Federal Agencies Have Spent Millions on KN95 Masks, Often Without Knowing Who Made Them

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In scrambling to buy protective equipment for the coronavirus pandemic, federal agencies purchased up to $11 million worth of Chinese-made masks, often with little attention to manufacturing details or rapidly evolving regulatory guidance about safety or quality, a ProPublica review shows.

Some agencies cannot say who made their masks at a time when thousands of foreign-made respirators appeared on the market, some falsely claiming approval or certification by the Food and Drug Administration. Some agencies bought the masks, known as KN95s, from companies that share a U.S. representative with another firm recently accused of fraud by the Justice Department.

The contracts reflect the intense pressure federal agencies were under to procure protective equipment as the pandemic surfaced and rapidly spread in the U.S. Now, some experts worry that the products could remain in circulation long past the crisis and be used by unsuspecting federal employees who believe they have legitimate respirator masks.

Agencies have relaxed procurement standards, including granting many contracts without competitive bidding, and have been tripped up by shifting FDA standards, the flood of foreign companies entering the U.S. market and a limited domestic supply of respirators made for medical use.

“I’m so glad we didn’t get involved in this KN95 market,” said Andy Mitchell, a vice president at Mallory Safety and Supply, which supplies N95 masks. “This isn’t right what’s happening here.”

ProPublica reported last month that the Indian Health Service had purchased $3 million of Chinese-made respirator masks from a company started by a former White House official, and that the masks did not meet FDA standards. A House of Representatives committee plans to hold a hearing on Thursday examining the IHS’ response to the COVID-19 pandemic.

ProPublica reviewed 21 contracts awarded by 11 federal agencies that specifically mentioned procuring KN95 masks, a Chinese version of N95 respirator masks. Five agencies — the Bureau of Prisons, the Department of Veterans Affairs, the U.S. Marshals Service, the U.S. Mint and the U.S. Forest Service — could not say who manufactured their masks or did not respond to questions. The total spent on the 21 contracts was more than $11 million, but some of the deals also involved other items such as ear loop face masks and hand sanitizer.

Foreign-made masks have come under increasing scrutiny from federal regulators. The FDA issued an emergency use authorization for some Chinese-made masks in health care settings in April, but it narrowed the authorization after some masks were found to let through far more particles than advertised.

In many cases, the agencies buying the masks are not directly involved in health care provision, and are thus beyond the scope of the FDA authorization, although the Indian Health Service and the National Institutes of Health were among the purchasers. Some agencies told ProPublica they would use the masks they purchased only in nonmedical settings, a recognition of the lesser protection they may provide.

But experts said the purchase of such products at all still poses a risk to employees. Dr. Meghan Dierks, a Harvard Medical School professor who previously worked at the FDA on medical device shortage issues, said she is concerned about “all of these potentially inferior products remaining in circulation, remaining on shelves” after the current crisis passes, whether used in medical or nonmedical settings.

“If you’re in charge of procuring a product that you expect to confer some level of safety or protection to your workers, there’s responsibility there for knowing what’s the basic performance criteria and what’s the regulatory authority in the United States that monitors this,” Dierks said.

The FDA tightened its April emergency rules rules a month later, after testing by the Centers for Disease Control and Prevention revealed that some Chinese masks let in too many fine particles. Dozens of Chinese manufacturers that had initially appeared on an approved FDA list were removed, tripping up buyers who had purchased masks just weeks earlier.

Dr. Suzanne Schwartz, deputy director of the Office of Strategic Partnerships and Technology Innovation at the FDA’s Center for Devices and Radiological Health, said the agency has “encouraged importers and distributors to do their own due diligence and take the appropriate steps to verify the product’s authenticity prior to importing, particularly those products not authorized by the FDA.”

Typically, the FDA moves slowly when issuing rules and regulations, but it quickened its pace during the pandemic, said Michael Abrams, a co-founder of Numerof & Associates, which advises hospitals, pharmaceutical companies, financial institutions and others on health care issues.

“They’ve been forced to make decisions that they sometimes need to go back on,” he said. “Certainly that makes it more difficult for anyone who’s relying on what these regulatory entities have to say.”

That includes the rest of the federal government. On May 1, the Department of the Interior purchased $114,400 worth of KN95 masks from Red River Resources LLC, a California vendor. The manufacturer was Guangdong ZhiZhen Biological Medicine Co. Ltd., according to the agency.

“At the time of purchase, the respirators were on the list of approved products,” Andrea Antunes, an Interior spokeswoman, wrote in an email. “Subsequently, they were removed from the approved list and will not be purchased again.”

Antunes did not respond to questions about what the agency would do with the purchased masks.

The website of Guangdong ZhiZhen Biological Medicine displays a mask it labeled “FDA approved FFP2 KN95 Mask.” Phone calls and emails sent to CCTC Service Inc., the company’s U.S.-based agent, were not returned. CCTC, based in Delaware, is named as the representative for nearly 1,600 devices listed with the FDA this year, including KN95 masks manufactured by two firms used by Zach Fuentes, a former White House deputy chief of staff, to fulfill the contract with the Indian Health Service.

In a federal court complaint filed June 5 against another Chinese mask manufacturer, King Year Printing and Packaging Co. Ltd., by the Justice Department, an FDA special agent said that there is “probable cause to believe CCTC is a fictitious corporation.” FDA records list a residential address for the company, the complaint said, and the house’s occupant and owners said they had no knowledge of or connection to CCTC. The Wall Street Journal first reported the federal complaint against King Year.

In the complaint, the government alleges that King Year falsely labeled its respirators with the logo of the National Institute for Occupational Safety and Health, which conducts medical device testing, and included “a test report showing compliance with the N95 standard despite the respirators not meeting the minimum standard for N95 respirators.”

Since a national emergency was declared in the U.S. on March 13, more than 3,600 Chinese-made products categorized as “surgical respirators” have been listed with the FDA, a ProPublica analysis of government data shows. In all of 2019, the total number of surgical respirators registered with the FDA was five.

“There are a lot of people producing face masks who are not necessarily reputable suppliers or historic suppliers of this product,” said Phil Farinelli, vice president at Government Scientific Source, a Northern Virginia supplier that sold KN95s to the National Institutes for Health. “I probably get 10 emails a day from people trying to sell me face masks from China.”

The NIH, the agency responsible for public health research, signed a separate contract worth nearly $700,000 for respirator masks in March with Missouri-based Phoenix Textile Corp., federal data shows.

The original contract was for N95 masks, the agency said in a statement to ProPublica. But because those were unavailable, Phoenix Textile proposed KN95s as an alternative.

“When NIH received the order and learned that the masks were not FDA-approved, NIH tested the products using the FDA standards for respirators and the product had failed,” the agency said.

NIH requested a refund for the masks it had already received, will not pay for any more and plans to return the masks to Phoenix Textile. Executives with Phoenix Textile did not respond to an email and voicemail requesting comment.

Tests of some imported respirator masks are finding that they often do not provide the level of protection they advertise. Evan Floyd, a professor at the University of Oklahoma’s Health Sciences Center, has been testing the filtration capability of KN95 masks purchased by the state of Oklahoma and private businesses.

Around one-third of the approximately 70 brands he has tested thus far do not meet the 95% filtration standard, Floyd said.

Dr. John Howard, the director of NIOSH, said in an FDA webinar on Tuesday that the agency recently had tested over 130 international respirator models and found that more than half were “substandard.”

The Indian Health Service purchased 4,000 KN95 masks manufactured by a Chinese firm, ZhangJiaGang ShineYa Sanitary Products Co. Ltd., in an April 9 contract, an IHS spokesman said. The contract is separate from the Fuentes deal. The masks were sent to the IHS office in Bemidji, Minnesota, which serves tribes in Illinois, Indiana, Michigan, Minnesota and Wisconsin.

ZhangJiaGang ShineYa does not appear on the FDA approved list of Chinese manufacturers.

Half of the masks are still in the Bemidji area office and “will not be distributed to health care personnel,” an IHS spokesman said. The other 2,000 masks are being used by IHS environmental health officers “and are being used in non-health care settings,” he said.

The company’s listed U.S. agent, John Flair, did not respond to a request for comment. The U.S. vendor that supplied IHS with the masks, California-based West Coast Business Products Inc., also did not respond.

The U.S. Marshals Service purchased $77,500 worth of KN95 masks in April from Knock-Out Specialties, a Texas firm that recently began selling PPE. The masks were made in China and “the products or vendors have been registered or certified by FDA,” said Drew J. Wade, a Marshals Service spokesman, in an email. They are being used in “non-medical, law enforcement situations.”

But “registration” with the FDA does not mean that the FDA approves the manufacturer or its products, a fact prominently mentioned on the FDA website. FDA’s registration and listing database serves merely to provide a public, central listing of companies that may sell certain medical equipment.

When asked to clarify if the masks were just registered with the FDA or had some further certification, Wade responded: “I’m not sure I can sufficiently answer that question at this time. USMS holds certificates that appeared to denote some sort of FDA approval.”

John Bottone, the owner of Knock-Out Specialties, did not respond to a phone call and email seeking comment.

One agency that kept up with the FDA’s shifting rules was the Department of Energy’s National Nuclear Security Administration. In a contract with a Georgia-based vendor, American Dream Builders, the agency purchased over $400,000 worth of KN95 masks. An NNSA spokeswoman identified the masks’ manufacturer as “Guangzhou Powecom Labor Insurance Supplies Company LTD,” which does appear on the FDA-approved list.

Another manufacturer was originally supposed to fulfill the order, spokeswoman Kate Hewitt said. But when the FDA updated its criteria and the original manufacturer fell off the approved list, the purchase order for the mask contract was modified on May 18 to change to “an FDA-approved manufacturer,” Hewitt said.

The Federal Emergency Management Agency also appears to have purchased KN95 masks from Guangzhou Powecom, although FEMA provided ProPublica with a slightly different manufacturer name when asked about a $4 million contract for KN95 masks it signed in May.

FEMA’s vendor was Osirius Group, an automotive manufacturing firm based in Birmingham, Michigan. Timothy Smith, Osirius Group’s CEO, said in an email that “they are the same company.” Osirius’ first shipment to FEMA was set to arrive this week.

Guangzhou Powecom and other firms with the FDA’s endorsement are being inundated with orders, Smith said.

“The FDA list has become a bible of sorts and any one on that list gets overrun,” he said via email. He said his firm has been doing business in China since 1992.

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Artificial Kidneys Are a Step Closer With This New Tech

10 percent of the global population suffers from some form of kidney disease. That includes 37 million people in the US, 100,000 of whom pass away each year awaiting a kidney transplant.

Our kidneys are crucial for keeping us alive and healthy. A sort of chemical computer that keeps our blood chemistry stable—whether we’re eating a sugary birthday cake or a vitamin-filled salad—they prevent waste buildup, stabilize our electrolyte levels, and produce hormones to regulate our blood pressure and make red blood cells.

Kidneys clean our blood using nephrons, which are essentially filters that let fluid and waste products through while blocking blood cells, proteins, and minerals. The latter get reintegrated into the blood, and the former leave the body in urine.

Scientists have struggled to come up with viable treatments for kidney disease and renal failure, and their complexity means kidneys are incredibly hard to synthetically recreate; each kidney contains around one million intricately-structured nephrons.

But new progress from chemical engineering researchers at the University of Arkansas has brought functioning artificial kidneys one step closer. The researchers created a device that was able to filter blood in a way similar to biological nephrons. They described the device in a recent paper published in Nature Communications Materials.

There are two basic processes that take place when blood passes through the kidneys. First, clusters of blood vessels called glomeruli let small molecules, waste, and water through, while proteins and blood cells stay behind. The material that gets through this first filter then flows into the nephron network, where it’s further filtered in a process called ion transport.

The researchers’ work focused on the second step, ion transport. They placed a porous mesh made of platinum between two ion-exchange wafers to create a wafer that pushes ions through membranes using an electric field. The platinum meshes serve as electrodes when voltage is applied, enabling the team to select different ions and adjust their transport rates independently. They tested the technology with various ions and were successfully able to mimic the ion transport done by the kidneys.

In their paper, the team points out that other research groups have tried creating artificial nephrons using living, cell-based systems, including stem cells; but outside a native, living environment and absent the physical and hormonal signaling that control their function, biologically-based systems have struggled to replicate the nephrons’ function, especially ion transport.

Christa Hestekin, Arkansas associate professor of chemical engineering and the lead author of the paper, said, “The system could work as a stand-alone device or in conjunction with peritoneal dialysis to control the chemistry of solutions used in treatment. And, minor modifications to the device could enable it to function as a wearable and potentially implantable artificial kidney.”

In the US alone, over 93,000 people are currently on the waiting list for a kidney transplant. Though a fully-functioning artificial kidney is likely still years away at best, scientists are making incremental progress in recreating this vital organ; an artificial nephron like the one described here is just one piece of a complex puzzle.

Another crucial piece is a functioning network of blood vessels. In 2015, scientists at Lawrence Livermore National Laboratory created bioprinted kidney tissue that replicated some of the functions of biological nephrons. In 2016 a group at Harvard’s Lewis Lab used 3D printing to re-create the nephrons’ tubules, complete with a vascular network for blood flow—but they only stayed alive for a little over two months.

The fully synthetic nature of the Arkansas team’s technology could thus have a leg up on biologically-based approaches. According to Hestekin, the nephron could be combined with ultrafiltration, nanofiltration, or reverse osmosis systems and integrated into an artificial kidney.

Given the vast number of people in need of them, artificial kidneys can’t come soon enough, and will be a miracle of modern science when they do arrive. Though it’ll be some time yet, incremental progress like this gives us the confidence to say “when” instead of “if.”

Image Credit: crystal light / Shutterstock.com




After Coronavirus the World Will Never Be the Same. But Maybe, It Can Be Better

Life has changed a lot in the past few days, weeks, or months, depending where you live. As efforts to contain the novel coronavirus ramp up, it’s likely going to change even more. But we’re already sick of being at home all the time, we miss our friends and families, everything’s been canceled, the economy is tanking, and we feel anxious and scared about what’s ahead.

We just want this to be over, and we figure it’s only a matter of time. We’re making plans for what we’ll do when things go back to normal—and banking on that happening.

But what if life never fully goes back to how it was pre-coronavirus? What if this epidemic is a turning point, and after it the world is never the same?

More importantly—or, at least, more optimistically—what if the world could come out of this crisis better than it was before?

Jamie Metzl, technology and healthcare futurist, geopolitical expert, novelist, entrepreneur, and Senior Fellow of the Atlantic Council, thinks this is possible—but it all depends on what we do and how we behave right now. In a talk at Singularity University’s virtual summit on COVID-19 last week, Metzl explained why he believes that we’re never going “back to normal”—and what we should be doing now to make the new normal a good one.

Marks of History

For many of us, the most impactful geopolitical event that’s happened during our lifetime was the terrorist attacks of September 11, 2001. The world changed that day, and it’s never returned to how it was before.

A flu-like pandemic with a relatively low mortality rate may seem minor compared to the deliberate murder of thousands of innocent people. But, Metzl said, “It’s my contention that this isn’t a 2001 moment, this is something much bigger. I think of this as a 1941 moment.”

1941 was the thick of World War II. Nobody knew what the outcome of the war was going to be, everybody was terrified, and the US and its allies were losing the war. “But even in the height of those darkest of times,” Metzl said, “people began imagining what the future world would look.”

It was 1941 when President Roosevelt gave his famous Four Freedoms speech, and when American and British leadership issued the Atlantic Charter, which set out their vision for the post-war international order. To this day, our lives exist within that order.

The situation we’re in right now is, of course, different; it’s not a war. It is, in Metzl’s words, “a convergence of the worlds of science and biology and the world of geopolitics.” And as the coronavirus crisis continues to play out, its geopolitical implications are going to become much greater.

The Old World Is Dying

Metzl shared a quote from Italian Communist theorist Antonio Gramsci, written in the 1930s: “The old world is dying and the new world struggles to be born. Now is the time of monsters.”

Oof—that’s a big statement.

Metzl deconstructed it. For starters, he said, the post-WWII order that we’ve all grown up with was dying before this virus appeared.

Post-WWII planners envisioned a world that shared sovereignty and curbed nationalism. But we’re now in a period of dramatic re-nationalization of the world, with populist, extremist, or authoritarian leaders in power from Brazil to the US to China, and many countries in between.

Institutions intended to foster global cooperation (like the World Bank, the International Monetary Fund, the United Nations, and the World Health Organization) have been starved in the context of this re-nationalization, and as a result we don’t have effective structures in place to address global crises—and not just coronavirus. Think of climate change, protecting the oceans, preparing for a future of automation and AI; no country can independently take on or solve these massive challenges.

Not all is lost, though. “There are some positive pieces of this globalization story that we also need to be mindful of,” Metzl said.

When the Spanish flu pandemic hit in 1918, there were only 2 billion people on Earth, and of those 2 billion only 30 percent were literate.; the “brain pool” for solving problems was about 600 million people.

Now we have a global population of 7.5 billion and an 86 percent literacy rate, which means over 6.5 billion people can be part of the effort to fix what’s broken. Just as crucially, we’re more connected to each other than we’ve ever been. It used to take thousands of years for knowledge to transfer; now it can fly across the world over the internet in minutes. “The pandemic moves at the speed of globalization, but so does the response,” Metzl said. “The tools we’re bringing to this fight are greater than anything our ancestors could have possibly imagined.”

But at the same time we’re experiencing this incredible bottom-up energy and connectivity, we’re also experiencing an abysmal failure of our top-down institutions.

Now Is the Time of Monsters

Have you felt afraid these last few days and weeks? I sure have. The economy is tanking, people are losing their jobs, people are getting sick, and we don’t know the way out or how how long it’s going to last. In the meantime, a lot of unexpected things will happen.

There will be an economic slowdown or recession, and there will be issues with our healthcare systems—and these are just the predictable things. Metzl believes we’ll also see significant second and third-order effects. If the poorer parts of the world get hit hard by the virus, we may see fragile states collapsing, and multi-lateral states like the European Union unable to support the strain. “Our democracies are going to be challenged, and there may be soft coups even here in the US,” Metzl said. Speaking of challenges to democracy, there are actors whose desires and aspirations are very different from our own, and this could be a moment of opportunity for them.

“The world is not going to snap back to being exactly like it was before this crisis happened,” Metzl said. “We’re going to come out of this into a different world.”

The New World Struggles to Be Born

We don’t know exactly what that world will look like, but we can imagine some of it. Basically, take the trends that were already in motion and hit the fast-forward button. Virtualization of events, activities, and interactions. Automation of processes and services. Political and economic decentralization.

But for the pieces of the future that we’re unsure of, now is 1941. “Now is the time when we need to think about what we would like the new world to look like, and start planning for it and building it,” Metzl said.

In hindsight, it’s easy to picture a far better response and outcome to the COVID-19 outbreak. What if, three months ago, there’d been a global surveillance system in place, and at the first signs of the outbreak, an international emergency team led by the World Health Organization had immediately gone to Wuhan?

“We—all of us—need to re-invigorate a global system that can engage people inclusively across differences and across countries,” Metzl said. “We need to be articulating our long-term vision now so that we can evaluate everything against that standard.”

There’s not a total lack of a positive long-term vision now; the UN sustainable development goals, for example, call for gender equality, no poverty, no hunger, decent work, climate action, and justice (among other goals) around the world.

The problem is that we don’t have institutions meaningful enough or strong enough to effect realization of these principles; there’s a mismatch between the global nature of the problems we’re facing and the structure of national politics.

Building the New Normal

Just as our old normal was the new normal for our grandparents in the mid-1900s, this new normal that feels so shocking to us right now will simply be normal for our children and grandchildren. But there are some critical—and wonderful—differences between the mid-1900s and now.

We have more educated people, stronger connections, faster sharing of information, and more technological tools and scientific knowledge than ever before in history. “The number of people who can be part of this conversation is unprecedented,” Metzl said. “We couldn’t have done this in the industrial age or even the nuclear age. There’s never been this kind of motivation combined with this capacity around the world.”

In 1941, the global planning process was top-down: a small group of powerful, smart people decided how things would be then took steps to make their vision a reality. But this time will be different; to succeed, the new global plan will need to have meaningful drive from the bottom up.

“We need to recognize a new locus of power,” Metzl said. “And it’s us. Nobody is going to solve this for us. This is our moment to really come together.”

Image Credit: Joseph Redfield Nino from Pixabay




Low-Wage Workers Are Being Sued for Unpaid Medical Bills by a Nonprofit Christian Hospital That Employs Them

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MEMPHIS, Tennessee — This year, a Methodist Le Bonheur Healthcare housekeeper left her job just three hours into her shift and caught a bus to Shelby County General Sessions Court.

Wearing her black and gray uniform, she had a different kind of appointment with her employer: The hospital was suing her for unpaid medical bills.

In 2017, the nonprofit hospital system based in Memphis sued the woman for the cost of hospital stays to treat chronic abdominal pain she experienced before the hospital hired her.

She now owes Methodist more than $23,000, including around $5,800 in attorney’s fees.

It’s surreal, she said, to be sued by the organization that pays her $12.25 an hour. “You know how much you pay me. And the money you’re paying, I can’t live on,” said the housekeeper, who asked that her name not be used for fear that the hospital would fire her for talking to a reporter.

From 2014 through 2018, the hospital system affiliated with the United Methodist Church has filed more than 8,300 lawsuits against patients, including its own workers. After winning judgments, it has sought to garnish the wages of more than 160 Methodist workers and has actually done so in more than 70 instances over that time, according to an MLK50-ProPublica analysis of Shelby County General Sessions Court records, online docket reports and case files.

Some of the debts were accrued while the employees worked at Methodist; others predated their time there. The figures do not include debts incurred by onetime Methodist employees who have since moved on.

Between January and mid-June, a reporter observed more than a dozen Methodist employees in court to defend themselves in suits brought by the hospital over hospital bills.

That includes a Methodist Le Bonheur employee who owes more than $1,200. In January, she proposed paying $100 a month, even though her sworn affidavit listed monthly expenses that exceeded her $1,650 monthly income. After conferring with an attorney for Methodist, Judge Betty Thomas Moore agreed to the worker’s proposal, but she has already missed a payment.

A few weeks later, a Methodist employee appeared for an initial hearing wearing hospital scrubs. The hospital had sued her for more than $4,000. When she left the courtroom, she was annoyed. Her employer knew where she worked, she said, and should have contacted her before suing her. “I don’t know why they can’t come upstairs,” she said outside the courtroom.

And in May, an employee who has worked for Methodist for more than four years carried a large envelope full of bills with her into the courtroom. She owed more than $5,400, which included a 2017 hospital charge from the newborn unit. That is the same year that her daughter was born, according to her sworn affidavit, which also listed a checking account balance of less than $4. She offered to pay $10 biweekly, or $20 most months, but Methodist’s attorney wanted $200 per month. The judge ordered her to pay $100 per month.

It’s not uncommon for hospitals to sue patients over unpaid debts, but what is striking at Methodist, the largest hospital system in the Memphis region, is how many of those patients end up being its own employees. Hardly a week goes by in which Methodist workers aren’t on the court docket fighting debt lawsuits filed by their employer.

Making matters worse, employees say, is that Methodist’s health insurance benefits only allow employees to seek medical care at Methodist facilities, even though the financial assistance policies at its competitors are more generous.

An expert in hospital billing practices said that if the hospital is suing a fair number of its own employees, it’s time to look both at the insurance provided to workers and the pay scale.

“One would hope that if this is an action being taken against a significant amount of employees, the hospital would look at the insurance they provide workers,” said Mark Rukavina, an expert in nonprofit hospitals and a manager at Community Catalyst, a health care advocacy organization.

Methodist declined requests for an interview. It did not respond to specific written questions about the lawsuits it files against its workers or about how its policies reflect the values of the United Methodist Church. Instead, in a statement, it said it is committed to working with patients who are having trouble paying their medical bills.

“As the second largest private employer in Shelby County, we recognize the responsibility we have as an organization to contribute to the success of the diverse communities we serve and are purposeful about creating jobs in our community — intentionally choosing to keep services like printing, laundry and others in-house that are typically outsourced by the healthcare industry,” the hospital said.

Methodist also declined to answer a question about whether it has any policy that prohibits employees being sued by Methodist from talking to a reporter about the lawsuits filed against them by the hospital.

Employer and Legal Adversary

On a single January day, there were 10 defendants on the docket whose place of employment was listed in court records as Methodist.

Employees in scrubs sat just feet away from the attorneys in dress suits whom their employer hired to sue them. The hospital’s role as a tax-exempt organization that both employs the defendants and is suing them went unremarked upon by judges, attorneys and the defendants themselves.

Methodist’s financial assistance policy stands out from peers in Memphis and across the country, MLK50 and ProPublica found. The policy offers no assistance for patients with any form of health insurance, no matter their out-of-pocket costs. Under Methodist’s insurance plan, employees are responsible for a $750 individual deductible and then 20% of inpatient and outpatient costs, up to a maximum out-of-pocket cost of $4,100 per year.

The housekeeper’s story is documented in Shelby County General Sessions Court records, including online docket reports and online payment history. A reporter interviewed the housekeeper multiple times in person and on the phone. The employee gave the reporter six years of itemized Methodist hospital bills, her credit report and other past-due medical bills. Most of her debts were incurred before she started working at Methodist.

Five times between 2012 and 2014, she visited the hospital for stomach problems, according to the itemized bills. (Years later, she had surgery to treat diverticulitis.) At those times, she had insurance through her job at a hotel, where she cleaned rooms for $10.66 an hour. After insurance paid its share, she owed just over $17,500.

In 2015, the housekeeper left the hotel job and lost her insurance. Three times that year she went to Methodist’s ER, but since she was uninsured and had little income, she qualified for financial assistance. Methodist wrote off more than $45,000 in hospital bills.

In a statement, Methodist said it gives an automatic 70% discount to uninsured patients and free care to uninsured patients at or below 125% of the federal poverty guidelines. For a single adult with two dependents, that would be just over $26,600. Uninsured patients who earn more than that, but less than twice the poverty limit, are also eligible for discounts, it said.

In 2016, unable to find work, the housekeeper left Memphis. For more than a year, she said, she and her son were homeless, bouncing between relatives in Chicago, where she was born, and Texas.

But she missed her daughter and grandchildren in Memphis, so in 2017, she returned. In August 2017, Methodist sued her for the bills she accumulated when she was insured years earlier. Later that month, she was hired at a Methodist hospital, starting at $11.95 an hour.

The hospital’s collections agency, which it owns, didn’t have her correct address and was unable to serve notice that she had been sued, but last year, Methodist tried again. This time, it had the right address.

In November, a process server handed her the civil warrant at her South Memphis apartment.

At the process server’s recommendation, she called the hospital’s collection agency and offered to pay $50 every two weeks. “But they said it wasn’t enough,” she recalled. “I would just have to go to court. They said I’d be owing them all my life,” she recalled.

In a sworn affidavit filed with the court this year, the housekeeper listed her dependents as a grandson and her 27-year-old son, who she said has bipolar disorder and schizophrenia. She told the court she earned $16,000 in 2017, which puts her more than $4,000 below that year’s federal poverty level for a family of three. (Because she had insurance, though, she was ineligible for assistance under the hospital’s policy.)

Fred Morton, a retired Methodist minister in Memphis, said he was surprised to learn that Methodist is suing its own employees.

“The employees should be paid an adequate minimum wage at the very least,” he said. “Certainly they should not be predatory to their own employees on medical bills. That’s very much contrary to Scripture.”

He said that Methodist bishops who serve on its board bear responsibility for reminding it of the denomination’s values.

“It’s a matter of the church pushing on its own,” Morton said.

Three United Methodist Church bishops serve on the hospital’s board. Bishop Gary Mueller’s office referred a reporter to Methodist Le Bonheur Healthcare’s communications office. Bishop Bill McAilly declined to comment. Bishop James E. Swanson did not respond to multiple requests for comment.

When the housekeeper appeared before a General Sessions Court judge this year, she’d filed a motion offering to pay $50 biweekly, or $100 in most months. When the hospital’s attorney asked for a $200 per month, she was stunned.

“This is my only job, this is my only income, so how am I supposed to live?” she remembered thinking.

Nervous that the judge would side with the hospital, the housekeeper made another offer.

“I could do $75 every two weeks,” she said quickly.

The attorney agreed and the judge signed the order.

Being an employee and defendant is “really kind of sad,” the housekeeper said. Asked how she manages to make ends meet, she says she doesn’t. “It’s killing me, killing me softly,” she said.

She said she didn’t reach out to the hospital’s payroll department or a manager about the hospital bills she’s being sued for. “They don’t care about that. … That I do know.”

“I Don’t Want to Be Homeless Again”

Part of what makes paying medical bills so hard for some Methodist employees is that their wages are low, lagging behind several other large employers in the Memphis market. In December, St. Jude Children’s Research Hospital announced it was raising its minimum pay for full and part-time workers to $15 an hour. St. Jude’s decision followed a similar commitment by the Shelby County government, Shelby County Schools and Blue Cross Blue Shield of Tennessee.

At Methodist, which operates five hospitals in Shelby County, the lowest-paid employees make $10 an hour and about 18% of workers make less than $15 an hour, the hospital reported in response to MLK50’s 2018 Living Wage Survey.

As recently as 2017, the Greater Memphis Chamber advertised on its website that the city offered a workforce at “wage rates that are lower than most other parts of the country.”

The United Methodist Church’s Social Principles, which state the denomination’s position on everything from climate change to the death penalty, speak directly to what employees should earn. “Every person has the right to a job at a living wage,” it states.

The Living Wage Model statement on the church’s website says, “Exploitation or underpayment of workers is incompatible with Christ’s commandment to love our neighbor.”

Methodist, which made Forbes’ 2019 list of Best Employers by State, did not answer specific questions about pay for employees. On its website, it says, “It is the policy of Methodist Le Bonheur Healthcare to pay its employees competitive, market-based wages.”

Neither Methodist, nonprofit Baptist Memorial Healthcare or Regional One, the public hospital, pay all their employees at least $15 an hour. Even that figure would make it impossible to make ends meet for an employee trying alone to support a household with dependents, according to MIT’s Living Wage Calculator and another created by the Economic Policy Institute, both of which take into account local living expenses.

The housekeeper’s $12.25 an hour pay falls well short of that. Without overtime, she said her take-home pay would be around $1,600 per month. Her rent is $610.

Even with as much overtime as she gets, she’s turned to payday loans. Since December, she’s renewed a $425 payday loan every two weeks, paying $71 each time. “You have to rob from Paul to pay Peter,” she said. “It doesn’t never seem like you can get ahead.”

The housekeeper applied for a job at Walmart but was told the store nearest her is not accepting applications. She doubts the pay will be any better, but she hopes it’ll be less stressful.

“Times be hard, because sometimes my body feels like I can’t make it, but I get up anyway, because I don’t want to be homeless again.”