Under a blistering sun here recently, armed with only bottled water, homemade signs and the plight of one deathly ill little boy, a dozen Latino immigrants came to shame leaders of the Seventh-day Adventist Church.
Their grievance: Hospitals operating in the name of the church overcharging and denying care to those least able to pay.
In the past year, lawyers for the poor have filed federal lawsuits in 22 states accusing nonprofit hospitals of failing to meet their tax-exempt obligations to provide indigent care. With those legal maneuvers unfolding at a glacial pace, one unlikely crusader is racing forward with a new line of attack, focusing on what he calls the un-Christian behavior of religiously affiliated hospitals.
"It's offensive these hospitals market themselves as providing the healing mission of Christ," said K.B. Forbes, the lead agitator and executive director of Consejo de Latinos Unidos, or Council of United Latinos. "There is nothing healing about charging someone quadruple and then sending the bill collectors after them."
Better known in Washington for his earlier work on Republican presidential campaigns, Forbes is applying pressure the old-fashioned way, with protests, news releases that scream indignation and always a sympathetic victim.
To add drama to the event, Forbes flew into St. Louis a petite 7-year-old Florida boy named Rodney Vega. He had just undergone his fifth surgery to remove brain tumors.
Rodney's parents are practicing Adventists; his father, a Venezuelan, is here on a special visa granted to religious ministers. Yet each time the family sought care at Florida Hospital, one of 38 owned by Adventist Health System, they say the hospital demanded money up front -- tens of thousands of dollars the family does not have.
"The real mission of the church is to help people like Christ did," said Rodney's mother, Judith Montilla Vega. "I don't like Florida Hospital saying they are Adventists. I don't want this hospital to use their name to do all these things."
Florida Hospital officials blame the Vegas' plight on miscommunication and misunderstanding. They emphasized that the Orlando-based hospital provides millions of dollars in charity care.
Orville Parchment, assistant to the president of the Seventh-day Adventist Church, said the church would step in if there was evidence the hospital operated counter to its principles. But he said he has not had time to "dig deeply" into the charges.
In Maryland, there are several Adventist-affiliated hospitals, but a unique state law regulating hospital prices means uninsured patients get the same rates as people with health coverage.
Here in St. Louis, it was unclear whether Forbes was having much impact; the thousands of Adventists barely broke stride as they passed the ragtag group protesting the conference they were attending.
"I don't even know if it's real," said M. Dinorah Rivera as she scanned a flier that accused Adventists of letting church-affiliated hospitals "turn their backs on our stated mission of healing."
Elsewhere in the health care industry, Forbes's street theater has been met with a mix of scorn and consternation, because he is one of the few people to have scored a major victory against the hospital industry.
"K.B. Forbes came knocking on our door several years ago complaining about this very same issue," said Harry Anderson, a spokesman for Tenet Healthcare Corp. who described the early encounters as "not very friendly." Still, Anderson said Forbes is "a passionate believer . . . a very formidable advocate."
So formidable that two years ago, Tenet agreed to Forbes's demands for deep discounts for the uninsured. Through its "Compact With the Uninsured," Tenet's 69 hospitals in 13 states gave about 80,000 uninsured patients the same reduced price given to local managed care companies, about 45 percent less than published rates.
At the core of the fight to help the indigent is a Byzantine billing system in which hospitals start with one standard set of prices and then give deep discounts to government purchasers and private insurers. The result: People without insurance are the only ones charged full price, often triple what insured customers pay.
Hospitals say that negotiating bulk discounts for major buyers is simply the free-market system at work. But advocates for the poor, a well-financed coalition of trial lawyers and a growing number of lawmakers argue the system is so out-of-whack that it amounts to a violation of consumer protection laws.
"It is illegal to charge [uninsured patients] three, four and five times what they charge other people," said Archie Lamb, a Birmingham lawyer handling several of the cases. "It is price gouging, and it is unfair."
At Florida Hospital, a standard appendectomy costs Medicare about $4,000 and private insurers $4,572, Lamb said. A patient without insurance would be charged $13,000 to $15,000 for the same surgery, he said.
Rodney Vega's brain tumor was discovered by chance after a car accident in Venezuela. After two operations there, the family moved to Florida in search of more sophisticated treatment. The family paid Florida Hospital $800 for a brain scan in 2002, which was later refunded. The two sides vehemently disagree over Montilla Vega's assertions that the hospital said surgery would cost them $20,000.
When a physician at Jackson Memorial Hospital in Miami told her Rodney had two weeks to live, Montilla Vega called Forbes in tears, begging for help. He, in turn, phoned his former nemeses at Tenet who, in the 2003 settlement, agreed to provide discounted care on an ad hoc basis to people Forbes said had run out of options.
Since then, the boy, who is disabled as a result of a stroke during his first surgery, has had three more operations at Tenet's St. Christopher's Hospital for Children in Philadelphia. The family is moving to Philadelphia to continue his therapy and make an end-of-life plan known as palliative care, said Rodney's physician, neurosurgery chief Joseph Piatt.
In the case against Florida Hospital, Forbes is using more than the woe of Rodney Vega. Forbes has compiled an avalanche of data on huge compensation packages for Adventist Health executives and the hospital's partnership with the National Basketball Association's Orlando Magic.
One pink flier distributed in St. Louis castigated the hospital for its joint venture with the team on the RDV Sportsplex, a for-profit fitness rehabilitation center, noting: "We turn people away who need help, price gouge those without health insurance, and use the profits to help millionaire basketball players? Is this what Jesus wants?"
Rich Morrison, the hospital's regional vice president for government relations, said such ventures are a common "way for hospitals to get involved in the health side."
The 1,750-bed hospital refuses to negotiate a pricing policy, Morrison said, because of Forbes's "strong arm" tactics.
Forbes, 38, the son of an Irishman and a Chilean immigrant, honed his spinning skills selling Republican presidential candidates Pat Buchanan and Steve Forbes. Critics say K.B. Forbes (no relation to Steve Forbes) is a front man for insurance giant and GOP donor J. Patrick Rooney.
Forbes said Rooney's Fairness Foundation paid him before this year and offered him $100,000 in seed money for advertising to help launch his investigation into alleged hospital gouging, but it was not needed. But Forbes said the accusations about him, his relationships and motives "are a pathetic attempt by the hospitals to deflect attention away from their own deplorable and egregious behavior."
Morrison agreed that hospital pricing has become a convoluted, illogical system of shifting costs from one payer to another. But he and other executives contend that the answer is not to squeeze hospitals, but to devise a national solution for treating the uninsured.
Forbes countered with IRS reports showing comfortable operating margins by Florida Hospital and others in the Adventist system. And although the Adventists were the first hit in Forbes's new assault, he intends to stage similar events in Denver this month to try to embarrass Catholic hospitals.