Women's health clinics, which have survived years of anti-abortion politics, now face a new threat--astronomical malpractice and fire insurance costs--that could deal a more severe blow than the rhetoric and arson fires ever did.
Some clinics report that insurance companies have refused to sell them malpractice insurance at all, and others have been able to obtain it only at rates that have increased as much as 400% in the last several years.
While malpractice insurance problems have hit many medical professionals, the women's clinics, most of which are nonprofit and often operate on small budgets, have been especially hard hit.
As a result, a few centers have had to stop offering abortions and prenatal services. Some have cut back on the number of abortions that they perform in order to obtain more reasonable insurance rates. Many others have cut services to their patients, most of whom are low-income women, in order to fit the costly insurance into limited budgets.
And while some clinics have formed their own self-insurance programs, others have carried on with no malpractice insurance.
"It's a terrible crisis," said Lois Schoenbraun, spokeswoman for the Washington-based National Abortion Federation. Two years ago, a carrier refused to renew the insurance for the federation, which includes 300 abortion providers. Unable to find a new policy, the federation spent thousands of dollars trying to form its own insurance company. But after a year, the group was unable to raise the millions of dollars worth of capital needed.
Insurance executives insist that the problems experienced by the clinics are a simple matter of economics: Those who provide riskier services have to pay higher premiums. But Steven Miller, executive director of Los Angeles-based Insurance Consumer Action Network, charged that since there are only a handful of companies nationwide providing malpractice insurance, they have an "almost monopolistic-like hold on those who want to be insured."
While there are no figures available on how many women's clinics have had to shut their doors, professionals estimate that hundreds of clinics nationwide have curtailed abortion services in order to get affordable rates.
Abortion Unit Closed
Westside Women's Clinic in Santa Monica, for example, closed its abortion unit in January after 12 years because it could not get affordable insurance, director Cynthia Emmets said. "We lost our insurance when our carrier decided not to carry community clinics. When we went looking for new coverage, all we could get was a policy for $120,000, compared to the $15,000 we had been paying."
The clinic, which still provides other gynecological services, had performed about 60 abortions a month, she said. She noted that in 12 years, there were 12 claims against the clinic; all were dismissed or the court found in the clinic's favor. One claim was settled out of court for $5,000. Defending the claims cost the insurer $52,000, she said.
She considered relying only on malpractice insurance held by clinic doctors, but found she still would not be able to obtain fire coverage for the building because of the threat of bombings by anti-abortion forces. The clinic now pays yearly premiums of $4,500 for routine care.
Laura K. Brown, director of Women's Choice clinics in California, tells of a similar experience. The 15-year-old nonprofit group, which included five family planning clinics statewide serving 40,000 women, recently closed down its Pleasant Hill clinic and curtailed abortions at its Richmond clinic. She noted that the facilities were charged $5,000 each for their policies, but when the insurer went bankrupt, the only replacement policies they could obtain cost $90,000 each. After two years of searching, she found premiums for $20,000 per clinic.
Clinic officials complain that even though they do not deliver babies and do not perform major surgery, they are being considered in the same high-risk category as obstetricians and gynecologists, who are among the most frequently sued medical professionals. (Federal health statistics show that abortion is a relatively safe medical procedure, with a death rate during the first trimester of one per 100,000 cases, compared to three per 100,000 for tonsillectomies.) Some underwriters insist they do not categorize the family planning clinics the same as obstetricians, but others acknowledge that does happen.
'Not a Perfect System'
"We'd like to be perfect in setting premiums, but it is not a perfect system. Information is sometimes limited, so insurers go with information they do have on similar procedures, such as gynecology and obstetrics," said one insurance executive, whose company is a major writer of malpractice policies.