Charity care ills run deeper than Tacoma hospital

From the Editorial Board

St. Joseph's Medical Center, on Tacoma’s Hilltop, is the flagship hospital of the CHI Franciscan Health System but has recently fallen under the cloud of a charity care lawsuit filed by the state Attorney General’s office.
St. Joseph's Medical Center, on Tacoma’s Hilltop, is the flagship hospital of the CHI Franciscan Health System but has recently fallen under the cloud of a charity care lawsuit filed by the state Attorney General’s office. News Tribune file photo, 2016

Christian charity was the driving force for a brave and persistent group of Sisters of St. Francis of Philadelphia in 1891, when they moved to wild west Tacoma and opened St. Joseph Hospital.

Their founding mission — to serve the poor and infirm, regardless of ability to pay — inspired the dwindling ranks of Franciscan sisters whom the TNT interviewed a year ago, on the eve of St. Joe’s 125th anniversary. Charity is not lip service for them; it’s a life calling.

Thus, a lawsuit filed by Washington Attorney General Bob Ferguson last month, which claimed St. Joseph Medical Center had illegally withheld charity care since at least 2012, cuts like a scalpel to the institution’s core.

Ferguson chose sharp words, perhaps for dramatic effect, when he told reporters that the hospital, now operated by Tacoma-based nonprofit CHI Franciscan Health, had “lost its way.”

Franciscan officials, in a meeting with the TNT Editorial Board, bristled at the characterization. “That’s a condescending remark for an organization that’s been around 126 years on Tacoma’s Hilltop,” serving some of the region’s neediest people, said Tom Kruse, the health system’s chief strategy, integration and innovation officer.

“We’re not perfect,” Kruse said, “but we haven’t lost our way.”

The lawsuit alleges St. Joseph wronged tens of thousands of eligible patients by concealing their right to apply for charity care, and demanding excessive income documentation. It says the hospital used collection agencies, wage garnishment and other aggressive means to compel payment from people who would’ve received charity care had they been screened.

“St. Joseph senior management were aware of the problems and did nothing,” the AG contends.

Franciscan officials paint a different picture. They’re quick to note St. Joe’s picks up the cost of care for people with incomes at 300 percent of poverty level; the state standard is 100 percent. The financial aid application has been simplified, and intake staff were retrained to more clearly notify patients they’re entitled to treatment they can’t afford.

As to the allegation that they “did nothing,” hospital leaders say they were aware of some problems and were working with Ferguson’s office to resolve them until several weeks ago, when things went silent. (In a statement Tuesday, Ferguson said St. Joe’s “did not change its conduct until well after we began our investigation” and must account for harming low-income patients.)

Which version to believe? Regrettably, legal proceedings might be the only way to sort it out.

What both parties agree on, more or less, is that charity care deficiencies pervade hospitals throughout Washington — urban and rural, nonprofit and for-profit.

Several days after his St. Joseph action, Ferguson filed a similar lawsuit against Capital Medical Center in Olympia. In a pair of 2015 and 2016 rulings, a Yakima County judge found two Central Washington hospitals had violated the state charity care and consumer protection acts.

Columbia Legal Services recently released a report, “Access Denied,” based on interviews with patients, service providers and legal advocates, and a review of charity policies at every Washington hospital. “The research confirmed that accessing charity care is a widespread problem,” according to the report. It cited language barriers as a major reason.

It’s clear that state lawmakers and health regulators must refine and better enforce Washington’s 1989 charity care law. They should standardize practices (including the possibility of raising income ceilings), ensuring all eligible patients know their rights and are fairly and sensitively screened. Hospitals must be audited scrupulously, and required to provide detailed uncompensated care data.

There’s also a moral imperative for hospitals to elevate charity care. Non-profits like St. Joseph, in particular, should aspire not to sit at the middle of the pack, but to lead it.

This is not a problem the courts should be left to fix alone. While litigation might bring justice to a limited number of patients, lawsuits also tend to create scapegoats for industry-wide struggles.

Whichever way the St. Joe’s case goes, we hope it leaves no stain on the charitable legacy of the Sisters of St. Francis, the original lightkeepers of the Beacon on the Hill.