By Katie Kerwin McCrimmon

The young lawyer and mother of two wheeled herself into the ER at Swedish Medical Center, suffering from severe pain after the amputation of her lower right leg earlier this year.

She was in no condition to be defending herself against a worker’s demand a short time later that she fork over a $400 “deposit” from her hospital bed.

Jessica Peck, the famed conservative activist, was diagnosed at age 5 with a condition known as vascular malformations. Then in 2013, she learned she had a rare neurological condition known as Reflexive Sympathetic Dystrophy. Together, the diseases trigger aggressive destruction of bone, muscle and tissue. She also suffers from tremors that come on without warning.

She’s had approximately 50 surgeries, including the amputation and the earlier implantation of a spinal stimulator that proved unsuccessful.

At times, she’s had to suffer indignities like having to let her 10 year-old daughter take over laundry duty or allowing both girls — the younger one is 7 — haul her 40-pound wheelchair in and out of the car.

“I’m like an 80-year-old, but I’m 36,” says Peck. “Some days I’m mobile and great, but it’s getting tougher with time.”

Despite all the physical challenges and the financial ruin of ongoing medical bills, Peck tries never to take a sick day. She has paid off tens of thousands of dollars in medical debt and is in court on behalf of clients multiple times a week. This week, she has been busy working on a case involving international child abduction.

Born in Virginia and raised in Colorado, Peck specializes in civil rights and family law, often defending young African American and Hispanic boys who she believes have faced disproportionate discipline in schools.

Along with her law degree from the University of Denver, she has a graduate degree from Johns Hopkins, where her dissertation focused on the role of race and gender in higher education.

“I have no intention of slowing down and will adapt to current and future limitations,” Peck says.

Last week, however, Peck was feeling lousy, so she went to Swedish where she’s been a patient for 25 years. She’s at high risk for blood clots and wanted to be sure her increased pain was not the result of a clot.

Soon after she arrived and was settled into a room receiving medication, a worker from the registration department came into the room and demanded that she pay a “deposit” for her care.

“I was groggy from meds in a dark room resting and this stranger came in and demanded $400,” Peck said.

It was money she didn’t owe.

Back in January, she had reached her out-of-pocket maximum for the year, then spent most of the month of February at Swedish when she had her lower right leg amputated.

“I met my co-pay obligations eight days into 2015,” Peck said.

The worker relented, but still insisted that unless patients have proof that they’ve met their deductible, the hospital requires a payment on the spot.

“I do not owe this and I will not pay this,” she said.

Peck wonders how the worker decided to charge her $400 and what happens to all the people who aren’t lawyers and might feel bullied into forking over cash they might not owe.

She said Swedish admissions staff should look at their own records before patients are ever billed, saying they should have known that she’d had extensive care in 2015.

“To arbitrarily demand payment of $400 is not acceptable,” Peck said.

Adam Fox, an advocate with the Colorado Consumer Health Initiative, said his group occasionally hears from consumers who are facing increasingly aggressive hospital billing agents.

Fox said it’s wrong for hospitals to hit up patients for cash when they are at their most vulnerable.
“When someone is in a hospital bed, that’s not what they should be thinking about. It’s not a fair practice. They’re trying to get money out of somebody when they’re at their most vulnerable, when they’re in a hospital and suffering what is potentially a major medical condition. That’s not the time for the hospital to be asking for payment,” said Fox, director of strategic engagement for the consumer advocacy group.
He said hospitals should be negotiating with insurance companies, who should then bill patients later. Under the Affordable Care Act, patients who need financial assistance are supposed to be getting more help from hospitals and Colorado also has a law requiring reasonable payment plans.
“It comes down to consumers being aware of what they are being charged and when,” Fox said.

Spokeswoman Nicole Williams said Swedish uses a computer program common in Colorado and around the U.S. called “Passport” that shows how much a patient will owe.

Williams said it’s standard practice for workers to collect payments in the hospital. Even as a hospital employee, she said she had to make a payment during a recent visit to Swedish after a minor car accident.
She said workers would not have made any exceptions for a patient in a wheelchair or someone with an amputation. If a patient is comatose, can’t breathe or is having a heart attack, hospital workers stabilize the patient first, then work on registering and billing them later.

“If we don’t standardize (the process), then it’s not fair,” Williams said. “It’s part of the process of coming into the ED (Emergency Department) anywhere in Colorado. At some point, you will hit admissions and be told what your deductible is. We don’t look at someone and say, ‘Oh, they’ve had a hard run.’ If someone says, ‘I can’t make a payment,’ we say, ‘OK.’ Everyone does have a different situation. We work very closely with our patients and obviously do a ton of charity care.”

In Peck’s case, she is insured through the ColoradoHealthOP. Her card does not list an ER co-pay and hospital officials say Passport doesn’t link with the HealthOP’s records.

When Peck asked the hospital worker if he had called the number on her card to find out what she owed, he said he didn’t. She wonders how he came up with the $400 figure and scoffed at a computer system that couldn’t detect any information about her, despite her long history as a patient at Swedish.

“I was there from Feb. 7 to March 3 (for the amputation),” Peck said. “Last summer, I was in for up to 18 days at a time. My body gets atrophied and I can’t move. Maybe their ‘Passport’ should show that I have 25 years of passport stamps at Swedish.”

Fox of the Consumer Health Initiative said it’s greatly concerning that hospitals are using a software system that could be wrong.

“Using a system other than going through the health insurer raises concerns about consumers being incorrectly charged, or, as in the case of this consumer, being charged when they shouldn’t be,” Fox said.
Furthermore, he worries that many patients will simply pay on the spot because they fear if they don’t, they’ll get poor care.

“If they’re feeling vulnerable and concerned about getting the health care they need, they’re probably going to pay whatever is asked of them.”
Williams said billing issues are never tied to care.

“A patient’s ability to pay a deposit or not at the time of service does not impact the care being given,” she said.
Peck said that for the most part, she has received great care from her doctors at Swedish.

But because her pain is extreme, her tremors are hard to diagnose and she needs surgeries twice or more a year, she must use powerful and somewhat experimental medications.

“I was in the ER a couple of years ago at my doctor’s insistence and a staffer said, ‘You’re a junkie.’”

Given that Peck is part of a federally monitored prescription drug program, she is required to provide urine and blood tests, often randomly and at least once or twice a month.

Even a single positive result for an improper medication would mean Peck would be booted from the program. After approximately 36 months of tests since she began the program, she says she has never tested positive for a single drug not prescribed to her.

When the hospital worker accused her of abusing pain meds, she went straight to the front desk attendant and said, “I want a refund. You didn’t provide care and you called me a junkie. That’s not care.”

The worker at the register told her she didn’t know how to give a refund. No one had ever asked for one before and Peck never got her money back.

She did, however, work with staff to create a standard of care whenever she arrives at Swedish.

To navigate all the medical bills, Peck has had to hire a patient advocate to fight on her behalf.
Said Peck: “The billing is worse than anything else in the world.”

That’s saying a lot when Peck has to endure regular treatments during which one of her doctors shoots ethanol into her body to try to break up the malformations and preserve the bones. She jokes that she has had to get used to being a “one-legged rabble rouser.”

Amputation was always in the cards and part of the discussion with Peck’s parents and doctors when she was a child. This year, she felt she had no choice, but to part with her right leg from the knee down.

“The pain was so extreme that I had begged for the amputation after a 2014 that included three months in and out of the hospital I thought, ‘the only way I can get out of here (the hospital) is if I cut the leg off,’ ” Peck said.

“The amputation has saved my sanity. I spend less time in hospitals now.”

Despite her frustration over the recent demand for cash, Peck says she’s doing relatively well at the moment.

“Things are calm, but in a split second, it could get out of control. The malformations are in my hip and my tremors are progressive.”

At risk now is her pelvis and spinal cord. Peck could be in deep trouble if her diseases strike either part of her body.

“They used to give a prognosis. Now, they don’t any more. It’s a strange way to live. Am I going to die or live to be 100? I don’t think I’ve ever taken a day for granted.”