More Protection for the Patient : Oversight of burgeoning outpatient facilities to get a much-needed review

The proliferation of plastic surgery clinics, birthing centers and other doctor-operated outpatient medical facilities has raised questions about consumer safety that should be addressed by the Legislature.

Some way of licensing, or at least accrediting, these facilities seems to be in order. Patients need assurance that the facilities are properly equipped to handle the procedures they advertise and that adequate backups are in place in case of emergencies.

Later this month, the Medical Board of California will conduct a hearing in San Diego on what can be done to protect the public. Kenneth J. Wagstaff, executive director of the board, said the hearing stems from concern that people too often assume that a clinic with all the trappings of a “mini-hospital” is required to meet state standards. That’s rarely the case.

Hospitals come under careful state regulation, but all that is required to set up an outpatient surgical clinic or a birthing center is a licensed physician at the helm. Of course, there are some standards that the physician must adhere to in order to stay in good standing in the medical profession, and there are enforcement actions or lawsuits that can be brought against those who engage in harmful practices.

In addition, it makes good sense for clinics or centers to seek certain official seals of approval in order, for example, to qualify for Medicare or private insurance payments.

That being said, however, there’s virtually no state oversight required of most outpatient facilities. As one administrator in the state Department of Health Services said, doctors in general can do “any damned thing they want” within their own domains. That opens the door much too widely to dangerous practices by a few unscrupulous physicians.

The Jan. 31 hearing in San Diego should help clarify ways to address this gap in public protection. Birthing centers and outpatient surgery clinics have made important contributions to the health care system. But more needs to be done to make sure there are better standards for treatment.