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Q&A: Doctor embraces First Choice ER concept

March 22, 2013
photo - Dr. Andrew Kosmowski  Photo by
Dr. Andrew Kosmowski Photo by  

It’s a first for First Choice.

First Choice Emergency Room, a suburban Dallas-based company that operates free-standing emergency rooms, opened a location this month at 2770 Powers Blvd. on the east side of Colorado Springs — the company’s first location outside of Texas. Dr. Andrew Kosmowski is the Springs facility medical director; he said he sees First Choice growing in Colorado, with several more locations up the Front Range and into Denver in the next few years.

Before joining First Choice ER, Kosmowski served in the U.S. Army Medical Department for 25 years, including tours in Iraq and Afghanistan. He has also worked as a traveling ER doctor in Colorado and a few other states.

He received his medical degree from Uniformed Services University of Health Sciences in Bethesda, Md., and completed his emergency medicine residency at the Madigan Army Medical Center at Fort Lewis in Washington.

Kosmowski, 47, was born in New York City and grew up in the Washington, D.C. area. He and his wife, Karen, have three children: Zach, 20, Luda, 16, and Nick, 15.

Question: You retired from the Army after a quarter-century. Why did you leave the service and how did you end up with First Choice ER?

Answer: After 25 years, and seven combat deployments for over 43 months total, the Army did not seem to have a challenging job for me that did not involve further deployment or relocation. I had great opportunities in the Army, including being chief of three different emergency departments, theater surgeon in Afghanistan in 2006 and adviser to the Iraqi surgeon general in 2010 as the U.S. was ending our mission there. After retiring from the Army in April 2012, I learned of First Choice Emergency Room in August. I think the business model interested me most. As a department in a hospital-based system, an emergency department is required to conform to policies that don’t really fit the unique ER situation. FCER appealed to me because we are only an ER and can focus specifically on providing the best care for the ER patient.

Q: First Choice ER brings a new concept to Colorado Springs. What do you see as the benefits and drawbacks of such a system to the patients and the staff?

A: The obvious benefit to patients is that we now represent a new and very expedient access to emergency care 24/7.  My goal is to have patients seen by a doctor within the first five minutes after walking through the door and then out the door within an hour later.  We have a small but efficient team who will have a patient evaluated, medicated, CT scanned and/or radiated with results and ready for discharge far quicker than the usual several-hour ER ordeal.  If a patient needs admission, we will send them by ambulance, or private vehicle, to either Memorial, Penrose-St Francis or Evans hospitals depending on what is the best care for their condition.

The main drawback we are seeing is that we are perceived as being so different from all of the other hospital-affiliated ERs that some are over cautious as to our capabilities.  The truth is that all of our doctors, nurses, CT/rad techs and front-office staff are seasoned and very experienced with the delivery of emergency care, and most have worked in the ERs around the community.  

Q: While First Choice ER is not affiliated with Penrose-St. Francis Health Systems or Memorial Hospital, some cases seen at your facility will require further care at one of the two hospital systems. What kind of relationship have you built, or are building, with the two?

A: We are near completion of transfer agreements with both Memorial and Penrose-St Francis and I am beginning coordination with Evans Army Community Hospital for a similar agreement.

Q: First Choice ER doesn’t accept incoming ambulances, so those emergency cases will still be going to a hospital. What types of emergencies are you seeing or expect to see?  

A: All kinds. Most patients who go to the ER get there without an ambulance while most patients who arrive by ambulance don’t get admitted.  Also, many patients may be evaluated by EMS and told that they do not need to go to the ER by ambulance, but may need to go to the ER at some point for evaluation.  While we don’t expect to see much major trauma since we don’t have ambulances coming here, there will certainly be seriously ill and injured patients who make there way to our doors.  Additionally, it is my intention to discuss further with the EMS community what could be FCER’s role in a mass casualty situation.  I feel we would be a great place for the triage category “green,” or minimally injured patients, to come for care, taking pressure off the trauma centers.

Q: What drew you to a career in medicine? And, specifically, emergency medicine?

A: I was good at science in junior high school, and then my father died of a heart attack when I was in high school.  I then began working toward medicine and learned of Uniformed Services University of the Health Sciences in Bethesda, Md. I felt that emergency medicine in the Army would give me many opportunities to care for soldiers in all kinds of environments and with a wide variety of conditions.

Questions and answers are edited
for brevity and clarity.

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