NYACK — Health Lifeline, a free clinic for uninsured adults, will soon mark its 10th year, and Dr. Lloyd Hamilton, who founded the clinic and still runs it, is clearly concerned there may not be an 11th.

There are funding issues. The volunteer pool has dipped. And Hamilton is 91.

"I'm not going to last forever," Hamilton said during a recent visit to the clinic. "I think I'm still good for a while."

But the Harvard-educated doctor said he can't do it alone.

Hamilton has been building up his volunteer base, seeking registered nurses, nurse practitioners and people with administrative skills for his clinic office in the former St. Ann Convent across Third Avenue from St. Ann Church.

"We have no salaried employees," Hamilton said.

The clinic runs on a shoestring budget of $24,000, of which $16,000 covers malpractice and building insurance. The rent is free, thanks to an agreement with the Roman Catholic Archdiocese of New York, and utilities cost $150 a month.

Patients provide up to $2,000 a year through small donations. At one time, donors provided the rest.

Hamilton long relied on his alumni buddies from his 1954 Harvard Medical School class.

"It was so easy, we never developed a fundraising base," said Hamilton.

Most of those donorshave passed away.

A Health LifeLine GoFundMe page with a $24,000 goal has been set up, but donations are not keeping pace. The page has only raised $100 as of Monday afternoon.

Despite the troubles, he's found another physician to help. Dr. Norbert Rainford, a New City cardiologist, comes in one morning a week.

"I believe in what Dr. Hamilton is doing," Rainford said Monday at the clinic.

Hamilton became a doctor 65 years ago, but his medical experience predates that. At 17, he enlisted in the Navy during World War II and was about to ship out as a medical corpsman with the Marines when the war ended. He then went to Yale and onto medical school.

He practiced psychiatry for 30 years, but decided he wanted a change. He then completed a residency in internal medicine. He practiced many places, and was an attending physician at Nyack Hospital.

"I went emeritus around the turn of the century," he said, referring to retirement from hospital duties.

But, Hamilton said, "without further donations, we will have to close our doors at the end of July."

A decade of care

The clinic is open 9 a.m. to 1 p.m. on Mondays and Wednesdays. On occasion, the clinic will stay open an hour longer. Right now, the clinic treats about 100 active patients and sees about 100 others for annual checkups. That's all they can handle.

When the clinic's future is more secure, Hamilton said, he wants to do more patient outreach.

Hamilton launched Health Lifeline in 2009 because Rockland County closed the medical clinic that he ran at the county's health complex in Ramapo.

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"I was out on the street with 400 patients," he said.

It was the Great Recession, Hamilton said. "We saw a lot of Americans down and out from the crash."

Hamilton said that a more stable job market and the Affordable Care Act helped ease the insurance crunch for Americans. According to the U.S. Census Bureau, between 2013 and 2016, the number of uninsured individuals in New York declined from 2.1 million to 1.2 million, a 42.9 percent decrease. But for undocumented immigrants, health coverage remains unattainable. While Rockland County health department statistics show that nearly 92 percent of Rockland adults have health coverage, those numbers don't reflect many people who are undocumented.

His patients are now primarily immigrants, most from Latin America, some from Haiti and a few other places. Volunteers, like Sister Agatha Cullen of the Sisters of Our Lady of Christian Doctrine, offer translation.

Despite the different patient demographics, Rainford and Hamilton agreed that their patients struggle with the same health challenges as many American-born adults.

Many have hypertension, diabetes, heart disease, thyroid disorders, arthritis. Those ailments are often related to obesity, he said.

"These patients are sick, chronically, with multiple diseases," Hamilton said.

And they are poor. Hamilton at first resisted seeking patient contributions. But, he said, accepting donations from patients became a smart medical decision.

"Even if they paid just a few dollars, it made them invested in the treatment."

Still, he said, even a few dollars is a financial struggle for them.

He uses his long connections in Rockland's medical infrastructure to help. When a patient needs to get tests or see a specialist, Hamilton finds them reasonably priced care.

"Most of my medicine is banking," Hamilton said. "I have to know the cost of everything."

Cullen, who has worked with Hamilton since their days together at the county clinic, gave a peek into the extent Hamilton goes to make sure his patients get the care they need.

"He even calls the pharmacy up to get cheaper medication," said the 82-year-old registered nurse who now cares for retired nuns at Marydell Convent in Upper Nyack and volunteers at Montefiore Nyack Hospital.

Convent shows through

Hamilton credits early community support, St. Ann's leadership and Nyack attorney Dennis Lynch for making it all happen. While the building is managed by the Catholic parish of St. Paul-St. Ann, the property is owned by the archdiocese

Hamilton said Cardinal Timothy Dolan was instrumental in allowing the clinic access to the building rent free as long as the utility bill is paid..

The old convent building's lineage can be seen around nearly every corner. Pocket doors with stained-glass windows open to a small chapel. The main examination room is a former sacristy, with a locked sink that once allowed for the proper disposal of holy water, and the screened portal of a confessional.

But it's clearly a doctor's office, albeit one that looks like it's out of the 1970s — from the orangeish waiting room chairs to the green exam tables and manual blood pressure machines.

The office may be no frills, but Rainford, 73, called the work rewarding and Hamilton inspiring. "It is the opportunity to do that which we went to medical school for — to help people."

Hamilton's still eager to work — as long as more funding for Health Lifeline can be found. Cullen said the clinic's closure would be terrible. "There's no other clinic like this that's free."

Nancy Cutler covers People & Policy for the USA Today Network Northeast. Twitter: @nancyrockland.