From today's Wall Street Journal: Reason Number 357 not to fuck with working people's access to affordable health care when SEIU is watching
ESPECIALLY IF YOU ARE ALSO TAKING OUT WARRANTS ON PEOPLE AND THROWING THEM IN JAIL! - I mean come on, Zaccagnino and Levin, how depraved can you freakin' get????? Here's the article:
Hospitals Try Extreme Measures To Collect Their Overdue Debts
Patients Who Skip Hearings On Bills Are Arrested;
It's a 'Body Attachment'
The Wall Street Journal, PAGE ONE
October 30, 2003
By LUCETTE LAGNADO
CHAMPAIGN-URBANA, Ill. -- Late one night in June 2000, a police
cruiser pulled up to Marlin Bushman's house on a quiet, tree-lined
street. While Mr. Bushman's wife and son stood by, an officer
handcuffed the burly truck driver and took him away to jail. The
charge: missing a court hearing about a $579 hospital bill.
The hospital that pursued Mr. Bushman, a 295-bed not-for-profit
facility called Carle Foundation Hospital, is one of several that has
at times employed debt collection tactics that are shunned by many
other creditors. It has filed hundreds of lawsuits, garnisheed
patients' wages and seized their tax refunds. Since 1995, Carle, the
primary teaching hospital of the University of Illinois, confirms it
has also sought 164 arrest warrants for debtors who missed court
hearings.
In one case, Carle went after an uninsured, part-time musician whom
it had treated for a gunshot wound in a suicide attempt. When the
man, James Bean, missed a hearing on his $7,718 hospital bill, Carle
asked the court for an arrest warrant, and in November 2001 Mr. Bean
landed in jail for several hours.
In another case, Carle obtained an arrest warrant for an uninsured
single mother, Kara Atteberry, who missed two court hearings on a
$1,678 debt she incurred for a miscarriage. Ms. Atteberry turned
herself in to authorities in October 2001 and was briefly jailed
before making a $100 bail payment. She now owes a total of $2,070 to
Carle, including a bill for other treatments, and she expects to file
for bankruptcy.
Some hospitals now rank among America's most aggressive
debt-collectors, as they put increasing pressure on poor and
uninsured patients to pay their bills. Adding to the problem, as The
Wall Street Journal has reported, hospitals generally charge
uninsured patients far more than the discounted rates negotiated by
health-maintenance organizations and other private insurers and
government agencies.
Some also use one of the harshest and least-known collections tactics
of all: seeking the arrest of no-show debtors. A review of court
records and interviews with hospital trade groups, collections
attorneys and consumer advocates shows that hospitals in several
states, including Connecticut, Indiana, Kansas, Michigan and
Oklahoma, have secured the arrest and even jailing of patients who
miss court hearings on their debts.
Tough Tactic
The legal tactic of arresting a debtor who fails to appear for a
court hearing -- known in some areas as "body attachment" -- is so
extreme that some of the country's biggest commercial creditors say
they never use it. For instance, Sears, Roebuck & Co. and Ford Motor
Credit Co., the finance arm of Ford Motor Co., say they expressly
prohibit their collections agents from asking judges to issue arrest
warrants against no-show debtors.
In many areas of the country, collections lawyers say, the procedure
has been all but abandoned. Judges grant a creditor's request for a
body attachment when someone misses one or more hearings or otherwise
flouts a court's authority -- technically, it's not punishment for
the debt itself.
In Connecticut, the state's largest hospital, Yale-New Haven, has
obtained at least 65 civil arrest warrants in the past three years
for debtors who have missed court hearings, according to an
examination of New Haven County court records by a researcher for the
Service Employees International Union, which represents some hospital
workers. After several inquiries from the Journal, the hospital,
which doesn't dispute the union's research, said it would severely
limit the tactic.
In Champaign-Urbana, a county agency was so shocked by hospitals'
debt-collection practices that it tried to strip Carle and another
hospital of their tax exemptions as charitable institutions. The
effort failed against Carle; the challenge to the other hospital, a
268-bed Catholic facility called Provena Covenant Medical Center, is
pending. "This concept of debtor's prison, you read about it in
Dickens, but it is still going on," says Laura Sandefur, a former
member of the agency, the Champaign County Board of Review
The hospitals' pursuit of body attachments is surfacing at a time
when many major U.S. medical centers are under fire for their billing
and collections practices. In June, the American Hospital
Association, the industry trade group, issued a memo urging its 4,800
members to examine their bill-collection practices and demand that
their collections agencies and lawyers "treat your patients with
dignity and respect."
Connecticut recently passed a law slashing interest rates that could
be applied to hospital debt. In California, a bill that would have
shielded patients from aggressive billing and collections was shelved
this summer following heavy industry opposition. Illinois is holding
hearings on how hospitals bill and collect from the uninsured.
Meanwhile, Congress has launched an investigation into the practice
of charging uninsured patients more than the discounted rates offered
to insured patients.
Patient advocates argue there is a fundamental difference between
medical debt and other types of consumer debt. "If it is a car or a
vacuum cleaner, they will simply repossess it. What do you want them
to do? Give the heart valve back?" says Jane Perkins, an attorney at
the National Health Law Program in North Carolina.
For their part, hospitals say they are forced to recoup every dollar
they can because health-care costs are soaring, and insurers and the
government are cutting their reimbursements for services. Hospitals
have also been squeezed by the rising numbers of the uninsured -- the
total hit a record 43.6 million people this year -- who often don't
pay their bills. Hospitals say they shouldn't be forced to bear the
disproportionate financial burden of a national crisis.
"You can't solve the issue of millions of uninsured by simply turning
to hospitals whose financial conditions are quite fragile and say,
'You do it,' " says Howard Peters, senior vice president of the
Illinois Hospital Association, a trade group representing more than
200 institutions, including Carle and Provena Covenant.
Carle defends its debt-collection practices, emphasizing that body
attachments are imposed by a judge as the legal result of a debtor's
violating a court order. "We are not going door-to-door to put people
in prison," says Carle's chief executive, James Leonard, 48, a family
doctor who still occasionally practices medicine. "It is your choice
to not show up in court."
In some cases, the debtors did appear for at least one court hearing.
Ms. Atteberry says that when she did come to court, she was talked
into accepting payment terms she couldn't afford -- including an
order not to spend her tax-refund money. When the judge summoned her
back, she didn't go because she feared "the whole hounding process"
would start anew. "Who would want to show up?" she asks.
After inquiries from the Journal, Carle said it would permit its
collections agencies to seek body attachments only after a review by
a new, three-person committee consisting of two hospital employees
and an outsider. Dr. Leonard says he still considers body attachments
useful, but the panel will try to assess the "human story" behind
each case. He says Carle, which handles 100,000 patient visits a
year, goes to great lengths to serve Champaign's poor and uninsured,
and has programs designed to provide discounted care. "We really are
a microcosm of part of the struggle that is going on," Dr. Leonard
says. "We are charged with sorting out who can afford to pay, who
can't afford to pay. How do you set the rules?"
Carle says its policy is to refer bills to an outside collections
agency once they are 100 days overdue. The hospital says it has
authorized its collections agencies to pursue legal action on about
7,300 bills since 1995, but many of those cases were settled before a
suit was filed. In response to inquiries from the Journal, the
hospital searched its records from 1995 to 2003, and said it had
obtained 164 body-attachment orders during that period. Carle said
not all of the orders had resulted in arrests; some were vacated and
others remain outstanding. The hospital wouldn't be more specific. It
also said it has sought far fewer body attachments in recent years
than previously.
Because Carle doesn't always file cases under its own name, the
number of body attachment orders and arrests resulting from its
collections lawsuits couldn't be independently confirmed. As recently
as a few years ago, the hospital did file such cases under its own
name, but since then suits against Carle debtors have increasingly
been filed under the names of collections agencies. Gretchen Robbins,
a Carle spokeswoman, says the hospital isn't trying to camouflage its
legal activities, but rather its collections agencies increasingly
file "consolidated" suits on behalf of multiple creditors, which she
says is more efficient and cost-effective, saving court costs for
both sides.
Mr. Bushman, the truck driver who was arrested in the middle of the
night, has had a long struggle to pay his hospital bills. In a series
of trips to the Carle emergency room over a period of five years, Mr.
Bushman, who is diabetic, sought care for his wife and their three
young sons. At times, the Bushmans were insured. Other times, they
lacked coverage, or their insurance didn't cover the entire bill.
They paid some of the Carle bills, but by late 1998, still owed $579
and had received several collections notices.
In February 1999, Carle filed a lawsuit in Champaign County Circuit
Court seeking payment. Mr. Bushman appeared at a court hearing on the
debt a month later. He says he couldn't afford a lawyer -- and in
Illinois civil arrest cases, unlike criminal cases, the court isn't
required to appoint one. At the hearing Mr. Bushman agreed to pay the
full amount within a month, even though he says he wasn't sure he
would have the money. After he failed to make the payment, the court
ordered him to appear at another hearing at the end of April.
This time, he didn't show up. He says he was worried about losing a
day's pay. He knew he was risking arrest, but he says, "I assumed I
could probably take care of it later" and, besides, he says, he
couldn't pay the debt. Mr. Bushman, who is now 40 and works as a
mechanic, says he was "expecting some money from a tax return" but
didn't get it.
The court, at the request of a lawyer for Carle's collections agency,
ordered a body attachment. However, Mr. Bushman wasn't arrested right
away. In Champaign County, body attachments are usually enforced only
when an officer confronts someone for another incident or alleged
offense.
About a year later, at 1:10 in the morning of June 13, 2000, Urbana
police picked up Mr. Bushman's 16-year-old son for drinking and
violating curfew laws, according to police records. When the officer
brought the teenager home, his last name triggered an alert about the
outstanding civil-arrest warrant against his father. Mr. Bushman's
wife, Diane, remembers thinking, "You bring home my son and take away
my husband?"
Mr. Bushman was booked and fingerprinted at the Champaign jail. He
posed for a mug shot, turned over his shoelaces and was escorted to a
cell. A judge imposed bail of $2,500 -- with $250 payable up front.
Mr. Bushman waited in a cell while his wife tried to come up with the
money. He says he fell asleep on the concrete bench, using a roll of
toilet paper as a pillow. Ms. Bushman borrowed the money from her
mother-in-law, and Mr. Bushman was freed a short time later. Within
three months, he paid Carle the balance of his debt, and the case was
dismissed.
Carle's chief financial officer, Robert Tonkinson, defends the use of
a body attachment against Mr. Bushman. Mr. Tonkinson pointed out that
Mr. Bushman had more than a year to pay his debt between the time the
body attachment was imposed and the day he was arrested. "He landed
in jail, and that is certainly where no one wanted him to be," Mr.
Tonkinson says, "but I struggle with the personal responsibility on
his part, and my responsibility as chief financial officer."
The use of body attachments -- known in some states as civil arrest
warrants, bench warrants or writs of capias -- varies widely from
state to state, and even from courtroom to courtroom, depending on
such factors as the aggressiveness of local collections agencies and
judicial sympathies. It isn't possible to determine how many
hospitals nationwide use the procedure. In body-attachment
proceedings, a collections lawyer acting on the creditor's behalf
generally can request the arrest, which is then ordered by a judge.
Hospitals, industry trade groups, collection lawyers and consumer
advocates in several states, including New York, Louisiana, Wisconsin
and Texas, say they had never heard of hospitals seeking the arrest
of no-show debtors. Laura Redoutey, president of the Nebraska
Hospital Association, expresses shock at the tactic, and says she
"can't fathom it has ever happened here." Stanley Brezenoff,
president and chief executive of Continuum Health Partners, the elite
New York hospital system that includes St. Lukes-Roosevelt and Beth
Israel, says he has never heard of a New York hospital pursuing an
arrest warrant related to a debt. "We are not in the business of
replicating 'Les Miserables,' " he says.
Nonetheless, just last month in Evansville, Ind., the not-for-profit
Deaconess Hospital sought the arrest of a 22-year-old debtor, Jamie
Ruston, who had missed two court hearings on a $5,664 debt related to
gynecological surgery. Ms. Ruston, who works at a McDonald's, was
briefly in custody before her mother arrived at the jail with the
$500 needed to secure her release. "I cried the whole time," Ms.
Ruston says.
Alan Shovers, a lawyer for Deaconess, says the hospital, which is
affiliated with the United Church of Christ, made "innumerable
efforts to get in touch" with Ms. Ruston to work out a payment plan
or to see if she qualified for charity care. "In the range of 16
times, she has ignored us, ignored the hospital, ignored the court
house," Mr. Shovers says. He defends the hospital's use of bench
warrants -- as the proceeding is known in Indiana -- saying the
hospital seeks them only when debtors have been repeatedly
unresponsive. "Most people, whether rich or poor or whatever, can to
some degree respond to the system -- and you have some people who go
through life without responding," he says. "The question is, are we
taking some unfair advantage, and I don't think we are."
In Connecticut, one of the debtors pursued by Yale-New Haven
hospital, John Franchi, 35, says a state marshal appeared at his East
Haven home one Saturday morning last November and announced he was
placing him under arrest and taking him to the local jail. "I have
two little kids, and it was unbelievable," Mr. Franchi says. He was
able to persuade the officer that he would appear court on his own
the following Monday. "I didn't want to go to jail," he says. "I was
terrified."
After appearing in court, Mr. Franchi, a warehouse supervisor, worked
out a payment arrangement on his $3,978 debt for treatment he says
was related to viral meningitis. He says the hospital is now
garnisheeing a portion of his $14.50 hourly wages. "It is devastating
me," Mr. Franchi says.
Yale-New Haven initially defended its use of writs of capias -- as
the proceeding is called in Connecticut -- saying they were a useful
way to compel recalcitrant debtors to appear. "If someone will be
uncooperative and they ignore the legal system, what is the
alternative?" said William Gedge, a Yale-New Haven hospital vice
president. However, after inquiries from the Journal, Mr. Gedge said
the hospital would severely limit the use of such warrants and would
scrutinize each one that is sought.
Another debtor, Leslie Caplan Block of Newton, Conn., says she was
home caring for her infant twins and 3-year-old daughter in September
2000 when two sheriffs' deputies arrived. They arrested her for
missing a court date on a $9,454 debt she had incurred at Yale School
of Medicine -- which is incorporated separately from Yale-New Haven
hospital -- for surgery on one of her babies. After her father agreed
to come over and watch the children, Ms. Block, now 34, was taken
away in the back of the officers' car and was put in a holding cell
while she awaited a judge. She was released after her husband paid
$350 in bail money. "I was scared to death," she says. In the ensuing
months, her debt swelled to $15,715, including interest and court
costs.
Tom Conroy, a spokesman for Yale University, says the medical school
has used writs of capias only as "a last resort." He says doctors at
Yale medical school -- who care for patients at Yale-New Haven
hospital -- don't inquire into a person's means before offering care.
Mr. Conroy adds that the institution has vacated Ms. Block's debt.
In Champaign-Urbana, James Bean, the man who was treated at Carle
hospital for a self-inflicted gunshot wound, says he has been pursued
aggressively by a collections agent since 1995, when the hospital
sued him over his $7,718 bill. In June 2001, Mr. Bean, who says he
held a series of odd jobs during that period and couldn't afford a
lawyer, missed a court hearing. He says he wasn't aware of the
hearing. Carle's lawyer obtained a warrant for his arrest, and a few
months later, Mr. Bean says, he heard about the warrant and turned
himself in. Bail was set at $3,500, and he spent six hours in jail
before his brother came up with the 10% required to release him.
Five months later, in April 2002, Mr. Bean missed another court
hearing, which he also says he wasn't aware of, and Carle requested
another body attachment. The judge granted it and set bail at $5,000,
but the body attachment was then quashed, according to court records.
Mr. Bean, 44, has recovered from the shotgun wound to his neck and
now works as a stage hand. He says he tried to kill himself because
he was despondent over the breakup of his marriage. Since then, he
made payments totaling $1,340 to Carle, but because of interest and
court costs, his debt swelled to $10,345. "It has been a nightmare,"
he says. "Is there ever going to be an end to it?"
Ms. Robbins, the Carle spokeswoman, says the hospital acted
appropriately after Mr. Bean had failed for years to pay his debt.
The suicide attempt was in 1991, and Carle unsuccessfully tried to
collect for more than four years before filing suit. She says the
hospital also encouraged Mr. Bean to apply for the state's insurance
program for the poor, but that he didn't follow through.
"It doesn't appear as if we were incredibly aggressive in seeking
payment," Ms. Robbins says. "There are many tragic situations we see
day in and day out, and so there is a time for people to work through
their grief, [and] there is time for them to deal with the finances
of their medical care." Ms. Robbins adds that Mr. Bean's bill didn't
have a code that indicated a suicide attempt, so "the folks that
process this wouldn't have known." After inquiries from the Journal,
Ms. Robbins says Carle's collection lawyer had agreed to eliminate
Mr. Bean's interest charges, and that Mr. Bean now owes the hospital
$6,535.
Carle also defends its pursuit of its October 2001 body attachment
against Ms. Atteberry, 26, the single mother whose $1,678 debt had
resulted from a miscarriage. Ms. Atteberry, who then was working as a
waitress at a local pizzeria and is now unemployed, says she turned
herself in to authorities after her shift ended one evening. She says
she didn't want to be arrested in front of her two daughters. At the
time, one was 3 years old and the other 3 months.
Ms. Atteberry was also the subject of an earlier body attachment
order in August 1998, stemming from a debt of $1,514 that she
incurred for various medical treatments in the mid-1990s at both
Carle and Provena Covenant. Ms. Atteberry, who then was working at
Kentucky Fried Chicken, says she turned herself in to authorities the
following month, even though she was nine months pregnant. "I was
freaking out," she says. "I didn't want to go into labor when they
arrested me." She was detained in a jail cell for under an hour while
her $250 bail payment was being processed.
Cheryl Harmon, Provena Covenant's chief financial officer, says the
treatment of Ms. Atteberry was consistent with general practices in
the industry. Ms. Harmon says Provena Covenant filed several hundred
collections lawsuits a year in the mid-to-late 1990s, but a change of
philosophy and collections agencies has drastically reduced that
number -- to as few as 19 in 2002. A court search revealed that
Provena Covenant obtained a body attachment against one of its
debtors as recently as February 2003. That patient, who was briefly
arrested in March, couldn't be located for comment.
Provena Covenant has "made a number of changes to make sure we aren't
sending people to collection who cannot pay," Ms. Harmon says. "It
really has been a soul-searching to find a way to distinguish between
those who can't pay and those who can." Provena Covenant says Ms.
Atteberry has paid $764, and the hospital has "purged" the rest of
her debt. Earlier this month, in response to inquiries from the
Journal, Provena Covenant's chief executive, Mark Wiener, 47, said
the hospital would no longer pursue body attachments.
Ms. Robbins, Carle's spokeswoman, says Ms. Atteberry ignored numerous
efforts to reach her. "We sent statements and we sent her letters,"
and also telephoned Ms. Atteberry and left a message with her father,
Ms. Robbins says. Noting that Ms. Atteberry could have avoided the
court proceedings by communicating with the hospital. She probably
would have qualified for discounts or other financial assistance, Ms.
Robbins says: "There is only so much we can do for folks."
