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These days, hospital emergency rooms are often run by a separate company, not the hospital itself. And until recently, one of the largest of those companies had been systematically suing patients who couldn't afford to pay. Blake Farmer from member station WPLN in Nashville has more.
BLAKE FARMER, BYLINE: Nashville General Hospital is where patients without insurance are expected to go. It's funded by the city. And it's where Sonya Johnson was sent after going to the doctor with a swollen tongue and feeling lethargic.
SONYA JOHNSON: He called me back that Halloween day and said, I need you to get to the emergency stat, and they're waiting on you when you get there.
FARMER: General Hospital kept her overnight for severe anemia and gave her a blood transfusion. They wanted to keep her a second night, but Johnson is a single mom who was uninsured at the time, and she was wary.
JOHNSON: And I just begged them not to, you know, because I was thinking, oh, this bill (laughter).
FARMER: The bill from the hospital itself wasn't so bad. The financial counselors offered a 75% discount since her job as a social worker didn't offer insurance. Then came a $2,700 bill from Southeastern Emergency Physicians.
JOHNSON: Didn't know who they are, even today.
FARMER: Turns out, it's a regional subsidiary of TeamHealth, one of the two largest ER staffing firms in the nation. She called TeamHealth to see if she could get a break. She could only leave messages. And then a knock at her apartment door over the summer - a sheriff's deputy with a summons to appear in court.
JOHNSON: It's very scary - I mean, thinking, what have I done? You know, and for a medical bill?
FARMER: Being sued over medical debt raises the stakes because a company can garnish a patient's wages. Medical debt is the No. 1 cause of bankruptcy in the U.S. And that's not good for the health of people who are uninsured, says Bruce Naremore.
BRUCE NAREMORE: Believe it or not, when patients owe money and they feel like they're being dunned all the time, they don't come back to the hospital to get what they might need.
FARMER: Naremore is the chief financial officer at Nashville General. Under his leadership, the hospital stopped suing patients for unpaid bills. He says it was rarely worth the court costs or the stress on patients. But he says he can't control doctors in the ER; they're employed by a firm owned by private equity investors.
NAREMORE: It's a private entity that runs the emergency room, and it's the cost of doing business. 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.
FARMER: This is a common refrain, says Robert Goff. He's a retired hospital executive who helped found a charity that focuses on medical debt.
ROBERT GOFF: The hospital sits there and says, well, you know, it's not my responsibility. We have a contract with them. We don't tell them what to do. So the hospital sits there and says, not my problem. That's irresponsible in every sense of the word.
FARMER: What's surprising to Goff is that an ER at a safety net hospital could be doing the same thing. Court records show 700 lawsuits in 2019 just from the doctors in that ER. TeamHealth operates roughly 1 in 10 ERs in the U.S. and has sued thousands of patients in Memphis, too. TeamHealth declined an interview request, but said in a memo they have stopped suing patients nationwide and say they'll drop pending cases, like the one against Sonya Johnson.
JOHNSON: (Laughter) How in the world can I pay this company when I couldn't even pay for health care?
FARMER: Johnson says she's been told she still owes her full bill; she just won't have her paycheck docked in order to pay up.
For NPR News, I'm Blake Farmer in Nashville.
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