Hospitals sue to collect from uninsured patients

August 15, 1993|By Dennis O'Brien | Dennis O'Brien,Staff Writer

Dennis Howes is 19, lives with his parents in Shady Side, works as a waterman -- and owes the University of Maryland Medical Systems $32,000 in medical bills.

Now, the hospital is suing him in Anne Arundel County Circuit Court to pay for his two-week stay at the Maryland Shock Trauma Center after a May 1992 truck accident.

"I really have no idea how I'll ever pay that," says Mr. Howes, who has no medical insurance.

He isn't alone. Records in Anne Arundel Circuit Court include dozens of cases like Mr. Howes' and show how the nation's health care crisis is affecting the lives of people with huge medical bills and no health insurance to help pay them.

Hospitals routinely file legal claims in Circuit Court for unpaid bills of more than $20,000. Claims for smaller amounts are handled in the state's District Courts.

And hospitals say the number of lawsuits and the amounts of the debts are increasing.

The amount left unpaid by patients -- uncompensated care -- more than doubled over the past five years, from $188 million in 1987 to $394 million last year, according to the state Health Services Cost Review Commission. That has led to a plethora of lawsuits.

The University of Maryland Medical Systems Corp., the parent organization for both Shock Trauma and UM Medical Center, has 23 claims on file in Anne Arundel Circuit Court against patients with unpaid bills.

William Flanigan, a health care consultant with W. F. Corroon, a health benefits firm in Baltimore, said hospitals often are forced to swallow debts incurred by patients who cannot pay. Those costs also are passed on in the rates charged everyone else.

He said the hospitals should not have to go to court to force payment, which only drives medical costs higher.

"The nation's health care system is really a very expensive one, and not a very intelligent way for hospitals to have to run a business," he said. He advocates a national catastrophic health care program that would offer medical coverage to everyone faced with huge bills.

Hospital officials, though, say they try to avoid suing to get their money.

"As a general rule, we try to stay out of court by trying to work with the patients and come up with some kind of payment plan," said Nancy Hemby, a spokeswoman for Anne Arundel Medical Center.

Robert Chrencik, senior vice president of finance for the University of Maryland Medical Corp., called lawsuits "a last-ditch effort, a last resort."

But it happens.

Mr. Howes was a passenger in a pickup truck on Shady Side Road near Dent Road about 11 a.m. May 15, 1992, when the driver lost control. The truck went into a ditch and hit a tree.

Mr. Howes' head hit the windshield and he fell from the truck, which rolled onto him. He spent the next two weeks at University Hospital, being treated for arm, back and head injuries and accumulating a $32,041 bill.

In another lawsuit, an 18-year-old Edgewater girl received a $61,953 bill at Shock Trauma for treatment of injuries sustained in an auto accident in March 1992.

Last week, the University of Maryland medical system asked a circuit judge to order her parents, Albert and Velma Contee, to pay.

Judge Robert H. Heller Jr. denied the request, saying the hospital failed to submit sufficient proof from medical experts that the services provided to the girl, Jolynda Contee, were necessary.

Richard Allen James, the Contees' lawyer, said the case will be heard by a jury.

His clients, both in their 40s, earn minimum wage as part-time employees in dry cleaning and laundry shops in Annapolis and cannot afford to pay, he said.

"Who do you know who has $61,000 lying around for something like this?" said Mr. James, a Greenbelt attorney who specializes in personal injury cases and agreed to represent the Contees at no charge.

Mr. Contee's health insurance failed to cover his daughter, even though she was 17 at the time, because she was living with a relative outside her parents' home.

Ms. Contee did not qualify for medical assistance because she was not "emancipated" from her parents and couldn't apply on her own, Mr. James said.

The Contees declined to be interviewed, but Mr. James said the couple cleaned out their $2,000 savings account to pay bills before the hospital filed the claim.

Lawyers say that most of the cases are settled out of court when patients, or their parents, agree to pay a lesser amount or to some type of scheduled payment plan.

"A major part of the whole health care issue is, what do you do with these people who can't pay?" said Robert Waldman, a Baltimore lawyer with the firm of Venable, Baetjer and Howard.

Hospital officials say the problem is that health care costs, although high, have to be paid by someone.

"One thing to keep in mind is that the dollars that don't get collected and paid have to be covered by those who do. The services have to be provided, and the costs have to be covered somehow," said Mr. Chrencik.

He said the average Shock Trauma patient stays about a week and runs up a bill of about $15,000. But he said many bills go higher because of the patient's need for immediate treatment in a setting where the operating room costs $10 per minute.

"This is a high-tech, 24-hour operation, and it's a costly one to operate," he said.

Hospital rates are regulated by the State Health Services Cost Review Commission, he said.

Hospitals usually ask the commission for rate increases about once every five years and must justify their request in a 150-page report that covers their rates, costs and schedules, said Dennis Phelps, associate director of the commission.

Usually, a hospital will be granted approval for a portion of the increase it requests, he said.

Most former patients say that they don't doubt that hospital costs may be justified -- they just cannot afford to pay them.

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