The medical news website, Kaiser Health News ran an article about a rural hospital in Oklahoma suing its patients over unpaid bills. This is now an old, familiar story in health care. Hospitals, including nonprofit organizations, sometimes sue patients for delinquent medical debts. Obamacare was supposed to do away with medical debt but many people still have cost-sharing they cannot afford.
Suing poor patients doesn’t exactly make nonprofit hospitals look particularly benevolent and some have stopped the practice, including major hospital systems in Virginia and North Carolina. The debt collection cases are still going strong in McAlester, Oklahoma, however:
It took little more than an hour for Deborah Hackler to dispense with the tall stack of debt collection lawsuits that McAlester Regional Medical Center recently brought to small-claims court in this Oklahoma farm community.
Hackler, a lawyer who sues patients on behalf of the hospital, buzzed through 51 cases, all but a handful uncontested, as is often the case. She bantered with the judge as she secured nearly $40,000 in judgments, plus 10% in fees for herself, according to court records.
McAlester Regional Medical Center has filed nearly 5,000 debt collection lawsuits in the past 30 years. McAlester, Oklahoma is a rural town of 18,000 people on US-69 about 125 miles southeast of Oklahoma City. The city has far more large employers than most rural towns. In addition to the Oklahoma state penitentiary, it has aerospace defense contractors. The following is from the City of McAlester website:
Home to the McAlester Army Ammunition Plant, Choctaw Defense, and Spirit AeroSystems, McAlester is a premier defense and aerospace community. Raytheon, General Dynamics, Textron, and Boeing utilize the McAlester workforce for its unique production specializations.
The City of McAlester’s economic base is better off than the vast majority of small rural towns and McAlester Regional is probably in better shape than most rural hospitals. Rural hospitals have a tough time staying afloat, yet communities need them. Rural hospitals are bleeding cash, while their poorer patients often don’t have the money to pay their bills or even their share of the bills. It’s a recipe for disaster.
The hospital, operated by a public trust under the city’s authority, faces its own struggles. Paint is peeling off the front portico, and weeds poke up through the parking lots. The hospital has operated in the red for years, according to independent audit reports available on the state auditor’s website.
The story of McAlester Regional Medical Center is a cautionary tale where there are no winners and a lot of losers.
Some of McAlester’s 18,000 residents have been taken to court multiple times. A deputy at the county jail and her adult son were each sued recently, court records show. New mothers said they compare stories of their legal run-ins with the medical center.
“There’s a lot that’s not right,” Sherry McKee, a dorm monitor at a tribal boarding school outside McAlester, said on the courthouse steps after the hearing. The hospital has sued her three times, most recently over a $3,375 bill for what she said out to be vertigo.
Some anecdotes involve people going to the emergency room for what turned out not to be emergencies, like gastritis or conditions better treated by a primary care provider. One woman even told an interviewer that she now avoids the hospital when her children need care. I wonder if that means she was using the ER for primary care? She should only consider taking her children to a hospital if they are in need of immediate medical attention.
Most people being sued for medical debts in McAlester (and elsewhere) don’t bother to show up and fight the charges. The judge noted that in cases where those being sued don’t show up to contest the case, he has no choice but to follow the letter of the law, even if he doesn’t like it.
This is a story that plays out in small towns all across America. Rural hospitals that operate in the red and try to stay afloat any way they can. This often means hospital emergency rooms that ambush patients at their weakest moments. Too many small town residents don’t have a primary care provider and seemingly use the hospital emergency room as their regular source of care. One uninsured man who went to the ER for gastritis and was later sued for $9,000, while a woman with vertigo owes $3,375. As I’ve said before, there is no easy fix for rural hospitals, and that includes some hospitals in rural areas that are less fortunate than McAlester’s.