Magazine article Clinical Psychiatry News

Liability Concerns Need Not Deter Free Clinics

Magazine article Clinical Psychiatry News

Liability Concerns Need Not Deter Free Clinics

Article excerpt

NEW ORLEANS -- Yes, you can start your own free clinic without getting sued or going into the red to support the venture, Dr. Mohan Nadkarni said at the annual meeting of the American College of Physicians.

Liability is the biggest anxiety for physicians who want to volunteer, but the idea that patients served by clinics sue more than other patients is a myth, said Dr. Nadkarni of the department of internal medicine at the University of Virginia, and founder of the Charlottesville (Va.) Free Clinic.

A 2003 national liability survey of 153 free clinics conducted by the National Association of Free Clinics (NAFC) found that patients who visit free clinics actually sue less often than those of higher socioeconomic status. Only seven claims were collectively brought against the clinics surveyed, and three were eventually dropped. Two are pending, and the other two settled for about $67,000, "well below the average payout for settlement," Dr. Nadkarni said. Data from the American Medical Association show that the average jury award is currently $3.9 million.

When establishing a free clinic, physicians have several mechanisms available to protect them and their staffs from liability, Dr. Nadkarni said.

Many states have extensions of "Good Samaritan" laws that protect emergency personnel. "If you're working at a free clinic, you can gain that sort of coverage," he said. Most states that offer coverage raise the bar for what someone can sue for.

"Rather than sue for simple negligence, you have to get up to the level of proof of gross negligence, or recklessness, or wanton disregard. So that really stems the possibilities for suits."

Other states allow free clinics to buy into a state risk pool and to get a better deal on malpractice insurance. A few states, such as Kentucky, reimburse free clinics for the cost of their malpractice insurance coverage, Dr. Nadkarni said.

Clinics that don't charge patients can register with the Federal Tort and Claims Act, which has a defense fund that provides malpractice coverage for people who volunteer. To do this, "you have to preregister. You can't do that in retrospect," he said.

The clinic's board members need insurance coverage as well, he added. As nonphysicians making decisions about the free clinic, they're also subject to liability.

Free clinics served 3.5 million patients and received $300 million in donations in 2003, according to the NAFC, which estimates there are at least 800 free clinics nationwide.

Conducting a needs assessment and targeting the area's patient population are some initial steps to establishing the clinic, Dr. Nadkarni said. Physicians should decide what type of model they want, and where it should be located.

"You may have a hospital-based, church-based, or freestanding clinic." Then there's the "clinic without walls" model, a clearinghouse where patients may contact a central source and be farmed out to various participating doctors in the community.

Decide what types of services will be offered, and whether clinic staff will refer to private offices for subspecialty care. Continuity of care is something free clinics always struggle with, said Dr. Nadkarni, whose own clinic hired care coordinators to ensure continuity of care.

There are other services to consider, such as social work, dentistry, and psychiatry, as well as inpatient care. "You may be able to do it all, or you may only be able to do a small part of it, but decide in advance what you want to do." Otherwise, "you can go down a road where you destroy the clinic if you use up lots of resources you don't have," he said. …

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