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By Mike Terry, Deseret News

Editor's note: This is the fourth in a five-part series.

Two days after an auto-pedestrian accident, Sonja Jorgenson lay in a hospital bed worried sick about her husband, Jerry — still unconscious in intensive care — and wondering how on earth walking across the street had upended their lives.

Things were about to get worse. A visitor came into her room at the Intermountain Medical Center in Murray, not to take a reading on how her recovery was going but to ask how she was going to pay for it.

"I didn't think anything could make me feel worse, but it felt like adding insult to injury," she said.

The Draper couple's injuries were bad enough. Her husband spotted the pickup just before the accident, and pushed her out of the way — almost.

He was struck directly and dragged 125 feet, essentially being grated by the asphalt and twisted like a washrag underneath the vehicle.

Three months of intensive care, more intense physical therapy and a long road back later, he is blind in one eye, his right leg was amputated and he is just now able to walk a bit each day with a cane. He won't be able to work again.

Sonja Jorgenson had severe knee, foot and ligament injuries, "nothing compared to what happened to my husband."

The treatment, surgeries and around-the-clock attention was excellent, and the couple has nothing but gratitude for the care they received. It was American medicine at its best — high-tech, laser-sharp, white-coated, acute emergency intervention. And expensive.

The final tab: $3.2 million, including $1 million just for Jerry Jorgenson's hospital stay. It was a crippling amount the couple couldn't possibly afford. Neither had insurance. They couldn't afford the premium while she finished law school, and he is uninsurable due to a liver transplant in 1997.

Intermountain wrote off a big chunk of the debt and Medicaid stepped in to partially cover the rest through an acute care and disability plan. Intermountain donated $131 million in charity care that year and wrote off $177 million in bad debt. Bad debts are defined as uncollectable bills from patients who were able to pay or who have not provided the documentation to qualify for charity care.

If donations and sponsorships of community health care programs, support of medical research and donations of medical equipment and supplies are added in, Intermountain's charitable and community improvement efforts totaled $607 million that year.

In the Jorgensons' case, the charity care provided by Intermountain erased much of their debt, but they were still left with thousands of dollars in bills.

"We wanted to pay. We wanted to have insurance, but there was no way," Sonja Jorgenson said, noting that the accident "was just one of those things that happen that no one thinks is ever going to happen to them."

Money and how to keep it flowing in is the shadowy side of America's gleaming, towering medical industry. The network of Utah health care providers, singled out by national news media as a model system for the country, provides millions in charity care but also helps create untenable financial circumstances through their bill collecting efforts. Providers turn over collection duties to law firms that often ratchet up threats and pressures to pay. The system routinely picks on those who don't have insurance coverage, charging them top retail for procedures — more than they charge people with insurance — even though they have the least capacity to pay.

"It's an impossible Catch-22 of our day, but anyone can fall into it," said Dr. Paul Winterton, a Salt Lake orthopedic surgeon who hopes the current reform effort will reverse what he considers health care's "often oppressive" bill-collecting practices. "Until we start addressing the financial devastation being created by bankrupting people over medical care costs, we shouldn't get too carried away with how well we're controlling health care costs," he said.

The Jorgensons and other patients interviewed for this story say the financial scars can last beyond traumatic injuries and will continue to prevent them from being full participants in the economy because of the credit black mark next to their name.

Particularly threatening in tone are demand letters from care through the University of Utah hospitals and clinics. Those letters don't come from private attorneys but from the Utah Attorney General's Office, the state's top law-enforcement agency.

A form letter to delinquent payers begins by noting that University Health Care, "a governmental entity of the State of Utah," has referred "a debt" to the attorney general's office for review and possible collection.

The first paragraph threatens a lawsuit twice, filed either by the attorney general's office or by an "independent collection agency." It states that the bill might be outsourced to balance the account. The recipient is advised that his Social Security number is being sent to the Utah State Tax Commission and inserted into the state's Finders Program, which legally allows a lien to be placed on tax refunds for unpaid debts and in effect will garnish them for eight years or until the debt to the U. is paid in full.

And, to bring the point home that the debtor can't get out from under the debt, U. Health Care will keep the Finders Program advised on all delinquent hospital accounts in effect, "regardless of any payment agreements that may exist between you and University Health Care."

A patient who received a notice of a debt of $67 nine months ago received another last week saying that the debt is now $1,407 and has a judgment requiring payment.

Speaking only on condition of anonymity — "because this is embarrassing and I'm scared what might happen if I say anything" — the recipient said the debt was incurred, that a repayment plan was worked out, but additional finance charges have been added. "That combined with being out of work has made it impossible to get out from under this."

The letter from the AG's office is a kind of last resort effort to obtain payment, said Chris Nelson, spokesman for the University of Utah Healthcare System. Two other letters reminding them of the bill and a telephone call precede the notice from the AG's office, Nelson said.

"We work very hard to work things out before it gets to that point," Nelson said. "We have people who owe millions of dollars and they're paying $15 a month. I'm not saying that we can do that for everyone, but we try to do what we can to avoid having things get to that point."

University Health Care averages about $25 million in charity care and another $25 million to $30 million in bad-debt writeoffs, he said.

Most of the people on the edge of bankruptcy have been pushed to that cliff here and across the country by medical bills, said attorney Rogena Jan Atkinson. Even when people are insured, it is often capped by a lifetime limit, or the time off of work and loss of income can make their debt situation go from bad to worse.

Ted Meeker has a whopper of a bill — $289,000. That's as much as a new Ferrari 458 Italia, complete aromatic leather, carbon-fiber cockpit and really cool navigation system.

Meeker, 78, knows about space-age metals: He's got $179,000 worth of titanium in his back that has kept him out of a wheelchair.

He helped design the Polaris ballistic missile that kept the Cold War cold and helped refine the concept of refirable rocket motors that allowed man to go the moon.

His trajectory these days has a flatter arc, but the physics of getting up and around and dealing with the gravity of living with a bad back have been no less daunting.

He is a retired and still-working senior who last February got the double whammy of a deteriorating economy and a disintegrating spine. He was laid off by a local printing company. He lost his insurance with the job Feb. 2, which meant he had to rely on Medicare to pay for do-it-or-else surgery to try to relieve constant, excruciating back pain. Even with 80 percent coverage from Medicare, he would be left with a bill of more than $50,000.

Once he was laid off, he had to decide right then, before the insurance coverage from the company ended. He had the surgery and Meeker, and his wife, Janice, who has her own history of heart trouble, kept their insurance coverage going under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

COBRA required them to pay the full premium of their employer's coverage, which they did in case the really expensive surgery was followed by really expensive complications.

When the two months of COBRA ran out, the couple purchased the government plan's supplemental program, Medicare Advantage, which covers most of the cost of Janice Meeker's heart medication.

The couple has had to scale way back but is grateful to be together taking on life.

"Nobody thinks it's going to happen to them, just like everybody thinks they won't be the one who gets sick or gets cancer," said Kori Novak, a public health professor with the University of Phoenix who's currently working on a gerontology doctorate. She noted that rising health costs alone, even if you never go to the doctor or get sick, are making just having insurance a financial strain.

When there is a tragic accident or illness, money and other concerns shift from being an issue in your mind to deep-seated feelings and fears in your heart, said Novak, who has been a health-care worker — and a patient — on four continents.

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"When it's the health of your child or your loved one or it's your own health, cost is no object," Novak said. But it's a big object to the health-care system providing the care, and it's often a big debt, which often will go unpaid. The United States has spent billions of dollars on the best, highest-tech advances and "providers like to use them, particularly in last-minute or end-zone kinds of cases," she said.

"But they cost a lot of money and are helping inflate overall health-care costs," Novak said. "But a kind of Catch-22 is occurring because people are dropping insurance coverage or being dropped from coverage, they are vulnerable to obtaining basic preventive care, or they have a traumatic accident and get left without any coverage and the provider gets left holding the bag."

e-mail: jthalman@desnews.com