Hospital sues thousands who may be insured but can’t pay

COOKEVILLE, Tenn. — Thursdays are reserved for debt collection in Putnam County’s courthouse.

Some owe a landlord. Others fell behind with a payday lender. And many have unpaid medical bills with Cookeville Regional Medical Center.

A WPLN News investigation found the city-owned hospital has sued more than 11,000 patients over two decades and has no intention of changing its ways.

One after the other, a judge asked patients of Cookeville Regional to stand. From their pew in the crowded courtroom, they acknowledged they owe the hospital various amounts — $583.43, $1,649, $9,634.69.

Then, they showed why they couldn’t pay.

The hospital’s attorney said they want at least $100 a month. The judge saw there’s no way. So he sent Susie Duvall of Jamestown to the clerk to set up payments of $60 a month.

“It’s a money racket, ain’t it,” Duvall sad under her breath on the way to the clerk’s window.

Even though $60 a month will break her budget, if she doesn’t try, the hospital will garnish her paycheck as a home health aide. And it may become more difficult to see a doctor when it’s not an emergency.

“It’s scary nowadays because who knows if they’ll treat you or not,” she said.

In late 2018, Duvall went to the emergency room in Cookeville because she thought she was having a heart attack. She stayed for a week of observation and tests. Even with insurance, she walked out with a $9,000 bill. If she can stay current, Duvall should pay off her unplanned hospital stay in 2032.

Every week, dozens of patients are summoned to Putnam County court for blowing off a bill from Cookeville Regional. Many are insured and employed, which makes it difficult for them to qualify for the hospital’s charity care policy.

But Judge Steve Qualls, who oversees the Thursday debtors docket, said a job and a health plan with a high deductible does not mean they can pay.

“You’ve got to take in both sides,” Qualls said. “Sometimes people just don’t have anything left to give … That’s why a lot of people end up filing bankruptcy because they absolutely can’t do it.”

Questioned about the hospital’s billing practices by WPLN News, CEO Paul Korth said he assumed the tactics are customary. And many hospitals have increasingly turned to the courts as patients seem to blow off paying their everhigher

“It’s scary nowadays because who knows if they’ll treat you or not.” — SUSIE DUVALL OF JAMESTOWN

deductibles.

But no hospital in Nashville has been suing with such frequency. Skyline Medical Center has comparable annual revenue at nearly $280 million. The hospital, owned by for-profit chain HCA, only took a handful of patients to court last year, according to court records.

Cookeville Regional — which is owned by the city government and the only hospital in town — sued 956 in 2019 alone. It also wrote off less charity care and unpaid bills.

Korth said his priority is the health of the hospital, which is the region’s largest employer.

“We are trying to run a business,” Korth said. “We’ve got 2,300 employees here, and I think it’s my obligation to make sure that this hospital stays open.”

Korth has helped Cookeville Regional remain profitable and even grow as other hospitals on the Cumberland Plateau struggle to survive.

The actual revenue generated from lawsuits is minimal, Korth said. The hospital reported taking in $305,000 in 2019 through garnishments and pay plans.

But the hospital has no plans to stop.

“Any dollar we get in here is worth the trouble because it’s a dollar we didn’t have,” he said.

Korth recommends patients just be more proactive about working with the hospital to set up a payment plan before the billing becomes a legal matter.

But that over-simplifies what it’s like to be swamped by medical debt, said Jeff Osborne.

“I have a reaction, at some point, when it all gets to be too much, where I just shut down and start ignoring things,” the 54-year-old graphic designer said. “I’m already struggling, and I just say this bill goes in the trash because I’m a nervous wreck.”

Osborne sat at the desk where he produces print ads for a community magazine in Cookeville, where his pay has shrunk to about $17,000 a year. In the top drawer, he stores a stack of outstanding medical bills related to years of heart trouble.

In December, Osborne was sued a second time by the hospital for the latest bill. He said he had no idea how widespread this practice was until he started following investigations by ProPublica and submitted his own experience.

“I don’t think most people in this town realize what’s going on,” he said. “And those of us who do get sued probably don’t realize how many of us are out there.”