I can explain a few things of what you encountered and the reasons behind the policies...
First off, I am not a nurse or doctor (yes, that's a disclaimer).
Secondly, anytime a diagnosis and treatment are administered, it has to be done under the supervision of a physician. This is the law. It is in place as much to protect you as it is to protect the practitioner.
Because you were seeking an immunization (tetanus)
AFTER stepping on a rusty nail, it would be in the best interest for both you and the physician treating you to check you for any signs or symptoms of infection. This may include taking a blood sample for laboratory tests. Since you called an emergency room for advice, they are presenting you with the safest options for healthcare. You have every right to accept or refuse treatment.
Third, because LRGHealthcare is part of a network they cannot refer you to a primary care physician (PCP) who is not part of their network. Again, this is for their protection as well as yours.
Let's say you were referred to a PCP and there was a medical error that resulted in a lawsuit. This could open up LRGHealthcare to liability because they referred to the PCP who made the error. Since they are familiar with the physicians in their system and covered by medical liability insurance, this does limit who they can refer. However, a PCP can refer you to an out-of-system specialist if you should need specialized care. (For example, say you needed an orthopedic specialist and wished to go to Concord Ortho for treatment - that's certainly an option.)
You have every right to take their referrals or not. You have every right to open up the Yellow Pages, go on the internet, ask friends, etc., - to get references for a PCP. Any hospital group, such as LRGHealthcare, are governed by the same rules for providing you with information. Concord Hospital or Frisbee Memorial Hospital or Dartmouth Hitchcock Memorial Hospital would have similar situations. Considering the litigious society we live in these days, I'm sure you can understand why things are this way.
The Hippocratic Oath was not broken in any way here, just to be clear. At no time were you denied care. You were simply given the options that are available and within the framework the network has in place. Again, this is for safety reasons. As I said, you are welcome to explore options and have every right to do so.
As for referrals:
HOSPITAL SOUP