Houston Two twin sisters in Knoxville, Tennessee both became nurses and when they retired, they organized something called Love’s Kitchen that provided meals and clothes to what they called the “five H’s: the hungry, homeless, helpless, hopeless, and homebound.” One sister, Ellen Turner, passed away recently at 87. The whole operation was funded by donations and run by volunteers. That is what charity is.
Public hospitals have an obligation to provide charity care. Private nonprofit hospitals have the benefit of tax exemptions because they literally swear to the government that they exist for charitable purposes.
Yet these same hospitals with their lofty slogans and “do no harm” mantras are regularly and with impunity suing the heck out of lower income families, eligible even under their own self-certified policies over health care bills. Looking at court records in Texas and North Carolina and talking to families, organizers, lawyers, and journalists, it is sometimes a head scratcher to figure out two things: are they charities at all and how do these hospitals think they can get blood from families that are stone broke. In both Texas and North Carolina, state law do not allow them to garnish wages, so when they file suit they are trying to attach property, most often houses, but also incredibly sometimes personal property, if there is any, from families too poor to own their own homes. How much do they think they can sell someone’s family Bible for?
A lawyer working for legal services in Charlotte pulled some cases for us on Carolinas HealthCare Systems, North Carolina’s largest hospital network, and a public nonprofit. Half of them were renewals. When asked, he explained that once you have a property lien in North Carolina, you have to file every ten years to renew the lien or you can’t collect. So, this huge chain is hanging around, a vulture perched on the wire, obviously waiting for someone to die so they can poach what little might be in their estate, or for some family barely hanging on to be forced to sell or have their house foreclosed, so they can take whatever they can.
Of course these families are in these court cases for some pretty serious crimes. They committed the criminal act of getting sick, while poor. Or at least to sick and too poor for the likely inflated charges still sticking to them decades later that are now falling on them and then to their sons and daughters and the sons and daughters of their sons and daughters. The lien and the debt becomes generational in the same way bondage works for generations working off debt in rock quarries in India. When we looked in Missouri, Arkansas, Texas, and elsewhere we also found that the amount of the debts triggering these liens were sometimes in the six-figures, but mostly were relatively small, five hundred here, two thousand there, and so forth.
Stories filed by investigative reporters for the Charlotte Observerindicate that the same patterns exist in that state as well. Several months ago Ames Alexander reported the “good news” that Carolinas Healthcare Systems only “filed about 1400 lawsuits against patients last year  – roughly half the number it filed in 2010.” That number they reported was almost half of the 3200 filed statewide, down from 6000 in 2010.
The new rules under the Affordable Care Act require nonprofit hospitals to clarify and promote their policies around charity care. Clearly one policy has to be to NOT sue poor families for chump change. Perhaps the limit should be cases over $10,000. Furthermore, their charity policies should mandate acceptance of good faith offers to pay.
Another story by the Charlotte Observer team interviewed former patients who were the brunt of these lawsuits. All of whom were eligible under the Carolinas HealthCare systems own charity policies. Most of them had offered a payment plan, usually $100 per month that they didn’t have, nonetheless the hospital rejected the plans and sued them.
I met a women in Charlotte who had recently gotten a bill from a New York hospital for over a half-million dollars for care twenty years ago! We have met no one while visiting families being sued in Houston, Texas by the giant Herman Memorial who were ever told that a charity care policy existed.
Whatever all of this is, I’m sure of a couple of things. First that it’s just plain wrong, and, secondly, that the Knoxville sisters at Love’s Kitchen could tell all of these hospitals that whatever they are doing, it’s definitely not charity.