A tastefully sized red neon sign announces "EMERGENCY" at Swedish Medical Center's new $20 million free-standing emergency room in Issaquah, the first of its kind in the state.

The emergency room opens tomorrow with state-of-the-art scanners and electronic systems, its ER-trained doctors and nurses standing ready to treat patients in the midst of medical emergencies. But most of those patients won't be stopping there.

They'll be in ambulances screaming past on Interstate 90, heading toward hospitals in Seattle or Bellevue.

Patients with emergency conditions who call 911, except for those with the most minor problems, must be taken to emergency rooms attached to full-service hospitals, according to a policy finalized Friday by Dr. Mickey Eisenberg, medical director for King County Emergency Medical Services.

Taking emergency patients to Swedish's new ER would be a "medically unsafe and unsound practice," said the Central Region EMS and Trauma Care Council, which advises the state on emergency-medical-service issues in King County.

The council voted unanimously in December that no ambulances carrying emergency patients should go to any facility not connected to a hospital, whether or not it calls itself an emergency room.

This stand, not surprisingly, is a major thorn in Swedish's side. It didn't spend $20 million on sophisticated technology — the biological-chemical decontamination unit, say, or the negative-air-flow rooms — just to care for patients with sore throats and ear infections.

Swedish officials plan to challenge the council's advisory and Eisenberg's decree at the council's next meeting March 9.

"Our plan is to present the facts," says Dr. John Milne, president of Eastside Emergency Physicians Group, which will staff the ER. "Our concern about the council is they made a rash, hasty decision without all of the facts in front of them."

This dispute is complicated by a backdrop of medical politics: Swedish and Overlake Hospital Medical Center in Bellevue are locked in a battle for state approval to build a new hospital in Issaquah.

Overlake recently opened a free-standing "urgent-care" clinic just miles from Swedish's new facility.

And some of the EMS and Trauma Care Council's most influential members hail from Harborview Medical Center, affiliated with Swedish's longtime rival, the University of Washington Medical Center.

At the Swedish ER, Milne argues there is no evidence that free-standing emergency rooms in other states have been implicated in bad outcomes for patients.

That's just the point, says Dr. Steve Marshall, who represents the King County Medical Society on the council — there's no research showing such ERs either hurt or help patients.

While it may make sense to have a free-standing ER in a community that's 50 miles from the nearest hospital, the council felt it wasn't so sensible when patients from Issaquah can get to Overlake in less than 10 minutes, and generally within 15 minutes to Harborview in Seattle, he said.

"We don't experiment with human beings without doing some research on it," says Marshall, who is medical director of Overlake's emergency department.

He said the patient-transport policy isn't new, but was reiterated in light of Swedish's decision to build an emergency room rather than an urgent-care center.

"Part of this is trying to figure out how to fit a new concept into a system that's working pretty well," Marshall says.

He says he's worried that because the Swedish facility calls itself an "ER," seriously ill patients will be taken there by family members or others.

"What I want patients to do is use the system that is already outstanding," Marshall says. "If you have a problem and you don't know whether it's severe, call 911 and let the system sort you out."

Eisenberg says he's taking the "conservative" approach for now.

"The reality is that a free-standing emergency department is a new player in this medical-care system," Eisenberg says. "I think everyone simply needs to get more experience with it before making lots of decisions."

He says he plans to study Eastside emergency cases over the next few months to see whether policies should be changed.

Milne, at Swedish's Issaquah ER, says Swedish isn't fighting for the "advanced life-support" cases — patients with severe trauma injuries or who are critically unstable. But for the myriad other emergency cases — even including those cases of "indigestion" that turn out to be heart attacks, Swedish is ready and equipped for excellent patient care, he said.

The Issaquah ER, says Kevin Brown, a Swedish vice president, is the most technologically advanced ER in the state.

Milne says he and his staff are equipped for virtually any patient. "We're prepared to deal with those patients who are sicker than they first appeared."

Instead of spending 10 or 15 minutes or more getting such a patient to a full-service hospital, that time could be better spent getting the patient stabilized at Swedish's Issaquah ER, Milne says, and then being transported. The hospital has contracted with a private ambulance company for such transfers.

But with other hospitals just minutes away, the EMS and Trauma Care Council said, Swedish didn't build the new ER because the community needed more emergency services, but because it wanted to gain a foothold on the Eastside to "enhance market share."

Milne, on the other hand, said the Issaquah community is enthusiastic about the new ER.

At the council meeting, Swedish will argue that free-standing ERs in other states, such as those operated by Inova in northern Virginia's suburbs, help reduce the time EMS ambulances are out of service.

"Mickey Eisenberg's problem right now is he doesn't know what to do with us," Milne says.

"In six months, once the medical community has had an opportunity to get comfortable with this facility, all of this will blow over," he predicts. "If the best thing for a patient and the community is to bring a patient here, I think the medics should be able to do that."

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com