Hundreds of US patients were sued by obstetrician-gynaecologist Dr Roger Marshall of Kansas – now a senator – for outstanding bills, and routinely charged an eye-watering 18% interest, with some also having their bank accounts garnished, reports The New York Times. One patient had to wait until 11 years, after paying off a payment plan for emergency surgery, for a judgment to be lifted.
Marshall, who is currently seeking re-election, filed lawsuits against more than 700 patients during his decades-long career, according to an analysis of Kansas court records, with police making arrests in 81 of those cases for missing court dates. In an additional 13 lawsuits, his lawyers sought warrants but it is unclear whether an arrest occurred.
They also garnished patients’ pay-cheques and bank accounts.
The unpaid bills ranged from several thousand dollars to as little as $101. About half the lawsuits were filed under Marshall’s name and the rest by Heartland Regional OBGYN, the medical practice he solely owned from 1998 to 2012 and then co-owned with another doctor from 2013 to 2019.
Unexpected arrest
On the Easter weekend in 2007, a police car pulled up to Joe Vasquez’s home in rural Kansas after the doctor filed a lawsuit against him and his wife over an unpaid $4 561 bill from her emergency hysterectomy three years earlier.
They had missed a court date, and the doctor’s lawyers had asked the court to issue an arrest warrant.
The police took the couple into custody as their grandchildren prepared for an egg hunt, Vasquez said. They spent two days in jail before their son could borrow the money to bail them out.
“We had no money to pay,” said Vasquez, now 68. At the time, his wife was working at a factory and he was on disability.
Some of those facing lawsuits were new mothers with outstanding bills from their deliveries. Most lived in a rural area with above-average uninsured and poverty rates. Some patients had no health insurance; others had health coverage but were responsible for part of their bill.
“I had every intention to pay, I was just struggling,” said Kellie Clutts, whom Marshall sued in 2015 over a $129 bill. She said the charge was from a postpartum visit shortly after her daughter’s birth.
Marshall sued her when her baby was nine months old, and eventually garnished her bank account.
“I was recently divorced, trying to do everything on my own,” said Clutts (45). “I told them I could make partial payments, but no matter what I said, they wanted the full amount at once.”
In response to The Times, a spokeswoman for Marshall said he had spent decades caring for patients regardless of their ability to pay.
“Judges issue warrants when people repeatedly miss court dates, not doctors,” the spokeswoman, Payton Fuller, said.
Court records show that Marshall’s lawyers repeatedly requested arrest warrants, including in Vasquez’s case. They filed dozens of briefs arguing that warrants were needed because of the defendant’s “refusal to obey Court orders”.
Steven Johnson, a lawyer who often represented Marshall in debt cases, defended the warrants and arrests as necessary to ensure that debtors attended court dates.
“If defendants were allowed to appear only when they wanted to without any consequences, the court would get no business done,” he said, adding that Marshall was “no different” from his other clients in allowing his law firm to take the steps it thought necessary to pursue an outstanding bill.
As a client, Marshall was not involved in decisions about when to seek warrants, arrests or garnishments, he added.
Doctors have wide discretion in how to handle unpaid bills. They can decide when to involve a debt collector, file lawsuits or drop the debt entirely if a patient seems unable to pay.
Some hospitals and doctors have increasingly relied on litigation as insurance deductibles have risen, leaving patients responsible for a great share of their bills.
Even so, wage garnishments and arrests of patients are “definitely on the extreme side”, said Barak Richman, co-director of the health law programme at George Washington University who has studied medical debt litigation in three states.
Neale Mahoney, an economist at Stanford University, has conducted research in one state finding that lawsuits against patients are relatively rare, with about 1.7% of hospital stays resulting in litigation.
“It’s not surprising there are outliers but this does seem to be an extreme case, in terms of how far a doctor went to pursue debt,” he said.
Debtors’ prisons have been outlawed in the United States for nearly two centuries, but many states’ laws allow for arrests when the defendant in a debt lawsuit misses a court date.
The Times interviewed eight people Marshall sued between 2003 and 2015. Most described themselves as living pay-cheque to pay-cheque, often deciding between paying medical bills or buying groceries. Two said that the bills Marshall pursued in court stemmed from late miscarriages that required surgery.
Marshall stopped practicing medicine after winning election to Congress in 2016. But some of his collection work continued during his time serving in the House of Representatives, from 2017 to 2021, The Times found.
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