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Nashville General Hospital is a safety-net facility funded by the Tennessee capital city. For a patient without insurance, this is supposed to be the best place to go in a city with many hospitals. But for the uninsured, it may have been the worst choice in 2019.

Its emergency room was taking more patients to court for unpaid medical bills than any other hospital or practice in town. A WPLN investigation found the physician-staffing firm that runs the ER sued 700 patients in Davidson County during 2019.

They include patients such as Sonya Johnson, a 52-year-old social worker and single mother. By juggling her care between a nonprofit clinic and Nashville General, Johnson had figured out how to manage her health problems, even though she was, until recently, uninsured.

In 2018, she went to see her doctor, who charges patients on a sliding scale. Her tongue was swollen and she was feeling weak. The diagnosis? Severe anemia.

鈥淗e called me back that Halloween day and said, 鈥業 need you to get to the emergency [room], stat 鈥� and they鈥檙e waiting on you when you get there,鈥欌�� she recalled.

Nashville General kept her overnight and gave her a blood transfusion. They wanted to keep her a second night 鈥� but she was worried about the mounting cost and asked to be sent home.

Staying the one night meant she was admitted to the hospital itself, and the bill for that part of her care wasn鈥檛 so bad, Johnson said. The institution鈥檚 financial counselors offered a 75% discount because of her strained finances and because her job didn鈥檛 offer health insurance at the time.

But emergency rooms are often run by an entirely separate entity. In Nashville General鈥檚 case, the proprietor was a company called听Southeastern Emergency Physicians. And that鈥檚 the name on a bill that showed up in Johnson鈥檚 mailbox months later for $2,700.

鈥淗ow in the world can I pay this company, when I couldn鈥檛 even pay for health care [insurance]?鈥� Johnson asked.

Social worker Sonya Johnson received a civil warrant to appear in court when the company that runs Nashville General Hospital鈥檚 emergency room threatened to sue her over a $2,700 ER bill 鈥� long after she鈥檇 already negotiated a reduced payment schedule for the rest of her hospital stay.(Blake Farmer/WPLN)

Johnson didn鈥檛 recognize the name of the physician practice. A Google search didn鈥檛 help much. There鈥檚 no particular website, though a listing of webpages that do turn up in such a search suggests the company staffs a number of emergency departments in the region.

Johnson said she tried calling the number listed on her bill to see if she could get the same charity-care discount the hospital gave her, but she could only leave messages. And then came a knock at her apartment door over the summer. It was a Davidson County sheriff鈥檚 deputy with a summons requiring Johnson to appear in court.

鈥淚t鈥檚 very scary,鈥� she said, and she recalled thinking 鈥淲hat have I done? And for a medical bill?鈥�

Handoff Of Lawsuits?

Being sued over medical debt can be a big deal because it means a business can get a court-ordered judgment to garnish patients鈥� wages, taking money directly from their paycheck. The strategy is meant to make sure patients don鈥檛 blow off their medical debts. But this is not good for the health of people who are uninsured, said , chief financial officer at Nashville General.

鈥淲hen patients owe money, and they feel like they鈥檙e being dunned all the time, they don鈥檛 come back to the hospital to get what they might need,鈥� he said.

Under Naremore鈥檚 direction in the past few years, Nashville General had stopped suing patients for hospital fees. He said it was rarely worth the court costs.

But Southeastern Emergency Physicians 鈥� which, since 2016, has been contracted by the hospital to run and staff its emergency department 鈥� went the other way, filing more lawsuits against patients than ever in 2019.

Naremore said the decision on whether to sue over emergency care falls to the company that staffs the ER, not Nashville General Hospital.

鈥淚t鈥檚 a private entity that runs the emergency room, and it鈥檚 the cost of doing business,鈥� he said. 鈥淚f I restrict them from collecting dollars, then my cost is going to very likely go up, or I鈥檓 going to have to find another provider to do it.鈥�

This is a common refrain, said Robert Goff, a retired hospital executive and board member of. The nonprofit helps patients trapped under a mountain of medical bills, which are the.

鈥淪o the hospital sits there and says, 鈥楴ot my problem.鈥� That鈥檚 irresponsible in every sense of the word,鈥� Goff said.

The practice of suing patients isn鈥檛 new for Southeastern Emergency Physicians or its parent company, Knoxville, Tennessee-based TeamHealth. But such lawsuits have picked up in recent years, even as the company its practice of听听patients.

TeamHealth is one of the two dominant ER staffing firms in the nation, running nearly 1 in 10 emergency departments in the United States. And its strategy of taking patients to court ramped up after it was purchased by the private equity giant Blackstone, according to an investigation by the journalism project听 in Memphis, Tennessee.

Under pressure from journalists, TeamHealth ultimately听pledged to stop suing patients and to offer generous discounts to uninsured patients.

Officials from TeamHealth declined WPLN鈥檚 request for an interview to answer questions about how widespread its practice of suing patients for ER doctors鈥� services and fees has been.

鈥淲e will work with patients on a case by case basis to reach a resolution,鈥� TeamHealth said in an email.

According to court records obtained by WPLN, the firm filed about 700 lawsuits against patients in Nashville in 2019. That鈥檚 up from 120 in 2018 and just seven in 2017. Its only contract in the city is with Nashville General鈥檚 ER, and the patients reached by WPLN said they were uninsured when they were sued.

What鈥檚 surprising to,听听at the nonpartisan Sycamore Institute, is that it was all happening at Nashville General 鈥� where treating uninsured patients is part of the hospital鈥檚 mission.

鈥淚t is curious that a company that works for a hospital like that might resort to those sorts of actions,鈥� Pellegrin said.

A Pledge To Drop Cases

As for Sonya Johnson 鈥� she eventually went to court and worked out a payment plan of $70 a month over three years.

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

鈥淲e will not file additional cases naming patients as defendants and will not seek further judgments,鈥� a TeamHealth spokesperson said in an emailed听statement. 鈥淥ur intent is not to have these pending cases proceed. We鈥檙e working as expeditiously as possible on resolving individual outstanding cases.鈥�

Johnson said she has been told that the lawsuit Southeastern Emergency Physicians filed against her will be dropped 鈥� but that she still owes the $2,700 bill.

This story is part of a reporting partnership that includes WPLN, NPR and Kaiser Health News.听