The trouble began on a Christmas Day.
That afternoon in 2005, Cleveland Davis head began hurting, and his speech became slurred. His family thought he might be suffering a stroke.
They rushed him from his Charlotte home to nearby Carolinas Medical Center. Doctors found problems, including a blood clot next to his brain and severe circulation problems in his legs.
Doctors amputated Davis left leg, drained blood from the clot and kept him for more than a month for an array of tests and procedures.
In early 2006, the bills started arriving. The hospital said Davis was responsible for paying nearly $200,000. Carolinas HealthCare System later sued to collect on the bill.
A combat veteran who received the Purple Heart for injuries suffered in Vietnam, Davis contends that if the hospital had done its job properly, the U.S. Department of Veterans Affairs probably would have covered his medical bills. In court papers, he argued that the hospital didnt properly process the documents needed to submit the bills to the VA.
Hospital officials say they tried to work with both Davis and the VA. But when the VA refused to pay, they say, the bill became Davis responsibility.
Davis is one of thousands of patients sued by Carolinas HealthCare. Its a bill-collection practice that most North Carolina hospitals have chosen to avoid. But officials say they are obligated to try to collect whatever they can from patients who can afford to pay.
In Davis case, the resolution of the dispute in 2008 proved costly. Davis said he agreed to pay $700 a month for three years to the hospital and clinics that provided his care. After that, he said, he agreed to pay $200 a month to the hospital. Those payments have been his single biggest monthly expense, he says, and he still cant understand how the total bill climbed so high.
Davis receives about $4,400 a month from the VA. After exhausting most of his savings, his modest three-bedroom house in northeast Charlotte valued at $134,000 had been paid in full before his hospitalization.
Otherwise, he says, theres no way he could make his monthly medical payments. For now, he closely watches expenses and cringes each time he sends his check to the hospital.
If I didnt have to pay this, I could pay my (other) bills without a struggle, said Davis, now 64. He has paid only a small portion of his bill so far. I know Ill spend the rest of my life paying this.
Bankruptcies linked to medical bills
Like Davis, many North Carolinians have found themselves owing more money to hospitals than they imagined possible.
Among those hurt the worst are the uninsured, who number nearly 1.6 million in North Carolina.
In a 2010 survey by Care Ring, a Charlotte nonprofit that helps low-income residents, 63 percent of clients polled reported they had medical debt. Among those with debt, more than half reported their credit had been harmed as a result.
Charlotte bankruptcy lawyer David Badger says medical debt has been the driving force in about a quarter of the cases he has handled over the past decade.
Nationally, such cases have soared as medical prices rise. A 2009 study in the American Journal of Medicine found that 62 percent of U.S. bankruptcies are linked to medical bills.
Straight to the funeral home
Davis has been able to avoid bankruptcy but not the stress associated with fighting the hospital.
Officials with Carolinas HealthCare say the VA initially agreed that Davis was covered. But later, after Davis was discharged, the VA notified CMC it wouldnt pay for his care.
Under federal rules, the VA will pay for emergency care in non-VA hospitals, but only until a patient is stabilized. After that, the policy says, the patient, a responsible party or the hospital should arrange for the patients transfer to a VA facility.
Carolinas HealthCare officials say they repeatedly contacted the VA regarding Davis transfer, but the patient was never offered a bed.
Carolinas HealthCare said in a statement that it tried to work with Davis and the VA but could never get the federal government to pay.
The patient legally remains responsible for payment of the care provided, the hospital said.
Usually even-tempered, Davis doesnt try to conceal his feelings about CMC.
I dont ever want to go back there, he tells his wife and children. If I get sick and the VA is full, take me straight to the funeral home.