Debt Follows Life-Or-Death Decision

LIVE NOW, PAY LATER. After surgery, Chris English promised to pay an emergency-room doctor who doesn't accept Medicaid. Now an overdue bill has turned into a battle of principles.

Two years ago, Chris English was a champion snowboarder who wowed skiers with his wily moves. Now he is idle. The young man made a bad jump in 1995 and his legs have been paralyzed since.

But this story isn't about the wheelchair English now must use at the age of 25. It's about a strange twist in the complicated area of health care.

The doctor on call when English was admitted to Overlake Hospital Medical Center in Bellevue was neurosurgeon Michael Schlitt. For a variety of philosophical and practical reasons, Schlitt does not accept Medicaid coupons. So, he refused that form of payment for the surgery he performed, requiring English to pay the $5,000 bill himself.

If just about any other surgeon had performed the operation, the bill would have been covered because the majority of physicians are Medicaid providers.

English does not dispute the $5,000 bill but questions the doctor's rejection of Medicaid, which provides medical assistance to low-income and disabled people. Every other doctor who assisted English was reimbursed through Medicaid, for bills totaling about $95,000.

Legally, Schlitt has every right to refuse to participate in the Medicaid program, even in the emergency room. He can create his own fee contract with patients. Normally, though, patients will shop around for doctors who accept Medicaid.

"We didn't have a choice," says English. "I was laying in the emergency room and was told, absolutely, you have to have surgery."

English later agreed to a payment plan but couldn't follow through on it. Now he is getting phone calls and letters from a collection agency, at a time when he's trying to rebuild his life in a Capitol Hill apartment. The studio is small but tidy, with enough space for English to maneuver his chair between the kitchen and a desk in the front room, where he studies for classes at Seattle Community College.

Like many people in their early 20s, English was uninsured when he went snowboarding that day in April 1995. He worked for a small snowboard company, but his employer did not provide medical insurance, and English did not purchase his own.

He and a friend went to the Alpental Ski Area to snowboard, even though the area was closed.

They built a jump on top of a small ridge and took turns corking over it. English liked the challenge - he had been skiing for about 11 years, competing in Colorado, Oregon and in Utah, where he lived with his family and attended the University of Utah.

He had moved to Seattle in 1993, primarily because of the skiing and outdoor lifestyle. His mother and sister followed the next year.

After several jumps on that April day, English made another approach, but lost momentum. He fell about 15 feet and slammed onto a road beneath the ramp. He felt searing pain in his back - and nothing in his legs. The Ski Patrol was summoned, and English was taken to Overlake.

Schlitt, a respected and politically active doctor, was the neurosurgeon on call. Only after surgery would English learn that Schlitt would not accept Medicaid payments.

Schlitt had dropped out of the Medicaid program in 1991, saying he had treated too many patients who "cheated the system." He has been a vocal critic of health-care reform, saying managed care is "immoral" because it limits fees doctors may charge and, in some cases, refuses to reimburse charges for particular procedures.

Schlitt has had several high-profile patients, including Seahawk Mike Frier, injured in a car accident in 1994. The American Medical Association calculates that the median income for surgeons in 1995 was $225,000.

Schlitt defends his stance in the English case.

"Mr. English came in after snowboarding in a closed area - I hope he pointed that out - with paralysis, which, through my surgery, we were able to partially reverse," said Schlitt. "We set up a payment plan that he reneged on."

Records show that Schlitt initially asked English to pay the $5,000 in full or start a $200-a-month payment plan. Upon English's request, Schlitt agreed to reduce that amount to $50.

At the time, English was unemployed, in rehabilitation and trying to finish school. He explained this to Schlitt and asked the state Department of Vocational Rehabilitation to intercede on his behalf regarding the bill. But those efforts failed. When English faltered on his $50 payments, Schlitt sent the bill to collections.

"We went the extra yard for this young man, after I quite literally saved his life," said Schlitt. "Now, after he doesn't comply with the plan he agreed to, I'm the guilty one."

The state acknowledges that the situation represents a gap in a system designed to assist people who don't have the money to pay for medical assistance.

"We can't intervene," says Robin Basset, a state Department of Social and Human Services employee who researched English's case. "I wish something could be legislated. Every once in a while, we do see a case like this, and sometimes the clients do get stuck."

Even in an emergency, it appears that the law allows doctors to refuse Medicaid. Wanda Gravett, Overlake spokeswoman, said hospitals are prohibited from dictating how physicians receive payments and that they are free to establish their own payment practices.

Dr. Peter McGough, past president of the Washington State Medical Association, criticized that practice. He said some physicians reject Medicaid because they don't think it pays enough and would rather collect full payment directly from patients.

Meanwhile, English is finally in a position to start paying the bill. He has a new job with a communications company and is paying for his own housing and rehabilitation, even though he's eligible for government aid. He wants to repay Schlitt, but not through a collection agency. He made that overture to Schlitt in December, but the response was, "No. . . . We already gave him extra chances," according to records.

So, the collectors keep calling and sending letters.

"I'm not doing this for spite," English said. "I was doing something I loved. I don't want to sue Alpental. I don't want to sue the snowboard manufacturer. I'm not bitter other than at this doctor. I want to let others beware."