Ileana Brenes had been feeling dizzy at the St. Petersburg nursing home where she worked. She was pale and tired all the time.
"My doctor called me with my blood results and told me to go to the hospital right away," said Brenes, 54, a nursing assistant. She went to Bayfront Health St. Petersburg, where doctors gave her a blood transfusion and prescribed medication to raise her iron levels.
At the time, in 2016, Brenes didn't have insurance. So she met with an administrator at the hospital and filled out paperwork to get help with the cost. She said she knew Bayfront Health was a "safety net" hospital in the region, meaning doctors there would still treat her regardless of her ability to pay.
What she didn't expect was the lawsuit Bayfront later filed against her for nearly $3,000, including court fees. "I think there was a miscommunication," she said, "because I did everything they told me to, but still had to go to court."
Brenes is one of hundreds of patients who have been sued by Bayfront Health St. Petersburg in recent years as the hospital evolved from a nonprofit institution to a for-profit arm of a national chain. The number of patients sued individually in Pinellas County civil and small claims court has risen from about 500 in 2015 to more than 730 so far this year, putting the hospital on pace to double that number by the end of 2019, a Tampa Bay Times analysis shows.
The increase represents a stark change from past practice. In 2012, when Bayfront was still a non-profit, the hospital filed hundreds of small claims cases against patients' insurance companies, not the patients themselves. That continued in 2013 and 2014 as the hospital quickly changed hands to one corporate chain, then another.
While the increase in lawsuits against patients is significant, Bayfront Health St. Petersburg isn't the only hospital that has adopted the strategy. In Florida, hospitals can impose a lien on patients for unpaid bills, which makes it unique compared with other states, said Jay Wolfson, a professor at the University of South Florida's College of Public Health and an expert on health care policy.
Tampa General Hospital, for instance "routinely placed liens on patients to ensure some collectability," Wolfson said.
Some hospitals have ramped up their debt collection efforts in part because of the higher premiums and deductibles some patients have seen as a result of the Affordable Care Act, he said. "For many of those patients, even with insurance, they do not have the cash to pay either the deductible or any copayments, so the hospital becomes the collection agent."
Another reason for suing patients, he said, is that "in certain instances, the patient gets a check from the insurance company and the hospital never sees the money."
Bayfront Health is St. Petersburg's largest and oldest hospital. A check of court records for the city's second-largest hospital, St. Anthony's, turned up no lawsuits seeking payment from individual patients.
When asked about the lawsuits, Bayfront Health spokesman David Larrick downplayed the numbers, initially saying the hospital had filed just 200 actions against patients this year. However, court records showed the hospital had filed 739 suits so far in 2019.
Larrick said the cases make up a small percentage of the nearly 100,000 patients the hospital sees every year.
"The majority of accounts which we seek to collect payment are patients with insurance who have not fulfilled their deductible, copayment, or coinsurance responsibility set by their health insurance plan — and who have chosen not to enter into a payment arrangement for those amounts," Larrick said in a statement. "It is our strong preference to work with patients on a payment plan. This action is always the last resort, after numerous other attempts to resolve the bill, and each case is evaluated individually."
Bayfront Health St. Petersburg, formerly known as Bayfront Medical Center, was an independent, not-for-profit institution with a long history of serving the city's poor residents before it was sold to the Health Management Associates chain in 2013. The company was quickly acquired by another chain, Tennessee-based Community Health Systems, one of the nation's largest owners and operators of hospitals.
Community Health Systems has struggled financially in recent years, posting heavy net losses quarter after quarter and selling dozens of under-performing hospitals from its portfolio. Among them was Bayfront Health Dade City, which was sold last year to AdventHealth.
Earlier this month, Bayfront Health St. Petersburg laid off 30 employees, Larrick said.
However, he also pointed to improvements the hospital has made, including expansions of its trauma and cardiovascular centers and a new satellite emergency department. "More than $100 million has been invested in Bayfront St. Petersburg in the last six years to ensure it remains a viable resource for the community," Larrick said.
The hospital also has hired a new CEO, Sharon Hayes, a registered nurse who had worked in an executive capacity at several hospitals in the Tampa Bay area. She replaced John McLain, who resigned suddenly in April, along with the hospital's chief financial officer.
Bayfront Health St. Petersburg is the flagship of the seven-hospital Bayfront Health network along Florida's Gulf Coast, spanning from Venice to Brooksville.
In 2015, the hospital sued 528 patients individually in small claims and circuit courts over payments that in most cases totaled less than $5,000, records show. That number spiked to more than 700 lawsuits in 2016 and 2017, then dipped to about 650 cases in 2018 before rising to the 739 cases found in a recent records check.
Larrick said that in 2017, a conversion of the hospital's electronic health records slowed the processing of patient accounts in 2018, which resulted in what "looks like an increase" in the number cases filed so far this year.
The Tampa Bay Times reached dozens of patients facing Bayfront Health suits. Several of them said they didn't know they were being sued.
Like Wolfson, Larrick also cited high deductibles and copayments as a reason behind the lawsuits. He said the hospital has "resources in place to help patients understand and meet their financial responsibility."
For Brenes, the suit filed by Bayfront Health meant taking a day off from work to be in court. On Wednesday, she sat in front of a mediator, who determined she must pay her hospital bill plus nearly $400 in court fees. She'll pay Bayfront's lawyer directly, using the firm's medical debt collection website.
"I filled out the papers the hospital told me to for financial assistance," Brenes said. "I turned them in and never heard anything from the hospital again. I thought everything was fine until someone came to my door to give me a letter that told me to go to court."
She said she now has health insurance through a plan she selected under the Affordable Care Act. But she's not working full-time, and cares for her 12-year-old autistic son. She said she tried to convince the attorneys to let her make monthly payments of $20 until the school year resumed, when she could return to working more hours. She was told to pay $50 a month.
"It makes me feel like the hospital only cares about the money. They don't care about the patients," Brenes said. "I think Bayfront has changed a lot."
Contact Justine Griffin at firstname.lastname@example.org or (727) 893-8467. Follow @SunBizGriffin.