A calling to care

"A calling to care" Continued...

Issue: "Race to the finish," Nov. 3, 2012

The American Medical Association on its website has a listing by state of licensing provisions and liability laws for senior physicians who want to volunteer their services. Laws vary greatly from state to state, but one trend is clear. Blue states like California, Connecticut, Massachusetts, New York, Vermont, New Mexico, and the District of Columbia are more likely to make “no provisions for volunteer or retired” in licensing, and “no provisions for non-emergency volunteer or charity medical care” in liability law.

Malpractice concerns affect active physicians also. Hospital employees may not have insurance that covers them outside the hospital. Even physicians who carry their own policies worry that rates might go up if a patient from a free clinic sues them. Even when states offer immunity from civil liability, some doctors are skeptical—especially when a law is untested. Many clinics provide malpractice insurance for their doctors, but it isn’t cheap. Hope Clinic in Ypsilanti, Mich., pays $17,000 a year for malpractice insurance even though Michigan has a law offering volunteers immunity.

Washington state purchases liability coverage for retired doctors “who provide gratuitous care at approved clinics.” But as the AMA website makes clear, the state will only purchase insurance up to “the extent of the funds provided for this purpose by the legislature.” Last year, threatened budget cuts in Olympia caused Diane Steward of Puget Sound Christian Clinic, whose 90 volunteers make it the program’s biggest user, to sound the alarm.

Steward wrote on her blog that if the program is eliminated, “60-70 of our volunteers will need to resign because they will not have malpractice insurance. Clearly, we will have to reduce clinic hours if that happens!” She said the program saves the state “millions of dollars in health care costs that otherwise would be absorbed by hospitals and an already overburdened health care system.”

The Federal Tort Claims Act has provided liability coverage to health professionals volunteering at charity clinics since 2004 and “Obamacare” expands the coverage to staff and board members. Clinics must apply and go through a rigorous privileging process for each volunteer. The government then “deems” those volunteers public health service employees, so if patients sue they are suing the federal government. Many clinics don’t apply for the coverage because the application process is complicated. One requirement—that clinics can’t accept third-party payments from insurance or government programs—rules out clinics like West Virginia Health Right, which participates in a federally funded mammogram and cervical cancer screening program.  

Some mission-driven doctors take the radical step of moving into poor neighborhoods and working full-time at Christian Federally Qualified Health Centers (FQHCs) that serve them. Dr. Joey Patrick works at the Orange Mound clinic, which is part of Christ Community Health Services in Memphis, Tenn. The clinic is in a poor, 98 percent African-American community with a reputation for gangs and drugs. His introduction to it came when he made a wrong turn and ended up there. “It was really scary. People came out and stared.” His oldest daughter cried, and a policeman pulled them over to give directions for getting out.

Now Patrick and his family live in the neighborhood, where they bought a house a short walk from the clinic. He plays basketball with neighborhood kids, who also come to his house for homework help, dinner, and Bible study. Patrick says living in the neighborhood allows him to provide better medical care.

The Greenville (S.C.) Free Medical Clinic has about 200 doctors, including specialists and dentists, who volunteer quarterly, allowing the clinic to see 4,000 patients a year—treating colds to cataracts. Dr. Pam Snape, the clinic’s volunteer medical director, started volunteering when the clinic opened a quarter-century ago. She was the only woman in her medical school class in 1964, and felt fortunate to be a doctor and have the chance to give back. She remembers growing up in a lower-income family and watching her mother struggle to pay for medical care: “We didn’t go as often as we should because we didn’t have the income to do that. That’s what motivated me to step out and give back.”

She says clinic volunteers appreciate not having “to figure out the cost for that visit and fill in a lot of paperwork for that visit, compared to a private office. … Nice not to have to worry about making money. Nice not to have to worry about the overhead.”

Clinics, especially those close to universities and medical schools, also rely on students as volunteers. Chris Catadal, now 26, was a 20-year-old college student waiting tables in Oregon when Dr. Bob Sayson came in for some shrimp fettucine and white wine. Sayson told Catadel about a Christian medical clinic he had founded in a dilapidated and graffitied building in one of Portland’s transient neighborhoods. Since the clinic offered on-the-job training for volunteers and Catadal was trying to get into nursing school, he decided to follow up.

With reporting by Tiffany Owens, Christina Darnell, and Kira Clark


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