When brave people share their stories – and journalists listen

A recent analysis of debt collection lawsuits caught my eye and reminded me of the power of partnerships between courageous residents and journalists.

I’m referring to MLK50: Justice Through Journalism’s-ProPublica’s 2019 “Profiting from the Poor” investigation, which led one of the area’s largest hospital systems and a private equity-owned doctors’ group to stop suing patients for unpaid medical bills.

The far-reaching impact of that investigation re-emerged in January when the Sycamore Institute, a nonpartisan Tennessee research center, released an analysis of Shelby County debt-collection lawsuits.

Mandy Spears, deputy director of the Sycamore Institute and the study’s author, said the data “tells us something about folks’ financial security, but it also tells us about business practices and how some businesses use our court system.”

For the MLK50 team, this impact is why our newsroom, which launched seven years ago today, exists. We are here to make a measurable, tangible difference in the lives of Memphians. 

In 2018, the year before our investigation, medical debt lawsuits made up 27% of all debt collection suits filed in county civil courts, the institute found. In 2020, the year after, that share fell by 70% to 8% of total suits. 

In fact, the two entities that were the focus of our reporting – Methodist Le Bonheur Healthcare and Southeastern Emergency Physicians – haven’t filed any suits since the stories published in June 2019 and November 2019, respectively.

The analysis also contained a pleasant surprise: Baptist Memorial Healthcare, which was not a target of the investigation, has all but stopped suing patients, too.

I’ve said it before, but it bears repeating: I owe a debt of gratitude to the dozens of defendants – almost all of whom were Black women – whose experiences informed our reporting. That includes Jency Garcia Delcid and Evette Strother, whose stories are below.

It was the power of the personal testimonies that, I believe, prompted these institutions to do right by patients. 

The prospect of paying for a health crisis looms large in most U.S. residents’ heads: A February KFF poll found that 74% of respondents were either very or somewhat worried about being able to afford unexpected medical bills.

Health care expenses have an oversized impact in Tennessee, where in 2023, 1 in nearly 5 residents had a medical debt in collections, according to the Urban Institute, a nonprofit research organization. 

The MLK50-ProPublica investigation found that Methodist, which is affiliated with the United Methodist Church, filed more than 8,300 lawsuits between 2014 and 2018 – more than all but one creditor during those five years.

As a nonprofit, Methodist was required by the IRS to offer charity care to low-income patients, but its policy was unusually stingy. Caught in the hospital’s debt collection machine was Carrie Barrett, who owed the hospital more than $33,000, including interest and attorney’s fees. If she’d paid as ordered, she would have been 90 by the time she satisfied the debt.

Methodist even sued its employees, including Marilyn Boyd, who earned $12.25 an hour cleaning hospital rooms and owed more than $23,000.

This especially infuriated Sen. Bernie Sanders, D-Vermont, who shared on Twitter (now X): “We live in the only industrialized nation where health care workers owe medical debt to the hospitals they work for. That is an outrage.”

Prompted (shamed?) by our reporting and within weeks of our award-winning investigation, Methodist overhauled its policies, including raising the pay of its lowest-paid workers from $10 an hour to $15 an hour, making its charity care policy twice as generous as before, dropping all pending lawsuits, and erasing nearly $12 million in unpaid debt owed by more than 5,300 defendants.

Jessica Curtis, a senior adviser at Community Catalyst, a national advocacy organization focused on health justice, has followed other nonprofit hospitals that have been the subject of similar media coverage.

“I was trying to remember when have I seen such a rapid switch,” Curtis said in 2019. “I don’t know that I’ve seen that before. The scale of what they are attempting to rectify is really commendable from what we’ve seen thus far.”

Ours was far from the first investigation into medical debt, but in almost all cases, the plaintiff has been a hospital system, often a nonprofit such as Methodist.

What set the practices of Southeastern Emergency Physicians and its parent, TeamHealth, apart: It’s a private equity-owned physician staffing firm that contracts with doctors in four Baptist emergency rooms. Physicians typically avoid suing patients en masse, instead sending overdue bills to collections or writing them off as bad debt.

In 2017, Blackstone, one of the nation’s largest private equity firms, acquired TeamHealth in a $6.1 billion deal, creating what one expert called an irreconcilable tension between doing what’s best for patients and maximizing profit to boost the bottom line. 

After the deal, the number of lawsuits filed by Southeastern skyrocketed. Between January 2017 and November 2019, it filed a whopping 4,999 lawsuits against patients. In the first six months of 2019 alone, Southeastern filed more lawsuits than Methodist, Baptist and the county’s public hospital, Regional One, combined.

In an interview, TeamHealth initially defended its practices but later reversed course, saying it would no longer sue patients and wouldn’t pursue lawsuits already filed. “It’s difficult to ensure that only patients with a strong ability to pay are ultimately impacted, so we’ve decided to eliminate it,” a TeamHealth spokesman said.

Baptist, a nonprofit hospital that had its start in the Southern Baptist Convention, drew its share of criticism for enabling Southeastern’s practices.

Mark Rukavina, then business development manager at Community Catalyst’s Center for Consumer Engagement in Health Innovation, a national advocacy organization, said nonprofit hospitals shouldn’t work with doctors groups that aggressively pursue patients for medical debts.

“They could say, ‘If you’re going to provide services in our hospital, you’re going to comply with our financial assistance policy,’” Rukavina said in 2019.

 In 2018, Baptist sued 1,338 people. In 2020, that fell to 64. According to online Shelby County General Sessions Court records, Baptist filed five suits in 2023 and so far in 2024, none.

Asked to explain, hospital spokeswoman Ayoka Pond cited the pandemic, which “caused us to re-examine how we communicate with our patients about their financial responsibilities.”

“We found that we could do some small things that would make a big impact, such as centralizing our collections efforts to make sure every patient receives complete, accurate information. We also placed an even bigger emphasis on being patient-friendly, particularly making sure patients understand our charity care policy and giving them more options for paying their bills.”

These adjustments are good news for patients but frustrating for those who understand how oppressive systems are maintained. You don’t need malice to do harm, just the tendency to do what’s always been done.

All these years later, here’s what frustrates me most: Using the courts as a collection agency was a choice. Baptist, Methodist and Southeastern administrators all knew – or had reason to know – that their choice could devastate families already struggling to make ends meet. All three knew – or had reason to know – that health care institutions across the country had decided not to sue patients.

There was an example to follow, but these institutions decided not to. Change came only after the MLK50-ProPublica team married the research and data with the powerful stories that defendants were willing to share. 

One of the defendants whose Methodist debt was erased is Jency (formerly Gatewood) Garcia Delcid, sued in 2018 for more than $10,300, including attorney’s fees. 

At the time, she thought her insurance at the hotel where she worked would cover the bill, but it didn’t. Methodist garnished her paycheck, taking out just over $200 every two weeks.

Garcia Delcid was living with her daughter and her daughter’s children, assisting with expenses when needed. With the garnishment, though, she was forced to turn to her daughter for help.

“I’m one of those people, I kind of will just sit back,” she said then. “If they’re garnishing my check, I just don’t fight it. I guess it’s because I don’t know who to turn to.”

Then, she couldn’t afford the $60 cream prescribed for her arthritic knees. But today, her finances and health are much more stable: She still works at the same hotel. That’s where she met her husband, whom she married in 2022. She had a knee replacement in 2023 and at 68, is on Medicaid.

“With me still working and getting Social Security and my husband’s income, we make it work,” she said.

When I talked to her last month, she was grateful. “I want to appreciate you for doing that story,” she said. “You opened up a lot of eyes.

“That actually took a lot of burden off me… I felt at that time, I was just drowning. But since then, I feel like I can see my way a little clearer, with getting my bills paid on time, and being able to breathe a little bit.”

While Garcia Delcid and dozens of others were willing to go on the record for the initial stories, others were understandably reluctant. Debt and shame often go hand in hand.

One reticent defendant is Evette Strother. I first saw her and her husband, Jerome Strother, in January 2019 in Shelby County General Sessions Court.

Evette Strother, an elementary school teacher, was one of more than 600 people sued by Methodist in 2019. She owed nearly $7,000, including attorney’s fees, following her now 14-year-old son’s premature birth, but she said Methodist never notified her about the overdue bill.

Before her court date, Evette Strother turned to her church’s ladies’ prayer group for support. “They were saying, ‘We’re going to pray for canceled debt,’” Evette Strother recalled, as she sat at her kitchen table.

At court, a nervous Evette Strother faced longtime Shelby County Court General Sessions Judge Betty Thomas Moore. “Here I am, trying to be as meek and mild as possible,” she said.

Evette Strother offered to pay $50 a month – nearly a third of what Methodist’s attorney asked for – but the judge bristled. “I won’t even consider it,” she said.

Jerome Strother spoke up, but Moore cut him off. “You married a grown-ass woman,” snapped Moore, who is outspoken about her Christian faith and the financial challenges she faced years ago as a divorced mother.

“Please don’t curse,” the teacher said.

“I apologize,” Moore quickly replied. “It’s just frustrating.”

At the time, the Strothers were living in an East Memphis apartment, which had been broken into, rattling the family’s sense of security. As they looked for a home, Evette Strother faithfully paid her Methodist bill, as they worked on boosting her credit score.

And then, they found the perfect home in Cordova, a beautiful two-story house on a corner lot. While their mortgage application was in the approval process, their loan officer advised them not to make any major purchases so their bank balances would stay the same. But the day before they were scheduled to close, the officer called with a question: Had they just paid off a big bill? And if so, where did they get the money?

Worried that they might lose  the home, Evette Strother insisted they hadn’t paid anything off. “It almost pulled the rug from up under our feet,” said Jerome Strother, who works in sales.

The loan officer had seen what the Strothers hadn’t yet learned: The Methodist debt had fallen off their credit report. They moved into the home in September 2019.

If not for the debt erasure, Evette Strother said, “We would not be living where we are living right now.”

To be sure, these policy changes don’t begin to fix what plagues low-income families. Medical debt is just one piece of a tangled web of systems that keep people in financial precarity. Low wages, lack of access to health care and transportation, and housing instability conspire in ways that make it nearly impossible for vulnerable people to get ahead.

The good news is that all of these systems are created and maintained by people. That means they can be changed by people – powerful people who set policy and the courage of others who get chewed up by those policies and speak up.

Fittingly, MLK50’s focus is poverty, power and policy – and this investigation fit neatly at the intersection of all three. As we head into our eighth year (and hopefully perpetuity), we redouble our commitment to expose the ways institutions profit from and punish the poor.

I hold dear the words of our namesake Dr. Martin Luther King Jr., and our inspiration, the anti-lynching investigative journalist Ida B. Wells.

“Of all the forms of inequality, injustice in health is the most shocking and inhuman,” said King.

“The people must know before they can act, and there is no educator to compare to the press,” said Wells. 

Wendi C. Thomas is the founder of MLK50: Justice Through Journalism and an investigative reporter through ProPublica’s Local Reporting Network. Contact her at wendicthomas@mlk50.com

This story is brought to you byMLK50: Justice Through Journalism, a nonprofit newsroom focused on poverty, power and policy in Memphis. Support independent journalism by making a tax-deductible donation today. MLK50 is also supported by these generous donors.

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