‘Minute Clinics’ Raise Round-the-Clock Risks
By Eric
Berkman
“Minute
clinics” will soon be opening in CVS stores across Massachusetts,
with nurses dispensing medical advice and prescriptions in what the
pharmacy chain claims to be a quick and inexpensive way for patients to
get care for minor medical problems. But in approving these clinics, has
the state Public Health Council made a risky move?
Doctors,
lawyers and consultants warn that the clinics open a host of liability
risks and other concerns for the nurse practitioners who will staff
them, the physicians who will supervise them and the primary care
physicians whose patients may visit them.
Lawyers tell
Massachusetts Medical Law Report that the operational model for the
typical clinic – a nurse practitioner treating patients on site
with the supervision of an offsite physician – creates legal
concerns for doctors and nurses alike.
“If I
were a physician, I’d be very concerned about trying to supervise
someone else at a distance whom I don’t really know, dealing with
a patient whom I’ll never see,” said Leonard Simon, a lawyer
in Waltham who represents plaintiffs in medical-malpractice
cases.
In addition,
doctors and lawyers are concerned about the fragmentation of care that
could result when patients visit clinics without the knowledge of their
primary care physician.
“From
what we’ve seen, these clinics are not integrated into the health
care systems that have been developed by physicians, provider groups and
hospital networks over the last number of years,” says Bruce S.
Auerbach, president-elect of the Massachusetts Medical Society and vice
president and chief of ambulatory services at Sturdy Memorial Hospital
in Attleboro.
With the
arrival of limited-service clinics – at more than two dozen CVS
stores in Massachusetts this year and probably other retailers in the
not-too-distant future – there will be new job opportunities for
nurse practitioners and primary care doctors.
But before
jumping in, doctors and lawyers suggest that providers:
-
Ensure that
the retailer will cover any malpractice claims that arise;
-
Verify that
the retailer has acceptable written guidelines for when to refer a
patient to their own physician or the emergency room; and
-
Affirm that
systems are in place to receive a patient’s medical history and to
report details of the visit back to the primary care
physician.
Next: Risky
Rewards?
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