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. 
  1. Dan says:

    “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 ?

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