Longtime Nurse Denied Cancer Care at Former Nonprofit Hospital

For almost three decades, Barbara Quarrell cared for patients as a nurse at Memorial Medical Center in Las Cruces, New Mexico, a nonprofit community hospital owned by the city and the county. When she received a devastating cancer diagnosis in 2022, she naturally turned to Memorial for treatment. “That’s my hospital,” she told NBC News. “My people are there.”

However, Memorial is now operated as a for-profit facility by Lifepoint Health, a hospital chain backed by private equity, and had different plans for Quarrell. When her doctor called to schedule chemotherapy, the facility asked about her health insurance. Quarrell was covered by True Health New Mexico, a marketplace plan under the Affordable Care Act for which she paid $800 a month.

Memorial denied her care, according to her doctor’s contemporaneous notes, which Quarrell provided to NBC News. Quarrell and her husband quit their jobs and relocated to Albuquerque, more than 220 miles north, where she received treatment at a facility that accepted her insurance.

“They didn’t even try to make it work,” she said of Memorial. “What happened to being humane and taking care of each other?”

Denials of Care at Memorial

Quarrell is not alone. Eleven other cancer patients and seven current and former Memorial clinicians described a facility where both insured and uninsured patients requiring various treatments were regularly met with denials of care or demands for upfront payments. Doctors’ contemporaneous notes confirmed some of these allegations, including those of an additional patient who subsequently died. Three patients gave Memorial permission to discuss their cases with NBC News.

The impact of these practices is especially pronounced among oncology patients because the nearest cancer center in the state is a four-hour drive away. Options in El Paso are at least 45 minutes away, and some plans do not cover care in other states. The denials do not occur in Memorial’s emergency department, which would be illegal.

Legal and Ethical Concerns

Although Lifepoint runs the 200-bed hospital, the facility and the land it sits on are owned by Las Cruces and Dona Ana County. Denying care to patients could violate Memorial’s lease, which requires the facility to generally continue providing care to “those unable to pay the full cost of healthcare services rendered to them.”

Moreover, New Mexico law states: “A qualifying hospital shall accept every indigent patient who seeks health care services from the qualifying hospital,” a provision that includes undocumented residents. The state defines indigent patients as those who are at specified low-income levels and unable to pay.

Hospital documents produced under open records requests show Memorial’s indigent care policy directed it to provide care to patients who were unable to pay the full costs of their treatments and discussed discounts or cost-sharing arrangements for people who met income criteria. For years, the hospital’s written indigent care policy covered cancer treatments. That changed in 2023, five years after Apollo Global Management, the private-equity giant co-founded by Leon Black, bought Lifepoint.

The lease requires Memorial to notify the city and county of changes it makes to services. The hospital said it notified them about excluding cancer from its indigent care policy verbally in 2016. Previously, documents show, it had always notified the city and county of changes in writing.

Impact on Patients

Veronica Hernandez tried in 2019 to get treatment for breast cancer at Memorial but was repeatedly denied because she was uninsured. Although she ultimately got insurance and help from CARE Las Cruces to receive treatment at Memorial, the experience still rankles.

“It came down to, ‘If you don’t have money, you cannot have the scans or MRI,’” Hernandez recalled in an interview. “I had to have my family help me come up with that money and get my testing done so I could start my chemo.” Dealing with Memorial was “always a hassle, a battle,” she said. She ended up moving to El Paso for treatment, where charges were roughly one-quarter of what Memorial charged.

Financial and Operational Changes

Memorial is one of many nonprofit hospitals across the country now operated as for-profits, a trend driven by private equity firms like Apollo. These takeovers can change the facilities’ operations, raising questions about access to care for residents, especially those of limited means. For-profit entities can also mean higher patient charges. Data from the Centers for Medicare & Medicaid Services (CMS) shows Memorial charges 6.7 times its cost of care, double that of the average nonprofit nationwide, according to research from Johns Hopkins University.

While Memorial says it does not deny care, two of its top officials called to apologize to two patients who had told NBC News they’d been turned away for care. Laura Thomas, Memorial’s chief financial officer since January 2023, contends that the hospital does not turn away patients and Lifepoint said “many of the assertions being made about Memorial’s practices, conduct and communications with patients are factually inaccurate.” Neither Memorial nor Lifepoint would identify specific inaccuracies or discuss the experiences of the nine patients described above, which were shared with the hospital.

Broader Implications

Memorial’s situation underscores a nationwide trend of for-profit entities taking over nonprofit hospitals’ operations. According to the American Hospital Association, 1,219 former community hospitals now operate as for-profits, or 24% of the total, up from 729, or 12.5%, in 1981. In Las Cruces, all three hospitals are for-profit.

These takeovers can significantly change how facilities operate, affecting access to care, especially for residents of limited means. For-profit entities often mean higher patient charges. Data from the federal government's Centers for Medicare & Medicaid Services (CMS) shows Memorial charges 6.7 times its cost of care, double that of the average nonprofit nationwide, according to research from Johns Hopkins University.

A Lifepoint spokeswoman said, “Lifepoint Health is committed to a mission of making communities healthier, and we are proud of the entire team at Memorial Medical Center for the integral role they play in supporting the Las Cruces community.”

Calls for Accountability

In 1989, when Memorial broke ground on the cancer center, city officials said the center “will be well serving the community,” minutes from a council meeting show. That community focus continued for decades; in 2010, five years after for-profit Lifepoint began operating the center, the indigent care policy explicitly included cancer care, a Memorial document states. Other documents, also on Memorial letterhead and produced under open records requests, show cancer care was first listed as an exclusion in August 2023.

Memorial has received criticism from local officials and advocacy groups for its practices. Yolanda Diaz, founder of CARE Las Cruces, a nonprofit that receives money from the city to help patients pay for care, said, “When a hospital denies and delays needed health care services, it is harming residents it’s supposed to serve, creating imminent danger to life and safety.”

Diaz, who has been alerting local officials to reports of denials of care at the hospital since 2021, said the hospital, the county, and the city are failing residents.

Legislative and Regulatory Response

Memorial’s practices have caught the attention of lawmakers. Senators Chuck Grassley and Sheldon Whitehouse are conducting investigations into how private equity ownership impacts hospital care. Grassley stated, “Every patient is deserving of the highest quality of care, including those in rural and underserved communities. Senator Whitehouse and I are taking a close look at how shifts in ownership may impact hospitals’ care. We’re fighting to ensure the medical system operates with positive patient outcomes at top of mind.”

Looking Forward

As Memorial faces scrutiny and potential legal challenges, the focus remains on ensuring that the hospital fulfills its mission to provide care to all residents, regardless of their ability to pay. For patients like Barbara Quarrell, the need for humane and compassionate care is paramount. Her story, and those of others denied care, highlights the urgent need for accountability and reform in the operations of hospitals transitioning from nonprofit to for-profit status.

Real-Life Impact and Broader Implications

In 2022, Nancy Skinner, another patient, faced similar struggles. Her doctor ordered a biopsy to assess a growth in her left leg, but because she had only Medicare Part A insurance coverage, the hospital demanded $2,000 upfront. She had to take out a bank loan to cover the cost. Subsequent treatments required further upfront payments, and her situation highlighted the broader issue of access to necessary medical care under for-profit hospital operations.

The changes at Memorial reflect a broader trend of private equity involvement in healthcare, which often prioritizes profit over patient care. The American Investment Council, a private equity lobbying organization, argues that private equity improves healthcare. However, independent academic studies suggest otherwise, showing significant cost increases for patients and payers, such as Medicare, and a decline in the quality of care.

Community and Legislative Response

The community's response has been strong, with local officials and advocacy groups demanding accountability. Robert Garza, a former Las Cruces city manager and Memorial board chairman, mentioned that the hospital’s indigent care program was working well under a government-funded program, but changes after the Affordable Care Act affected funding. The current situation may lead to legal challenges, similar to cases in North Carolina and Pennsylvania where hospitals were accused of failing to provide promised care.

Senators Grassley and Whitehouse's investigation into private equity’s impact on healthcare may lead to more stringent regulations and reforms to protect patients. The scrutiny and potential legal challenges facing Memorial could set a precedent for other hospitals transitioning from nonprofit to for-profit operations.

Conclusion

Memorial Medical Center's transition from a nonprofit to a for-profit hospital under Lifepoint Health highlights significant challenges in ensuring access to care, especially for low-income and uninsured patients. The stories of Barbara Quarrell, Veronica Hernandez, Nancy Skinner, and others underscore the urgent need for accountability, transparency, and reform inthe healthcare system. As lawmakers and advocacy groups push for changes, the focus must remain on protecting patients and ensuring that hospitals fulfill their mission of providing care to all residents, regardless of their ability to pay.