Doctors groups criticize plan for drugstore clinics
Urge safeguards against lax care
When Mary Manning's granddaughter contracted an ear infection last month while visiting from France, Manning searched in vain for a doctor who would see her that day.
"I didn't want to go to the emergency room because I knew it would take eight hours," the retired nurse told state health officials at a hearing yesterday on proposed rules to allow the opening of medical clinics in retail stores.
Manning, who is also an official with the Massachusetts Association of Registered Nurses, is the kind of customer the pharmacy chain
Manning's testimony provided a personal note at a meeting dominated by criticism from physicians groups that said the rules would not do enough to protect clinic patients from infections or to ensure that patients receive consistent medical treatment from providers who know their histories.
A Public Health Department official said the agency will consider whether to revise the proposed rules to respond to doctors' concerns.
Dr. Bruce Auerbach, president-elect of the Massachusetts Medical Society, called some of the regulations "an open surrender of basic standards." He said the department's decision not to require that clinics have their own sinks represented a threat to public health at a time when hospitals are working to reduce the transmission of germs.
Paul Dreyer, director of the health department's Bureau of Quality Assurance and Control, dismissed that concern in an interview, saying the basic services the clinics would provide do not require the same sanitation standards as hospitals or doctors' offices. But he said regulators would look at requiring clinics to answer phone calls after hours and establishing a minimum age for patients, as the state organization of pediatricians recommended.
"We received a good deal of thoughtful testimony both in favor and opposition to the regulations, and those that were opposed made very helpful suggestions on how to make the regulations better," he said.
The department developed the rules after CVS asked for permission to open as many as 30 "MinuteClinics" in the Boston area. The regulations would require clinics to limit the number of repeat visits, refer patients to primary care doctors for complex illnesses, and provide a copy of records from the visits to the patients and their doctor.
Dreyer said the department has since received calls from other groups interested in opening such clinics.
Michael Howe, chief executive of MinuteClinic, a subsidiary of CVS, said in an interview that the company is largely pleased with the rules, which he said would allow clinics to provide affordable, convenient services at a time when demand for primary care is growing because of the new state law mandating health insurance.
Howe said the company's Massachusetts clinics, if approved, would open in 2008 and charge $59 per visit. The company is negotiating with state insurance providers to cover the service.
Doctors at the hearing also questioned whether a conflict of interest would be created when clinic staff prescribed drugs sold by their own employer.
"Unlike in a pediatric office, there may not be an incentive to provide the most cost-effective drugs," said Dr. Karen McAlmon, head of the state chapter of the American Academy of Pediatrics.
Howe said that MinuteClinic staff are trained to prescribe generic drugs whenever possible and that every prescription states that patients can purchase the medicine at a pharmacy of their choice.
The state Public Health Council could vote on the revised rules as early as November.
