Better Solutions for Healthcare

WSJ: Jeanette White Is Long Dead But Her Hospital Bill Lives On

By Lucette Lagnado, March 13, 2003

Quinton White lies in bed at his home in Bridgeport, Conn., suffering from kidney ailments and the aftereffects of a heart attack and dreaming of a trip to Paris, which he has seen only in the movies.

But for Mr. White, a retired dry-cleaning worker, seeing Europe is probably as likely as a trip to the moon. In addition to his health troubles, the 77-year-old is strapped with nearly $40,000 of debt.

He owes the money to Yale-New Haven Hospital, a distinguished not-for-profit facility where his wife, Jeanette, was treated 20 years ago. Mrs. White died in 1993, but her debt lives on, growing like her cancer because of the 10% interest charged on her original $18,740 bill. Back in 1983, the hospital’s lawyer got a lien on the Whites’ house, and in 1996 nearly cleaned out Mr. White’s bank account.

Mr. White figures he will be stuck paying the hospital until his own dying day, though he adds, with a mischievous glint in his eye, “They will never get the whole amount. I am not gonna live that long.”

Mr. White isn’t alone in his predicament. Many hospitals besides Yale-New Haven have adopted aggressive collection practices aimed at their uninsured and underinsured patients as they seek extra income to stay afloat. Collection dollars are one of the ways hospitals are compensating for the squeeze on HMO and government reimbursements and countering their losses from caring for the uninsured.

Recently patient advocates from Connecticut to California have begun to criticize the way hospitals pursue patients who owe them money. As part of a national campaign by the Service Employees International Union, the New England health-care local has been researching Yale-New Haven’s collection practices. Grace Rollins spent months looking up court cases the hospital has brought and interviewing some of the patients involved. Some of these people “are living hand to mouth,” Ms. Rollins says. “These debts are literally crippling them.”

Indeed, medical bills are now the second biggest cause of personal bankruptcies, according to a study by Elizabeth Warren, who heads Harvard University’s Consumer Bankruptcy Project. Along with the astronomical cost of even routine hospital procedures, she blames hospitals’ aggressive collection tactics.

The patients who suffer the most aren’t necessarily indigent. The very poor can get Medicaid, the government health plan that pays hospital tabs for those who qualify, while most middle-class families have health coverage that picks up the bulk of their medical bills. It is working-class families like the Whites, with some assets but no insurance coverage, who are penalized the most by the system.

Yale-New Haven, the primary teaching hospital for Yale University’s medical school, defends its collection practices. The hospital, whose board includes the university’s president and the medical school’s dean, says prudent business practices mean that the hospital must at least try to get back money for care rendered. “I can attest vehemently to the ethics, the goodwill, and the intent of this organization,” says Marna Borgstrom, Yale-New Haven’s chief operating officer.

Mr. White seems more resigned to his fate than resentful. Leaning back on his mattress, his skinny limbs covered by a worn blanket, he points to desk drawers stuffed with stacks of canceled checks. Many are made out to Yale-New Haven Hospital, tangible proof, he says, of how month after month he faithfully attempted to repay the institution for its care.

Over the years, Mr. White has paid Yale $16,000 — close to the amount the hospital originally billed for his wife’s stays. But interest on the bill now exceeds $33,000. Indeed, between the principal Mr. White has paid off, the principal that remains to be paid, and the interest and fees owed to the hospital’s attorneys and others, the total bill for Mrs. White’s treatment has ballooned to around $55,000. The hospital confirms that Mr. White still owes $39,000. “I accept it. That’s the way it is,” Mr. White says with a shrug. “How are you gonna fight them?”

But E. Richard Brown, a professor at the UCLA School of Public Health who studies the uninsured, argues that a hospital’s tax-exempt status should require it to steer clear of hard-nosed tactics, including lawsuits, wage garnishing, liens and unrelenting claims for payment. “If we are going to give them that status,” Professor Brown says of hospitals, including Yale-New Haven, “they should be responsible for fulfilling the intent. The intent is to create a community benefit, a public good, and not simply act like a for-profit hospital but with a taxpayer subsidy.”

Mr. White, who married Jeanette in 1946, says the two struggled from the beginning to make a life for themselves and their four sons. They bought a house on Seaview Avenue in the 1960s. Mrs. White worked part time as a cleaning woman and Mr. White worked as a spotter, or stain remover, for a dry-cleaning shop in Westport, Conn., a suburb on New York’s Long Island Sound. The occasional movie star would wander in, he recalls, including Westport’s most famous resident, Paul Newman, whom he laughingly describes as “that short, blue-eyed guy.”

Then, in 1982, Mrs. White was diagnosed with throat cancer and admitted to Yale-New Haven, first in March and again in May. In return for her care, she signed a note agreeing to pay the hospital “regular charges” and late fees. A couple of months later, her husband signed a similar note agreeing to guarantee payment.

Doctors thought they had removed all of his wife’s cancer, Mr. White says. Still, a pall descended on the Whites’ house. The couple’s son, Anthony, who lives with his father and helps take care of him, recalls that his parents’ friends all seemed to vanish after his mom had her voice box removed. “She couldn’t talk, and everyone stopped coming,” he says.

The hospital says it held frequent discussions with the Whites over how its bill would be paid. Early on, Mrs. White applied for Medicaid but was turned down. She offered to pay $25 a month, but the hospital considered that unacceptable. In August 1982, Yale-New Haven’s lawyer, Joseph Tobin, was brought in, and several months later he got a court order for a lien on the Whites’ house, guaranteeing that the hospital’s debt would be repaid in the event of any sale.

Numerous motions were filed with the court in late 1982 and early 1983, culminating the following May in a summary judgment and an order for payment that included the original debt, Mr. Tobin’s $2,811 in legal fees, $192 in court costs and $153 in late charges, for a total of nearly $22,000. The judge then signed off on a payment schedule of $5 a week.

In 1993, Mrs. White succumbed to her cancer, but her husband continued to send the hospital checks. In January 1996, hospital lawyers sought a higher monthly payment, and a judge agreed, tripling the amount Mr. White had to pay to $15 a week.

That same year, the attorneys upped the ante again, moving to seize Mr. White’s savings to pay down his debt. He responded that he had been making regular installment payments and that the funds the hospital sought amounted to his entire savings. He also pointed out that some of the money came from Social Security payments deposited directly to his bank account but protected by law from seizure by creditors. As a result, the court agreed to allow Mr. White to keep $5,416.87 and let attorneys for Yale-New Haven seize $9,627.49.

Even after Mr. White retired from his job at the dry cleaner’s, he continued to make payments on his wife’s bill. But last year, he became seriously ill himself, suffering from heart and kidney conditions. Though his niece and his son were supposed to pay his bills while he was hospitalized at St. Vincent’s Medical Hospital in Bridgeport, Conn., his son concedes that he missed some hospital installments. (Yale-New Haven says that Mr. White has missed 17 payments over the past 20 years, the bulk of them in 2002.)