Vote on retail medical clinics delayed

By Liz Kowalczyk
Globe Staff

The state Public Health Council yesterday delayed a vote until January on whether to allow medical clinics to operate inside retail stores in Massachusetts.
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CVS Corp. had asked for waivers from existing regulations so the chain could open 20 to 30 MinuteClinics in Boston-area stores in the next year, to treat minor illnesses such as strep throat, poison ivy, and ear infections. Instead, to address more broadly the concept of retail clinics, state health officials decided to develop new regulations.

During a meeting yesterday, council members asked staff at the Massachusetts Department of Health to amend the proposed regulations for a second time to address several concerns, including ensuring that nurse practitioners at the clinics are trained to treat children and that they refer patients for appropriate follow-up treatment with their primary care doctors, if they have one. Council members also asked staff to research whether they could ban cigarette sales at stores with medical clinics – or at least post signs warning patients.

“I have a real concern about people going to a pharmacy looking for medication to make them better and buying tobacco that could kill them,” said council member Alan Woodward, an emergency physician at Emerson Hospital in Concord and past president of the Massachusetts Medical Society, which has voiced some of the strongest concerns about retail clinics.

Several council members said they are concerned that MinuteClinic staff might prescribe unnecessary drugs so that CVS can make money selling those medications to patients.

But Paul Dreyer, director of healthcare quality at the Department of Public Health, pointed to a recent study in the American Journal of Medical Quality showing that MinuteClinics in Minnesota treated common sore throats correctly the vast majority of the time, rarely prescribing unneeded antibiotics.

Dreyer said the proposal to allow limited-service clinics in Massachusetts has generated “extraordinary interest,” with dozens of doctors, legislators, and business people sending letters in opposition or support to his department.

Opponents are concerned that retail clinics will not provide as good care as doctors’ practices and that clinic staff will not have access to patients’ medical records. Supporters argue that people need quick, convenient care for minor problems for which they now wait hours in an emergency room or days to get an appointment with their doctor.

Most council members appeared undecided about the issue, but Harold Cox, associate dean at the Boston University School of Public Health, said he supports the proposal. “I like the idea of being able to go someplace to get additional care,” he said. “I recognize it will provide additional access for some and additional competition for others.”

Michael Howe, chief executive of MinuteClinic, said after the meeting that he was not discouraged by the delay and, if the regulations are approved, that he plans to open 30 to 50 MinuteClinics in Massachusetts over the next three years.

Public Health Commissioner John Auerbach said he expects a final vote to be taken next month.

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