TULSA, Okla. -- EMSA has filed more than 1,400 liens since last year against people transported by ambulance after automobile accidents, records show. EMSA's written policies show it is standard practice for the agency to file liens in all cases involving motor vehicle accidents. The policy surprised even one of its board members after his family member was named in a lien. Since Jan. 1, 2011, EMSA has filed with the Tulsa County Clerk's Office 1,411 liens against people for ambulance services, a Tulsa World investigation shows.
Steve Williamson, CEO of the Emergency Medical Services Authority, said he worked to get state legislation passed authorizing the ambulance liens. He said the practice is standard in the medical community.
"One of the tools we use is a statutory lien not on property but on proceeds," Williamson said.
He said the liens do not affect credit scores. The liens are public record, even after they are released, at the Tulsa County Clerk's Office. The liens require that EMSA's bill for ambulance service be paid out of any insurance settlement, including those who pay a fee on their city utility bills to avoid out-of-pocket fees for ambulance service. EMSA's policies state there must be a "zero balance" on the account before a release is filed. About 6 percent of EMSA transports statewide are related to car accidents. During discussion of the utility-fee program in 2007, officials made it clear that insurance would be billed in cases where it is available.
Those without insurance would pay nothing under the program. The fact that EMSA would be filing liens to collect settlements after car accidents was not discussed. Liens are also not mentioned in the city ordinance authorizing the utility program or in the agreement governing it.
"If there's money out there for ambulance service, we are going to go collect it," Williamson said. "When the settlement is made, they have to cut us a check." In cases in which the settlement is less than a patient's combined medical bills, "we just see how much there is," Williamson said.
Since Jan. 1, EMSA has filed 205 liens against people in Tulsa County. Tulsa's largest hospital, St. Francis, filed 208 liens during that time, records show.
"As a not-for-profit health-care organization, we make an effort to provide as many options for medical bill payments as possible," said Sevan Roberts, a spokeswoman for St. Francis Hospital. "These options include extended payment plans and charity care to those who qualify. Only in limited circumstances are liens considered."
Cheena Pazzo, a spokeswoman for St. John Medical Center, issued a statement regarding how the hospital handles liens.
"St. John pursues recovery of medical expenses from third-party sources on a case-by-case basis after considering the relevant circumstances. For example, in situations where our patients have been injured in an automobile accident, St. John may file a medical lien if liability insurance could pay for the medical expenses incurred by the St. John patient."
Tulsa County Clerk Earlene Wilson said the liens filed by EMSA remain in place until EMSA files a release. Wilson said the County Clerk's Office sends a letter to those who are named in the liens. Records show that a nephew of EMSA trustee Clay Bird was among those named by the agency in a lien. Bird, economic development director for the city, represents Tulsa on the board that oversees EMSA's operations.
Bird said his nephews were in a car accident in December. He said he was not aware EMSA was filing liens against people until he was contacted by the World. Records show his nephews' south Tulsa home address is enrolled in the utility-fee program. Hank Bird said his 19-year-old son, also named Clay Bird, was a passenger in the car driven by his 22-year-old brother, Tyler Bird. The father said Tyler Bird was seriously injured, and his younger son wanted to ride with his brother to the hospital.
"On Clay, the EMSA driver kind of forced him to give the (insurance) information in the vehicle. ... My youngest son had a cut on his head, and they basically put them both in the same ambulance," Hank Bird said. "My youngest son said, 'Hey if this is going to cost anything, I don't need to ride in the ambulance.' They both received a bill for the same ride to the same hospital. ... I'm not real impressed with that."
Hank Bird said "it was rather shocking" when he received notice of the lien in the mail. Williamson said the agency cannot comment on individual cases. He said "it's a normal EMS procedure" to bill both patients for riding in the same ambulance if they receive any medical treatment.
EMSA does not charge people who merely accompany a relative in an ambulance, Williamson said. Gladys Gray, 70, said her leg was broken in a car wreck on Oct. 28, 2010. She said her husband, who had "minor bruises" from a seat belt, rode in the ambulance with her. Gray said EMSA sent them two bills for $1,145 each. Like all bills EMSA initially sends patients, they contained no information acknowledging the Grays were members of the utility program and listed a dollar amount "due from patient."
A form requesting insurance information is also included with the bills EMSA sends patients. Once EMSA receives a patient's insurance information, patients are sent a bill showing amount "due from insurance." Records show that the Grays' Tulsa address is covered by the utility-fee program. Gray said her attorney told her EMSA's program did not include coverage for car wrecks. She said she later received a letter from Works & Lentz, a law firm representing EMSA, about the bill. The firm has filed more than 1,300 lawsuits on behalf of EMSA since 2009, records show. It receives 35 percent of what it collects plus attorney fees. In addition to the law firm's letter, Gray received two notices that EMSA had filed a lien against her and her husband, she said.
"I thought it was very unfair. It was almost like a shock when the first one came. I thought, 'Hey, we're not even close to being well yet.'"
She said she paid the EMSA bill when she received an insurance settlement but does not believe she should have been turned over to a law firm while she awaited payment.