Safety Net Hospital Sues Poor Patients For Unpaid Bills

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Nashville, TN – Nashville General is the city-funded, safety-net hospital. For a patient without insurance, this is supposed to be the best place to go. But its emergency room has been taking more patients to court for unpaid medical bills than any other hospital or practice in town.

A WPLN investigation finds the physician staffing firm that runs the ER at Nashville General sued 700 patients in Davidson County this year — roughly the same number as all the other hospitals and physician staffing firms combined.

They include uninsured patients like Sonya Johnson, a social worker and single mother from Antioch.

Between a nonprofit clinic and General Hospital, Johnson had figured out how to manage her health problems even though she was uninsured until recently. Last year, she went in to see her doctor who charges on a sliding scale. Her tongue was swollen and she was feeling weak. Turns out she was severely anemic.

“He called me back that Halloween day and said, ‘I need you to get to the emergency (room), stat, and they’re waiting on you when you get there,’” she recalls.

General Hospital kept her overnight and gave her a blood transfusion. They wanted to keep her a second night, though she asked them to send her home, worried about the mounting cost.

Staying overnight means she was admitted to the hospital itself, and the bill for that part of her care wasn’t so bad, Johnson says. The financial counselors offered a 75% discount, because of her finances and lack of insurance.

But these days, emergency rooms are often run by an entirely separate entity. In this case, Southeastern Emergency Physicians. And that’s the name on a bill that showed up months later for $2,700.

“How in the world can I pay this company when I couldn’t even pay for health care?” she says.

Johnson didn’t recognize the name of the physician practice. A Google search doesn’t help much. There’s no website. Johnson says she tried calling to see if she could get the same charity care discount hospital gave her, but she could only leave messages.

And then, a knock at her apartment door over the summer. It was a Davidson County sheriff’s deputy with a summons to appear in court.

“It’s very scary,” she says. “I mean, (I’m) thinking, what have I done? And for a medical bill?”

Being sued over medical debt can be a big deal because it means the business can get a court-ordered judgment to garnish the patient’s wages, taking money directly from their paycheck. The strategy is meant to make sure patients don’t blow off their medical debts. But this is not good for the health of people who are uninsured, says Bruce Naremore.

“Believe it or not, when patients owe money, and they feel like they’re being done all the time, they don’t come back to the hospital to get what they might need,” he says.

Naremore is the chief financial officer at General Hospital. The hospital itself has stopped suing patients under his direction. He says it was rarely worth the court costs.

TeamHealth subsidiary Southeastern Emergency Physicians has operated the emergency room of Nashville General Hospital since 2016, which means it bills patients for ER services.

But Southeastern Emergency Physicians, which has been contracted to run the ER since 2016, has gone the other way, filing more lawsuits than ever this year. Naremore says that’s the company’s decision, not General Hospital’s.

“It’s a private entity that runs the emergency room, and it’s the cost of doing business,” he says. “If I restrict them from collecting dollars, then my cost is going to very likely go up, or I’m going to have to find another provider to do it.”

This is a common refrain, says Robert Goff. He’s a retired hospital executive and founder of RIP Medical Debt. The nonprofit helps patients trapped under a mountain of doctor’s bills, since they’re the number one cause of personal bankruptcy.

“The hospital sits there and says, ‘Well, it’s not my responsibility. e have a contract with them. We don’t control them. We don’t tell them what to do.’ This is the biggest welshing of responsibility,” Goff says. “I’ve heard it for years from hospitals.”

The practice of suing patients isn’t new for Southeastern Emergency Physicians or its parent company, Knoxville-based TeamHealth, but it has picked up in recent years. TeamHealth is one of the two dominant ER staffing firms in the nation, both based in Tennessee. And its strategy of taking patients to court ramped up after it was purchased by private equity giant Blackstone, according to an investigation by the journalism project MLK50 in Memphis. Under pressure, TeamHealth pledged to stop suing patients and offer generous discounts to uninsured patients.

According to court records, WPLN found the firm filed some 700 lawsuits in Davidson County this year, up from 120 in 2018 and just seven in 2017. Its only contract in Davidson County is with General Hospital’s ER, and the handful of patients reached by WPLN say they were uninsured when they were sued.

What’s surprising to Mandy Pellegrin of the Sycamore Institute, who has been researching medical billing in Tennessee, is that it was all happening at Nashville General — where uninsured patients are expected to go.

“It is curious that a company that works for a hospital like that might resort to those sorts of actions,” she says.

For Sonya Johnson, she eventually went to court and worked out a payment plan — $70 a month for three years starting next week.

But now TeamHealth tells WPLN that its intent is to drop pending cases.

“We will not file additional cases naming patients as defendants and will not seek further judgments,” a TeamHealth spokesperson says in a statement. “Our intent is not to have these pending cases proceed. We’re working as expeditiously as possible on resolving individual outstanding cases.”

Johnson and other patients say they haven’t been notified yet, but they’re hopeful the new policy means their debts will be erased.