnostic Center, he said.

Donna Fernandez of Chantilly, Va., said she never saw a doctor, or a nurse, at a walk-in clinic in Virginia where she brought her son, then 3, in 1988 after a candy ball lodged in his throat. The center billed itself as an ″immediate care clinic,″ but when she arrived, one doctor had already left and his replacement had not yet arrived, she said.

Her son was saved by a policeman who happened by.

″Today, I am a little wiser,″ Fernandez said, ″and I don’t put much faith in a sign that says ″immediate care.″

One of the fastest growing segments of the ambulatory care industry is the surgical center. The Joint Commission on Accreditation of Healthcare Organizations, a nonprofit organization that develops performance standards for health care groups, identified 853 non-hospital surgicenters in 1987. That had grown to 1,227 two years later.

Dennis O’Leary, president of the accreditation commission, said only a small number - about 58, or 14 percent - of outpatient surgery centers voluntarily participate in the accreditation process.

″There is at present no documented crisis,″ he said, ″but there is a valid public interest issue.″

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