Religion-linked hospitals accused of price-gouging uninsured

ST. LOUIS -- Under a blistering sun here recently, armed only with bottled water, homemade signs, and the plight of one deathly ill little boy, a dozen Latino immigrants came to shame leaders of the Seventh-day Adventist Church.

Their grievance: hospitals operating in the name of the church overcharging and denying care to those least able to pay.

In the past year, lawyers for the poor have filed federal lawsuits in 22 states accusing nonprofit hospitals of failing to meet their tax-exempt obligations to provide indigent care. With those legal maneuvers unfolding at a glacial pace, one unlikely crusader is racing forward with a new line of attack, focusing on what he calls the un-Christian behavior of religiously affiliated hospitals.

''It's offensive these hospitals market themselves as providing the healing mission of Christ," said K. B. Forbes, protest leader and executive director of Consejo de Latinos Unidos, or Council of United Latinos. ''There is nothing healing about charging someone quadruple and then sending the bill collectors after them."

Better known in Washington for his work on Republican presidential campaigns for Pat Buchanan and Steve Forbes (no relation), K.B. Forbes, 38, is applying pressure with protests, news releases that scream indignation, and always a sympathetic victim.

To add drama to the event, Forbes flew in Rodney Vega, 7, a Florida boy who had just undergone his fifth surgery to remove brain tumors. Rodney's parents are practicing Adventists; his father, a Venezuelan, is here on a special visa granted to religious ministers. Yet each time they sought care at Florida Hospital, one of 38 owned by Adventist Health System, they say, the hospital demanded money up front -- tens of thousands of dollars the family does not have. ''The real mission of the church is to help people like Christ did," said Rodney's mother, Judith Montilla Vega. ''I don't like Florida Hospital saying they are Adventists. I don't want this hospital to use their name to do all these things."

Florida Hospital officials blame the Vegas' plight on miscommunication and misunderstanding, emphasizing that the hospital provides millions of dollars in charity care. Orville Parchment, assistant to the president of the Seventh-day Adventist Church, said the church would step in if there was evidence the hospital operated counter to its principles, but he said he has not had time to ''dig deeply" into the charges.

Elsewhere in the healthcare industry, Forbes's street theater has been met with a mix of scorn and consternation, because he is one of the few people to have scored a major victory against the hospital industry. Two years ago, Tenet Healthcare Corp. agreed to Forbes's demands for deep discounts for the uninsured. Through its ''Compact With the Uninsured," Tenet's 69 hospitals in 13 states gave about 80,000 uninsured patients the same reduced price given to local managed-care companies, about 45 percent less than published rates.

At the core of the fight to help the indigent is a Byzantine billing system in which hospitals start with one standard set of prices, then give deep discounts to government purchasers and private insurers. The result: People without insurance are the only ones charged full price, often triple what insured customers pay.

Hospitals say that negotiating bulk discounts for major buyers is the free-market system at work. Advocates for the poor, a well-financed coalition of trial lawyers and a growing number of lawmakers, argue that the system is so misguided that it amounts to a violation of consumer protection laws.

''It is illegal to charge [uninsured patients] three, four, and five times what they charge other people," said Archie Lamb, a Birmingham lawyer handling several of the cases. ''It is price gouging." At the Orlando-based Florida Hospital, a standard appendectomy costs Medicare about $4,000 and private insurers $4,572, Lamb said. A patient without insurance would be charged $13,000 to $15,000, he said.

Rodney Vega's brain tumor was discovered by chance after a car accident in Venezuela. After two operations there, the family moved to Florida for more sophisticated treatment. For a 2002 brain scan, the family paid Florida Hospital $800, which was later refunded. The two sides vehemently disagree over Montilla Vega's assertions that the hospital said surgery would cost them $20,000.

When a physician at Jackson Memorial Hospital in Miami told her Rodney had two weeks to live, Montilla Vega called Forbes in tears, begging for help. He, in turn, phoned his former nemeses at Tenet who, in the 2003 settlement, agreed to provide discounted care on an ad hoc basis to people Forbes said had run out of options. Since then, the boy, who is disabled after a stroke during his first surgery, has had three more operations at Tenet's St. Christopher's Hospital for Children in Philadelphia. The family is moving to Philadelphia to continue his therapy and make an end-of-life plan known as palliative care, said Rodney's physician, neurosurgery chief Joseph Piatt.

In the case against Florida Hospital, Forbes has compiled data on huge compensation packages for Adventist Health executives and the hospital's partnership with the National Basketball Association's Orlando Magic. One flier castigated the hospital for its venture with the team on a for-profit fitness rehabilitation center, noting: ''We turn people away who need help, price gouge those without health insurance, and use the profits to help millionaire basketball players? Is this what Jesus wants?"

Forbes intends to stage similar events in Denver this month to try to embarrass Catholic hospitals.