A recent trend in Washington is changing the face of hospital medical care. Hospitals are merging, acquiring other hospitals, or otherwise entering into arrangements for some kind of operating control or joint practice. Examples include Swedish Medical Center, which has taken over the former Stevens Hospital (now called Swedish Edmonds). Swedish, in turn, is now in a partnership arrangement with the Providence hospital group in Washington, Oregon, and Alaska.

Elsewhere, Multicare in Tacoma now operates Auburn hospital and Harrison’s in Bremerton. The University of Washington is now operating Northwest Hospital and Valley Medical Center. And in Spokane, there is an entity called “Rockwood Health System” which now includes Deaconess Medical Center, the Rockwood Clinic, and Valley Hospital.

Another trend is for these mega-hospitals to purchase existing physician clinics and practices. It is now very common for a physician who sends a patient to a hospital to also be an employee of that hospital, even while working out of a separate clinic or medical practice. An advantage for the hospital is obtaining a steadier stream of admissions. The physician obtains the benefit of a more certain income and, usually, malpractice insurance purchased by the hospital.

There are also obvious advantages for the hospitals in terms of economies of size and the ability to have better and more consistent systems in place.

What it all means for patients of the physicians and hospitals involved is less than clear. Sometimes rapid growth means a delay in establishing good procedures and guidelines for patient care, or a rush to hire providers who may not be properly trained or supported.

This trend also presents challenges for those of us who represent injured patients. Rather than dealing with a local risk manager at a hospital, we are now dealing with claims representatives at remote sites who have been hired by national risk management firms.

In addition, in the past we might use a physician or nurse at, for example, Providence Everett to be an expert in a case involving Swedish. Now those potential experts have conflicts of interest that prevent them from serving as an expert. It makes it more likely that plaintiffs’ attorneys have to go out of state to find independent experts to testify in Washington medical negligence cases, which adds to the costs of litigation.