Hospital leaders from around the Puget Sound area engaged in a spirited exchange yesterday, as members of the Central Region EMS and Trauma Care Council debated what kind of patients Swedish Medical Center's new free-standing Issaquah Emergency Room can safely treat.

Despite testy exchanges and accusations, Swedish won a promise that the council will revisit its recommendation to not allow ambulances to take emergency patients to the $20 million facility, which opened last week.

Under policies developed by the council and Dr. Mickey Eisenberg, King County's emergency-medical-services director, only patients with minor injuries or illnesses may be brought to the Issaquah ER by Medic One ambulances because it isn't attached to a hospital.

Swedish asked for time to argue its case at the council's regular meeting yesterday.

Dr. Ronald Dobson, Swedish's director of emergency services, argued that its state-of-the-art facility can cope with "literally anything that would come through the door."

But several hospital-based members of the council accused Swedish of going around the emergency medical system. Some charged Swedish built the Issaquah ER simply as a beachhead to give it a "leg up" against Overlake Hospital Medical Center in the hot competition for state approval to build a hospital in the affluent, growing community.

During the meeting, Swedish and various council members argued about standards for care of stroke patients, about just what Dobson meant when he said the Issaquah facility might not be the only free-standing ER that Swedish builds, and whether the experiences of free-standing ERs in other states show they help or hurt patients.

Some council members asked whether hospitals should be allowed to "cherry pick" paying patients regardless of how it affects other hospitals.

David Jaffe, Harborview Medical Center's executive director, said Swedish's statement that it treats "all patients regardless of their ability to pay" was simply not true.

"This is really insulting to me," countered Dobson. He said that while the hospital treats all patients, it can't make private-practice physicians see patients who can't pay.

Even so, Jaffe said, Swedish's statement is "very misleading."

For the most part, council members seemed concerned that a free-standing ER would compromise care for patients.

Dr. Steve Marshall, emergency-services director at Overlake, said he worried that the wife of a man having a heart attack would drive him to Swedish's ER. "That's scary," he said.

Swedish's free-standing facility, though built to hospital emergency-room standards, is not connected to a hospital building. Patients who need the services of an operating room, an intensive-care unit or emergency heart procedures such as catheterization would have to be transported to a hospital.

Eisenberg, who sets medical policy for the emergency medical technicians and paramedics who care for patients in the Medic One system, said he wants to take a conservative approach, because this is the first free-standing ER in this area.

The council voted to revisit the issue in six months.

Eisenberg said he would look closely at transports of emergency patients over the next few months.

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