Needy Mothers, Babies Would Suffer : Insurance Squabble May Shut County Clinics

Health care for pregnant women and new mothers with limited resources will have to be curtailed at the end of this year if the County of San Diego doesn’t step in to provide temporary malpractice insurance for 12 community clinics, clinic officials said Tuesday.

The clinics’ representatives asked the county Board of Supervisors to extend the county’s protection to the clinics’ support staff for six months beginning Jan. 1, when the current insurance policies for the care centers expire.

By July, 1987, the clinics expect to line up new insurance through a cooperative arrangement coordinated by a state association of community clinics.

The supervisors agreed Tuesday to study the issue for two weeks but stopped short of endorsing a plan offered by Supervisor Brian Bilbray.

Bilbray argued that the county would eventually pay the increased costs of care for unhealthy children if it doesn’t now enable the community clinics to provide important preventive care to women before they give birth.

“We either address this issue up front or we’re going to inherit a lot of issues down the line,” Bilbray said. “We can’t just walk away from it, because it’s going to come back and bite us in the you-know-where.”

Clinic officials said the centers provide care for about 1,200 needy women each year under a program coordinated by UC San Diego Medical Center. The babies are delivered at the hospital, and physicians and nurse practitioners who are employees of the university provide the prenatal care at the clinics.

Dr. Suzanne Dixon, director of the UCSD unit that cares for the new babies, said minor medical attention during pregnancy can avoid much more expensive care for newborn babies.

For example, Dixon said, mothers who haven’t taken a $2.50 skin test for tuberculosis must have a $39 chest X-ray at UCSD after their babies are born; mothers who have syphilis can be treated for less than $10 while they are pregnant, but care for a baby born to a mother with the venereal disease can cost $700 or more.

If needy mothers don’t get adequate prenatal care, Dixon told the supervisors, “I will see the results and you will pay the bill.”

The clinics’ insurance crisis arose when the companies that provide such coverage insisted that the clinics buy insurance not only for their administrative, clerical and laboratory staff but also for the UCSD medical staff working in the clinics.

Such coverage could cost each clinic as much as $20,000 a year, according to Ann Bush, director of the Comprehensive Perinatal Program.

“We have a major problem facing us, a problem that is going to shut down the program in December if something is not done,” Bush said.

Board members other than Bilbray were reluctant to approve the insurance without first studying the legal and political issues involved. They cautioned that damages from any lawsuits filed while the county was providing insurance would have to be paid from the county’s general fund.

“This isn’t the only life-threatening thing that is being threatened by insurance costs in San Diego County,” Supervisor George Bailey said. “It is one of many. We have a precedent here that will snowball on us.”

Supervisor Paul Eckert said the clinics were unfairly burdening the county with finding a solution to the crisis.

“The responsibility to take care of our community is society’s responsibility,” Eckert said. “It is not as simple as you would like to make it. It’s a very difficult issue to deal with.”