Published by the Students of Johns Hopkins since 1896
April 18, 2021

TRU and CAHH question Hospital’s medical-debt collection practices

By NOELA LU | March 5, 2020

COURTESY OF NOELA LU Prominent student activist groups met at Red Emma's on Wednesday.

Hopkins Teachers and Researchers United (TRU) and the Coalition for a Humane Hopkins (CAHH) co-hosted a discussion about Hopkins Hospital’s debt collection practices against low-income patients at Red Emma’s Bookstore on Wednesday. 

The event was endorsed by Hopkins Nurses United, the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO), JHU Sit-In, Hopkins Coalition Against Ice, Refuel Our Future, Latino/a Medical Student Association, Black Student Union, Asian Pacific American Medical Student Association, Incarceration and Health Justice Collective, Student National Medical Association, and First Generation Low Income Partnership in Medicine (FLIP-MD).

The panelists included Ed Keyser, an AFL-CIO researcher; Dr. Zack Berger, an physician and associate professor at the School of Medicine; Steph Saxton, a PhD candidate at Hopkins and a member of Students Against Private Police; Derek Jannarone, a registered nurse at the Hospital; Rachel Strodel, a first-year student at the School of Medicine; and Joel Pally, a member of the Baltimore Teachers Union.

Keyser drew attention to the disconnect between the Hospital’s medical-debt collection practices and its status as a non-profit institution. Since 2009, the Hospital has filed over 2,400 lawsuits to pursue alleged medical debt from their patients, many of whom were likely eligible for financial assistance through the Hospital’s charity-care funds. 

According to “Taking Neighbors to Court: Johns Hopkins Hospital Medical Debt Lawsuits,” a report published in May 2019 by National Nurses United, AFL-CIO and CAHH, the Hospital annually receives tens of millions of dollars in tax breaks due to its non-profit status. The report argues that these tax breaks should be used to provide charity care to low-income patients. 

However, Keyser emphasized that a majority of his patients who have been sued for medical debt were surprised to learn that the Hospital’s charity-care programs existed. Of all the eligible charity-care patients, 47 percent of them were denied by the Hospital, compared to the average denial rate of 10 percent by other hospitals in Maryland.

Berger shared the story of one of his patients to highlight the negative impact of the Hospital’s medical debt collection practices on low-income patients in the Baltimore community. 

One of his patients was a black woman from a low-income neighborhood in Baltimore who had a series of complicated medical problems and had been a Hospital employee. However, Berger said, because she was unable to pay her medical bills the Hospital sued to garnish her wages. Berger said that because of this she was unable to then purchase necessary medication.

“Her employer was denying her access to her own money. This is the antithesis of good care. It is... [an] example of a corporation that reduces human beings to columns in a balance sheet,” he said. 

Reflecting on his time as a registered nurse at the Hospital for the past three years, Jannarone voiced his confusion regarding how vigorously the Hospital pursued medical-debt collection. 

In 2018, the profits that the Hospital collected through medical debt lawsuits accounted for less than 0.05 percent of the Hospital’s annual revenue. Jannarone explained that his involvement in helping form Hopkins Nurses United was grounded in his desire to take back some of the power that he believes the Hospital currently holds over Baltimore. 

“Hopkins loves the power it has over Baltimore,” he said. “One of the ways we work to take that power back is, a lot of nurses at Hopkins have come together to form a nurse’s union. The only way we’re going to share that power [that the Hospital has] is if Hopkins is contractually obligated to share it with us.”

In addition, Jannarone used his experiences with the Hospital trying to stop the formation of Hopkins Nurses United to highlight the importance of forming alliances between medical professionals, community members and students to prevent further medical-debt collection practices. 

“In their dealings with us trying to form this union, we see that they’re scared,“ Jannarone said. “When they see numbers of people that are coming together to oppose their power, then we can accomplish something that’s stopping them from using these despicable medical debt collection practices. The only way we’re going to do that is by coming together.”

Both Saxton and Strodel discussed how their respective affiliations with Students Against Private Police and Incarceration and Health Justice have influenced their understanding of the Hospital’s medical-debt collection practices. 

“Like mass incarceration, we believe that the practice of suing patients for medical debt... uses the legal system... to perpetuate the inequities in our communities instead of working to resolve them,” Strodel said.

As a Hopkins alum himself, Pally emphasized that alumni and donors can help prevent further medical-debt collection practices by the Hospital if they were to stop donating money to the institution. 

“We have to hit Hopkins at the only things they care the most about: their brand and their pocketbooks. Why are alumni... donating their money to this institution, an institution that’s getting billions of Bloomberg dollars and millions of dollars in charity care? That money should be going to these patients,” he said.

In an interview with The News-Letter, Claudine Castano, a nurse at the Hospital who joined Hopkins Nurses United last year, expressed her concerns with the Hospital’s medical-debt collection practices.

“I like Hopkins and I think we have such potential for good … but that good shouldn’t be tied to whoever can pay for it, especially when there are already systems in place that aren’t being used, that could be used, that could make such a big difference in the lives of my patients,” she said. 

In terms of her hopes for the future, Castano emphasized the importance of educating patients on their financial rights and their eligibility for charity care, citing her own experiences distributing “Know Your Rights!” brochures to patients outside coming into the Hospital’s emergency rooms. Published in October 2019, the brochure details what percentage of financial assistance patients qualify based on their current income as a form of financial screening.

“How can [the Hospital] claim to be a world-class institution if you don’t even serve your backyard?“ she said. “The hospital was built to serve this community.”

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