The federal government’s rule designed to support health workers who opt out of providing care that violates their moral or religious beliefs will not go into effect in July as scheduled. The effective date has been delayed by four months, according to court orders.

The “Protecting Statutory Conscience Rights in Health Care” rule was originally issued in May by the Department of Health and Human Services’ Office for Civil Rights. It aligns with that office’s religious freedom priorities and would put new emphasis on existing laws that give health care workers the ability to file a complaint with that office if they are forced to participate in medical care that violates their conscience — such as abortion, gender confirmation surgery, and assisted suicide.

As NPR has reported, the rule also expands the type of workers who are able to file this kind of complaint to billing staff and receptionists and anyone else who in any way “assist[s] in the performance” of a procedure.

Complaints of “conscience rights” violations are relatively rare — for a decade, the office would receive an average of one complaint like this each year. Last year, that number jumped to 343. That number is dwarfed by the number of complaints the Office for Civil Rights receives over issues like health privacy or race, sex and age discrimination, which typically number in the thousands.

Several groups sued the federal government over the rule immediately after it was issued. New York state led a coalition of 23 cities and states in one suit, and three jurisdictions in California also sued, including California state and San Francisco. Yet another plaintiff, Santa Clara County in California’s Bay Area, made the case that the rule put patient safety at risk, since it gave health workers the right to opt out of providing care without prior notice — potentially even in an emergency.

“If the rule goes through as it’s written, patients will die,” Santa Clara’s county executive, Dr. Jeff Smith, told NPR last month. “We will have a guaranteed situation where a woman has had a complication of an abortion, where she’s bleeding out and needs to have the services of some employee who has moral objections. That patient will die because the employee is not providing the services that are needed.”

Santa Clara and several other plaintiffs had filed for a preliminary injunction to prevent the rule from going into effect while the legal process played out.

“The federal government actually reached out to all the plaintiffs in all of the different cases and basically said that they didn’t want to have to deal with a preliminary injunction,” says James Williams, county counsel for Santa Clara. He says the government is seeking “summary judgment,” which means the judge could rule in its favor based on the arguments and documents it files with the court. According to Williams the government told the plaintiffs that it “would be willing to stipulate to a delay in the effective date to allow that to happen.”

That new effective date is Nov. 22 — the federal judge in the California cases made that official over the weekend, and in the New York case, the federal judge certified the change on Monday.

HHS made clear in its court filing that by agreeing to this delay, it is not suggesting that the plaintiffs are likely to succeed in ultimately blocking the rule. Instead, the agency says, it’s a logistical move.

“In light of significant litigation over the rule, HHS agreed to a stipulated request to delay the effective date of the rule until November 22, 2019,” an HHS spokesperson wrote in a statement to NPR, adding that the delay will “allow the parties more time to respond to the litigation and to grant entities affected by the rule more time to prepare for compliance.”

For plaintiffs, like Santa Clara County, the delay gives some “breathing room” while the lawsuits continue, according to county counsel James Williams.

“The delay is certainly good news because it means that this rule isn’t going to take effect and that the harms are not going to happen now,” Williams says. “But it’s just an interim step, and we’re going to be pressing forward very vigorously with getting a decision and summary judgment to vacate the rule.”

All parties are hopeful that the judges will make their decisions in these cases before the new effective date in November.

Let’s block ads! (Why?)

Government officials are bickering over hundreds of millions of dollars in settlements paid by Big Pharma, stemming from the nation’s deadly opioid epidemic.

The pharmaceutical industry paid out more than half a billion dollars over the last year alone. All sides expect the scale of settlements to grow fast as more cases go to trial.

Drug companies are accused of kick-starting the addiction crisis by aggressively marketing opioid pain medications over the past two decades. During the epidemic, roughly 218,000 Americans have died from overdoses tied to prescription pain pills, according to the Centers for Disease Control and Prevention.

Federal, state and local officials have filed hundreds of lawsuits against drug companies, using different teams of lawyers, while often making substantially different claims and legal arguments.

A growing number of sources have told NPR they’re concerned that the effort to hold the pharmaceutical industry accountable could unravel into a legal fight between governments.

There’s no agreement in place for how payouts will be distributed. In recent days, feuding between local, state and federal agencies has begun to spill into the open.

In an Ohio courtroom this week, a federal judge suspended work on a plan to compensate 24,000 local governments for their opioid-related costs, after state attorneys general weighed in strongly against the proposal.

“If we get money, how are going to use it?” asked Joe Rice, an architect of the proposal, who leads a team of attorneys representing more than 1,200 local governments suing Big Pharma.

Their cases have been consolidated into a single trial set to begin in federal court in Ohio in October. “Let’s get a plan in place. Because it also has to fit together,” Rice added.

The federal judge overseeing the consolidated trial, Dan Polster, has repeatedly urged officials to come up with just such a roadmap for compensation that will hasten a “global” settlement with the drug industry.

But after Rice’s group came up with a concept that would involve every local government in the U.S. — creating a kind of super-sized class action lawsuit – state attorneys general cried foul.

“To certify a negotiation class so quickly and so early in the process, before everyone’s had a chance to determine what their best interest is, constitutes a new and novel procedure that could result in a grave miscarriage of justice,” cautioned Texas Attorney General Ken Paxton, in a June 24 letter to Judge Polster.

The letter was co-signed by 26 other state attorneys general. Judge Polster delayed action on the plan until August.

Meanwhile, the federal government has entered the money fray, seeking to garnish “a portion” of Oklahoma’s recent $270 million settlement with Purdue Pharmaceuticals.

The demand came in a June 12 letter from the Centers for Medicare and Medicaid Services, which argued that part of Purdue’s payout was meant to cover alleged Medicaid fraud, which harmed federal as well as state taxpayers.

“We are aware of the letter and are reviewing it,” wrote Alex Gerszewski, a spokesman for Oklahoma Attorney General Mike Hunter, in an email to NPR. “This will not affect state revenue,” he added.

Even within individual states there are growing tensions over how opioid money will be allocated. When Hunter won Oklahoma’s settlement with Purdue in March, he agreed unilaterally to a plan for how the money would be spent.

The lion’s share won’t go to fund programs designed to aid people who are opioid-dependent, or to help local governments struggling with the crisis. Instead, Hunter agreed to divert roughly $200 million to pay for a new addiction research center at the Oklahoma State University in Tulsa.

State lawmakers in Oklahoma were furious. “Rose petals were not strewn in my path,” Hunter acknowledged in a speech before the Bipartisan Policy Council in Washington DC last month. “There was a great consternation with me going around the appropriations process.”

Now that the federal government is asking for its slice of the money, his plan has become even more controversial.

Oklahoma’s legislature has since passed a state law requiring that future opioid settlements go into the state’s general fund. Last week, the state’s politicians narrowly averted a legal clash over an $85 million payout from another drug firm called Teva Pharmaceuticals.

This money fight is playing out against the troubled history that followed the tobacco settlements of the 1990s. Cigarette makers agreed to pay more than $240 billion to end their liability for cancer deaths caused by their products.

But much of that cash has since been diverted by government officials away from health programs and campaigns aimed to reduce smoking rates.

Critics worry that drug industry settlements could also be used to fill budget gaps or to pay for local, state and federal programs unrelated to the opioid epidemic.

Let’s block ads! (Why?)

One Monday in February, 65-year-old Karen Endicott-Coyan gripped the wheel of her black 2014 Ford Taurus with both hands as she made the hour-long drive from her farm near Fort Scott, Kan., to Chanute.

With a rare form of multiple myeloma, she requires weekly chemotherapy to keep the cancer at bay.

She made the trip in pain, having skipped her morphine for the day to be able to drive safely. Since she sometimes “gets the pukes” after treatment, she had her neighbor and friend Shirley Palmer, 76, come along to drive her back.

Continuity of care is crucial for cancer patients in the midst of treatment, which often requires frequent repeated outpatient visits. So when Mercy Hospital Fort Scott, the rural hospital in Endicott-Coyan’s hometown, was slated to close its doors at the end of 2018, hospital officials had arranged for its cancer clinic — called the “Unit of Hope” — to remain open.

Then “I got the email on Jan. 15,” said Reta Baker, the hospital’s CEO. It informed her that Cancer Center of Kansas, the contractor that operated and staffed the unit, had decided to shut it down too, just two weeks later.

“There are too many changes in that town” to keep the cancer center open, Yoosaf “Abe” Abraham, chief operating officer of the Cancer Center of Kansas later told KHN. He added that patients would be “OK” because they could get treated at the center’s offices in Chanute and Parsons.

From Fort Scott, those facilities are 50 and 63 miles away, respectively.

For Endicott-Coyan and dozens of other cancer patients, the distance meant new challenges getting lifesaving treatment. “You have a flat tire, and there is nothing out here,” Endicott-Coyan said, waving her arm toward the open sky and the pastures dotted with black Angus and white-faced Hereford cattle on either side of the shoulderless, narrow highway she now must drive to get to her chemo appointment.

Nationwide, more than 100 rural hospitals have closed since 2010. In each case, a unique but familiar loss occurs.

Residents, of course, lose health care services as wards are shut and doctors and nurses begin to move away.

But the ripple effect can be equally devastating. The economic vitality of a community takes a blow without the hospital’s high-paying jobs and it becomes more difficult for other industries to attract workers who want to live in a town with a hospital. Whatever remains is at risk of withering without the support of the stabilizing institution.

The 7,800 residents of Fort Scott are reeling from the loss of their 132-year-old community hospital, which was closed at the end of December by Mercy, a St. Louis-based nonprofit health system. Founded on the frontier in the 19th century and rebuilt as a 69-bed modern facility in 2002, the hospital had outlived its use, with largely empty inpatient beds, the parent company said.

For the next year, Kaiser Health News and NPR will track how its citizens fare after the closure in the hopes of answering pressing national questions: Do citizens in small communities like Fort Scott need a traditional hospital for their health needs? If not a hospital, what then?

Traveling the distance for cancer care

Reta Baker, the hospital’s CEO grew up on a farm south of Fort Scott. She understood that the hospital’s closure was unavoidable. She scrambled to make sure basic health care needs would be met afterward.

Mercy agreed to keep the building open and lights on until 2021. And Baker recruited a federally qualified health center to take over four outpatient clinics, including one inside the hospital; former employees were bought out and continue to operate a rehabilitation center; and the nonprofit Ascension Via Christi Hospital in Pittsburg reopened the emergency department in February.

But cancer care, which requires specialists and the purchase and storage of a range of oncology drugs, presents unique challenges in rural areas.

Rural cancer patients typically spend 66% more time traveling each way to treatment than those who live in more urban areas, according to a recent national survey by ASCO, the American Society of Clinical Oncology. Dr. Monica Bertagnolli, a cattle rancher’s daughter who is now chair of ASCO’s board, called this a “tremendous burden.” Cancer care, she explained, is “not just one visit and you’re done.”

ASCO used federal data to find that while about 19% of Americans live in rural areas, only 7% of oncologists practice there.

People in rural America are more likely to die from cancer than those in the country’s metropolitan counties, according to a Centers for Disease Control and Prevention report in 2017. It found 180 cancer deaths per 100,000 people a year in rural counties, compared with 158 deaths per 100,000 in populous metropolitan counties.

The discrepancy is partly because habits like smoking are more common among rural residents, but the risk of dying goes beyond that, said Jane Henley, a CDC epidemiologist and lead author of the report. “We know geography can affect your risk factors, but we don’t expect it to affect mortality.”

From an office inside a former Mercy outpatient clinic, Fort Scott’s cancer support group, Care to Share, continues its efforts to meet some of the community’s needs — which in some ways have increased since the Unit of Hope closed. It provides Ensure nutritional supplements, gas vouchers and emotional support to cancer patients.

Lavetta Simmons, one of the support group’s founders, said she will have to raise more money to help people pay for gas so they can drive farther to treatments. Last year, in this impoverished corner of southeastern Kansas, Care to Share spent more than $17,000 providing gas money to area residents who had to travel to the Mercy hospital or farther away for care.

The group expects to spend more on gas this year, having spent nearly $6,000 during the first four months of 2019.

And the reserves of donated Ensure from Mercy are running out, so Simmons is reaching out to hospitals in nearby counties for help.

With Mercy Hospital Fort Scott closed, the likelihood of residents here dying from their cancer will grow, experts worry, because it’s that much harder to access specialists and treatments.

Krista Postai, who took over the Fort Scott hospital’s four primary care clinics, said it’s not unusual for her staff to “see someone walk in [with] end-stage cancer that they put off because they didn’t have money, they didn’t have insurance, or it’s just the way you are… We wait too long here.”

‘If they can’t cure me, I’m done’

Art Terry, 71, a farmer and Vietnam veteran, was one of them. Doctors discovered Terry’s cancer after he broke a rib while bailing hay. When they found a mass below his armpit, it was already late-stage breast cancer that had metastasized to his bones.

With his twice-weekly chemotherapy treatment available in the “Unit of Hope,” Terry spent hours there with his son and grandchildren telling stories and jokes as if they were in their own living room. The nurses began to feel like family, and Terry brought them fresh eggs from his farm.

“Dad couldn’t have better or more personalized care anywhere,” said his son, Dwight, bleary-eyed after a factory shift.

Terry knew it was difficult to find trustworthy cancer care. The shortage of cancer specialists in southeastern Kansas meant that many, including Mercy Hospital Fort Scott’s patients, counted on traveling oncologists to visit their communities once or twice a week.

Wichita-based Cancer Center of Kansas has nearly two dozen locations statewide. It began leasing space in Fort Scott’s hospital basement in the mid-2000s, the center’s Abraham said. The hospital provided the staff while the Cancer Center of Kansas paid rent and sent roving oncologists to drop in and treat patients.

At its closing, the Unit of Hope served nearly 200 patients, with about 40% of them receiving chemotherapy treatment.

When Art Terry was diagnosed, his son, Dwight, tried to talk to him about seeking treatment at the bigger hospitals and academic centers in Joplin, Mo., or the Kansas City area. The elder Terry wasn’t interested. “He’s like, ‘Nope,’ ” Dwight Terry recalled. “I’m going right there to Fort Scott. If they can’t cure me, I’m done. I’m not driving.’ “

In the end, as the elder Terry struggled to stay alive, Dwight said he would have driven his father the hour to Chanute for treatment. Gas — already a mounting expense as they traveled the 20 miles from the farm near tiny Prescott, Kan., to Fort Scott — would be even more costly. And the journey would be taxing for his father, who traveled so little over the course of his life that he had visited Kansas City only twice in the past 25 years.

As it turned out, the family never had to make a choice. Art Terry’s cancer advanced to his brain and killed him days before the hospital’s cancer unit closed.

What happens next?

As Endicott-Coyan and her friend Palmer drove to Chanute for treatment, they passed the time chatting about how the hospital’s closure is changing Fort Scott. “People started putting their houses up for sale,” Palmer said.

Like many in Fort Scott, they had both spent their days at the Fort Scott hospital. Endicott-Coyan worked in administration for more than 23 years; Palmer volunteered with the auxiliary for six years.

The hospital grew with the community. But as the town’s fortunes fell, it’s perhaps no surprise that the hospital couldn’t survive. But the intertwined history of Mercy and Fort Scott is also why its loss hit so many residents so hard.

Fort Scott began in 1842 when the U.S. government built a military fort to help with the nation’s westward expansion. Historians say Fort Scott was a boomtown in the years just after the Civil War, with its recorded population rising to more than 10,000 as the town competed with Kansas City to become the largest railroad center west of the Mississippi.

The hospital was an integral part of the community after Sisters of Mercy nuns opened a 10-bed hospital in 1886 with a mission to serve the needy and poor. Baker, Mercy Hospital Fort Scott’s president, said the cancer center was an extension of that mission.

The Unit of Hope began operating out of the newest hospital building’s basement, which was “pretty cramped,” Baker said. As cancer treatments improved, it grew so rapidly that Mercy executives moved it to a spacious first-floor location that had previously been the business offices.

“Our whole purpose when we designed it was for it to be a place where somebody who was coming to have something unpleasant done could actually feel pampered and be in a nice environment,” Baker said.

The center, with its muted natural grays and browns, had windows overlooking the front parking lot and forested land beyond. Every patient could look out the windows or watch a personal television terminal. Each treatment chair had plenty of space for family members to pull up chairs.

When Endicott-Coyan and Palmer arrived at the Cancer Center of Kansas clinic in Chanute in February, things looked starkly different. Patients entered a small room through a rusted back door. Three brown infusion chairs sat on either side of the entry door and two TV monitors were mounted high on the walls.

A nurse checked Endicott-Coyan’s blood pressure and ushered her back to a private room to get a shot in her stomach. She was ready to leave about 15 minutes later.

The center’s Abraham said the Chanute facility is “good for patients for the time being” and not a “Taj Mahal” like Mercy’s Fort Scott hospital building, which he said was too expensive to maintain. Cancer Center of Kansas plans to open a clinic at a hospital in Girard, which is about 30 miles from Fort Scott, he said.

Some oncology doctors would say driving is not necessary. Indeed, a few health care systems across the country, such as Sanford Health in South Dakota and Thomas Jefferson University Hospitals in Pennsylvania, are administering some chemotherapy in patients’ homes. Oncologist Adam Binder, who practices at Thomas Jefferson in Philadelphia, said “over 50% of chemotherapy would be safe to administer in the home setting if the right infrastructure existed.”

But the infrastructure —that is, the nurses who would travel to treat patients and a reimbursement model to pay for such care within our complex health care system — is not yet in place.

Back in the car, Palmer took the wheel and Endicott-Coyan began planning for future cancer treatments in the void left by Mercy Hospital Fort Scott’s closure. “I put a note on Facebook today and said ‘OK, I have drivers for the rest of February; I need drivers for March!’ “

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

Let’s block ads! (Why?)

This article was produced in partnership with nonprofit news organization MLK50, which is a member of the ProPublica Local Reporting Network.

This year, a hospital housekeeper left her job just three hours into her shift and caught a bus to Shelby County General Sessions Court in Memphis, Tenn.

Wearing her black and gray uniform, she had a different kind of appointment with her employer, Methodist Le Bonheur Healthcare: The hospital was suing her for unpaid medical bills.

In 2017, the nonprofit hospital system based in Memphis sued the woman for the cost of hospital stays to treat chronic abdominal pain she experienced before the hospital hired her.

She now owes Methodist more than $23,000, including around $5,800 in attorney’s fees.

It’s surreal, she says, to be sued by the organization that pays her $12.25 an hour. “You know how much you pay me. And the money you’re paying, I can’t live on,” says the housekeeper, who asked that her name not be used for fear that the hospital would fire her for talking to a reporter.

From 2014 through 2018, the hospital system, which is affiliated with the United Methodist Church, has filed more than 8,300 lawsuits against patients, including some of its own workers. After winning judgments, it has sought to garnish the wages of more than 160 Methodist workers and has actually done so in more than 70 instances over that time, according to an MLK50-ProPublica analysis of Shelby County General Sessions Court records, online docket reports and case files.

Some of the debts were accrued while the employees worked at Methodist; others predated their time there. The figures do not include debts incurred by onetime Methodist employees who have since moved on.

It’s not uncommon for hospitals to sue patients over unpaid debts. In fact, as NPR reported Tuesday, recent research shows that more than a third of hospitals in Virginia do so. And earlier reporting from NPR and ProPublica found the practice in several other states.

But what is striking at Methodist, the largest hospital system in the Memphis region, is how many of the patients being sued are the hospital’s own employees. Hardly a week goes by in which Methodist workers aren’t on the court docket fighting debt lawsuits filed by their employer.

Between January and mid-June, a reporter observed more than a dozen Methodist employees in court to defend themselves in suits brought by the hospital over hospital bills.

That includes a Methodist Le Bonheur employee who owes more than $1,200. In January, she proposed paying $100 a month, even though her sworn affidavit listed monthly expenses that exceeded her $1,650 monthly income. After conferring with an attorney for Methodist, Judge Betty Thomas Moore agreed to the worker’s proposal, but she has already missed a payment.

A few weeks later, a Methodist employee appeared for an initial hearing wearing hospital scrubs. The hospital had sued her for more than $4,000. When she left the courtroom, she was annoyed. Her employer knew where she worked, she said, and should have contacted her before suing her.

“I don’t know why they can’t come upstairs,” she said outside the courtroom.

And in May, an employee who has worked for Methodist for more than four years carried a large envelope full of bills with her into the courtroom. She owed more than $5,400, which included a 2017 hospital charge from the newborn unit. That is the same year that her daughter was born, according to her sworn affidavit, which also listed a checking account balance of less than $4.

The woman offered to pay $10 biweekly, or $20 most months, but Methodist’s attorney wanted $200 per month. The judge ordered her to pay $100 per month.

What makes matters worse, employees say, is that Methodist’s health insurance benefits only allow employees to seek medical care at Methodist facilities, even though the financial assistance policies at its competitors are more generous.

A specialist in hospital billing practices says that if the hospital is suing a fair number of its own employees, it’s time to examine both the insurance provided to workers and the pay scale.

Given that the hospital is suing some of its own employees, “one would hope … the hospital would look at the insurance they provide workers,” says Mark Rukavina, a former nonprofit hospital consultant and currently a manager at Community Catalyst, a health care advocacy organization.

Methodist declined requests for an interview. It did not respond to specific written questions about the lawsuits it files against its workers or about how its policies reflect the values of the United Methodist Church. Instead, in a written statement, it said it is committed to working with patients who are having trouble paying their medical bills.

“As the second largest private employer in Shelby County, we recognize the responsibility we have as an organization to contribute to the success of the diverse communities we serve and are purposeful about creating jobs in our community — intentionally choosing to keep services like printing, laundry and others in-house that are typically outsourced by the health care industry,” the hospital said.

Methodist also declined to answer a question about whether it has any policy that prohibits employees being sued by Methodist from talking to a reporter about the lawsuits filed against them by the hospital.

Employer and legal adversary

On a single January day, there were 10 defendants on the docket whose place of employment was listed in court records as Methodist.

Employees in scrubs sat just feet away from the attorneys in dress suits — attorneys their employer had hired to sue them. The hospital’s role as a tax-exempt organization that both employs the defendants and is suing them went unremarked upon by judges, attorneys and the defendants themselves.

Methodist’s financial assistance policy stands out from peers in Memphis and across the country, MLK50 and ProPublica found. The policy offers no assistance for patients with any form of health insurance, no matter their out-of-pocket costs. Under Methodist’s insurance plan, employees are responsible for a $750 individual deductible and then 20% of inpatient and outpatient costs, up to a maximum out-of-pocket cost of $4,100 per year.

The housekeeper’s story is documented in Shelby County General Sessions Court records, including online docket reports and online payment history. A reporter interviewed the housekeeper multiple times in person and on the phone. The employee gave the reporter six years of itemized Methodist hospital bills, her credit report and other past-due medical bills. Most of her debts were incurred before she started working at Methodist.

Five times between 2012 and 2014, she visited the hospital for stomach problems, according to the itemized bills. (Years later, she had surgery to treat diverticulitis.) At those times, she had insurance through her job at a hotel, where she cleaned rooms for $10.66 an hour. After insurance paid its share, she owed just over $17,500.

In 2015, the housekeeper left the hotel job and lost her insurance. Three times that year she went to Methodist’s ER, but since she was uninsured and had little income, she qualified for financial assistance. Methodist wrote off more than $45,000 in hospital bills.

In a statement, Methodist said it gives an automatic 70% discount to uninsured patients and free care to uninsured patients at or below 125% of the federal poverty guidelines. For a single adult with two dependents, that would be just over $26,600. Uninsured patients who earn more than that, but less than twice the poverty limit, are also eligible for discounts, it said.

In 2016, unable to find work, the housekeeper left Memphis. For more than a year, she says, she and her son were homeless, bouncing between relatives in Chicago, where she was born, and Texas.

But she missed her daughter and grandchildren in Memphis. So in 2017, she returned. In August 2017, Methodist sued her for the bills she accumulated when she was insured years earlier. Later that month, she was hired at a Methodist hospital, starting at $11.95 an hour.

The hospital’s collections agency, which it owns, didn’t have her correct address and was unable to serve notice that she had been sued, but last year, Methodist tried again. This time, it had the right address.

In November, a process server handed her the civil warrant at her South Memphis apartment.

At the process server’s recommendation, she called the hospital’s collection agency and offered to pay $50 every two weeks. “But they said it wasn’t enough,” she recalls. “I would just have to go to court. They said I’d be owing them all my life.”

In a sworn affidavit filed with the court this year, the housekeeper listed her dependents as a grandson and her 27-year-old son, who she says has bipolar disorder and schizophrenia. She told the court she earned $16,000 in 2017, which puts her more than $4,000 below that year’s federal poverty level for a family of three. (Because she had insurance, though, she was ineligible for assistance under the hospital’s policy.)

Fred Morton, a retired Methodist minister in Memphis, says he was surprised to learn that Methodist is suing its own employees.

“The employees should be paid an adequate minimum wage at the very least,” he says. “Certainly they should not be predatory to their own employees on medical bills. That’s very much contrary to Scripture.”

He said that Methodist bishops who serve on its board bear responsibility for reminding it of the denomination’s values.

“It’s a matter of the church pushing on its own,” Morton says.

Three United Methodist Church bishops serve on the hospital’s board. Bishop Gary Mueller’s office referred a reporter to Methodist Le Bonheur Healthcare’s communications office. Bishop Bill McAilly declined to comment. Bishop James E. Swanson did not respond to multiple requests for comment.

When the housekeeper appeared before a General Sessions Court judge this year, she’d filed a motion offering to pay $50 biweekly, or $100 in most months. When the hospital’s attorney asked for a $200 per month, she was stunned.

“This is my only job, this is my only income, so how am I supposed to live?” she remembered thinking.

Nervous that the judge would side with the hospital, the housekeeper made another offer.

“I could do $75 every two weeks,” she said quickly.

The attorney agreed and the judge signed the order.

Being an employee and defendant is “really kind of sad,” the housekeeper says. Asked how she manages to make ends meet, she says she doesn’t: “It’s killing me — killing me softly.”

She says she didn’t reach out to the hospital’s payroll department or a manager about the hospital bills she’s being sued for. “They don’t care about that. … That I do know.”

‘I don’t want to be homeless again’

Part of what makes paying medical bills so hard for some Methodist employees is that their wages are low, lagging behind several other large employers in the Memphis market. In December, St. Jude Children’s Research Hospital announced it was raising its minimum pay for full and part-time workers to $15 an hour. St. Jude’s decision followed a similar commitment by the Shelby County government, Shelby County Schools and Blue Cross Blue Shield of Tennessee.

At Methodist, which operates five hospitals in Shelby County, the lowest-paid employees make $10 an hour and about 18% of workers make less than $15 an hour, the hospital reported in response to MLK50’s 2018 Living Wage Survey.

As recently as 2017, the Greater Memphis Chamber advertised on its website that the city offered a workforce at “wage rates that are lower than most other parts of the country.”

The United Methodist Church’s Social Principles, which state the denomination’s position on everything from climate change to the death penalty, speak directly to what employees should earn. “Every person has the right to a job at a living wage,” it states. The Living Wage Model statement on the church’s website says, “Exploitation or underpayment of workers is incompatible with Christ’s commandment to love our neighbor.”

Methodist, which made Forbes’ 2019 list of Best Employers by State, did not answer specific questions about pay for employees. On its website, it says, “It is the policy of Methodist Le Bonheur Healthcare to pay its employees competitive, market-based wages.”

Neither Methodist, nonprofit Baptist Memorial Healthcare nor Regional One, the public hospital, pay all their employees at least $15 an hour. Even that figure would make it impossible to make ends meet for an employee trying alone to support a household with dependents, according to MIT’s Living Wage Calculator and another created by the Economic Policy Institute, both of which take into account local living expenses.

The housekeeper’s $12.25 an hour pay falls well short of that. Without overtime, she says, her take-home pay would be around $1,600 per month. Her rent is $610.

Even with as much overtime as she gets, she’s turned to payday loans. Since December, she’s renewed a $425 payday loan every two weeks, paying $71 each time. “You have to rob from Paul to pay Peter,” she says. “It doesn’t never seem like you can get ahead.”

The housekeeper applied for a job at Walmart but was told the store nearest her is not accepting applications. She doubts the pay will be any better, but she hopes it will be less stressful.

“Times be hard, because sometimes my body feels like I can’t make it,” she says. “But I get up anyway, because I don’t want to be homeless again.”

Wendi C. Thomas is the editor of MLK50: Justice Through Journalism. Email her at wendicthomas@mlk50.com and find her on Twitter at @wendi_c_thomas.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for ProPublica’s Big Story newsletter to receive stories like this one in your inbox as soon as they are published.

Let’s block ads! (Why?)

There’s a green van parked on the edge of downtown Miami on a corner shadowed by overpasses. The van is a mobile health clinic and syringe exchange where people who inject drugs like heroin and fentanyl can swap dirty needles for fresh ones.

One of the clinic’s regular visitors, a man with heavy black arrows tattooed on his arms, waits on the sidewalk to get clean needles.

“I’m Arrow,” he says, introducing himself. “Pleasure.”

This mobile unit in Miami-Dade County is part of the only legal needle exchange program operating in the state. But a new law in Florida — a needle exchange law that won the support of Florida’s conservative legislature, and was signed by Gov. Ron DeSantis Wednesday — aims to change that.

Needle exchanges have been legal in many other states for decades, but southern, Republican-led states like Florida have only recently started to adopt this public health intervention.

The timing of the statewide legalization of needle exchanges comes as Florida grapples with a huge heroin and fentanyl problem. When people share dirty needles to inject those drugs, it puts them at high risk for spreading bloodborne infections like HIV and hepatitis C. For years, Florida has had America’s highest rates of HIV.

Even so, Arrow says he and every user he knew always put the drugs first. Clean needles were an afterthought.

“Every once in a while, I did use someone else’s and that was a thrill ride — wondering whether or not I was going to catch anything. But I’m blessed; I’m 57 and I don’t have anything,” says Arrow, whose full name NPR has agreed not to use because of his use of illegal drugs.

“Now I can shoot with a clean needle every time,” he says.

The Miami experiment

According to the Centers for Disease Control and Prevention, needle exchanges prevent the spread of viruses among users of injection drugs.

But the advocates who want to offer needle exchanges face challenges. For example, carrying around loads of needles to hand out without prescriptions can violate drug paraphernalia laws. Many states mapped out legal frameworks decades ago to handle this particular public health intervention. But it was illegal to operate exchanges in Florida until 2016. That’s when the state legislature gave Miami-Dade County temporary permission to pilot a needle exchange program for five years.

“This is more than just a needle exchange,” says Democratic state senator Oscar Braynon. “This has become a roving triage and health center.”

Braynon has been sponsoring needle exchange bills — including the bill for the pilot project — since 2013. This year he introduced Senate Bill 366 to allow the rest of Florida’s counties to authorize similar programs.

In three years of operation, Miami’s pilot program has pulled more than a quarter million used needles out of circulation, according to reports the program filed with the Florida Department of Health. By handing out Narcan — the drug that reverses opioid overdoses — the exchange has prevented more than a thousand overdoses. The program also offers clients testing for HIV and hepatitis C, which is how Arrow knew he was negative. Finally, the program connects people to medical care and drug rehab.

“We have made it so easy for people to get into HIV care now, and we have so many people who we never would have known were infected — and would have infected countless other people — who are on their medications,” says Dr. Hansel Tookes, head of Miami’s needle exchange pilot program He has been pushing legislators to legalize needle exchanges since he was a medical student six years ago.

Tookes was in Tallahassee, the state capital, this May when the expansion bill passed its final vote. He said he spent the return flight home to Miami staring out the window.

“I looked down at Florida the entire ride,” he says, “and I just had this overwhelming feeling like, ‘Oh my God, we just did the impossible and we’re going to save so many people in this state.’ “

Why harm reduction trumped politics

When Republican state senator Rob Bradley first deliberated over needle exchanges in Florida six years ago, he was critical.

“You’re trying to make sure the person has a clean needle, which is outweighing the idea of the person breaking the law,” he declared back in 2013, before casting his vote against the idea.

This is the primary objection of conservative lawmakers — the concern that these programs promote illegal drug abuse.

Responding to this skepticism with data has been central to changing lawmakers’ minds. Decades of research show needle exchanges do not encourage drug abuse, and that they lower other health risks to people who are vulnerable and often hard to reach. It’s part of a public health approach known as “harm reduction.”

At a recent meeting ahead of the vote on statewide legalization, Ron Book — a powerful Florida lobbyist who chairs the Miami-Dade County Homeless Trust — voiced a question that comes up a lot about the needle exchange and heroin use.

“Doesn’t that help encourage it?” he asked Tookes.

“Nobody who used our program — and we collect a lot of data — was a first-time user of opioids when they came there,” Tookes told him. “Not one person.”

In Miami, the needle exchange pilot project has also earned the support of law enforcement. Officers say it’s a relief to know more injection drug users are keeping their syringes in special sharps containers, provided by the exchange, to safely dispose of dirty needles.

“Now, for our officers, when they’re doing a pat down … that sharps container is really protecting you from a loose needle 100 percent of the time,” says Eldys Diaz, executive officer to the Miami Chief of Police. “That’s an extraordinary source of comfort for us.”

This year, when state senator Bradley heard discussion of the needle exchange bill again, he had a different response.

“I just want to say, when I started my career in the Senate, I voted against the pilot project — and I was wrong,” he said as he voted for the bill this time. “And the results speak for themselves. It’s very good public policy.”

The state’s new needle exchange law passed unanimously in the Florida Senate and 111 to 3 in the Florida House, and goes into effect July 1.

Arrow gets a future

If it weren’t for the tattoos running down his arms, it would be hard to recognize Arrow as the man who once slept under highway overpasses. His skin is now clear, and he has some meat on his bones — he looks healthier.

“How have you been?” Tookes asks, greeting Arrow at a clinic where needle exchange clients can get follow-up care.

“Wonderful,” Arrow says. “I feel good.”

He looks and feels better, but it’s been a rough year.

Last May, Arrow’s girlfriend died from a heart infection — a serious condition that can happen to people who inject drugs. After that, Arrow says, he overdosed on purpose. Narcan from the needle exchange brought him back.

But he kept using.

Arrow says he doesn’t remember a lot from this period, but does remember using so much heroin that he ran out of fresh needles between visits to the exchange. So he grabbed other people’s used needles.

And then he tested positive for HIV and hepatitis C.

Tookes and his colleagues threw Arrow another life raft: They got him an inpatient drug treatment bed.

At Arrow’s checkup with Tookes, a string of keychains from Narcotics Anonymous clicked at his waist.

“My chain of sobriety,” he says of the links. “I got 30-days, 60-days, and 90-days chips,” he says.

Arrow’s HIV is under control. And he’s connected to health services for people living with HIV, including getting medication that cured his hepatitis C.

Now, he’s focused on staying sober, one day at a time. And he’s starting to want new things. “Thanks to this man right here,” he says, nodding to his doctor — Tookes.

As more Florida counties elect to begin needle exchanges, there’s no guarantee that every person who turns to them will get as far as Arrow. But Tookes, Braynon and other supporters hope such services will at least give more people the chance to recover from addiction — and protect themselves from needle-borne illnesses.

This story is part of NPR’s reporting partnership with WLRN and Kaiser Health News, a nonprofit news service of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.

Let’s block ads! (Why?)

Today, antiretroviral medicines allow people with HIV, the virus that causes AIDS, to live long, productive lives. But at the onset of the AIDS epidemic in the early 1980s, the disease was considered a death sentence. No one was sure what caused it or how it was spread. Some doctors and nurses refused to treat patients with the disease; others protected themselves by wearing full body suits.

Cliff Morrison, a nurse at San Francisco General Hospital at the time, remembers being appalled by what he was seeing: “I would go in patients’ rooms and you could tell that they hadn’t had a bath,” he says. “They weren’t being taken care of.”

In 1983, Morrison organized a team of healthcare providers to open Ward 5B, an in-patient AIDS special care unit at San Francisco General Hospital. The medical team on the unit encouraged patients to make their rooms like home, and allowed families and partners to visit whenever they could. They comforted patients by touching them, and would even sneak in pets.

5B was the first unit of its kind in the nation — and it became a model for AIDS treatment, both in the U. S. and overseas. Now, a new documentary, called 5B, tells the story of the doctors and nurses who cared for patients on the ward.

Dr. Paul Volberding was a doctor on Ward 5B and went on to co-create an AIDS clinic at the hospital, which was one of the first in the country. He emphasizes how critically ill the patients on the unit were.

“These were people that were really, sometimes literally, dying when they came into the hospital, so whatever we could do to make them more comfortable was really important,” he says.

The work on 5B was emotionally draining, and death was a constant reality. Still, Volberding describes his time there as a “blessing.”

“The care that patients were getting was really special and very different than the rest of the hospital,” he says. “It was always a complete privilege to do this work.”

Morrison adds, “I had some really wonderful experiences with people in their passing, and they taught me a great deal. It really put in perspective the fact that life is on a continuum, and death is just part of that continuum. I saw people have beautiful deaths, and that was wonderful.”

Interview highlights

On how everyone who came into the hospital with the virus in the early 1980s died

Volberding: I don’t think most people can understand today how devastating a disease AIDS was back in those days. … It’s just impossible to appreciate that HIV, if it’s untreated, kills essentially 100 percent of the people. It’s much worse than Ebola, much worse than smallpox. So, everyone died. Every patient that was sick enough to come to us to look for medical care would die from this disease. And people knew that there was a lot of education to be done, but they knew that this was a really bad situation.

On how they didn’t know if what they were seeing was infectious when the first patients came in with the rare cancer, Kaposi’s sarcoma, which ended up being one of the symptoms of the as-yet-unknown AIDS virus

Volberding: I wasn’t worried about catching anything from the patients because that’s not what I expected in taking care of cancer patients. I didn’t expect to be worried about anything, and wasn’t really. But the care that the patients were getting was pretty spotty in the hospital. I think that was one of the things that led Cliff and the others to really put together the nursing unit.

Morrison: In my experience, in already what had been seen and what I was hearing from the specialists around us with the information that was coming out, was that I wasn’t at risk providing care to people by touching people. And everybody around us was saying, “Oh you’re just being cavalier. This is really not what you should be doing, and you’re giving the wrong message.” And our response always was, “We’re giving the right message.” So we were dealing with a lot of hysteria and misinformation and just outright discrimination, I think, very early on.

On expanding the hospital’s family and visitors’ policy for Ward 5B

Morrison: We also noticed right away … that we needed to really look at issues around family and visitation, because healthcare was very rigid and was really stuck on this whole idea [regarding] visiting hours that it could only be immediate family. Most of our patients didn’t have family around. … We almost immediately began talking about, in all of these regular meetings and sessions that we had, that maybe we needed to start letting our patients tell us who their family was, and that we needed to kind of move away from this whole idea of traditional family and biological family.

Volberding: I think that the patients were so sick — and they were so in need of support — that the idea of visiting hours and keeping people away didn’t make sense.

Morrison: There were times when they were alone in their rooms and they always needed something. They were very anxious. It not only made them more comfortable, it made our lives a lot easier having people that were there in the rooms most of the time.

On the bond that existed among 5B staff members

Volberding: It was a family. The physicians, the staff and the clinic and in the inpatient unit — we all worked so closely together because those were our patients. As physicians, those were our patients. And we were on the unit every day seeing our patients, and it was, again, a very special group of people.

On how the homophobia of the time influenced patient care

Morrison: That was, I think, probably the most glaring reality of the situation. Even in San Francisco — which, even at that time was considered the gay mecca — gay people had very established careers and homes and families, and yet all of that started coming apart. And it really was centered around homophobia. There were people in the hospital that should have known better. … There was a group of nurses that basically said that what we were doing was crazy and that we were putting all of them at risk. It went before the labor board — but that was all homophobia.

On the evolution of AIDS treatment

Volberding: In 1987 we began to have some drugs that were doing something. … And then, by 1996, the so-called triple therapy was developed and that was really a turning point in the epidemic. We could suddenly start seeing some of our patients actually get better — not just die more slowly, but actually get better.

And some of those people are still alive today. The effort since ’96 has been to take those potent drugs and make them less toxic and more convenient. Today, we treat this very typically with what we call single tab regimens — one pill taken once a day that contains two, three or even four drugs — all in the same pill. Many of my patients don’t have any side effects at all from the medicines they’re taking. The change from the early days, and seeing the drugs being developed, and now seeing that this is truly a chronic condition is, I think, one of the most amazing stories we’ll ever hear from in medicine.

Amy Salit and Mooj Zadie produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.

Let’s block ads! (Why?)

The Fredericksburg General District Court is a red-brick courthouse with Greek columns in a picturesque, Colonial Virginia town. A horse and carriage are usually parked outside the visitor center down the street.

On a sunny morning — the second Friday in June — the first defendant at court is a young woman, Daisha Smith, 24, who arrives early; she has just come off working an overnight shift at a group home for the elderly. She is here because the local hospital sued her for an unpaid medical bill — a bill she didn’t know she owed until her wages started disappearing out of her paycheck.

The hospital, Mary Washington, sues so many patients that the court reserves a morning every month for its cases.

Inside the courthouse, it’s not hard to figure out where to go. Right through court security, there are signs on colored paper: “If you are here for a MW case, please register at the civil window.” When the elevators open, there’s another Mary Washington sign. Wearing name badges, Mary Washington billing staff members walk through the halls. They’ve set up a kind of field office in a witness room at the back of the courtroom, where they are ready and waiting to set up payment plans for defendants.

On June 14, only a handful of the 300 people summoned to court show up. Most of the lawsuits were filed by the hospital, along with some others from medical companies affiliated with Mary Washington Healthcare.

The hundreds that did not come have default judgments made against them, meaning their wages can be garnished.

Those who did who did sit scattered throughout the bright, mostly empty courtroom, under the schoolhouse lamps.

At 9 a.m., the judge walks into court, and everybody rises.

“Good morning,” he says. “This is what we call the hospital docket.”

Bill collection through the courts

Not every hospital sues over unpaid bills, but a few sue a lot. In Virginia, 36% of hospitals sued patients and garnished their wages in 2017, according to a study published Tuesday in the American Medical Association’s journal, JAMA. Five hospitals accounted for over half of all lawsuits — and all but one of those were nonprofits. Mary Washington sued the most patients, according to the researchers.

Mary Washington defends the practice as a legal and transparent way to collect bills. It says it makes every effort to reach patients before it files papers to sue.

But others who observe and research the industry find it troubling that hospitals, especially nonprofits, are suing their patients.

“Hospitals were built — mostly by churches — to be a safe haven for people regardless of one’s race, creed or ability to pay. Hospitals have a nonprofit status — most of them — for a reason,” says Martin Makary, one of the JAMA study’s authors and a surgeon and researcher at Johns Hopkins Medicine. “They’re supposed to be community institutions.”

There are no good national data on the practice, but journalists have reported on hospitals suing patients all over the United States, from North Carolina to Nebraska to Ohio. In 2014, NPR and ProPublica published stories about a hospital in Missouri that sued 6,000 patients over a four-year period.

Typically these aren’t huge bills. In Virginia, the average amount garnished was $2,783.15, according to the JAMA study. Walmart, Wells Fargo, Amazon and Lowe’s were the top employers of people whose wages were garnished.

“If you’re a nonprofit hospital and you have this mission to serve your community, [lawsuits] should really be an absolute last resort,” says Jenifer Bosco, staff attorney at the National Consumer Law Center.

Bosco explains that IRS rules require nonprofit hospitals to have financial assistance programs and prohibit them from taking “extraordinary collection actions” on unpaid medical bills without first attempting to determine patients’ eligibility for financial assistance.

Nonprofit hospitals, Bosco says, “have to provide some sort of financial help for lower-income people, but the federal rules don’t say how much help, and they don’t say how poor you have to be to qualify [or] if you have to be insured or uninsured.”

As a result, she says, nonprofit hospitals have “a lot of free rein to make up their own policy of what they think is appropriate.”

“Hospitals sometimes can legally sue their patients for medical debts,” Bosco says. “The question is whether that’s something that they should be doing.”

For Makary, as a doctor, the answer is simple: “It’s a disgrace every place where it happens,” he says.

The “hospital docket” at the Fredericksburg court illustrates how far hospitals will go to pursue debts, he says: “It’s almost as if the courthouse has converted into a taxpayer-funded collections agency.”

“Who’s garnishing my check?”

Smith is unflinching when she talks about Mary Washington and what happened to her after she went to the hospital in 2017.

At the time she didn’t have insurance. She was working part time at Walmart for $11 an hour. She doesn’t want to give the details about why she ended up at the hospital. “I was not myself,” she says. “So I walked myself into Mary Washington to get help — to get myself on track.” She says she was admitted for two weeks.

Smith says no one told her about the financial assistance program or talked to her about her bill. According to the hospital’s policy, someone making less than $25,000 without health insurance should qualify for “free care.” But the hospital sued her for $12,287.68. She had a default judgement against her and did not realize she had been sued until she saw her paycheck mysteriously disappearing.

“When I looked at my pay stub, I’m like, ‘Why do I only have like $600-something in my account?’ ” She noticed “garnish” written on the bottom of her pay stub. “So I called my company and asked them, ‘Who’s garnishing my check?’ ” They told her it was Mary Washington.

With the garnishment, her take-home pay for a month of work comes to about $1,400. Her rent is $1,055. “I literally have no food in my house because they’re garnishing my check,” she says.

She knows she is not the only one that Mary Washington has gone after for an unpaid bill. Her relative had one, too, and got on a payment plan. Her co-worker was also sued.

“And that’s crazy,” she says, shaking her head. To Mary Washington Hospital, she says: “People need help. You all are just money hungry.”

A thin slice of revenue

In the courtroom, on hospital docket day in June, the judge ran through the cases quickly. One man owed $1,500 after an emergency room visit. A nurse was on the hook for over $20,000 after one of her children had a mental health evaluation. Another woman wasn’t sure why she was being sued for $1,400 — it could have been from an outpatient surgery she had three years ago. The day’s hearings are all over in 45 minutes.

Mary Washington Healthcare stands by its practice of suing patients and says that lawsuits are relatively rare.

“It’s important to us, as a small community, and a safety net hospital, that we’re doing everything we can for our patients to avoid aggressive collections,” says Lisa Henry, communications director for the health care system.

Henry says Mary Washington has a months-long process for trying to reach patients before it takes legal action. “By phone, by mail, by email — any access point we’re given from them when they register,” she says.

“Unfortunately, if we don’t hear back from folks or they don’t make a payment we’re assuming that they’re not prepared to pay their bill, so we do issue papers to the court,” she says.

Mary Washington Healthcare includes two hospitals, a network of physician practices, specialty care and outpatient centers.

Henry says the “vast majority” of patients who are eligible do get signed up for their financial assistance program, getting discounted or free care or setting up a payment plan. “A small percentage then goes on to collection and then even smaller goes to litigation,” she says. “We see thousands of patients a year and less than 1% go to litigation.”

In fact, Henry says that the revenue the hospital got from garnishing people’s wages was only 0.21% of its $624 million total revenue in 2018. That’s slightly higher than the average collected by other Virginia hospitals, according to the JAMA study, which found hospitals collected an average of 0.1% of their total revenue from garnishments.

Erin Fuse Brown, a law professor at Georgia State University whose work focuses on health care costs, says there are bigger philosophical questions here about a hospital’s role.

“There has to be a balance between getting their bills paid but also being a reasonable community member,” she says. Regarding lawsuits, she adds: “It doesn’t seem to be worth the effort, and it’s so ruinous to the patient — not just the financial obligation but the effect on your credit, on your record, the emotional effect of being sued.”

Mary Washington Healthcare has chosen to go through the legal system intentionally, Henry says. “We selected to do this because we think it is a fair and appropriate way to help our patients reach out to us — to open the lines of communication,” she says. “There are many cases resolved before litigation. The court summons alone is enough to open that door of communication so that we can work with them.”

Henry says the Virginia hospitals that don’t sue patients are probably outsourcing their collection of unpaid bills. “Most sell their debt. We have elected not to ever sell our debt in small claims,” she says. “The reason for that is the collections agencies can be aggressive.”

Fuse Brown says IRS rules for nonprofit hospitals don’t distinguish between whether a hospital is trying to collect an unpaid bill directly or using a private collection company. “They’re recognized to be fairly harsh tactics, whether the hospital is the one doing the suing or whether it’s a debt collection agent,” she says. “Certainly to the patient, all of that feels equally stressful and burdensome.”

She says it’s hard to know at a national level how many nonprofit hospitals sue patients who haven’t paid their bills, how many sell the debt, and how many write it off. “I haven’t seen any good studies that tried to estimate the number of hospitals that are doing this or the percentage of patients who are subjected to this type of debt collection activity,” Fuse Brown says.

She adds, it’s a shame information about hospitals’ collection practices isn’t widely available. “Wouldn’t you like to know that if you were a patient?” she asks.

“Do you owe this money?”

On June 14, a group of doctors, pre-med students and a lawyer headed to the Fredericksburg court early, and as patients collected in the hall outside the double doors of the courtroom, the group approached them, asking, “Are you here because you’ve been sued by Mary Washington?” Nearly everyone nodded cautiously. And most were open to talking about and sharing what happened to them.

This group is part of an advocacy campaign to support patients who are being sued by the hospital. The effort is led by Johns Hopkins researcher Makary, the author of the JAMA study.

He first found out about this hospital’s lawsuits last fall while working on The Price We Pay, his forthcoming book on dysfunction in the American health care system. He was so outraged by what is happening to patients in Fredericksburg that he has started showing up every month when hospital cases are heard in the court.

“To see these aggressive, and even predatory, collection strategies affect everyday teachers, farmers, even nurses — it’s heartbreaking and it’s wrong and it needs to stop,” Makary says.

Part of the advocates’ strategy to help patients fight these lawsuits is to encourage them to contest their bills, rather than admit they owe the money.

“The No. 1 thing we need them to do is when the judge asks that initial screening question, ‘Do you owe this money?’ the answer they need to say is, ‘No,’ ” Makary explains. “That allows us to make the arguments and to have a hearing.”

If they say yes, which many of them do, “That’s kind of the kiss of death — you’re going to get a judgment against you,” says Joseph Kirchgessner, the local attorney working with the advocacy team.

The underlying thinking is that patients rarely have a chance to negotiate the cost of medical services in advance and that bills may be unreasonable, especially in light of their financial circumstances. A patient who contests may be able to negotiate a better price or have the bill forgiven.

Kirchgessner says he plans to argue that hospital contracts, often signed under duress during a medical crisis, aren’t valid. Makary is ready and willing to be an expert medical witness, to testify about whether there are hospital markups or unnecessary procedures.

But Kirchgessner hasn’t had a chance to defend a Mary Washington case in court yet, he says, because each time he gets close to a trial date, the hospital withdraws its case against the patient. This leaves the issue unresolved. The hospital can still try to collect, or bring a future lawsuit.

The advocates are also politely asking hospitals like Mary Washington to end the practice of suing over unpaid bills. Makary has chatted with doctors in the hospital cafeteria, imploring them to tell their administrators to stop. (Makary has been doing that himself, at his own hospital — Johns Hopkins Hospital — which was also recently reported to be suing patients over their bills.) He sent a letter to Mary Washington Healthcare’s CEO and board members asking that they stop the suits.

“We’ve told the hospital that we will plan to be there on every single court date until the hospital decides to stop suing low-income patients for bills that they simply can’t afford,” Makary says.

Mary Washington’s Henry says that because all of the court records are public, they are subject to more scrutiny than hospitals that use collection agencies.

“We’re really unclear as to why Mary Washington Healthcare in particular has become the face of this,” she says. “I don’t think we’re alone — all hospitals are struggling with, ‘How do we collect appropriately from our patients to stay open as a safety net hospital?’ “

A “wild card” case

Thanks to the volunteer advocates, Smith now has an attorney — Kirchgessner.

He says taking her case “was a bit of a wild card” since it’s too late for her to contest the bill. All he can do for her now is try to get the garnishment lowered or removed altogether. “There are certain laws in Virginia about how people are garnished, how much they can take,” he explains.

The next step is to meet with Smith to work out her income and expenses and make a plan.

Since her paycheck started being garnished, Smith had to take on another job to keep up with her rent. “The second job’s not helping much, but it’s something,” she says. She is also now working full time at the group home and is enrolled in Medicaid.

If her check weren’t being garnished, she says, “I’d be fine. I would have everything that I needed — saving money, everything would be paid, food would be in the house.” She’s glad to have a lawyer helping her with her case. There is a new hearing date set for July.

Now, if she has a medical issue, “I go to urgent care,” she says. “I stay away from Mary Washington.”

Let’s block ads! (Why?)