A report published last week in a medical journal revealed that medical debt is disproportionately affecting minorities and lower-income individuals in St. Louis, whi are being sued far more than other groups. Between January 2020 and May 2023, two major academic physician groups in St. Louis — SLUCare Physicians and Washington University Physicians — filed 973 small‑claims suits against patients over unpaid medical bills. Of these cases:
- 54.6% resulted in judgments (531 cases), and 87.0% of those were default judgments.
- 84.4% of default judgments led to wage garnishments, compared with 51.5% of consent (contested) judgments.
“We know providers need to operate and stay solvent, but suing low‑income patients for very modest sums may not make financial or ethical sense, especially when we consider the large financial reserves these institutions have,” said Mary Shannon, one of the researchers behind the study, in a published report.
Who’s Being Sued? Zip‑code analysis showed clear racial and economic patterns:
- Majority‑Black zip codes (21.9% of the region’s population) accounted for 41.1% of lawsuits and 47.3% of total judgment dollar, and saw 48.0% of garnishments.
- By contrast, majority‑White areas (70.8% of residents) saw 44.0% of suits and 40.8% of judgment totals .
- Income matters, too: each additional $1,000 in median zip‑code income corresponded with 0.19 fewer lawsuits and $242 less in judgment amounts.
What’s Driving These Trends?
- Default bias: The high rate of default judgments suggests many patients lack awareness of court filings or the resources to defend themselves. When they do appear, they’re more likely to negotiate manageable payment terms; unchallenged suits almost always lead to garnishment.
- Economic pressure on academic centers: Although SLUCare and Washington University report these suits don’t significantly affect their financial stability, limited hospital reimbursement and rising uncompensated care may prompt aggressive collection to plug budget gaps.
- Systemic inequities: Lower‑income and majority‑Black communities face both higher medical debt burdens and more aggressive litigation, compounding existing health‑equity challenges.
How the Physician Groups Responded:
- WashU Medicine Physicians, representing some 1,900 faculty doctors, point out they treated nearly 1.5 million patients and provided $752 million in uncompensated care during the study period. Spokeswoman Julie Flory says collections target only those “with the means to pay,” excluding unemployed or part‑time workers, and that financial‑assistance options are offered before suits are filed.
- SLUCare Physicians, now part of SSM Health, were under SLU policies that limited lawsuits to debts over $500 and working patients ineligible for aid. SSM says it no longer pursues garnishments, liens, or legal action for unpaid medical bills.
