A knock came on the door of Hope Cantwell’s East Nashville apartment early this year. She still hadn’t been vaccinated and says she wasn’t really answering the door to strangers. So she didn’t.

But then several more attempts came over the course of a week. Eventually she masked up and opened. A legal assistant handed her a summons to appear in court.

“I couldn’t believe someone — someone? a corporation? a company? — was doing this during a pandemic,” Cantwell says.

It started with a hospital visit in May 2019.

Cantwell was referred to the Tennova Healthcare-Lebanon facility owned at the time by Community Health Systems, a publicly traded company based in Franklin. Her insurance covered most of the stay, but it still left her with $2,700 to pay. Nearly a year later, she was in a financial position to start chipping away at the bill.

But the online payment portal was gone. Cantwell did a little googling and noticed the 245-bed facility was bought by Vanderbilt University Medical Center around the time of her stay.

Then the pandemic hit. She was furloughed from work for three months. And soon after, a letter arrived. A law firm representing the former hospital owner demanded payment and threatened to take her to court. She wasn’t sure what to do since she couldn’t come up with all the cash.

Pandemic push

A WPLN News investigation finds the Tennova Lebanon hospital sued more than 1,000 patients over the past two years after striking a deal to be sold. And hundreds of those suits — in Wilson, Davidson and Rutherford counties — were filed during the pandemic, at a time when many companies have been backing away from taking patients to court over unpaid medical debt. The state of New York even banned the practice.

When her summons arrived, panic set in for Hope Cantwell.

“My mind went immediately to the stimulus payments,” she says. “At least I have a way to take care of this now.”

When her final pandemic stimulus money dropped into her bank account, Cantwell says she sent it straight to the company that sued her, even though she says she almost felt like the victim of a scam. She wondered if she really owed all the money or if she qualified for financial assistance.

But lawsuits are a rich man’s game. She couldn’t justify trying to find an attorney or fighting a publicly-traded company that would pursue her for $2,700.

“I don’t have the resources and emotional and mental capacity to handle anything more than just kind of rolling over and handing over whatever amount of money they would be happy with,” she says.

CHS’s debt problem

Court records indicate Community Health Systems stepped up filing lawsuits against patients in 2015, at the same time the company’s stock price plummeted over concerns about its outsized corporate debt. The company has been trying to climb out of a hole ever since.

Aside from selling dozens of hospitals to stay afloat, it also went harder after patients. And CHS didn’t let the pandemic slow that plan, even though the company received more than $700 million from the federal government in its own COVID relief money.

A spokesperson for HCA, the largest for-profit hospital chain in the country, says its hospitals do not sue patients over unpaid medical debt — during the pandemic or otherwise. The Nashville-based corporation also returned all of its COVID relief funding.

An investigation by CNN found CHS sued at least 19,000 patients during the pandemic. That tally didn’t count Tennessee hospitals, since court records are harder search here.

WPLN News started digging and found that not only did the Wilson County hospital sue at least 1,000 patients after being sold — filing new suits as recently as last month — the CHS hospitals in Shelbyville and Tullahoma also continued taking patients to court after selling to Vanderbilt at the first of this year.

“Community Health Systems and its subsidiary Tennova Healthcare is a private company that is not owned or operated by Vanderbilt University Medical Center,” spokesperson John Howser says in a statement. “As such, VUMC is not involved in these lawsuits.”

Howser says Vanderbilt does not sue patients to collect on medical debt.

“The thing is, these aren’t rich people who don’t want to pay their bills,” says Christi Walsh, a nurse practitioner who directs clinical research at Johns Hopkins University. Her team focuses on hospitals suing patients and actively pressures them to stop. “I’ve been on the ground in the courthouses. These are people who don’t have the money to pay it.”

For one family in Wilson County, the husband and wife had both been sued by the hospital. He works in a distribution center that shut down for months during COVID. She cared for their foster kids and delivered meals with DoorDash, telling WPLN News they were too busy to bother with a court date.

The problem is, not showing up to face a debt in court in Tennessee can allow a company to take a cut of someone’s paycheck. It also wrecks their financial credit and can lead to physical health problems.

‘It threatens the public trust’

Dr. Marty Makary is a surgeon at Johns Hopkins who wrote a book about billing called “The Price We Pay.” He says most hospitals have changed tactics because suing their patients doesn’t make them tons of money, after attorney and court fees, and it hurts their brand. But he says CHS — with 84 hospitals in 16 states — has not expressed such concern.

“Community Health Systems, in all of our research of hospital pricing and billing practices, stands out as an aggressive institution that uniformly, across the country, engages in very aggressive predatory billing — suing patients in court to garnish their wages,” he says.

Even if CHS is willing to take a hit to its reputation, Makary says patients think of the health system as a whole. And they’ll think twice next time they need to go to the doctor.

“It threatens the public trust in our community institutions. And medical institutions are supposed to be above those games,” he says.

In a statement to WPLN News, a CHS spokesperson says that the company used its COVID relief money to pay for pandemic expenses and make up for lost revenue. As of January, the company has decided to take patients to court only if they make at least twice the federal poverty level — or about $52,000 annually for a family of four.

“We continually evaluate modifications to our collection practices to support patients who struggle to pay their hospital bills,” spokesperson Rebecca Pitt says in an email.

The policy change is meant to be retroactive. CHS will withdraw litigation for anyone who qualifies, Pitt says. They’re being made aware in legal correspondence and can call 1-800-755-5152 to begin the process.

Update: This story has been updated with a statement from Vanderbilt University Medical Center. They say they have not been involved in the litigation and do not sue patients to collect medical debt.