WIS Investigates: Urgent care facilities vs. emergency rooms

COLUMBIA, SC (WIS) - Urgent care facilities have popped up across South Carolina, especially as federal numbers show a doctor shortage. While some may compare the retail medical centers to emergency rooms, the differences a WIS investigation uncovered may surprise you.

Our investigation started in January, when a man who claimed to be a licensed practical nurse at a West Columbia urgent care was charged with sex crimes. As a result of the investigation, Kerston Turner was also charged with unlawfully representing himself as a nurse. Turner's case is pending in court.

When we started investigating, the investigative team discovered some medical facilities have more regulations than others.

Turner isn't a registered LPN with South Carolina, which was verified by a search on the S.C. Department of Labor, Licensing and Regulation website. However, a Lexington County arrest warrant identifies Turner as a LPN at MEDcare in West Columbia, where he was charged with sex crimes.

When we asked MEDcare's corporate office in Charleston about Turner's employment, MEDcare said Turner was hired as a medical technician, not a LPN. But the Lexington County Sheriff's Department said Turner was doing duties beyond what a medical technician is qualified to perform.

"You put a lot of trust in, as a patient, in the fact that the physician is licensed, and that he is practicing to a good, professional standard," said Lynn Bailey, medical economist.

Employee credentials

Our investigative team wanted to know who is responsible for ensuring the person drawing blood or taking your temperature or blood pressure has the credentials to do so.

"In South Carolina, I would say that there are no state regulations specific to urgent care," said Doctors Care President Dr. Thomas Gibbons, Jr.

We discovered that a medical technician, sometimes called a medical assistant, does not need a certification to work in an urgent care facility. These technicians or assistants are the ones assisting physicians in the facilities.

Doctors Care has 18 locations in the Midlands, while they don't have a credentialing committee like a hospital to vet its employees, the company has an in-depth hiring process.

"We do drug screenings. We do background checks. We use – it used to be LexusNexus, I think now it's First Advantage, and what they do is they go back seven years," Gibbons said. "Every county that you've lived in there's either an electronic or a manual process to sort out whether or not this person has any issues that might be important to know."

MEDcare has a three-tier interview process and three different types of background checks – criminal, worker's compensation, and sexual offender checks. Technicians are put through their own six- to eight-week training that includes classroom lessons, hands-on orientation with prosthetic limbs, and a training period with a MEDcare associate.

Doctors Care also has a training plan for its employees.

"Let's say a medical assistant," Gibbons said. "There's a checklist. They have to take a test on how to give medication dosages, on how to demonstrate how to administer injections. So could someone possibly pull something over? I guess, but it would be exceedingly difficult in the process that we have in place for that to happen."

For the employees that do require certification are verified by the state's LLR, which handles licensing for 44 agencies.

"The same administrative persons regulate the people who cut your hair and do your nails and do your feet with the same people who deliver your babies," Bailey said.

Staffing aside, when it comes to facility regulations, our investigation uncovered major differences in regulations from a hospital to an urgent care to a traditional doctor's office.

When certified personnel licenses are checked, LLR doesn't make site visits to check the business. When it comes to a hospital's emergency department, they answer to the S.C. Department of Health and Environmental Control, Center for Medicaid and Medicare Services and LLR, and a credentialing committee checking everyone's certifications.

"They will check with LLR to see if they have a current license," said James Walker Jr., S.C. Hospital Association senior vice president. "If it's required for that profession, they will check to see if there are any complaints against those individuals. They may do their own background check on the individual to make sure the people have the credentials they claim to have and that there are no complaints against them."

A hospital's emergency department is also required to meet certain staffing levels and the regulations on a trauma center are tougher, requiring certain physician specialties to be at the facility 24 hours a day, seven days a week. DHEC also has some oversight of X-ray services and labs at urgent care facilities.

"DHEC is involved with radiology," Gibbons said. "If you have a radiology suite, which all of our offices do, well it has to be approved. We have laboratories in our offices and so again CLIA (Clinical Laboratory Improvement Amendments) is what manages that. That has to be approved as well and you have to have a lab director for that office."

A DHEC spokesman said the agency does not regulate a minor emergency clinics. After talking to agencies, like DHEC and LLR, it's apparent they don't react until a complaint is brought to their attention.

"The Board of Medicine does follow up if there is a complaint. They will investigate," Bailey said.

LLR has a website patients can use to check their doctor's status. Unfortunately, there's little information available on the website. It is likely you'll find more information on a restaurant's health inspection than you do before walking through the doors of an emergency room or urgent care facility.

"There's a big different between an A and B and a huge different between a B and a C," Bailey said, when discussing restaurant health inspections. "We don't have anything like that in health care."

Health professionals recommend patients ask plenty of questions before going to a medical facility.

"It's very much a buyer beware," Bailey said. "You gotta know before you go."

This is part one of a four-part series taking a closer look at the regulations, services and cost differences between urgent care facilities and emergency rooms at hospitals.

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