Adding Insult to Injury Adding Insult to Injury

A Newhouse Spotlight Team Investigation

(Amelia Kohli)
I’m not really certain of the benefit of going after people who cannot pay for hospital bills and penalizing them for daring to get sick…

(Peyton Spellacy)
Medical debt is one of the leading causes of bankruptcy in the United States, and it’s an issue Amelia Kohli sees every week…including here in Central New York.

She’s the debt program director at the Volunteer Lawyers Project of CNY…Many of her clients are being hit with lawsuits regarding medical debt, some wrongfully…

It’s become clear that certain areas of New York, including central New York, are the really big hot spots, and that it is a burden, especially on communities of color and lower income communities that are being targeted for these bills. They have even less resources to pay.

The Newhouse Spotlight Team sorted through lawsuits filed by the State of New York…money owed to SUNY Upstate Medical University for medical services in the last four years.

As you can see right here…the highest point of the graph…… that represents people with lower income in Syracuse who are getting hit with hundreds of more lawsuits than those with high incomes –

And take this graphic….this shows…the number of summons issued by the state for medical debt with Upstate has tripled since 2021.

We reached out to Upstate for comment 2 times… and have received no response.

the patient usually does not have representation. They usually don’t even answer or they don’t know how to answer, which results in the hospital getting what’s called a default judgment.

And part of the problem is also the fact that some of these indigent patients are eligible for charity care but don’t know they’re even eligible…or that there are people who earn a little too much to qualify but yet are struggling financially to stay afloat.

According to the Community Service Society of New York. They say Upstate Hospital made $1.5 billion in 2021. If Upstate collected on all the judgments from 2019 and 2021 combined, they would have only made about 17 million dollars, which is just a drop in the bucket.

Donna Ce’Cartel was one drop then, but to her, hospitals were taking everything she had.

yes, I had savings, but it went really fast. And once you get sick, it seems to me that even if you look at your future, that there’s more down the pike…

Ce’ Cartel was diagnosed with breast cancer in 2007… She SAYS she’s been sued by Upstate and other hospitals for thousands in the past… she’s just above charity care’s income cutoff by 100 dollars.

literally would shut down and not be able to do anything when I got a bill like ((edit the bite)) So don’t do anything like for 2 or 3 days, it would take me 2 or 3 days to get back to even doing the things I like to do I could afford to do at the time.

American Cancer Society research shows that medical debt isn’t just a financial headache—it can actually mess with your health because of all the stress it brings. Ce’Cartel stresses out just going to her mailbox.

I’m like putting it in the box or putting in the, you know, plastic bag or whatever I have with me from the mailbox, literally, and going, it’s got to sit here because I can’t live with that right now.

(Ursula Rozum)
like many people, just are not, you know, being properly informed of their rights as patients. and so I think that goes back to the accountability that we’re talking about from our healthcare system.

Ursula Rozum is someone who is spearheading the issue. She is a health care advocate who fights policy issues at the state level … She believes the hospitals aren’t doing their job telling patients their rights.

they’ll say that they were not informed. And, I mean, I believe them because, you know, why would you want to put yourself in the position to be pursued by debt collectors if you could avoid it?

Just this week, she has helped pass a bill in Albany that removes the asset test that requires people to prove they are poor enough to qualify for assistance.

And Lawsuits aren’t just solo gigs; they drag the whole family into the drama. Gayle Davis’ son Darrius was stabbed and had to undergo multiple surgeries.

(Gayle Davis)
That’s my Darrius

He couldn’t find a time to sit down with us, but we know from his mom this happened over a decade ago and while he’s all good physically now, financial scars from the $16,000 lawsuit are still fresh.

So what in the world is going on? You know? It seemed totally horrendous. Unfair. You know, my child, you know, even though he was grown, had been assaulted, required surgery, was hospitalized and then to be hit with an enormous medical bill

Darrius is stuck in that financial limbo: he earns too much for assistance yet falls short of paying the 16,000. Gayle advocates for some sort of system tailored to assist individuals like this…

Even credit card companies, you know, are willing to work with people. They discount things and whatnot in New York to come after its own people Who are caught between a rock and a hard place. Its an anathema to me.

I’m Peyton Spellacy for the Newhouse Spotlight Team,.

 by Grace McConnell, Wyatt Miller, Peyton Spellacy and Meghan McCloskey

SYRACUSE, N.Y. (NCC NEWS) – When Cynthia Long woke up in SUNY Upstate Hospital following her kidney transplant, her main focus was on her now-functional kidney. She said she had been close to dialysis and felt a switch in her body following the transfer. 

Long’s new kidney was strong but closing the stomach wound raised issues. She stayed in the hospital for a week being monitored with a packed open wound. After that week, a different surgeon than the one who performed her surgery visited her room. They wanted to open the wound back up to see if they could improve the closure. 

Terrified of potential infection, she agreed to the second surgery. 

“The kidney was fine, the kidney’s been great,” Long said. “It was just the closure. And they operated on me again, so I was in there again for this thing to heal up. I ended up with a hernia because I guess they couldn’t pull enough skin or whatever to get it to close.”

Although her surgery happened two years ago, Long still struggles because of her hernia to this day. 

In total, Long’s time at Upstate cost $880,000, which became $53,000 after insurance. She was able to pay about $26,000 after draining her own savings, but that was it. Her previous injuries and current hernia meant that Long couldn’t work with furniture like she had done previously, and therefore couldn’t make money to pay off her hospital bills. 

Despite keeping up with the costs of her copay and after visits, Long was unable to pay the remaining $27,000 of her hospital bill. Not only is she unable to, but she doesn’t believe that all the cost should fall on her after a mistake made by Upstate. She let Upstate know this, but still was eventually served a lawsuit by them. 

Cynthia Long was just one of the many vulnerable patients targeted by the hospital’s search to collect and obtain medical debt. Research by Community Service Society (CSS) profiling Upstate Hospital in 2022 concluded that “Upstate Hospital’s medical debt practices indicated that it is an outlier – suing more patients than any other hospital in New York State.” 

Our team looked through over 5,000 lawsuits by Upstate to New York residents from the years 2020 to 2023. Further analysis of that data revealed that the hospital is disproportionately suing lower income communities. This is in addition to research done by the Urban Institute that proved the largest racial/ethnic disparities in rates of medical debt is seen in Central New York.


Scatter plot showing lower income communities get sued for more than higher incomes
The average money owed for neighborhoods under $80,000 is significantly higher than those above, as are the number of lawsuits in each average income bin. All neighborhoods within a $5,000 range are grouped together and the size equates to the volume of lawsuits for areas in that income range.
© 2024 Wyatt Miller

The Spotlight Team has reached out twice to officials with Upstate for a comment regarding our investigation but never heard back. 

Long worked an office job but had to leave because she was not able to work around others during the pandemic. She took a part-time job at Wegmans bagging groceries but can no longer do that because lifting groceries with her hernia is too difficult. 

She has gone back to get her hernia scanned and it is growing, but apparently not enough to be considered an emergency. Long plans on getting a surgery to get it removed, but is worried about having another hospital bill to pay off. 

Her fear is warranted, and common among those facing medical debt. In a survey done by the Kaiser Family Foundation (KFF), they found that adults with health care debt are more than twice as likely as those without debt to postpone or skip getting needed health care because of the cost. Medical debt often triggers a cycle of financial burden as those in debt cut costs in other aspects of their life. Around 63% of adults in debt have cut spending on food, clothing, and other basics while 48% reported having used all or most of their savings in paying back debt. 

Nonprofit hospitals are meant to serve the community they are a part of through health care services. Our investigation indicates Upstate is doing the opposite through its alleged targeting of the vulnerable population of the Syracuse and Central New York area.

The median household income in Syracuse is $43,584, according to the 2022 census. But, based on the Spotlight Team’s findings, the neighborhood average for median household income on the receiving end of these lawsuits since 2020 is $31,558. That means Upstate seems to be disproportionately suing poorer communities in Syracuse.

Upstate is a state-owned, public hospital. This means that any lawsuits issued by them are sent to the New York Attorney General’s office, where it is verified, filed and sent out. Upstate’s policy is that they will turn to legal action following six months after a hospital visit and after attempting to reach out to a patient three times. 

All hospitals in New York are required by federal law to provide financial assistance or payment plans and are given money from the government to do so. Nonprofit hospitals like Upstate are required to provide charity care. 

No hospital, however, is required to spend a minimum amount towards financial assistance in order to get their tax exemptions. 

This is where issues arise, because hospitals have been leaving patients uninformed for their own monetary gain. Under Upstate’s “frequently asked questions” page, the hospital answers exactly how one can set up a payment plan and the process of qualifying for financial assistance. If this were information explicitly shared with patients, would it need to be frequently asked about?

A source who has asked to remain anonymous was sued for $12,000 by Upstate following their time in and out of the hospital during COVID. They were traveling when Upstate had sent them the letters preceding a lawsuit. They were also not expecting their bill to be so large because they were under the impression that insurance would be covering a most of the cost. 

That was when they found out their employer canceled their insurance during the pandemic, so it showed up null and void on Upstate’s records. This person decided to call the Attorney General’s office through Upstate to prevent the lawsuit from further escalating with a court date.

The letters being sent out told them to contact the Attorney General’s office to work out a payment agreement, but all additional information about figuring things out before court date came from them, not Upstate.

Open communication from the hospital about options for payment plans or financial assistance would act as a resource for a patient rather than become a new thing for them to worry about during a stressful time. 

Various states across the United States have fast-track programs of presumptive eligibility for patients, helping them qualify for financial assistance automatically.  In Maryland, hospitals are required to view patients already enrolled in other need-based programs for low-income residents as qualifying for free care. 

Illinois has a presumptive eligibility policy that outlines categories demonstrating financial need that automatically consider a patient as requiring assistance. Oregon’s nonprofit hospitals must screen patients for presumptive eligibility if they are uninsured or owe more than $500. And in Minnesota, uninsured patients are scheduled an appointment with an application counselor in order to make the process of applying for financial assistance easier. 

Many of these policies were enacted within the past five years, part of a growing advocacy movement to protect Americans against the issue of medical debt. It has been a growing topic of conversation, and therefore, a topic of research. And one of the biggest things being looked into was the goal of hospitals in suing patients. 

The conclusion: most hospitals aren’t. 

In New York, Upstate is an outlier because a lot of hospitals are not suing their patients at the same rate. The hospitals within the Syracuse area are Upstate, Crouse Hospital, and St. Joseph’s. According to data from CSS, Crouse Hospital sued 672 patients in 2019, 46 patients in 2020, and no patients in 2021-2022. St. Joseph’s sued six people in 2019, five in 2020, and three in 2021. Upstate filed 1,562 lawsuits in 2019 alone. 

Maanasa Kona, an assistant research professor at Georgetown University’s Center of Health Insurance Reforms, confirmed that there is no proven reason as to why hospitals are suing patients, just theories.  

“I think it is a question that a lot of people who are advocates in this space have sort of struggled with because the returns on this outstanding debt are just so minimal and the dollar amounts per debt tend to be small for the most part,” said Kona. “So it begs the question, why is it worth going through all this?”

The colors in this interactive map of Syracuse indicate how many medical debt lawsuits have been brought against people in each zip code. The neighborhoods that were targeted most live in neighborhoods that have median incomes well below the median for the city of Syracuse.

Some of the most damaging ways hospitals impact the lives of the patients they sue is through medical debt affecting credit scores, garnishing wages and placing liens on people’s homes as a form of collection. If hospitals were to benefit from these lawsuits, it would be from these methods. One reason Upstate stands out, apart from the large number of lawsuits compared to other hospitals, is because of its continuation of lawsuits despite many New York hospitals no longer suing their patients or suing only a single-digit number of patients. 

In 2022, Gov. Kathy Hochul passed a legislation prohibiting health care providers in New York from collecting medical debt via wages and home ownership. Then in December of 2023, another legislature was signed that made it so medical debt would not affect credit scores. This means that New York hospitals, such as Upstate, can no longer profit from medical debt in that way. 

Hochul’s latest proposal would ban hospitals in New York from suing anyone with an income under 400% of the poverty line. Additionally, it would extend the time that hospitals must wait before sending unpaid bills to collections to 180 days, prevent hospitals from selling debt to third parties, allow people between 300% and 400% of the poverty line to qualify for financial aid, and open financial aid to uninsured people whose medical costs are greater than 10% of their gross annual income.

According to Kona, providing medical debt protection is just a Band-Aid for the larger issue at hand, and medical debt was never meant to turn into a secondary form of insurance. 

“At the end of the day, I think that medical debt protections are important and essential, and states and governments should focus on making them strong and ensuring that people are covered,” said Kona. “But I think on the front end, it’s really, really important to manage health care costs and make sure it doesn’t even get to this place in the first place.” 

Many eyes have been on Upstate recently following the release of multiple research reports and articles calling attention to the large number of lawsuits they sent out. While there has been a decrease in lawsuits being sent out, there is no guarantee that the practice will not start back up again once the public uproar has died down. If Hochul’s most recent proposal passes, it will limit a hospital’s ability to sue low-income patients. 

Long is not out to get Upstate. In fact, she is very grateful for them, and will continue to go there for treatment in the future. She just wants to make sure that she’s only paying for the things she’s responsible for.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

(Meghan McCloskey)
Desperation – in the 9-1-1 call – the rush to the emergency room – the unanswered questions. For many, Upstate University Hospital is the line between life and death… but what if you’re uninsured, out of work, or just can’t afford your visit? Upstate University Hospital has sued thousands of patients – most of them from low-income communities. Some patients can afford their bills – some patients are eligible for charity care – but what happens to the people who fall through the cracks? This is your NCC News Team investigation.

Over ten years ago, Gayle Davis’s son named Darius was out of work when he was attacked. He was rushed to Upstate University Hospital for surgery. This emergency life-saving care cost 16-thousand dollars that he couldn’t pay. His mom says that he wasn’t aware of any charity programs he may have been eligible for at the time of the attack and that this bill is still affecting his life – over a decade later. His mom – Gayle Davis – a proud, lifelong New Yorker says it is a betrayal.

(Gayle David)
What in the world is going on? You know. It’ seemed totally horrendous, unfair. My child, even though he was grown, had been assaulted, required surgery, was hospitalized, and then to be hit by an enormous medical bill.

And Darius is not alone. For thousands of people like him, an emergency hospital stay can lead to a multi-thousand-dollar lawsuit. Just between 2020 and 2023, Upstate sued 5070 patients. The N-C-C News Team sorted through every single one… and it is clear that these lawsuits predominantly affect lower-income communities. We reached out to Upstate twice – and did not get a response. Donna Ce’Cartel is one of the thousands who have been sued. She was battling her lawsuit while in Upstate inpatient care… too sick to appear in court.

(Donna Ce’Cartel)
So sick. I was down here inpatient when I was supposed to be going to court, I believe. Or I was up there inpatient, I don’t know, but I was very sick. And they didn’t know what was happening, and actually the autoimmune disorder kicked up because stress exasperates it. It’s not caused by stress, but if you’re under a lot of stress, it exasperates it.

Donna is one of many Central New Yorkers who have fallen through the cracks. Most people pay for medical bills because they can afford to with the help of insurance – some people get their bill covered through charity care – but Donna doesn’t fall into either of those categories. She could not be eligible for charity care because her annual income was just one hundred dollars above the threshold.

(Ursula Rozum)
I think that Donna, like many people just are not you know, being properly informed of their rights as patients. I think that goes back to the accountability that we’re talking about from our health care system.

That was Ursula Rozum speaking – she works in health advocacy – assisting Donna and other people facing medical debt.

People fall through the cracks sometimes, like in our really complicated health insurance. Things don’t sync up people’s insurance doesn’t sync up and is covered by insurance, but it’s not. And then time passes within which they could apply for assistance. It’s not so much that Upstate is targeting paitents, but that people are falling through the cracks in a very complicated system.

Although the problem isn’t going away – there are signs that improvement is coming. In January, Kathy Hochul proposed legislation that would make it harder for hospitals like Upstate to collect debt from patients. Ursula and her team are also fighting for improvements on a state level – and have seen some recent success.

one of the changes, that there will no longer be an asset test, which means that patients don’t have to prove like how little they have to put on. Patients are able to apply for financial assistance at any point in the collections process, for example.

Although this may improve for future patients – no litigation erases the pain for the tens of thousands of people who are still financially scarred from their Upstate stay. With the NCC News investigative team, I’m Meghan McCloskey.

Reported by

Peyton Spellacy

Peyton Spellacy is a sophomore studying Broadcast and Digital Journalism from Sacramento, CA. She is dedicated to the integrity of journalism and allows everyone to find a voice through her reporting.When Peyton is not in class, you can find her on the tennis court, hosting her radio show on WERW, or on-air or producing at CitrusTV.

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