Pain in the neck: nonprofit hospitals are strapped for cash, but critics say they can do more.

It was a typical weekend afternoon in July when Solecito, 24, and her husband took their 3-year-old daughter to Sears to buy new clothes. Solecito s Honda sedan had just passed the six-corner intersection on Milwaukee Avenue when a red Plymouth Voyager rammed into her car. The collision caused Solecito's neck to jerk forward and then snap back with the seatbelt.

Solecito, whose name is changed to protect her identity, fainted from shock as the drunken driver sped off and hit two more cars. She was rushed to the emergency room at Saint Mary of Nazareth Hospital Center in her Humboldt Park neighborhood.

When she regained consciousness, Solecito was in a neck brace. After an X-ray and a urine test, the doctor gave Solecito two painkillers, removed her neck brace and sent her home. Besides some slight neck pains over the following days, Solecito said everything was fine--until she received a $1,700 bill.

With the help of organizers at West Town Leadership United, a local community group, Solecito sent a bundle of documents to apply for "charity care"--free or discounted care--from Resurrection Health Care, which owns Saint Mary. Within a few weeks, Solecito received a letter asking her to submit a set of other documents--including her marriage license and the birth certificates of her daughter and her husband--before her application could be processed.

Solecito, an undocumented immigrant from Mexico, said the letter frightened her. "Why are you going to come and ask me for documents for other people that you didn't take care of?" she said.

Solecito sent a letter back saying she would not provide the additional information, only to receive another bill in December.

Resurrection officials say all qualified patients, regardless of their immigration status, are eligible to receive charity care, and that additional documents are sometimes requested in an attempt to authenticate patients' identities.

To critics, however, Solecito's story reveals Resurrection's apparent indifference to the needs of its patients--a sign that Chicago's second-largest nonprofit hospital chain is moving away from its mission of providing charitable services to the community.

Experts, meanwhile, say that the story epitomizes the financial state of nonprofit healthcare more than Resurrection's management practices. They point out that, as growing numbers of uninsured patients come to seek their services, Resurrection and other nonprofits are forced to make tough financial decisions just to stay afloat.

Nonetheless, few have drawn the kind of publicity that Resurrection hospitals have in recent months. Officials say that's because the American Federation of State, County and Municipal Employees Council 31 has been running a "smear-like" campaign in an attempt to unionize hospital employees. And they maintain that they are committed to serving the poor. "We spend a great deal of money to make sure we have everything that we need to care for patients," said Brian Crawford, senior director of System Public Relations at Resurrection. "Our business is caring for the sick. In the interest of our hospital, it would make no sense for us to not provide the resources."

Crawford added that fliers and brochures in multiple languages are available to patients informing them how to apply for charity care. In fiscal year 2004, he said, Resurrection's nine Chicago-area hospitals spent $172 million in providing "free care," which includes the costs for "charity care," as well as "bad debt" incurred from uncollected bills.

But critics argue that "free care" is a poor measure of how much charitable service Resurrection is providing, insisting that there is nothing charitable about the aggressive bill-collecting tactics the hospitals are employing. "We don't think that dollars that they have hounded people for and ruined their credit over and placed liens on their property to collect ... is money that they should be claiming as a charitable service to the community," says Meg Lewis-Sidime, researcher at the Council 31.

Lewis-Sidime points to Resurrection's charity care figures as evidence that its attempts to inform patients about the service simply aren't enough. According to the Illinois Attorney General's Office, 0.51 percent of Resurrection's total expenses went toward charity care in 2003, the latest year for which the data are available.

Others say Resurrection's poor quality of service is reflected beyond charity care figures. "Nurses are frequently driven to tears by the end of their shift due to the stress of being expected to do too much with too little," Kelly Beringer, an 11-year registered nurse at Oak Park's West Suburban Hospital, told reporters at a November press conference held by the union.

Such outcries are getting the attention of officials in Springfield. The Illinois General Assembly is considering a bill that seeks to ensure that nonprofit hospitals are providing an adequate amount of charity care. And state Rep. Mary Flowers, a Southwest Side Democrat, is sponsoring legislation that requires a mandatory minimum staffing level for nurses.

But Harold Pollack, faculty chair of Health Administration Studies at the University of Chicago, cautions that the debate should take into account the increasing financial burden that nonprofit hospitals are shouldering. As the number of uninsured Americans hovers around 46 million, there's a rising demand for charity care at nonprofit hospitals, he says. "The problem is especially bad in places like Chicago where the health care sector is beleaguered by so many uninsured patients," Pollack said. "If government refuses to cover the uninsured, if it offers inadequate reimbursement rates for those whom it does cover, these patients will not receive the care they deserve."

Jill Horowitz, an assistant professor at the University of Michigan Law School, adds that nonprofit hospitals offer services to the community that aren't necessarily reflected in their charity care figures. "Nonprofit hospitals have goals that are unrelated to profit-making, and that's a potential benefit for everybody who goes to a nonprofit hospital--not just people in need of charity care," said Horowitz, whose expertise include laws on health care and nonprofits.

For decades, tax-exempt status has been awarded to hospitals "engaged in the promotion of heath for the benefit of the community." But no regulation has spelled out precisely what kinds of services hospitals are supposed to provide to become eligible for tax-exempt status.

But, in August 2003, state lawmakers passed the Illinois Community Benefits Report Act, which directed nonprofit hospitals to file an annual report with Attorney General Lisa Madigan detailing the amount of community benefits--such as charity care, language assistance services, education and research--that they provide.

According to its report, Resurrection spent nearly $35.8 million in education and more than $2.5 million in other community benefits like the use of child care centers.

And, in January, Madigan announced her proposal to direct nonprofit hospitals to spend at least 8 percent of their expenses on charity care. The proposal was drafted into House Bill 5000, which was approved by the House Health Care Availability and Access Committee in February. But, in response to stiff opposition from hospital administrators, the bill was referred back to a committee in March. Madigan's office is now holding a series of meetings to determine if any other charges, besides charity care, should be included in the 8 percent figure.

But many say that, besides the level of charity care, there are other quality-of-care issues that concern them. A case in point is Resurrection's proposal to eliminate 168 beds from Saint Elizabeth as part of a plan to merge some programs with those at nearby Saint Mary of Nazareth.

The proposal galvanized area residents to establish the Coalition for the Future of Saint Elizabeth Hospital to oppose the move. In September, it organized a rally in which protesters donned patient gowns, appealing to the Illinois Health Facilities Planning Board, whose approval was required for the cuts to be made.

Despite the outcry, the board approved Resurrection's cutbacks in November. Crawford, of Resurrection, assures that the beds being eliminated have been deemed "excess" by the board. Since the two hospitals are so close to each other, area residents won't even have to travel a mile to find the next closest hospital, he added.

Pollack, of the University of Chicago, says some changes are sometimes inevitable in any businesses. "This is often a very painful process-and one which requires attention to protect the quality of patient care," he said. "That said, we must recognize that every industry goes through periods of consolidation and retrenchment."

And, to ensure the quality of care, nonprofit hospitals will need more support, said Horowitz, of the University of Michigan. "It's important that everybody in society get access to health care, but to think that nonprofits can fund that care in my view is unrealistic," she said.

Contributing: Sean Redmond.

Milagros Abril and other organizers at West Town Leadership United say Rusurrection Health Care is abandoning the mission to serve its community.