Del. Shane E. Pendergrass, who was disappointed by the General Assembly's defeat this year of a bill to extend health insurance to thousands of Maryland's uninsured, is trying to resolve some vexing health care issues closer to home.

The Howard County Democrat recently convened two small discussion groups with county health care providers, insurers and others to talk about gaps in care, specifically the lack of a small-scale urgent-care office. Urgent-care centers generally are less expensive to operate than a hospital emergency department. Their services often are available on evenings and weekends for minor medical needs, such as an ear infection, when doctors have left their offices.

Pendergrass said she hopes that the group is able to stimulate enough interest in the health care community to inspire someone to offer county residents after-hours alternatives to the emergency room. That, she said, could also help achieve another goal: making health care more accessible and less expensive to county residents, whether they have insurance or are among the 15,000 in Howard who do not.

She said her efforts were sparked by the shuttering, about three years ago, of a widely used urgent-care facility in Columbia run by Patuxent Medical Group. That left many county residents with small medical emergencies few options for after-hours care other than Howard County General Hospital's emergency room. So far, the emergency room, which was recently expanded, has not been forced to operate at full capacity but it has come close, hospital officials said.

"We've been talking for about three years in Howard County about the need for an urgent-care facility," Pendergrass said after a discussion group that met Monday at the hospital.

"I am a believer that we have to be able to deliver health care to everyone. Until we do that, we are not doing a good job. . . . My goal is that we have urgent-care service and everyone works together," she said.

Nighttime Pediatrics, a for-profit urgent-care company that has sites in Anne Arundel County and one in Montgomery County, has been looking for possible rental space in Howard, company officials said during Monday's meeting. Pendergrass hopes to find out whether nonprofit organizations can play a role here as well.

Nighttime Pediatrics generally serves clients who have insurance, but it also sees those who do not on a limited basis, said Laura Ketchum, an attorney representing the company.

Pendergrass said she was also intrigued by Calvert Memorial Hospital in Calvert County, which runs urgent-care facilities in two communities that are each about 20 miles from the hospital.

Richard M. Krieg, president of the Horizon Foundation in Howard, a large county philanthropy that often focuses on health issues, said his group is examining the possibility of attracting a nonprofit clinic from neighboring Baltimore County.

That clinic is largely responsible for serving low-income residents, with and without insurance.

Howard's health department provides limited health care services to low-income people, including immunization, substance abuse prevention and prenatal care, through county health centers.

In addition, a free clinic operated by the Health Alliance near the hospital in Columbia offers limited services from volunteer physicians.

It is funded principally by the Horizon Foundation, which has given it $500,000 over the past four years.

"We have a need for more primary health care for people who lack it," Krieg said.

Del. Shane E. Pendergrass focuses on county.