For 12 years, Emeline Fuller, a local artist and 2021 Emporia State graduate, has endured a legal battle for her life. The catalyst? A 2012 lymph node biopsy and cat scratch disease diagnosis resulting in a medical bill she simply couldn’t afford. Since May of that year, she has been sued 10 times by Emporia health care providers and has had wage garnishments released and reordered for bills she says she “just can’t pay,”.

The lawsuits, which have resulted in the garnishment of Fuller’s wages and levies on her bank account, have left her in a mountain of medical debt that have made even the simplest of everyday utilities the most sought-after luxury. 

For five years, her heat was shut off because she couldn’t afford the bill. Shortly afterward, this caused a pipe to burst, leaving her without running water.

“It was dehumanizing,” Fuller said. 

She relied on public restrooms for a time because she didn’t have plumbing–an effect of the burst pipe– which eventually became unavailable when the Covid-19 lockdown ensued. Because of the compounding effect growing medical debt had on her living situation, she attempted suicide during that time. 

“It was just like … it was just an unbearable life,” she said. 

The medical debt also impacted Fuller’s access to medication, where it became a matter of having the cheapest medication instead of an effective one. Moreover, her access to care was increasingly hindered. When medical attention was necessary, there were times she couldn’t even afford an $8 co-pay. 

“It just kind of destroyed my life for a really long time,” she said. 

‘Heartless’ 

Cat scratch disease is a rare bacterial infection caused by a scratch or bite from a cat that causes swollen lymph nodes, bumps and/or rashes, and fever. After Fuller’s 2012 lymph node biopsy and diagnosis, Fuller was billed by Newman Regional Health, Flint Hills Community Health Center, which now operates as CareArc, and the anesthesiologist for her biopsy. Later, she got pneumonia and was billed by FHCHC and NRH for the care she received. 

“After I had been sick, it took me a long time to recover,” Fuller said. “I had been hospitalized for mental health a few times.” 

Her mental health hospitalization also reaped multiple medical bills. One from Crosswinds, another from NRH, and Stormont Vail, a Topeka-based health care facility. Because Fuller was uninsured at the time, she was unable to pay for her medical care. Her bill from CrossWinds was written off, but when she contacted NRH’s billing department, she says she was told by a representative that a payment plan would not be accepted if she couldn’t pay off the bill within a year.

“I remember really clearly it just was really heartless, I guess,” she said. “I called them and I was like ‘hey, this bill is $6,000, I make $6,000 a year. I’m a student, like I can’t pay this, and they told me that I had to be able to pay off the entire bill within a year or they wouldn’t accept a payment plan.” 

She was later sent to local collections agency CBCS Collections, LLC. and sued on behalf of the hospital by Butler & Associates, a Topeka-based law firm. 

Steven Bazan, director of business development at NRH, responded to The Bulletin’s request for comment regarding payment plans offered by the hospital.

“Newman Regional Health accepts payments on an account for up to 18 months depending on the amount of patient responsibility,” he said in an email. “When patients need an extended payment plan, Newman Regional Health partners with a local financial institution to assist with payment options.” 

Fuller was eligible for charity care at the time, which is financial assistance offered by a hospital for patients who are unable to pay for all or part of their care. If patients meet certain eligibility criteria, they can receive care for free or at discounted rates. Fuller claims Newman did not tell her that charity care was an option.

“Back then, they didn’t let people know that charity care was an option. You had to kind of already know and you had to specifically ask for a charity care application … I was like ‘well guess I’m screwed,’” she said. 

Bazan said in a later phone interview that the hospital has to tell patients about financial assistance and assistance options are disclosed to patients. 

“We have to tell, and we do tell people by word and by letter … so they’re all notified,” he said. 

Patients are sent three letters before they are sent to collections that indicate what steps to take and who to call if they need financial assistance. Patients have to apply for charity care to determine their eligibility for assistance. For patients who have been sent to collections, Bazan said they can still call the hospital for help. 

“We meet with them and work with them to help … and we can’t forgive everything, but they have to fill out an application … that application would be, to me, a part of a step to get the help, because there has to be documentation,” he said.

Because the entities suing Fuller for unpaid debts–NRH, FHCHC, Emporia Anesthesia Associates and Stormont Vail–are separate from one another, they also garnish separately. The move is legal in the state of Kansas as only a single entity is prohibited from garnishing a debtor more than once in a 30 day period for a wage garnishment and more than twice in a 30 day period for a non-wage garnishment. In Fuller’s case, the non-wage garnishment comes in the form of a levy on her bank account. 

The separate, repeated levies on Fuller’s bank account continuously tank her account to the negatives. In an interview with The Bulletin, Fuller indicated her bank account balance was negative $85. 

“I never have more than I owe, so they just take all my money and they leave me with nothing.” she said. 

On top of withholding the amount required for garnishment, banks can also withhold a $15 administrative fee. While she uses a paycard during the school year for the earnings of her paycheck and receives a paper check for her summer job, Fuller also has a small business selling art. The money she earns from her small business is sometimes deposited into her bank account. Since these earnings do not derive from a paycheck, all of that money is withheld when her bank account is garnished as it is not technically protected income.

To date, Fuller owes $46,578.12 in medical debt; over half of that total is the result of interest, which has exceeded the principal amount of $22,369.49. Fuller says she isn’t exactly sure what she has paid because the previous lawyer facilitating the lawsuits, Jay Vander Velde, filed the NRH and FHCHClawsuits together. However, she believes she would have the bills paid off “if not for the interest.” The amount of accrued interest sits at $24,208.63.

“I just owe more money than I could ever pay off,” she said. 

Stormont Vail Healthcare, Inc. v. Sievers 

In January 2019, Stormont-Vail, a Topeka-based healthcare system, sued Harold Sievers for $3,008.09 plus costs and interests and filed requests to garnish Sievers’ wages and his bank account. Sievers objected to the garnishment of his bank account, claiming that the funds within the account were only his wages and, therefore, “earnings.”

K.S.A 61-3505 (b)(1) indicates that a non-wage garnishment applies to “attach intangible property other than the earnings of the judgment debtor.” At the time, earnings were defined by Kansas statutes as “compensation paid or payable for personal services.” 

The district court and the Court of Appeals ruled against Sievers’ objection. The Court of Appeals held that “once wages are deposited in a bank account, they lose their identity as “earnings” as defined under K.S.A. 2019 Supp. 60-2310(a)(1)” and could therefore be garnished after deposit because earnings only exist within the “employer-employee relationship.”

In 2021, the Kansas Supreme Court reversed the rulings of the lower court. The Supreme Court ruled that “wages can be “earnings” … even after they are paid if the employee can directly and specifically identify the funds as wages” and “such earnings cannot be garnished.” 

“We are convinced that the simple, ordinary, plain language of K.S.A. 2020 Supp. 60-2310 means that “paid” wages may in certain factual circumstances be deemed earnings for purposes of garnishment,” the Court said in its opinion. 

In Fuller’s case, NRH and FHCHC obtained a portion of her wages during a May garnishment of her bank account after some back and forth to pay on a credit card deposited money back into the account. The lawyers used by NRH and FHCHC are the same lawyers used by Stormont-Vail in Stormont-Vail Healthcare, Inc. v. Sievers: Butler & Associates. Zachary King, the attorney for FHCHC, argued the case against Sievers in 2019. 

On May 21 of this year, Fuller filed a petition for a hearing on the case after Judge Douglas P. Jones approved the non-wage garnishment request. 

“The funds the plaintiff is attempting to take are my paid wages/earnings,” Fuller said in her petition. “It is improper for the plaintiff to take my paid wages/earnings via an order of garnishment using K.S.A 61-305 and 15 U.S.C 1672(a) & c. The only proper procedure to take my wages/earnings is by an order of garnishment earnings, K.S.A 61-3507. I am prepared to prove to the Court that the funds in my account are my paid wages/earnings, as required by K.S.A 61-3508(c).” 

In a June 10 garnishment hearing, the court ruled against Fuller. The ruling comes from a 2022 amendment to the wording in K.S.A. 60-2310 which effectively overturned the Supreme Court’s ruling.

On Feb. 14, 2022, Todd Butler, principal owner of Butler & Associates, testified before the Kansas House Committee on the Judiciary in favor of HB 2608. The bill “amends and repeals law related to enforcement and collection of criminal restitution, wage garnishment, and dormant judgments” and amended the definition of “earnings” previously held by the Supreme Court. 

During his testimony, Butler proposed that the word “paid” in K.S.A. 60-2310 be removed from the statute so “employee earnings deposited into bank accounts are not exempt from garnishment indefinitely.” Butler’s stance partially rested on the absence of an exemption relating to “cash in a bank account” in K.S.A. 60-2313.

The statute only provides exemptions for pensions, annuity, and retirement benefits; public assistance benefits; workers’ compensation; unemployment benefits; crime victims compensation award; liquor and beverage licenses; life insurance policies; fraternal benefit society benefits; cemetery merchandise trust funds; and prearranged funeral agreement funds. 

“There is now no incentive to pay bills or judgments, as a defendant who can show that funds held by garnishment are traceable to employment can indefinitely protect those funds from seizure,” Butler said. “Judgment-debtors may now request a hearing to have the court review past bank statements and any finds that are traceable to wages at any point in time cannot be garnished.”

In response to Fuller’s objection to garnishment, Kaleb A. Schumacher of Butler & Associates wrote in a motion: “The amendment shows legislative intent to exclude deposited wages from the exemptions from garnishment under K.S.A. 60-2310(b).” 

‘Is this worth it?’

Fuller continues to struggle to pay her bills due to the ongoing garnishments. Having faced this battle the majority of her adult life, she says the thing that has made it “more difficult than anything” to hold down a job and be stable is the healthcare system. 

“They’re the ones who are making me more sick than anything,” she said. 

Recently, Fuller attended a dental appointment at CareArc where she found out they charged her in full for her previous visit. According to Fuller, CareArc did not scan in the income paperwork she had provided them for the sliding fee scale discount, which bases the amount a patient pays off of federal income levels. Because the paperwork, which would have still been valid at the time of her appointment, was not scanned in, she was also charged in full for her dental appointment. 

“I anticipate being sent to collections for this as well as I in no way can afford the appointment,” she said.

By far, Fuller says the lack of access to follow-up and consistent care and medical testing has had the biggest impact on her mental and physical health. At one point, Crosswinds wanted to put her on lithium for her mental health but couldn’t because Fuller couldn’t afford blood testing, which is required for Lithium users. As a result, she had to opt for medication that was “way too sedating” and “really made my mental state actually worse.”

“It was the only affordable medication,” she said.

Fuller wants to see transparency from NRH, specifically in terms of collection of financials and the amount of return the hospital receives from collecting on patient accounts. 

“That way we as the community stakeholders, the people of Lyon County who own Newman hospital, according to their charter, can say ‘okay, look is this worth it? Is this worth having people not seek out medical care? Is this worth having people commit suicide, you know, is the financial benefit there?” she said. 

In the hospital’s annual financial audits for fiscal years 2021, 2022, and 2023, NRH disclosed that it paid a sum of money to “a company that is owned by a board member for patient account collection services.” 

CBCS Collections, LLC. is the collections agency used by NRH to collect debt from patient accounts, including Fuller’s. While NRH has used the agency for over 29 years according to Bazan, it became an LLC in October 2020 under Richard and Monica Duncan. Both Richard and Monica Duncan are listed as “members” of the company in the 2024 Information Report. In Kansas, members are considered owners of a limited liability company (LLC). Monica Duncan confirmed in an email that both she and Richard are “members with more than 5% of capital in CBCS Collections.” 

Richard Duncan served two terms on NRH’s Board of Trustees from 2015 to 2022. He does not currently hold a position on the board. Monica Duncan, who is also manager of the company, is a community volunteer on the hospital’s Quality and Compliance Committee; she has never been a board member. 

Audits prior to 2021 do not show NRH making payments to a collections company owned by a board member.

Fuller went on to say she would also like to see the hospital go through the financial records of those in collections and write off the debts of patients who truly cannot pay their medical bills, especially those who have been paying for years. Additionally, she wants to know why there isn’t a path out of collections. 

“They don’t settle the debts for any reason, I contacted their collection agency,” she said. “They said they don’t settle debts, you have to pay in full. So, they won’t accept any lesser amount than the amount you owe, which is constantly going up through interest.”

Bazan said that the answer is not black and white; there is an application and financial need has to be demonstrated. NRH doesn’t settle or negotiate with every patient who calls because not every patient demonstrates need. He said there have been rare instances where patient bills have been reworked to get out of collections or the hospital has settled with patients.

“It’s rare. I wouldn’t want to give the public the wrong perception of like, yeah, we settle all the time, but it is possible, there is a process to it, and it does involve engaging yourself in the process,” he said. 

Fuller now seeks most of her medical care in Lawrence, where she says her medical care is much better and her doctors are “horrified” about what is happening in Emporia. 

“I really just never want to be involved with any of these facilities again. I don’t, I feel so much fear every time I have a doctor’s appointment, any time I have any type of appointment, because it’s like, you know, when’s the other shoe gonna drop?” Fuller said. 

On June 25, NRH contacted Fuller, offering to work out a payment plan, revisit her bills in collections, and pause garnishment while she applies for financial assistance. In a call on June 26, the hospital agreed to pause garnishment while Fuller fills out application paperwork for assistance. A 6-month collection moratorium has been placed on Fuller’s account collections by Butler & Associates for Stormont Vail and CBCS Collections, LLC for all others. 

“They will accept two payments of $25 a month and stop garnishments while I get the application done,” she said.