A national insurance crisis that has hit obstetricians, day care centers and abortion clinics is threatening to close four nonprofit community health clinics in metropolitan Washington, including the area's only clinic that focuses on AIDS.
The clinics are among the approximately 120 community clinics nationwide that have received cancellation notices from Integrity Inc., a Paramus, N.J., firm that has provided medical malpractice coverage for members of the National Association of Community Health Centers.
The clinics include the Whitman-Walker Clinic, which is the focus of the District's newly announced AIDS efforts, the Washington Free Clinic, Clinica del Pueblo, all of the District, and the Prince George's County Volunteer Health Clinic in Capitol Heights. Officials at the clinics said the centers will close in the next two months unless insurance is found.
"The situation is very bleak," said Susan Bisgyer, program director of the Washington Free Clinic, who said the clinic has never been sued in its 17-year existence. "We've called all over the country looking for coverage. We're a very low-risk operation, but we're getting lumped in with for-profit centers."
However, an underwriter for the insurance firm said Integrity, like several other medical malpractice firms, decided to drop community health centers because their premiums did not cover the number of claims.
"On a national basis, we've seen nothing but terrible losses on community health centers," said Lou Cohen of Integrity. "The rest of our business is halfway houses, drug abuse centers, shelters for battered women and the like, and the losses are nowhere near as high."
In recent years, the rising number of malpractice claims and awards has caused insurers to drop coverage, or to drastically raise premiums, for medical professionals and facilities. Several of the largest insurers recently imposed moratoriums on writing any new malpractice coverage.
One solution for some, such as the clinics that belong to the National Abortion Federation, has been to set up self-insurance programs.
But officials of the local clinics say the start-up costs of self-insurance are prohibitively high. The four clinics, along with several others that may be canceled in the future, are coordinating efforts to seek new coverage.
"It would be totally foolhardy to operate without insurance," said Jim Graham, director of the Whitman-Walker Clinic, which serves the area's homosexual population. The clinic is to receive $250,000 this year from the District for AIDS-related services -- including testing, counseling and educational programs -- and $80,000 to set up housing for people with AIDS.
Like the other local clinics, Whitman-Walker has never been sued in its 12-year history, Graham said. It handled just under 6,000 patient visits last year. "Closing would cause a serious impact on our AIDS evaluation unit and our sexually transmitted disease clinic, which is the point of access to the community's high risk groups. We are very concerned."
Julia Doherty, executive director of the 15-year-old Prince George's County Volunteer Health Clinic, said the clinic's insurance expires Feb. 14. The clinic, located in a house on county property, operates three evening clinics for general health care and a daytime clinic for children.
"We're caught in the crunch, but we, too, have no malpractice problem," she said. The clinic served 2,700 people last year, mostly unemployed or uninsured people who aren't eligible for federal or state medical help.
The clinics have sought help from state insurance commissions, but regulators cannot act unless insurance is found to be denied arbitrarily. In New Jersey, where the state legislature recently passed a law aimed at reducing the number of insurance cancellations, companies with documented losses can decide not to renew policies, according to Michael Labradorf, of Garden City, N.Y., a broker for the health clinics.
"Unfortunately, a lot of innocent people are getting caught up in these decisions by firms to get out of medical malpractice and product liability," said Labradorf.
Claudia Green, membership services specialist with the National Association of Community Health Centers, a D.C. organization of 350 nonprofit clinics, said members throughout the country are threatened with closure. About one-third of its members were insured by Integrity and have been receiving nonrenewal notices in recent weeks.
"Anyone who provides health care is getting penalized," Green said. "The situation looks very, very grim. The long-term solution has to be legislative help."