Spurred by a death and a case of paralysis in Prince George's County, the state health department is moving to regulate some walk-in, independent clinics for the first time.
The move comes as an increasing number of patients are going to so-called "Doc-in-a-Box" clinics for medical care of all kinds, instead of to more expensive hospitals.
State health officials say current law gives them no authority to regulate or investigate many such clinics, leaving patients at some risk.
The 1989 death of a patient and paralysis of another at the Hillview Women's Medical Surgical Center, an abortion clinic in Suitland, whichwere highlighted by the news program, "60 Minutes," sparked the health department's interest.
In addition, the department has received complaints that non-licensed personnel were seeing patients and apparently passing themselves off as doctors or nurses at two Baltimore clinics, according to state health Secretary Nelson J. Sabatini.
"There would be a steady stream going in and being treated by non-doctors," Sabatini said.
But health officials had no authority to go into and investigate the clinics, which were not owned by doctors. The best they could do was refer the matter to the board that licenses doctors and ask prosecutors to investigate whether anyone was practicing medicine without a license, Sabatini said.
"There's a real void in terms of regulatory authority," he declared.
The department is drafting a bill that would require clinics that are not connected to hospitals or owned by physicians to be certified by the state. As it is, health department officials say they don't even know how many such clinics are operating.
Sen. Mary H. Boergers, D-Montgomery, said she is preparing a more far-reaching bill for the 1992 legislative session that would require the state to license walk-in clinics in much the way it licenses hospitals.
"You just assume that somebody doing those medical procedures has some kind of regulatory review," Boergers said.
Independent clinics provide a wide variety of medical services, ranging from abortions to plastic surgery and cataract operations.
A report prepared this year by the staff of a congressional subcommittee concluded that walk-in clinics, while generally safe, are mostly unregulated across the country.
Congressional investigators highlighted a Texas case in which a child died in a diagnostic center after an untrained employee administered a lethal amount of sedative. In California, a woman died after being anesthetized by a surgi-center's bookkeeper, investigators said.
But, the congressional report adds, "Firm data on specific ambulatory care problems are currently unavailable, in part due to the unregulated environment in which these facilities operate. State officials do not even know the number of ambulatory care clinics or the kind and quality of services offered."
Some doctors and regulators have questioned whether clinics that have names suggesting they provide "urgent care" or "immediate care" are capable of providing emergency care. In an emergency, a patient could lose valuable time by going to one of these clinics instead of a hospital, critics suggest.
Rep. Ron Wyden, D-Ore., who chairs a congressional subcommittee studying the issue, is preparing legislation to regulate walk-in clinics.
The prospect of more regulation concerns Maryland abortion-rights advocates, who fear the issue may turn into a debate over access to abortion. During the 1991 session, the General Assembly rejected legislation introduced by anti-abortion lawmakers that would have regulated abortion clinics.
"I think our main concern is that bills like this could be vehicles for anti-abortion amendments," said Bebe Verdery, a lobbyist for Planned Parenthood of Maryland. "We don't want to see abortion singled out for political reasons."
Boergers, a former lobbyist for the National Organization for Women and an abortion-rights advocate, said she had "no intention" of trying to make it harder to get an abortion. Sabatini said the health department's measure was in no way targeting abortion clinics.
Clinics are really no different from a doctor's office and should be treated as such, said Arthur E. Auer, secretary of the National Association for Ambulatory Care, which represents about 1,000 clinics. The organization urges its members to meet accreditation standards for its medical care, Auer said. He added, though, that state officials must have the power to ensure public safety at clinics.
Doctors, one of the most powerful lobbying groups in Annapolis, oppose any further regulation, said Gerard E. Evans, lobbyist for the state medical society.
"Physicians' offices and their entire practices are subject to intense regulation simply because of the fact they hold a Maryland medical license," Evans said.
The state physician quality assurance board and the state attorney general's office are reportedly investigating alleged problems at the Hillview clinic in Prince George's County. The owners of that clinic have denied that any improper medical care was delivered.