Are there any rules for urgent care walk-in facilities?

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Are there any rules for urgent care walk-in facilities?

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Our go to urgent care medical walk-in doctor closed his office during the pandemic and moved back to Iran with no notice. He was a wonderful doctor and I'd been taking my mom to him for about 12 years. My mom a couple weeks ago needed to see a doctor so I took her over the Hacksensack Meridian Health Urgent Care medical walk-in here in town. Hackensack Meridian Health is the largest provider in NJ now as they own over a dozen hospitals and hundreds of other facilities like Urgent Care offices. So I took my mom over there because she had a big red circle 3 inch diameter on her arm and it felt hot. Probably reaction to the 2nd covid booster shot she got. They refused to see her saying "we did not cause the medical issue so we do not have to see you". The receptionist said go to the ER. That to me is the stupidest reason I ever heard of. It wasn't serious enough to go to the ER. It wasn't innocent enough to wait 3 weeks to get an appointment with a primary care practice doctor. It fit the basic definition of why an 84 year old woman would go to an Urgent Care medical walk-in on a Saturday morning. To get a few kind words from a doctor, tell her she's not dying, and look at the circle and tell her to take benadryl or something. 90 percent of medical care for the elderly is psychological I think. I am livid still that they refused to see my mom. Gave her severe symptoms of stress and anxiety for 3 days because they refused to see her. Are there rules for office designated as Urgent Care in NJ?

Elder Law Emergency Care Mom Senior Health

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What I'd like to know is how the receptionist and whoever she popped her head round the door to ask both knew that James's mother wasn't shyly going to confide in the doctor that she hadn't been able to pass urine for 36 hours but she didn't want to worry her son.

Or similar.

If you stick a sign on your door advertising urgent care for the general public you'd better have a flipping good reason for turning a patient away unseen. I'll be interested to hear how James gets on with his complaint.

Mind you, there are some very odd goings-on in primary care all over. There always *have* been, of course, but these times we're living in do seem to be particularly "interesting" in the Chinese curse sense of the word. In our little backwater city, five or six general practices have amalgamated into one brave new corporate group with a grand shiny tower block of a building supposed to house one-stop access to every conceivable healthcare service short of acute care. Exciting! Except I'd heard rumours from clients about how difficult it was to speak to a GP now - about prescriptions, new side effects, problems with taking medication, all the little ills you're supposed to ask your doctor about - and then last Monday I needed to ask one simple admin question that anyone there could have dealt with. From 08:00 to 17:00 I called their number at regular intervals. Normally you join the waiting system - "you. are. caller number. thirty NINE. in the queue" - and you sit there with a nice cup of coffee and the crossword and leave your phone on speaker and it's not really a problem. But on Mondays you can't even join the wait. The outgoing message says something like "all our reception team are working at capacity to help our patients. If your requirements are urgent go to your nearest Emergency Department, or call back later." There is also an online form you can fill in, and then when you submit it you get a message saying they aim to respond within 48 hours. And where does that leave my little old lady client who's been sick an hour after she took her new medication and doesn't know if it matters or not, eh?

My advice is that on the occasions when you come across a doctor or allied healthcare professional who is both helpful and effective, write the name down, get their number or email address and then don't let them out of your sight.

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Exactly. When a 84 year old woman in a wheelchair comes to the office, doctors in this kind of setting I describe should feel obligated to do a routine exam and talk with her, find out what is wrong. That is just basic ordinary doctoring.

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James,
You’ve already taken this to the providers employer. You got a written communication back saying they are looking into it. Work with them.

The anger you’ve displayed here won’t be conducive to further talks, and you suspicions about illegal discrimination could well be unwarranted because you can’t know the whole situation.

I know someone who had a large cyst lanced at an urgent care. It exploded, sending bloody smelly pus all over the room. Other medical maladies could involve Explosive and messy vomit, poo or pee, and that wouldn’t be something a clinic would typically share especially amidst handling the situation. Or the doctor may have himself been feeling under the weather or managing an emergent situation.

Not saying any of those are true, but they could be equally or more plausible than your immediate assumption this is age discrimination.

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The provider is the employer. I believe Hackensack Meridian Health is considered the provider. When I looked them up on wikipedia it said they are the largest PROVIDER in NJ. But I am just going by that. I don't think they are reading people's posts on aging care forum. Urgent Care medical walk in is the same as going to see a primary care doctor if you have a HMO. For those on medicare there is no HMO, you are allowed to go anywhere that takes medicare. It is a routine regular doctors office visit, but as a walk-in.This is what they are in business for, to be doctors for people who either don't have or can't get to what would be considered a traditional primary care doctor. But both doctors have the medical degree, have the same training, and are expected to perform the same job. One that work at places like Hackensack Meridian do so because they want a paycheck without having to open their own practice and handle all the responsibility of running it. As far as the doctoring go it is the same.

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Have you contacted the appropriate folks at Hackensack and complained?

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Yeah. He said he got an apologetic communication from their Office of Patient Experience and an invite to discuss this further.

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Does your mother have a primary care medical provider? It sounds that the urgent care MD first treated her when she was 72, and continued to manage ordinary small problems. It worked out well, it seems. He is gone, and the medical landscape has changed a lot. It is a business, so that there are all sorts of new 'unspoken rules" that are now in place. The reasons sound vague but like good ideas...but there is no flexibility for individual patients and their families.
They did not refuse care to her, they felt that her problem could be beyond the level of care that they provide, and that it would be wrong to go through the whole urgent care workup and THEN be told to go to the ER.
At 84, she is medically frail (no matter how she seems to a lay person). Good care would be to have a PCP, and once she has scheduled an initial appt with one, she may wait 3 weeks. However, once she is on that wait list, that practice can advise you what to do. It might have saved a trip to urgent care.
A pharmacist can give information about an over the counter product for you to choose to you. That is not a substitute for medical advice.
Her sx could be reaction at COVID injection site, some sort of tick or insect bite that could cause both infection in the soft tissue of her arm and systemic infection, or some unusual skin cancer manifestation. And plenty of other things.
No provider can make decisions about diagnosis and treatment without both examining the patient and getting relevant lab work, checking previous medical records, etc. No provider will risk their own hard earned license to practice their skill and earn a living by failing to meet the basic standard of care.

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This is what they are in business for. And medicare does not require a primary care doctor. They do not assign a HMO in medicare. Urgent care doctors are the same as primary care doctors. You go to the doctor, the doctors does a routine exam, listen to the problem, takes a look, and says what he thinks. No big deal. By the way, my niece sent my my mom photos of examples of "covid arm". It looked exactly like what my mom has, a big red circle. put it this way, there IS NO WAY IN THE WORLD anyone is going to convince me a general practitioner doctor in a medical walk-in setting open to the general public could not take a look and say what he thinks. It is insane to have this type of medical setting when doctors are refusing to see patients based on really nothing legitimate.

It is risking his license to refuse to see a person based on age, that because a person is elderly, they would have medicare, and thus not the kind of money they want per visit. That is against the law. And also, the doctor in this setting is not the provider. Hackensack Meridian Health is the provider, and the doctor is employed to work there.

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The reason they gave you for declining to see your mother was utter nonsense. If she'd been having a severe adverse reaction to a new px from another doctor, would they have refused her treatment for that too? Tosh. I've never heard the like.

That said, and partly because it is such transparent tosh, it also sounds to me like the third or fourth argument a stressed-out receptionist might put up in defence against a frustrated and annoyed relative trying to get his mother seen when for other reasons it wasn't possible to offer her a slot. How busy was the clinic that day?

I suppose even private providers who describe their services as Urgent Care are regulated and have to have some sort of approved triage system. I have to go to bed in a minute because I have a week's work to fit in to tomorrow, but if you have more time at your disposal you could have a trawl through
https://nj.gov/health/healthfacilities/
and see if there are any pointers there.

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It was a Saturday morning, around 11 AM and not one person was in the waiting room. Not one. Maybe they have like 5 or 6 individual patient rooms, and maybe patients were in there, but no family members waiting in the waiting area. My mom speaks for herself , she still has a working active mind, she is just handicapped from a car accident in 2008. Wheeled her in and first the receptionist said it would be an hour wait. I suspect that was to deter us to get us to leave. We agreed to wait and I started rolling my my mom by the chairs to wait. Then the receptionist said hold on let me see if the doctor will see you. Then she goes back and first says they are short handed and can't see us, then she says they did not cause the medical issue and dont have to see us, then she said short handed again. But no one was waiting in the waiting area. What they saw was an elderly woman in her 80's in a wheelchair, knew it was going to be medicare, so like $35-$40 they pay to see a general practitioner, and decided it wasn't worth the money to see my mom, and kicked us out. That is against the law to refuse medical care based on age. Federal Civil Rights Act of 1975.

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James, what kind of insurance does your mother have?

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The insurance didn't even matter. They never asked for the cards or how we wanted to pay. For all they knew we were paying cash. But I think they saw an elderly person in their 80's in a wheelchair, knew it was medicare, and panicked because medicare pays very little, I think like $35 dollars to see a general practice doctor. But they do take medicare on face of the business. This is Hackensack Meridian Health, the largest provider in NJ, owning over a dozen hospitals and countless hundreds of other medical facilities, such a medical walk -in urgent cares, and other stuff. They take medicare. And as they take Medicare payments, the Civil Rights Act of 1975 kicks in, they cannot discriminate based on age. My mom has Medicare and AARP as the 20% supplemental. She has never had an issue seeing any doctor for anything, ever. There is no HMO, no primary care mandate, you need no referrals, and for services you need prescriptions for things like mammograms and ct scans, stuff like that. There was no one in the waiting room either. They just didn't feel like seeing my mom. That's insane.

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I too was turned away from urgent care in the early weekday afternoon with a more urgent issue than the one described. There was no recourse besides traveling many more miles across state lines to find one that would take me or go to the local ER. As with any business, as long as they do not deny services based on the Federal and State-specific protected lists, they can deny services. They are allowed to run their business as they choose. They referred you to ER. They didn't have to do anything more than that as not all businesses desire to see as many patients/customers as possible.

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Ok, but that's insane. Can Burger King say they don't want to sell you a Whopper? Can the supermarket say they don't want to sell you groceries? Can a flourist say they won't sell you flowers? What is the point of putting the business there and not taking in the customers? But with healthcare it is worse than that. And if what you say is true, then this following is also true. Town governments, the Mayor and town council , who have to approve every business who wants to be here, can simply vote to to kick out Hackensack Meridian if they are going to refuse to see the elderly of the township. In other words, we the people, through our town government, approved this business to be here, and we can easily disapprove them to be here. As a life long resident here 56 years, and my mom here 57 years, we have the Right to receive the services from any business we approve to be located here in town. They vote all the time to allow or disallow any business. Do we need a Wawa, another gas station, a Dunkin, whatever it is, they weigh the pros and cons and vote on it. And have public hearings on it. It is my stance we cannot allow this urgent care here if they are not going to provide medical care to our residents. What is the point. Put one in where people will be seen.

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James, the er is the only place that can’t decline patients. As far as discrimination against a protected class, all they would have to do is show during that period was that a person over 65 had been seen. That would, of course, blow your lawyers legal argument out of the water. Plus said lawyer would not be pleased that you threw all sorts of identifying info up here where anyone can google it.

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This is the 2nd time my mom was denied there, we had went about 2 years ago and was denied, made up reasons. It makes no sense to me what happened. You go in to see the doctor, you see the doctor. I am 56 years old, and I have never heard of a general practitioner doctor refusing to see any patient for any reason. This has to be something new going on. To me it is unconscionable to do this in this setting, where a person can walk in off the street, to a store front open to the general public, no appointment place, and be refused. We were willing to wait the hour the receptionist said even though no other person was in the waiting room. This is insane to me. Something is very wrong. And who said anything about a lawyer? I can complain to the State and Federal government. It makes no sense to me what happened. Doctors in setting like this should be glad people are coming in. It is money to the business from which they get paid.

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I'm sorry to hear about this experience. Experiences and "rules" for clinics and networks vary by state and by insurer. An important question: is your mother on Medicaid? Because many doctors and clinics do not accept Medicaid patients.

Another issue is that doctors schedules are so full that they often don't accept new patients, no matter what (this is how it is in my state, MN).

Your statement that healthcare is a "right" in NJ is not accurrate. This is from your governor's website:

“New Jersey has advanced strong policies to protect access to health care for our residents, access which I **believe** is a human right. With this law, we take another step in securing the access families need to gaining more affordable health coverage."

Someone believing something is a "right" is not the same as it actually being a legal right. Your state protects *access* to healthcare, but it's not codified into law as a right that I'm aware of. FYI if it was a right and the government provided the "free" healthcare to all, it would basically be Medicaid. Many of us on this forum who have to deal with Medicaid have a few choice words about it's quality and bureaucracy.

One more fact to ponder: the US is short 30,000 doctors because of the increase in the boomer and somewhat large millenial population, and due to med school being so outrageously expensive, and also the US having a very strict policy about what it takes to permit non-citizen doctors to practice medicine here.

You bringing your LO so that a very busy doctor can meerly "reassure" her when her issue was clearly not urgent was not a productive decision for anyone. Does your state have a nurse's hotline where in the future you can first call to get guidance from a licensed nurse who can tell you whether you can do home care remedies, need to go to Urgent Care or go straight to the ER? My state has this. Please see if this is a resource for your mom for future medical issues. It's not a doctor or medical staff's job to talk your mom off the edge — it's your responsibility. Our elderly LOs need us to do this a lot and we all need to learn how to do it so we don't exhaust ourselves and others.

I will be honest here: if I was the person waiting after you in that clinic office knowing your mom's case was not truly urgent when I or my child had an actual medical issue, I'd be pretty pissed and rightfully so. FYI I've sat in an empty ER *for hours* when my mom broke her arm and another time when she needed stitches in her head. We have no idea what's really going on behind the scenes.

When people perceive things as a "right" or get something for free, they tend to overuse the resource. That's been proven over and over. Finally, "free" healthcare is not really free, it is paid for by taxpaying citizens.

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No, she has medicare and aarp as the supplemental. But it did not even get to how we were going to pay. We could have been paying cash in 20 dollar bills for all they knew. And it is not a scheduling situation, as this is a open to the general public medical walk-in office. And no one was in the waiting room. Maybe the patient rooms were full, maybe they have 5 or 6 of individual rooms , one patient each, to see the doctor. I disagree about what what you say the doctor should have done. This is BUSINESS. THE IDEA IS TO SEE AS MANY PATIENTS AS POSSIBLE, TO MAKE AS MUCH MONEY AS POSSIBLE. You don't turn anyone away in a general walk-in off the street store front practice like this. You line them up and move the line as fast as possible. And again, not one person was in the waiting room. And like I said in my first post to start, the other walk-in that closed when Dr. G. had to go back to Iran, didnt turn anyone away for anything. You go to the doctor and the doctor examines you, listens to whats wrong, and talks to you. PERIOD. THERE SHOULD NEVER EVER EVER EVER BE WELL ITS NOT THAT IMPORTANT.When a person is 84 years old and in a wheel chair, you check her out. Listen to her chest, take the blood pressure, and see what is going on.
And I never said it was free. I AM SAYING IT IS A RIGHT UNDER THE CIVIL RIGHTS ACT OF 1975 IN THE HEALTHCARE SECTION. WALK-IN OFF THE STREET STORE FRONT DOCTORS OFFICES OPEN TO THE GENERAL PUBLIC AT WILL, NO APPOINTMENT, DO NOT HAVE THE RIGHT TO SEE A PATIENT IS ELDERLY AND START MAKING UP EXCUSES TO NOT SEE HER. IT IS A CIVIL RIGHTS VIOLATION TO DENY A PERSON A DOCTOR BASED ON AGE IN THIS SETTING.

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I think this Urgent Care gets to make their own rules, which is obvious by the way your mother was treated. They probably saw a "Covid vaccination issue" and backed away from IT rather than HER being an elder, that's my guess. In any event, your only recourse is to contact their Office of Patient Experience at if you wish to discuss this matter further. In other words, you'll probably get another apology from them and sent on your merry way. And treated the exact same way if you showed up again with your mother in tow with a red swollen circle on her arm! Who knows WHAT scenario they had conjured up in their mind when they saw her? It's sad these days when we're turned away from MEDICAL FACILITIES for whatever reason they come up with as an excuse. And that's how I view it: an excuse.

I remember when our insurance provider, Kaiser, shut DOWN their building entirely during the pandemic. When they finally FINALLY reopened, I told my doctor I thought it was horrifying that in the middle of a pandemic, my INSURANCE PROVIDER decided to SHUT THEIR DOORS leaving me totally stranded in the event I needed medical care! Know what she said? "Oh the CDC told us we had to shut down." Okaaaay, then let me rephrase: I think it was horrifying that in the middle of a pandemic, my INSURANCE PROVIDER took orders from the CDC and decided to SHUT THEIR DOORS leaving me totally stranded in the event I needed medical care. Truth is, the medical industry these days uses the CYA principle instead of doing the right thing oftentimes, which is giving US the medical care we are seeking! Ain't that the truth?

Sorry this happened to you and your mom, James. Seeking justice often leaves us depleted, doesn't it?

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It was nonsense what happened. A doctor in that type of setting, a store front setting, open to the general public, on a walk-in basis, as general practitioners staffed by several different doctors employed by the state's largest provider, not in private practice,, capable of looking at virtually any ailment, and making a medical decision to go to the ER, see a specialists, get tests done, prescribe prescription or over the counter medicine, and do a general medical exam for heart rate, blood pressure, as well as customary assessment of psychological issues, which they do without the patient even knowing it, simply by talking with the patient, I think have the responsibility to see an 84 year old woman who walks in with a routine medical issue. 90 percent of that exam and treatment would be psychological. The doctor could not be bothered with it? What are they in business for?

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James, regardless of the experience, how your mother was treated, and your frustration if not anger at the situation, you should NEVER identify specific people and/or entities on a public forum when you're making accusations.

Your comments could be construed as libel.

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It isn't libel. It is what happened. It is only libel if I made it up. They are a business open to the general public, as a store front. . They are open the public saying if that business is good or not, based on the actions of the business. The news does it 24/7 about any and every business they want. Ever see on the tv news, or in the news paper those reporters that do the "on your side" type of thing, to try to get justice for people wronged by a company? Happens everyday. And none of it is libel.

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I would call Nicole in the Office of Patient Experience and ask her what she was going to do about their receptionist/urgent care center. An apology isn't enough detail about how they'd remedy the situation, nor what you should expect from their UC location.

I can only think of one time I didn't wait at least an hour in an urgent care clinic, and that was when my husband darned near cut off one of his fingers with a power saw. Still, they did take us in and look at it before sending us to the ER. It was clearly out of their league.

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If any urgent care md or any md feels that the situation would be best seen in the er, it’s their right to make that judgment. Ers have hospital labs attached to them plus all sorts of other stuff urgent cares do not have for diagnosis.

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That's not what they said. They said they were short handed that day, and it would be an hour wait. There was not any other person in the waiting room but us. Maybe the patient rooms were full, they probably have 5 or 6 rooms. But we were willing to wait the hour. When I started to wheel my mom to the waiting area, that is when they panicked. They did not want to see my mom under any conditions for any reason. I say it was age discrimination. After complaining to Hackensack Meridian Health, one of their patient complaint people sent the following Email to me. And what you say might be true, but the doctor would need to first examine my mom and make that decision. That decision cannot be made by a receptionist. They say they office did the wrong thing.
"I do apologize for the delay in our response, I was working on an email to your original when the second came into our mailbox. We appreciate you taking the time to write us this detailed message. We take these very seriously since we want to ensure all our patients are given the best treatment possible. That said, it's disappointing to learn about your mother's treatment at our Freehold Urgent Care location. The behavior you experienced is not representative of our standards. Please accept our apology and contact the Office of Patient Experience if you wish to discuss this matter further."
Thank you,
Nicole
The Office of Patient Experience
Jersey Shore University Medical Center
1945 Route 33, Neptune, NJ 07753

Email:

Are there any rules for urgent care walk-in facilities?

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