Patients Work Off Debts at Maine Hospital

How much is a gall bladder operation worth?

Most folks would answer that question with a dollar amount. But Della O’Leary paid for her operation by doing about 20 hours of clerical work each week for four months at Franklin Memorial Hospital.

“I put data in the computer. They needed that very badly, and I helped them out,” said the 59-year-old Maine native.

Franklin Memorial Hospital, a 70-bed hospital deep in the Maine countryside, recently launched a program that lets uninsured or underinsured patients pay off their debts by working at the hospital.

“It’s basically the barter system, brought into the current context,” said Richard Batt, Franklin Memorial’s president.

The hospital’s board of directors approved the program, called Contract for Care, earlier this year. It allows uninsured or underinsured patients whose incomes fall between 100% and 200% of the poverty level to work off their debts. Friends and relatives can work, as well. It’s believed to be the first program of its kind in the nation.

Batt estimates that between 18% and 20% of the 40,000 people who live in the economically stagnant 3,000 square miles covered by Franklin Memorial have either no insurance or “extremely marginal insurance.”

For O’Leary, who participated in a pilot version of the program, the opportunity to work off her debt meant financial salvation.

“I would have been the rest of my life paying it off,” said the uninsured receptionist of the operation’s $8,000 price tag.

It also offers a solution to people trying to take care of their own debts with dignity.

“It makes anyone feel like they’re doing something and not just a charity case. It gave me a very good feeling,” O’Leary said.

“The theory is that everyone has talent,” Batt said after describing all the painting, gardening, typing, filing, cleaning, repairing and other projects the hospital has on its wish list.

Participants in the Contract for Care program, which is expected to be up and running by spring, will be paid $20 an hour for their work.

Bo Jespersen, a 24-year-old carpenter who also participated in the pilot program, faced years of debt after a motorcycle accident in 1994.

“I was paying them barely $25 a month,” he said, recalling the struggle to pay off his debts and attend college simultaneously.

Last year, Jespersen worked several weeks in the hospital’s emergency room where he ran errands, took samples to the lab, made beds, cleaned up spills and kept paperwork in order.

“There’s a nobility when you can work off something you owe and make a difference,” he said.

Jespersen eventually left the program to take a construction job far from Farmington, but he said he plans to work off more of his debt during an expected layoff of several weeks this spring.

“I really enjoyed it; I don’t want to lose that experience,” he said.

“Bo is typical of the hard-working folks in this area,” said the hospital’s chairman, Darryl Brown.

Brown said that when the Contract for Care program was first proposed, he was reminded of his childhood on a rural Maine farm. “We used to pay our taxes by cutting brush on the side of the road,” he said. “It’s an old idea that’s gotten lost.”

Richard Wade, senior vice president of the American Hospital Assn., said Franklin Memorial has formalized and updated an age-old tradition. “The seed of this probably goes as far back as you’ve had hospitals,” he said. “I can remember administrators talking about how farmers would supply them with produce.”

Contract for Care participants will be hired by the hospital as “independent contractors.” Money they are paid will then be deducted from their outstanding balance.

Batt stressed that no hospital employees will be laid off to make way for Contract for Care workers, and that patients who fall below the poverty line will still qualify for free charity care. He also acknowledged that those who choose to participate in the program are technically earning income that could come back to haunt them at tax time.

“We’re offering a means of income to someone that is low-income; they can reject it,” he said. “We’re just trying to give options to individuals.”

Joe Ditre, executive director of Maine Consumers for Affordable Health Care, worries that by earning money at the hospital, some people may inadvertently make themselves ineligible for government assistance.

On a more theoretical level, Ditre felt health care should be treated as a human right--not a salable commodity.

“I just think that it’s basically and fundamentally wrong for a health system to be headed in this direction,” he said.