COLUMBIA, SC (WIS) - The word "emergency" comes with state regulations when it is used for medical facilities. WIS' investigation discovered a Lowcountry chain of urgent care facilities is using the term to market its facilities even at the discouragement of a state department.
A hospital emergency department provides around-the-clock readiness and has to meet certain guidelines from the S.C. Department of Health and Environmental Control. Using "emergency" to market an urgent care or another medical facility aside from a hospital creates confusion for customers who need immediate medical attention.
"There is no legal definition of emergency," said Lynn Bailey, a medical economist.
However, in a healthcare emergency when minutes count, it could make a difference which facility you go to.
"When I hear somebody say they provide emergency care, then I have an expectation they can take care of an emergency," said James Walker Jr., S.C. Hospital Association senior vice president.
It appears to be what most people expect.
"A heart attack or whatever, a seizure, that's an emergency," said Donna King of North Charleston. "You need to see me right away, that's an emergency. It's a matter of life and death."
In the Lowcountry, an urgent care facility operated by Nason Medical Center is using "emergency" on all its buildings. Brittney Richardson's son was seen by Nason Medical's doctors after he stubbed his toe and it got infected.
"They are actually cheaper than going to the ER with copays, so that's where we went," Richardson of North Charleston, said.
If it had been an emergency, Richardson said it wouldn't be her first choice.
"I'm kind of in the medical field, and places like that, nah, because they're just going to ship you off to an emergency room," Richardson said.
So why use the word emergency if the facility doesn't have the means to care for a life-threatening case?
"What good is it to have on the marque, 'Come on in. Emergency?'" said Lee Jailor of North Charleston. "We accept all people whatever condition, but when you get in there, it's the red tape."
Is it false marketing?
WIS asked Nason Medical to explain on camera why it uses "emergency" on its sign when it is an urgent care. Two days before the scheduled interview, they canceled.
In a written response, the center's Chief Medical Officer Dr. Barron Nason said, "We wanted to bring to urgent care the same level of patient triage, assessment, diagnosis and treatment practiced by doctors in the emergency rooms, with most of the same technologies. But we also sought to reduce waiting time and patient expense."
Nason said they've chosen "not to compete directly with hospital-based emergency departments in three ways." Nason Medical Centers do not accept ambulances, and they're not open 24 hours a day. The business claims patients who come in with life-threatening conditions are referred or transferred to partner hospitals.
Other urgent care facilities and the S.C. Hospital Association do not think medical facilities outside of a hospital should use "emergency" on its signs.
"I personally think that's wrong," said Dr. Thomas Gibbons Jr., Doctors Care president.
It boils down to buyer beware.
"All of this is buyer beware, so I find it no more dubious than other things we do in health care," Bailey said.
As WIS' investigation continued, it was discovered that Nason Medical altered its images on its website only to change the actual emergency signs on the building to say "ambulatory."
"Through our own recent consumer research, news reports and other sources – national and local – we have come to understand that a substantial segment of the public may be confused about the difference between urgent care and emergency care – and which to seek when," Nason said. "We have begun to help clarify these distinctions by changing our website, and perhaps later, our building signage to include a new term we are testing – 'ambulatory care.'"
Bailey said Nason Medical should take the emergency sign off its buildings.
WIS secured a letter from DHEC with a February date, telling Nason Medical it does not meet the guidelines for being a "freestanding emergency service." DHEC's reasoning is that emergency departments at hospitals do fall under regulations. By law, emergency departments must be open 24 hours a day, seven days a week and take any patient regardless of ability to pay or medical condition.
Nason Medical's facilities close at 8 p.m., require up-front payment if the patient does not have insurance, and are not asked to meet specified staffing levels. DHEC told Nason Medical it "must not advertise or display any signs or symbols that would identify the service as a freestanding emergency service."
A spokeswoman for Nason Medical told WIS on May 1 that "Nason has stopped illuminating the word emergency on marquees in anticipation of changing the descriptor. They are going to change the signs shortly once the choice has been decided."
"We do get, across our system every day, emergencies that we have to get EMS involved and get them over to the hospital," Gibbons said. "But we don't put ourselves out as providing that service. It's only if it presents that we try to deal with it as best we can."
State regulations under consideration
WIS' investigation uncovered only Arizona requires a specific urgent care license. Florida also regulates urgent care entities, along with New York, Maryland, Minnesota and New Hampshire. Some are calling the State House to consider whether that nine-letter word "emergency" should come with some conditions.
"If it's legislated and regulated, I think Texas, for instance, has freestanding emergency centers, but it's regulated," Gibbons said. "And they have to actually follow EMTALA (Emergency Medical Treatment and Active Labor Act) rules, and they have to have, it's very much like structures, just like a hospital."
House Bill 3983 is currently before the state legislature and would let closed rural hospitals within the last three years reopen as freestanding emergency healthcare facilities with certain conditions, including being open 24 hours a day, seven days a week.
"I think we could use a comprehensive look at how we regulate health and health services in South Carolina in light of the things that are changing and the things that have changed," Bailey said.
Physicians say that's because they've been told of experiences when patients have chosen the urgent care with the emergency signs over the hospital across the street, only to find out they have to be transferred by ambulance from the urgent care facility to the hospital for treatment.
"You really just have to try to step back for a second, figure out what you think you really need and then try to get to the most appropriate place possible," Walker said.
DHEC said there are several enforcement options they're considering and that there are several things the agency is still checking into.