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Leaning on patients

Rep. Dennis Jones, R-Treasure Island, sounded vexed the other day that legislators from other counties were trying to block one of his local bills.

The legislation would make it possible for hospitals in Pinellas County to get first crack at the money that patients have coming from lawsuits or insurance settlements.

It struck Jones as odd that the legislators who were objecting _ "on behalf of the trial lawyers," as he put it _ represent counties where such laws are already in effect.

But that should have told him something: A hospital lien law, if poorly written, can turn out to be a dreadful idea.

Jones wouldn't have to look any further than neighboring Hillsborough County to see why.

Hillsborough's law, as used with a heavy hand by Tampa General Hospital, allowed the hospital to take as much as it claimed to be owed, even if that meant leaving nothing for an accident victim's living expenses or legal fees.

"If you lose your legs, it's too bad," says Emmett Abdoney, a lawyer who is suing Tampa General over its lien policy. "If you're quadriplegic, it's really too bad."

Worse, the hospital would use the lien law to stick its patients with the sizeable differences between its published charges and the discounted rates it had negotiated with their insurance companies. That's what the lawsuit, still untried though more than 4 years old, is about.

Some accident victims, facing hospital liens larger than the other drivers' policy limits, reportedly said to their lawyers, "What's the use?" and refused to press their claims.

Tampa General lost the use of the lien law when it changed from a public to a private hospital last year. So it's lobbying the Legislature for a new law that would let the Hillsborough County Commission approve liens for private hospitals, too.

True to its take-no-prisoners reputation, Tampa General has refused compromise terms that would limit its claim to two-thirds of the amount recovered after legal fees and costs are paid. Lake County's hospital lien law reads like that.

"They're unwilling to even sit down and talk about this," says Sen. John Grant, R-Tampa, a lawyer. "So what is happening is that I'll be the bad guy who kept them from getting the lien. We need a reasonable lien law, but the hospital has got to protect consumers."

While he's at it, Grant ought to look carefully at the Pinellas bill, too. As in Hillsborough, a patient crippled for life in some ghastly accident could wind up with nothing for rehabilitation or living expenses if a verdict or insurance settlement turned out to be less than the hospital's claim.

Neither piece of legislation makes provision for doctors' bills. It's a fair question why hospitals alone should be so privileged, especially now that so many are operated not for charity but for profit by corporations such as Columbia/HCA.

Jones' bill (HB 4743) may be better than Hillsborough's in one respect. It specifies that the lien can't be greater than "the nongovernmental, commercial health insurance or managed care contractual rate applicable to the injured person at the time medical care or treatment was rendered plus the amounts for which the patient is personally responsible." (Emphasis supplied.) Hillsborough's (HB 4081) has no such limiting language.

But to what does it refer? The patient's co-payments under his or her insurance policy? Or something more? Would uninsured patients, as a House committee staff report warned, see their insurance settlements seized to satisfy the hospital's undiscounted sticker price?

"I'm not sure what that means, and I'm an attorney," says Roy Glass, a St. Petersburg lawyer who wrote to the Pinellas delegation objecting to the bill.

Jones didn't seem to know either.

"Those type questions will have to be answered at the time the implementing ordinance is enacted," he said. "It's meant basically to be an enabling bill to allow counties and cities to move forward."

Owing to different county charters, Hillsborough's lien could be implemented countywide by the County Commission, while separate lien ordinances would have to be enacted by the Pinellas County Commission and various municipalities.

"Concerns exist," remarked the House Community Affairs Committee's staff report, "as to the consistency of ordinances between municipalities of the county and between the county and its municipalities."

Jones argues, plausibly enough, that hospitals today "don't have as much wiggle room in their budgets" as in the days before managed care. It's true also that patients should not be able to walk off with lucrative settlements while leaving nothing on the table for the hospitals that restored them to health. But these bills are one-sided the other way. To ask city or county commissions to clean up after the Legislature trusts entirely too much to whimsy and chance.

"There are studies that hospital billings are, more often than not, overstated, exaggerated and inaccurate," Glass said in an April 10 letter to the 13 members of the Pinellas delegation. "The patient should be given the right to challenge this lien and, if successful, an opportunity to recover attorney's fees and costs incurred in doing so. . . .

"This is not the type of law any legislator should knee-jerk support without very critically thinking through how, and in what manner, this is going to impact upon all of your constituents," he concluded.

Thirteen days later, said Glass, not one of the 13 legislators had replied.

He was diplomatic about it.

"I suspect they are just busy," he said.