It was a late Saturday night in June 2008. Barbara Phipps had been in discomfort off and on for months, constipated and bloated, heavy bleeding. That night, the pain was more than she could bear.

“I didn’t want to go into the emergency room because we didn’t have insurance,” the 60-year-old Longview woman recalled Thursday. “But I couldn’t take the pain any more.”

At the St. John Medical Center Emergency Department, a doctor ordered a CAT scan of her abdomen. And there it was — “in black and white,” her husband, Don, said. “An absolute blockage that was 6 inches. Cancer in her colon.”

Insurance or no, Barbara was immediately admitted to the hospital and scheduled for surgery three days later.

“We went in with calmness and reassurance that everything was going to be taken care of,” said Don, 52, an unemployed electronics installer. “We were told that finances were going to be there, the surgery was going to be successful and we were going to be taken care of — and we were.”

The Phippses qualified for St. John’s “bridge assistance” program, which provides medical services at a reduced cost or without charge if payment can’t be made through any other sources, such as private insurance, federal or state funds.

“We don’t refer to it as charity help,” said Kevin McAndrews, system vice president of financial services at St. John. “We want patients to maintain their dignity and worth.”

During the last 12 months, as of Aug. 31, St. John has provided nearly $30 million in charity care, whether in the form of bridge assistance or what it’s had to write off as bad debt — a spike of 36.6 percent from the same time period a year ago. Hospital officials expect the upward trend to continue as the area continues to suffer from a high unemployment rate.

Don and Barbara Phipps are among that population, but it wasn’t always that way.

Barbara moved to the area in 2003 from Pennsylvania. Her past experience as a deli manager landed her a job at Sinnett’s Market Place, where she earned “pretty good money” and, more importantly, had health insurance. Don was working at a small, three-employee company that installed electronics systems. After they were married in 2004, he was on her insurance plan, but when Sinnett’s closed in early 2006, they found themselves without insurance.

Barbara worked six months at Your Market Place, which opened later that year in the former Sinnett’s store on Commerce Avenue, but 25 years of working on concrete floors, a bad back and her then-unknown cancer were making it hard to continue.

“There wasn’t health insurance, otherwise I might have toughed it out,” she said.

At the time of Barbara’s cancer surgery, Don was making about $2,000 a month, a low-enough figure to qualify them for St. John’s bridge assistance with 100 percent coverage.

“If you’re living at or below 200 percent of the federal poverty guidelines, we have 100 percent assistance,” McAndrews said. In Don and Barbara’s case, they needed to be below $28,000 per year.

St. John has about 10 financial advisers that walk people, like the Phippses, through the paperwork, and not just for the bridge assistance.

“Someone from the finance debarment came right up to the hospital bed,” Don said. “She filled out everything from the bridge assistance to trying to get food stamps to Medicaid to cover every base,” Barbara added.

“We have trained on-site financial counselors that can assist you with state and federal programs you may or may not be eligible for and may or may not know exist,” McAndrews said. “When all else fails, we have a responsibility to help you find long-term assistance. Your financial situation would not inhibit your ability to get medical care.

“We have a saying here in financial services: ‘We’re not here to heal them clinically and make them ill financially.’ “

Some still struggle

Sometimes the bridge isn’t enough.

John and Darlene “Sunnie” Smith also have found themselves among the unemployed and uninsured. John, 48, lost his job at Green Mountain mill in April 2008 and, four months later, Sunnie, 56, lost her job at Disability Resources. Both are receiving unemployment.

The Castle Rock couple each have their own health issues: she has asthma, scoliosis, arthritis and high blood pressure. He had a heart attack about four years ago and had four stents put in. He also has high blood pressure and high cholesterol. Sunnie recently had a pulmonary function test, and her doctor wants her to have another type of test to figure out why she continues to have shortness of breath.

“I’m just not going to do the test,” she said. “I already owe $900 for the last one. I don’t need to get more in debt.”

On the recommendation of their doctor, the Smiths applied for St. John’s bridge assistance and received word they would qualify for a 25 percent reduction. On a previous bill for $294, the amount was reduced to $220. They’ve made arrangements to pay $40 a month on that one.

Based on their monthly combined net income of $3,200 and expenses of $3,125, the 25 percent reduction — while better than nothing — won’t be enough for Sunnie to get more tests, she said.

“Right now, I have a choice of taking care of my health or take care of my property taxes,” she said.

In the meantime, she and John are receiving assistance from St. John on some of their medications, and she said she will try to negotiate on the $900 bill.

Hospital tries to help

McAndrews said his group does all they can to help patients like the Smiths.

“We are available to sit down and help people who are worried about this and try to ease that sense of worry, to point you in the right direction,” he said. “It’s not easy work, obviously. If we provide charity care to someone who has the ability to pay, then we’re putting the burden on those who use St. John. On the other hand, if we put a stringent collection policy on someone unable to pay, then that goes against our mission.”

St. John has two loan programs, based on the length of time patients need to pay.

“If the patient believes they can repay the loan within six months, PeaceHealth will extend credit at no cost,” St. John spokesman Randy Querin said. “There is no application fee, no interest and no cap on the loan amount. The patient merely has to agree to pay the loan back in six equal payments.”

Patients who can’t repay within six months are referred to a Health First Financial, which is separate from PeaceHealth. The agency charges a 14.5 percent interest rate for use of its money. “Again, this is an unsecured loan — no collateral, no credit check,” Querin said.

PeaceHealth doesn’t get any of the interest money, Querin said, and if a patient defaults on the Health First loan, PeaceHealth repays the company the outstanding amount.

St. John charity care growing

Most of St. John’s charitable work — including bad debt write-off — begins in the Emergency Department.

Barbara Phipps was among the nearly 9,200 uninsured patients who came through St. John’s Emergency Department in 2008. Another 17,000 patients were low-income or underinsured, meaning it’s unlikely they were able to fully pay for their treatment. The numbers predicted for this year are even higher.

“The number of visits for July and August are the busiest we’ve seen for the last five years,” said Andrew Robottom, clinical manager of the emergency department. “The trend is definitely up.”

St. John’s budget for uncompensated care — charity or bad debt — for its current fiscal year (July 2009 to June 2010) is $36.2 million, but it will use whatever is needed, Querin said. In the first two months, July and August, it’s already hit $6.8 million, a pace that could mean $41 million for the year. Last year, the budget was exceeded by $1.9 million.

“There are less people with medical insurance, but not less people needing health care,” Querin said. “That plays out every day at hospitals, clinics and ERs across the country. What’s happening here is a reflection of what’s happening everywhere.”

For Barbara and Don Phipps, the bridge assistance has gone beyond her cancer treatment. She has since been treated for carpal tunnel syndrome and a sleep disorder. Recently, Don had to make an Emergency Department visit for a bacterial infection and heart and chest pain.

Their year of bridge assistance just expired, but St. John has already assured them they will continue to qualify. They are quick to express their gratitude.

“We barely floating with rent and utilities. We don’t want to go backward and lose the home we can afford to rent,” said Don, who continues to look for work. “This means we don’t have to worry or stress about how we’re going to pay for her to stay well.”