BALTIMORE—Rich Johns Hopkins Hospital, one of the most prestigious hospitals in the U.S., aggressively sues and garnishes wages of patients who live in the poor neighborhoods north, northeast and southeast of Hopkins’ location just outside downtown Baltimore, a new report says.
Using debt-collecting attorneys and getting court judgments, Hopkins pursued 2,438 patients from 2009-18 in those poor surrounding city wards for as little as $280 each in debt.
And 86% of those it pursued were African-American. The largest employer of garnished patients was Hopkins itself, followed by low-paying Walmart and McDonalds.
The Taking Neighbors to Court report relied on legal records of wages, garnishments, and lawsuits, augmented with testimony from the patients. The patients qualified under federal law for free or reduced-price charity care. But investigators found Hopkins brass rarely told patients about it, and its forms and procedures made charity care difficult to get.
Hopkins Hospital’s pursuit of poor debtors flies in the face of a blunt statement from Johns Hopkins himself, who founded the hospital. On his deathbed in 1889, Hopkins willed the funds for the creation of a hospital that would, among other requirements, “treat the poor without charge… regardless of the patient’s age, sex or color.”
Classified as a non-profit institution, Hopkins gets subsidies to treat the poor.
The report, commissioned by the Coalition for a Humane Hopkins, National Nurses United, and the AFL-CIO, comes as NNU has campaigned for months to organize registered nurses at both Hopkins and its Bayview Medical Center subsidiary. The union’s key issues are short-staffing, high turnover, no raises, benefit cuts and erratic hours for the hospital’s RNs.
“For too many years, Johns Hopkins put nurses on the back burner either through ignoring patient safety concerns, cutting benefits, or keeping wages stagnant. We have the opportunity to change that and we hope that you will join us in the fight for our patients and for our profession,” the Hopkins RN’s organizing committee, which approached NNU, wrote to their colleagues.
“Many units are hemorrhaging experienced nurses, which puts our patients in danger,” the organizers added. NNU issued a prior report about the state of nursing at Hopkins, too.
“When one nurse has to double their patient load, so their coworker can take a much-needed break, our patients are in danger. When nurses are forced to pick up overtime shifts in order to support themselves and their families, our patients are at risk. Now, our financial security is even more threatened” by management cuts in health and other benefits, they wrote.
“Severe understaffing, unsafe nurse-to-patient ratios, stagnant pay and declining benefits hinder our ability to provide excellent patient care. All these factors result in a failure to retain nurses. Hopkins management has been burning out nurses and pushing them out the door.”
The new report follows a prior Baltimore Sun series on Hopkins’s treatment of its poor patients earlier in the 21st century. And the report comes at a time when it medical care costs account for the largest single share of U.S. personal bankruptcies.
A typical garnishment victim was patient Eric Simmons, who had an ankle injury treated at Hopkins six years ago. The injury cost Simmons his job at a bakery, but he got a new “and more difficult job at Amazon.” Two years later, Hopkins sued him and won, garnishing his wages until it got its $524 back.
“Stop lying and tell the truth. I was never offered charity care. You withheld information from me – information that could help me and my family,” Simmons said.
A Latina who worked for Hopkins had two major surgeries in four months and temporarily lost her Hopkins-provided health insurance while recuperating after it paid for 80% of the costs. She knew about the charity care program and applied, but the hospital denied her application. Later, Hopkins sued her for the $2,300 left, won, and took $650 from her for each of the next four months.
Some patients fared even worse. One woman, who lived within three miles of the hospital, had her insurance cover all but $280 of her bill. Hopkins sued her for the sum, won, and seized – and cleaned out – her bank account, which had $92.18. That exposed her to later bad check and overdraft fees.
The report also pointed out Hopkins didn’t need to pursue the poor for the money.
Hopkins received $189 million in federal and state reimbursements and tax credits for charity care in 2018 alone. It recovered $975,000 from the lawsuits, its highest figure in the decade of data. It’s total regular revenue that year was $2.07 billion.
“For a wealthy hospital like Johns Hopkins to hound economically distressed patients for even minor medical debt is unconscionable and disgraceful,” NNU Co-President Zenei Cortez, RN, e-mailed to local media. “For Hopkins, the payoff is minor, but for the families they target the consequences can be devastating.”
Those hardships show up in tables in the report. Grouping the neighborhoods around Hopkins by zip code, the report details the percentage of poor people in each, the percentage of poor kids, how many poor patients it pursued and the average it gained from suing each.
The highest number of lawsuits Hopkins filed in 2018 was 153 against residents of zip code 21213, several miles northeast of the hospital. Some 28% of its residents are poor, and its median household income is $34,917, just under half of the Maryland median. It’s 89.6% African-American.
The AFL-CIO isn’t happy either. It opposed a big Hopkins Bayview reconstruction and expansion project which a Maryland commission had to approve.
Hopkins, the federation said, “failed to comply with charity care requirements for low-income patients, proposed rate hikes to support the project” and had “quality of care issues. And Hopkins brought thousands of lawsuits against patients to collect medical debts.”
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