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In This Oklahoma Town, Most Everyone Knows Someone Who鈥檚 Been Sued by the Hospital
Chipped paint marks the front of McAlester Regional Health Center鈥檚 administrative offices in McAlester, Oklahoma. (Mitchell Black for 素人色情片Health News)
Diagnosis: Debt

In This Oklahoma Town, Most Everyone Knows Someone Who鈥檚 Been Sued by the Hospital

McALESTER, Okla. 鈥 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.

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.

It鈥檚 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.

Some of McAlester鈥檚 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.

鈥淭here鈥檚 a lot that鈥檚 not right,鈥 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.

In recent years, major health systems in Virginia, , 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.

But with some 100 million people in the U.S. burdened by health care debt, medical collection across the country, researchers have found. In places like McAlester, a hospital鈥檚 debt collection machine can hum away quietly for years, helped along by powerful people in town. An effort to failed in the Oklahoma Legislature in 2021.

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.

McKee said she wasn鈥檛 sure how long it would take to pay off the recent judgment. Her $3,375 debt exceeds her monthly salary, she said.

鈥淭his affects a large number of people in a small community,鈥 said Janet Roloff, an attorney who has spent years assisting low-income clients with legal issues such as evictions in and around McAlester. 鈥淭he impact is great.鈥

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.

Recent times have been tougher for McAlester, now home to 12 marijuana dispensaries and the state鈥檚 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.

A woman in a black and white top holds a single use coffee cup and stands in front of a red SUV truck.
McAlester Regional Medical Center lawsuits against its patients affect “a large number of people in a small community,” says Janet Roloff, an attorney who has spent years assisting low-income clients with legal issues such as evictions in and around McAlester, Oklahoma. (Mitchell Black for 素人色情片Health News)

The hospital, operated by a public trust under the city鈥檚 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 .

鈥淚鈥檓 trying to find ways to get the entire community better care and more care,鈥 said Shawn Howard, the hospital鈥檚 chief executive. Howard grew up in McAlester and proudly noted he started his career as a receptionist in the hospital鈥檚 physical therapy department. 鈥淭his is my hometown,鈥 he said. 鈥淚 am not trying to keep people out of getting care.鈥

The hospital operates a , whose webpage notes it has 鈥渓imited appointments鈥 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.

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.

While audits show few McAlester patients get financial aid, many get taken to court.

Renee Montgomery, the city treasurer in an adjoining town and mother of a local police officer, said she dipped into savings she鈥檇 reserved for her children and grandchildren after the hospital sued her last year for more than $5,500. She鈥檇 gone to the emergency room for chest pain.

Dusty Powell, a truck driver, said he lost his pickup and motorcycle when his wages were garnished after the hospital sued him for almost $9,000. He鈥檇 gone to the emergency department for what turned out to be gastritis and didn鈥檛 have insurance, he said.

鈥淓veryone in this town probably has a story about McAlester Regional,鈥 said another former patient who spoke on the condition she not be named, fearful to publicly criticize the hospital in such a small city. 鈥淚t鈥檚 not even a secret.鈥

The woman, who works at an Army munitions plant outside town, was sued twice over bills she incurred giving birth. Her sister-in-law has been sued as well.

鈥淚t鈥檚 a good-old-boy system,鈥 said the woman, who lowered her voice when the mayor walked into the coffee shop where she was meeting with 素人色情片Health News. Now, she said, she avoids the hospital if her children need care.

A wide shot a an empty road with one white car parked and several buildings along the street
East Choctaw Avenue in McAlester, Oklahoma, is one of this frontier town鈥檚 main drags. (Mitchell Black for 素人色情片Health News)
A cream wall, the front of an office, with black lettering reading "Donald R. Hackler" on one line and "Deborah L. Hackler" on another.
A few blocks from the county courthouse in McAlester, Oklahoma, the law office of Hackler & Hackler is protected by steel bars. (Mitchell Black for 素人色情片Health News)

Nationwide, most people sued in debt collection cases never challenge them, a response experts say reflects widespread misunderstanding of the legal process and anxiety about coming to court.

At the center of the McAlester hospital鈥檚 collection efforts for decades has been Hackler & Hackler.

Donald Hackler was city attorney in McAlester for 13 years in the 鈥70s and 鈥80s and a longtime member of the local Lions Club and the Scottish Rite Freemasons.

Daughter Deborah Hackler, who joined the family firm 30 years ago, has been a deacon at the First Presbyterian Church of McAlester and served on the board of the local Girl Scouts chapter, according to the , which named her 鈥淲oman of the Year鈥 in 2007. Since 2001, she also has been a municipal judge in McAlester, hearing traffic cases, including some involving people she has sued on behalf of the hospital, municipal and county court records show.

For years, the Hacklers鈥 debt collection cases were often heard by Judge James Bland, who has retired from the bench and now sits on the hospital board. Bland didn鈥檛 respond to an inquiry for interview.

Hackler declined to speak with 素人色情片Health News after her recent court appearance. 鈥淚鈥檓 not going to visit with you about a current client,鈥 she said before leaving the courthouse.

Howard, the hospital CEO, said he couldn鈥檛 discuss the lawsuits either. He said he didn鈥檛 know the hospital took its patients to court. 鈥淚 had to call and ask if we sue people,鈥 he said.

Howard also said he didn鈥檛 know Deborah Hackler. 鈥淚 never heard her name before,鈥 he said.

Despite repeated public records requests from 素人色情片Health News since September, the hospital did not provide detailed information about its financial arrangement with Hackler.

McAlester Mayor John Browne, who appoints the hospital鈥檚 board of trustees, said he, too, didn鈥檛 know about the lawsuits. 鈥淚 hadn鈥檛 heard anything about them suing,鈥 he said.

At the century-old courthouse in downtown McAlester, it鈥檚 not hard to find the lawsuits, though. Every month or two, another batch fills the docket in the small-claims court, now presided over by Judge Brian McLaughlin.

After court recently, McLaughlin, who is not from McAlester, shook his head at the stream of cases and patients who almost never show up to defend themselves, leaving him to issue judgment after judgment in the hospital鈥檚 favor.

鈥淎ll I can do is follow the law,鈥 said McLaughlin. 鈥淚t doesn鈥檛 mean I like it.鈥

A smalll white building with black roof in a concrete car lot. A sign on the front reads "Credit Data and Adjustment Bureau."
In McAlester, Oklahoma, lawsuits brought by McAlester Regional Health Center 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. (Mitchell Black for 素人色情片Health News)

About This Project

鈥淒iagnosis: Debt鈥 is a reporting partnership between 素人色情片Health News and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country.聽

Additional research was聽, which analyzed credit bureau and other demographic data on poverty, race, and health status for 素人色情片Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute聽聽from a sampling of Chase credit card holders to look at how customers鈥 balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with 素人色情片Health News on a survey of its clients to explore links between medical debt and housing instability.聽

素人色情片Health News journalists worked with 素人色情片public opinion researchers to design and analyze the 鈥.鈥 The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Reporters from 素人色情片Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.