COOKEVILLE, Tenn. (AP) - Thursdays are reserved for debt collection in Putnam County's courthouse.
Some owe a landlord. Others fell behind with a payday lender. And many have unpaid medical bills with Cookeville Regional Medical Center.
A WPLN News investigation finds the city-owned hospital has sued more than 11,000 patients over two decades and has no intention of changing its ways.
One after the other, a judge asks patients of Cookeville Regional to stand. From their pew in the crowded courtroom, they acknowledge that they owe the hospital various amounts - $583.43, $1,649, $9,634.69.
Then, they show why they can't pay.
"I have all my bills and my income tax from last year," says Susie Duvall of Jamestown as she shuffles through envelopes with her mortgage, her electric bill, her car payment.
The hospital's attorney says they want at least $100 a month. The judge sees there's no way. So he sends Duvall to the clerk to set up payments of $60 a month.
"It's a money racket, ain't it," she says under her breath on the way to the clerk's window.
Even though $60 a month will break her budget, if she doesn't try, the hospital will garnish her paycheck as a home health aide. And it may become more difficult to see a doctor when it's not an emergency.
"It's scary nowadays because who knows if they'll treat you or not," she says.
In late 2018, Duvall went to the emergency room in Cookeville because she thought she was having a heart attack. She stayed for a week of observation and tests. Even with insurance, she walked out with a $9,000 bill. If she can stay current, Duvall should pay off her unplanned hospital stay in 2032.
Every week, dozens of patients are summoned to Putnam County court for blowing off a bill from Cookeville Regional. Many are insured and employed, which makes it difficult for them to qualify for the hospital's charity care policy.
But Judge Steve Qualls, who oversees the Thursday debtors docket, says a job and a health plan with a high deductible does not mean they can pay.
"You've got to take in both sides," Qualls says. "Sometimes people just don't have anything left to giveThat's why a lot of people end up filing bankruptcy because they absolutely can't do it."
''WE ARE TRYING TO RUN A BUSINES'S'
Questioned about the hospital's billing practices by WPLN News, CEO Paul Korth says he assumed the tactics are customary. And many hospitals have increasingly turned to the courts as patients seem to blow off paying their ever-higher deductibles.
"It's hard on us," he says. "These are our friends and family, people that live next door to us, go to church with us."
But no hospital in Nashville has been suing with such frequency. Skyline Medical Center has comparable annual revenue at nearly $280 million. The hospital, owned by for-profit chain HCA, only took a handful of patients to court last year, according to court records.
Cookeville Regional - which is owned by the city government and the only hospital in town - sued 956 in 2019 alone. It also wrote off less charity care and unpaid bills.
Korth says his priority is the health of the hospital, which is the region's largest employer.
"We are trying to run a business," Korth says. "We've got 2,300 employees here, and I think it's my obligation to make sure that this hospital stays open."
Korth has helped Cookeville Regional remain profitable and even grow as other hospitals on the Cumberland Plateau struggle to survive.
The actual revenue generated from lawsuits is minimal, Korth says. The hospital reports taking in $305,000 in 2019 through garnishments and pay plans.
But the hospital has no plans to stop.
"Any dollar we get in here is worth the trouble because it's a dollar we didn't have," he says.
A PUBLIC SECRET
Korth recommends patients just be more proactive about working with the hospital to set up a payment plan before the billing becomes a legal matter.
But that over-simplifies what it's like to be swamped by medical debt, says Jeff Osborne.
"I have a reaction, at some point, when it all gets to be too much, where I just shut down and start ignoring things," the 54-year-old graphic designer says. "I'm already struggling, and I just say this bill goes in the trash because I'm a nervous wreck."
Osborne is sitting at the desk where he produces print ads for a community magazine in Cookeville, where his pay has shrunk to about $17,000 a year. In the top drawer, he stores a stack of outstanding medical bills related to years of heart trouble.
In December, Osborne was sued a second time by the hospital for the latest bill. He says he had no idea how widespread this practice was until he started following investigations by ProPublica and submitted his own experience.
"I don't think most people in this town realize what's going on," he says. "And those of us who do get sued probably don't realize how many of us are out there."
It's difficult to isolate the long-term effects on the financial health of the community. Tennessee already has the highest rate of personal bankruptcy filing in the country.
But for individuals, there can be a very direct effect on their physical health. One man, whose wife works at the hospital, said he can't get fluid drained off his ear until he pays up for a bout with pancreatitis. Osborne says he's putting off a procedure for his heart known as an ablation.
"I know at some point it will become necessary, and it's not even an option for me right now," he says. "I know I can't afford it, even with insurance."
Osborne talked to a financial counselor at the hospital, who tried to assure him that he wouldn't be paying on these bills the rest of his life. Maybe not, but right now, he says, the hospital is asking for his last dollar every month.