"The board of trustees expects us to have prudent business practices," said Ronald R. Peterson, president of the Johns Hopkins Health System. "We could have bad behavior from people who are in that category of deadbeats."
But former Gov. Marvin Mandel, who helped set up the rate-setting system in the early 1970s, said that he was "astounded" by the number of lawsuits and worried that the system has veered off its mission to help the poor.
He expressed concern that some hospitals may be sending unpaid bills to debt collectors "who don't distinguish between those who don't pay and those who can't pay."
"Maybe the system has gotten too good," he said. "In their minds, everybody can pay."
'Responsibility is zero'
White, the Baltimore woman sued by Johns Hopkins, expected to pay for getting sick for a long time.
A housekeeper for more than four decades, White had grown so infirm from headaches and dizziness that she had a tough time getting up and down the stairs in her home.
In June 2005, her daughter took her to the hospital, where tests spotted a brain aneurysm, a potentially deadly condition in which blood forms a pocket in the brain. She spent 10 days in Johns Hopkins Bayview recovering from the surgery to collapse the aneurysm and restore blood flow.
White had health insurance, but it didn't cover the bulk of her care. When bills started showing up about a month after her discharge, she signed up for the financial assistance program commonly called charity care.
A few months after her discharge, Hopkins sent her a ruling on her request for assistance that read, "Your responsibility is zero," according to court records.
White said she rejoiced.
"I was saying, 'Oh gee, thank the Lord, because any time you have an operation like this, you know it's going to be a lot,' " she said.
But the bills kept coming. When her daughter asked why, the hospital said that charity care only covered one day's charges.
Hopkins officials said it was possible for charity care to be approved for one day.
In January 2007, Bayview sued White in Baltimore City Circuit Court, stating in part that she "refuses to pay the amount due." That comment bothered White, who mailed a typed note to the court stressing that she "never refused to pay the bill," but simply didn't have the money to do so.
