Wheat Ridge firm on ER prohibition

wheat ridge» Freestanding emergency rooms may be on a growth streak in Colorado — there are around three dozen facilities today from just a handful a few years ago — but not everyone is rolling out the welcome mat.

On Monday night, the Wheat Ridge City Council voted to extend a year-long moratorium it had placed on free-standing ERs in 2016 for another year as it comes up with regulations for the medically advanced, emergency care centers before the first sets up shop in the city.

Wheat Ridge appears to be the only community in Colorado with a temporary ban on the ERs, which have been popping up in suburban strip malls and shopping centers in and around Denver. In just a 10-minute drive through Arvada, for example, you can pass two UCHealth emergency room buildings and another owned by Centura Health.

The centers typically are staffed by board-certified emergency-medicine doctors and nurses and have labs, X-ray machines and other complex technology available on site to treat issues as serious as heart attacks and strokes.

Wheat Ridge’s main concern is with the around-theclock nature of the facilities, with bright lights burning all night and traffic — including ambulances — moving in and out. City officials question whether freestanding ERs should be zoned the same as medical clinics and urgent care centers, which don’t have the same intense uses and long hours.

“Is there a need in our community for ERs to be sprinkled throughout our city?” asked Wheat Ridge City Manager Patrick Goff. “We want to be sure we have time to look at how to regulate them.”

Stand-alone ERs have faced resistance in Colorado in the past few years. Critics have blamed them for confusing consumers, who might think they are getting lower-cost care typical of urgent care clinics when, in fact, they are getting charged much higher emergency room rates, even when their injury or illness do not necessitate high-level care.

Free-standing ERs, whether affiliated with large hospitals or independent operators, have flourished in Colorado because it is one of only a few states that do not require a certificate of need for a new hospital building. A New England Journal of Medicine Catalyst report published last fall reported that the majority of the nation’s free-standing ERs are in Texas, Arizona and Colorado — states without the requirement for a certificate of need.

Colorado’s legislature has attempted to write rules for the nascent sector in the past few sessions, with a bill three years ago that would have prevented free-standing ERs not under a hospital’s license from charging patients emergency-facility fees. It was defeated.

Just last month, Senate Bill 64 went down in committee. The bill, sponsored by Sen. John Kefalas, D-Fort Collins, would have prohibited new stand-alone ERs from opening until July 2019 while also requiring the centers to post online the fees they charge patients.

Kefalas on Monday said he hadn’t heard about Wheat Ridge’s efforts to stop the opening of freestanding emergency rooms, but he wasn’t surprised.

“It suggests that local communities and the state are concerned about the proliferation of free-standing ERs,” the senator said. “If the state doesn’t take action on these facilities, communities will.”

But Linda Gorman, director of the health care policy center at the libertarianleaning Independence Institute, cast doubt on Wheat Ridge’s stated reasons for putting the stop on freestanding ERs. She said there is no evidence existing ERs are causing any more disruption to neighborhoods than regular commercial businesses do. And, she argued, ambulances typically don’t serve the centers.

She said free-standing ERs are convenient and more user-friendly than hospitals — and that’s why they are multiplying. Gorman wondered if the city isn’t acting under the pressure of Lutheran Medical Center.

“One has to ask whether Wheat Ridge has other reasons for banning them,” she said. “It sounds like they’re trying to protect their local hospital ER from competition.”

At Monday’s meeting, the only person to give testimony during public comment was Carol Salzmann, vice president of community and government affairs for Lutheran Medical Center, which is in Wheat Ridge. She successfully urged the council increase its moratorium extension from six months to a year.