A scandal has been engulfing Yale-New Haven Hospital, garnering two weighty Wall Street Journal articles and numerous headlines in the New Haven Register, Hartford Courant, Connecticut Post and local TV news, but surprisingly little here in the eye of the storm. The nonprofit hospital has allegedly been engaging in disturbingly aggressive debt collection practices to recover money from its poorest, uninsured and underinsured patients, all while failing to mention to them that it has the means and obligation to provide free care and even has a $37 million endowment to spend on free care for the poor. The one angle that these exposes have failed to uncover is Yale University’s direct role in this affair.
One could approach this story through the lens of 77-year-old Quinton White, who, as The Wall Street Journal recently reported, owed Yale New-Haven Hospital $40,000 from when his late wife Jeanette attended the hospital for cancer treatment over 20 years ago. The hospital’s cutthroat collections lawyers, Tobin and Melien, put a 10 percent interest charge on his original $19,000 bill, got a lien on his house, seized his $10,000 in retirement savings, and also attempted to empty his $491 bank account in 2002.
But one could also approach the story through Felicia Jaynes, who worked for the hospital in the early 1990s and was charged $4,000 by a department of the Yale School of Medicine for treatment she had received at the hospital for an aneurysm. That’s the Yale School of Medicine, a part of Yale University, not Yale-New Haven Hospital. The medical school used the same collections law firm as the hospital, Tobin and Melien, to come after her: It won a court judgment against her for the $4,000 because she could not afford legal defense and then began charging 10 percent interest and demanding monthly payments of $50. When another aneurysm struck Jaynes, she contacted Yale’s collection agency to tell them that as a result of her condition she was out of work and couldn’t make the monthly payments. Last September, as medical school students returned to classes, Jaynes returned to work, only to find that Yale had received an order to begin garnishing 25 percent of her paycheck. As a single mother with two kids, she was already struggling financially, but the wage garnishment broke the camel’s back. “Right now I’m scrounging every penny just to make it,” said Jaynes. “Yale doesn’t want to hear it. They just want their money.”
As the Connecticut Center for a New Economy describes in its report “Uncharitable Care” (www.ctneweconomy.org/pubs), White and Jaynes are not exceptional. Yale-New Haven Hospital and the School of Medicine sue thousands of patients each year. Many of those patients, including White and Jaynes, aren’t paying their hospital bills because they can’t, but they were never told of the hospital’s charity care programs that are designed specifically for such cases. Many, such as White and Jaynes, are driven from poverty into utter destitution by the brutal treatment they undergo at the hands of collections lawyers.
Yale-New Haven Hospital is on the defensive. Connecticut Attorney General Richard Blumenthal sued the hospital in February, accusing it of hoarding its $37 million in free care donations (“free bed funds”), and sending collectors after the patients who most needed free care. There are rumblings in the New Haven community for the hospital to provide “debt amnesty” for patients and overhaul the way it provides charity care. And in response to pressure created by the Wall Street Journal story on White, a senior vice president of the hospital personally called White to inform him that his debt was being cancelled. While this token gesture is wonderful news for White, he is only one of probably thousands of working-class people who need to be freed from debt bondage.
Yale School of Medicine has until this point been left out of the scandal, but it should be recognized that it is not above the fray. While Yale University and Yale-New Haven Hospital are (as President Levin has repeatedly maintained) technically separate corporations, together they form what is commonly called an “academic medical center,” a patient care and research complex composed of an affiliated medical school and teaching hospital.
In addition to the obligation of nonprofit hospitals like Yale-New Haven to provide charity care to their host communities, teaching hospitals like Yale-New Haven traditionally are expected to serve as “safety-net hospitals” for the uninsured due to the plentiful “Graduate Medical Education” funds they draw to train residents. One of 17 teaching hospitals in Connecticut, Yale-New Haven received over $30 million of GME funds last year, one-fifth of all such funds in the state.
As joint medical providers within the hospital, Yale University and Yale-New Haven share staff. Residents are jointly employed, and most doctors at the hospital are also medical school faculty or employed by the medical school. So it is that for almost every stay at the hospital, one receives two bills: one for the use of Yale-New Haven (beds, medicine, nursing, etc.), and another from the Yale School of Medicine for the doctor’s services. In fact, after endowment earnings and grants, revenue from medical services is the highest source of income for Yale University — more than the University rakes in from donations and even student tuition.
It’s an unfortunate symptom that the evidence of the integration of Yale and its teaching hospital is that the School of Medicine and Yale-New Haven Hospital employ the same cutthroat collections law firm and the same tactics. But the “separate institutions” line will hurt hospital patients even more if the Yale administration ignores the scandal at the hospital: Yale-New Haven has declared that its free care programs do not apply to charges from the Yale School of Medicine balances, which means that even if the hospital were to do an about-face and provide free care, patients would still receive hefty bills and heartless treatment from the medical school. This clearly does not satisfy the intent of the free bed fund donors and the government subsidies, which is to help the poor regardless of who’s on the letterhead of the hospital bill. Indeed, the attorney general has challenged this distinction in his lawsuit against the hospital, claiming that the free bed funds should be available for any balance incurred at the Hospital. Even if the hospital were to provide debt amnesty, those in bondage to the medical school will remain so unless the University also repents and reforms.
The School of Medicine has financially assaulted members of its “community” who are unable to pay hospital bills. While touting its Homebuyers Program, Yale is placing liens on dozens of homes in impoverished New Haven neighborhoods in an effort to squeeze out payments on hospital debts. With resources vastly exceeding even those of the hospital, can’t the University spare a little charity for uninsured patients? Is President Levin, a member of the boards of both the hospital and its parent company, prepared to take responsibility for these predatory debt collections practices? What about the others who are doubly responsible, such as Linda Lorimer (Yale’s secretary), Bob Culver (Yale’s chief of finance), and Bob Kessler (dean of the School of Medicine), who are also on the hospital board? What about the Yale Corporation? It’s high time that both Yale University and Yale-New Haven put their rhetoric of charity and community aid into action.
Matthew Schneider-Mayerson is a junior in Davenport College. His column appears regularly on alternate Tuesdays.