Public Health Council postpones vote on limited service clinics

After nearly 90 minutes of discussion on a wide range of issues, the state Public Health Council today tabled a vote on new proposed regulations governing "limited service clinics" in drug stores and other retail establishments. The Council will now vote at its January meeting at the earliest, after amendments have been added to the regulations and selected proposed regulations have been revised.

The 13-members of the newly re-constituted Public Health Council engaged in vigorous discussion about topics that focused on quality of care and public health and safety. The public health expertise and experience of the panel greatly contributed to the quality of the debate.

Among the specific issues raising questions were the capabilities and training of on-site staff to adequately address the differences between adult care and pediatric care; the conflict engendered by the sale of tobacco products in a healthcare environment; the location of toilet facilities and waiting room areas, away from the normal retail consumer traffic; the availability of back-up and follow-up care and interpreter services if needed by the patient; how referrals to additional care would be addressed; and how the Public Health Council and Department of Public Health would handle violations of regulations. 

"The focus of today's discussion," said Bruce Auerbach, M.D., President-Elect of the Massachusetts Medical Society, "clearly demonstrated the Council's deep concerns about limited service clinics in the areas of quality of care, ensuring the public’s health through sanitation and infection control, potential conflicts of interest and patient safety. The Council is to be commended for its thoughtful approach to public health policy." 

Dr. Auerbach said that the Council pinpointed some of the same issues that have been raised by physicians, hospitals, and community health centers regarding limited service clinics. 

The revised regulations presented today to the Council followed two public hearings and a public comment period in which some 50 individuals and organizations offered testimony and comment. 

DPH Commissioner John Auerbach chaired the meeting of the council and presided over the discussion. The Commissioner identified ten specific areas for further amendments to be developed prior to next month’s vote on a revised set of proposed regulations. The identified areas were:

1. Potential conflicts of interest in siting clinics in pharmacies.
2. Requirements for a more distinct waiting area to address infection control and patient privacy.
3. Whether clinics should be prohibited in stores selling tobacco or whether a disclosure posting on health impacts would suffice.
4. Services involving disrobing were prohibited but this may need further definition.
5. Adequate credentialing of practitioners and supervising physicians must be guaranteed to ensure competence of those serving pediatric and adult populations.
6. Location of toilet and janitor facilities must be more specific.
7. Hand sanitizers may be mandated, ( The new version mandates handwashing facilities specific to examination rooms.)
8. The role of the Public Health Council in reviewing complaints and license actions will be revisited.
9. The issue of referrals of patients with needs beyond those the clinic may meet and the question of payment when services may be duplicated will be addressed.
10. Systems of quality evaluation may be mandated. 

Comments

[Dan]

“The identified areas were:
1. Potential conflicts of interest in siting clinics in pharmacies.”
Does someone really think that a Public Health Council vote will ever solve the problem with the conflicts of interest between siting clinics in pharmacies ?