\n\tMitchell Black and Noam N. Levey<\/span><\/p>\n

McALESTER, Okla. \u2014 It took little more than an hour for Deborah Hackler to dispense with the tall stack of debt collection lawsuits that McAlester Regional Medical Center recently brought to small-claims court in this Oklahoma farm community.<\/p>\n

Hackler, a lawyer who sues patients on behalf of the hospital, buzzed through 51 cases, all but a handful uncontested, as is often the case. She bantered with the judge as she secured nearly $40,000 in judgments, plus 10% in fees for herself, according to court records.<\/p>\n

It\u2019s a payday the hospital and Hackler have shared frequently over the past three decades, records show. The records indicate McAlester Regional Medical Center and an affiliated clinic have filed close to 5,000 debt collection cases since the early 1990s, most often represented by the father-daughter law firm of Hackler & Hackler.<\/p>\n

Some of McAlester\u2019s 18,000 residents have been taken to court multiple times. A deputy at the county jail and her adult son were each sued recently, court records show. New mothers said they compare stories of their legal run-ins with the medical center.<\/p>\n

\u201cThere\u2019s a lot that\u2019s not right,\u201d Sherry McKee, a dorm monitor at a tribal boarding school outside McAlester, said on the courthouse steps after the hearing. The hospital has sued her three times, most recently over a $3,375 bill for what she said turned out to be vertigo.<\/p>\n

In recent years, major health systems in Virginia<\/a>, North Carolina<\/a>, and elsewhere have stopped suing patients following news reports about lawsuits. And several states, such as Maryland and New York, have restricted the legal actions hospitals can take against patients.<\/p>\n

But with some 100 million people in the U.S. burdened by health care debt<\/a>, medical collection cases still clog courtrooms<\/a> across the country, researchers have found. In places like McAlester, a hospital\u2019s debt collection machine can hum away quietly for years, helped along by powerful people in town. An effort to limit hospital lawsuits<\/a> failed in the Oklahoma Legislature in 2021.<\/p>\n

In McAlester, the lawsuits have provided business for some, such as the Adjustment Bureau, a local collection agency run out of a squat concrete building down the street from the courthouse, and for Hackler, a former president of the McAlester Area Chamber of Commerce. But for many patients and their families, the lawsuits can take a devastating toll, sapping wages, emptying retirement accounts, and upending lives.<\/p>\n

McKee said she wasn\u2019t sure how long it would take to pay off the recent judgment. Her $3,375 debt exceeds her monthly salary, she said.<\/p>\n

\u201cThis affects a large number of people in a small community,\u201d said Janet Roloff, an attorney who has spent years assisting low-income clients with legal issues such as evictions in and around McAlester. \u201cThe impact is great.\u201d<\/p>\n

Settled more than a century ago by fortune seekers who secured land from the Choctaw Nation to mine coal in the nearby hills, McAlester was once a boom town. Vestiges of that era remain, including a mammoth, 140-foot-tall Masonic temple that looms over the city.<\/p>\n

Recent times have been tougher for McAlester, now home by one count<\/a> to 12 marijuana dispensaries and the state\u2019s death row. The downtown is pockmarked by empty storefronts, including the OKLA theater, which has been dark for decades. Nearly 1 in 5 residents in McAlester and the surrounding county live below the federal poverty line.<\/p>\n

The hospital, operated by a public trust under the city\u2019s authority, faces its own struggles. Paint is peeling off the front portico, and weeds poke up through the parking lots. The hospital has operated in the red for years, according to independent audit reports available on the state auditor\u2019s website<\/a>.<\/p>\n

\u201cI\u2019m trying to find ways to get the entire community better care and more care,\u201d said Shawn Howard, the hospital\u2019s chief executive. Howard grew up in McAlester and proudly noted he started his career as a receptionist in the hospital\u2019s physical therapy department. \u201cThis is my hometown,\u201d he said. \u201cI am not trying to keep people out of getting care.\u201d<\/p>\n

The hospital operates a clinic for low-income patients<\/a>, whose webpage notes it has \u201climited appointments\u201d at no cost for patients who are approved for aid. But data from the audits shows the hospital offers very little financial assistance, despite its purported mission to serve the community.<\/p>\n

In the 2022 fiscal year, it provided just $114,000 in charity care, out of a total operating budget of more than $100 million, hospital records show. Charity care totaling $2 million or $3 million out of a $100 million budget would be more in line with other U.S. hospitals.<\/p>\n

While audits show few McAlester patients get financial aid, many get taken to court.<\/p>\n