The Toyota Corolla flipped four times, injuring Northam's spine and leaving her paralyzed. Doctors at Ogden's McKay-Dee Hospital saved her life and her legs, and in time she learned to walk again.
The medical bills are what crippled her.
At the time of the May 1996 accident, Northam was recently divorced, between jobs and without medical insurance. When the Ogden woman filed for bankruptcy eight years later, all but $10,000 of the original $100,000 in doctor bills had been forgiven or forgotten.
Still, it was more than Northam, a cashier at Wal-Mart, could afford.
"You always hear about people who use their credit cards like crazy and then decide, 'I'm just going to go file.' You hear that all the time. But then something happens out of your control and you're stuck," Northam says.
"There were times I'd just sit and cry because I had all these bills and a child to raise. Sometimes I would send them a little money so they would leave me alone for a week. After a while I just got mean about it."
Bankruptcy was always in the back of her mind, Northam says, but there was the stigma and warnings from relatives that doctors might refuse to treat her. For most people, it takes something big - a lawsuit, car repossession, garnishment of wages - before they grab the legal safety net. For Northam, it was a marriage proposal. She didn't want her fiancé to pay for her past.
She wanted to start over.
A common thread: More than 21,100 Utahns filed for personal bankruptcy between July 31, 2003, and June 30, 2004, and six out of 10 claimed unpaid medical bills - twice the national average, a Salt Lake Tribune study found.
Most are married with jobs, kids, cars and house payments. They carry 9 percent less overall debt and 22 percent less credit card debt than filers with no medical bills. And they're just as likely to have health insurance.
They're bank tellers, cabinet makers and cocktail waitresses. They sell fast food and unclog slow drains. One is an administrative assistant to the LDS Church First Presidency. One is an IRS clerk. One is a senior account manager at Discover Card. Another used to be a reporter for The Salt Lake Tribune.
Of course, not everyone who lists medical bills on bankruptcy forms went broke because of them. In The Tribune's sample, medical debt ranged from $15 to $212,000. And yet bankruptcy records probably understate the role medical problems play in bankruptcy, says Melissa Jacoby, an expert on medical-related bankruptcy and author of a 2000 Harvard study on the subject.
That study found one-third of Americans in bankruptcy claim unpaid medical bills, but nearly half of those who don't said health problems were to blame for their situation. Jacoby cites several reasons people don't list medical bills on bankruptcy forms.
Families raid savings, use charge cards, or take personal loans to pay their doctors, she says. Others, feeling loyalty to their physicians, pay medical bills and fall behind on others. Workers lose wages while recuperating or caring for a sick relative, and some patients just can't remember how much they owe or to whom.
Consider the case of one South Salt Lake woman who had 82 separate medical creditors pursuing her by the time she declared bankruptcy in February. She earned $813 a month and spent $663. She owned a 1992 Chevy Lumina, a $20 stereo, $5 camera, some clothes and costume jewelry. She had $25 in her checking account, $1 in her pocket, and $67,000 in medical bills.
"The policy debate on health care used to be: Are people insured or are they uninsured? And, is it making them sicker or die earlier?" says Jacoby, now a University of North Carolina law professor. "Now it's: What happens when people get proper health care and the costs are beyond their control?"
Declining wages a factor: The number of Americans who spend more than a quarter of their earnings on health care has jumped 23 percent in the past four years. In Utah, the increase was 44 percent.
This could explain why twice as many Utahns claim unpaid medical bills on their bankruptcy petitions as those in the Harvard survey. But there is more to the equation than rising medical costs. In fact, Utahns spend less on health care, per person, than residents of any other state. And the average Utah family listing medical bills on bankruptcy forms owes just $5,856 to doctors and hospitals - a small percentage of their overall debt.
But that same family earned just $1,696 a month in wages after taxes, meaning if they spend every penny of take-home pay on nothing but medical bills, it would take 3 1/2 months to get caught up.
So declining wages are part of the problem.
The Tribune study turned up example after example of Utahns whose income waned in the two years leading up to bankruptcy, and the majority of bankruptcy filers were employed in jobs typically paying within a few dollars of minimum wage. With wages and health-care costs speeding in opposite directions, it doesn't take much to go from just getting by to being a drain on the system. Northam's collapse was triggered by a near-fatal car accident, but it could have been a slip on the sidewalk.
Some say Utah hospitals, especially nonprofit Intermountain Health Care, are simply too aggressive, making a desperate situation worse by garnishing a patient's wages or forcing them into court. IHC, the state's largest hospital chain, starts collection procedures after 90 days.
Finally, Utahns themselves are partially to blame.
The state's youthful and healthy population keeps medical costs down, but residents also marry young and have more babies when their earning power is at its lowest. They buy houses and cars, building their lives and the economy, but are financially stretched and ill-suited to handle medical emergencies. Often, they lean on parents who are dealing with their own health problems, making them more vulnerable to financial collapse as well.
In Jacoby's study, only 14 percent of people younger than 25 cited medical reasons for their bankruptcies, compared with 48 percent of people ages 55 to 65.
"We're talking about a population that already lives on the edge," Jacoby says of Americans in bankruptcy. "We're talking about the middle class."
Three bankruptcies later . . . Meet Greg Topham, a 56-year-old from St. George and Mr. Middle Class. Topham is in his third bankruptcy, his life a treatise in starting over. In some ways, it's how he got into this mess.
Greg and wife Lynda Topham found each other late in life after failed first marriages. The couple lived in a crummy trailer, along with two teen-age sons, and saved for furniture to go with the house they were building. The $900 a month mortgage would still allow them to play a little - a cruise for Lynda, maybe a NASCAR race for Greg. Even with Topham's health problems, they thought they could manage.
In 1997, the truck driver was crushed by a concrete shute. His employer kept him on the payroll, but, as Topham says, there was no sick leave.
"If I got up in the morning and had no feeling in my arms and hands, I would call in and say, 'Today is a bad day,' " he says. "I lost a lot of money."
He held onto the job four years, waiting for workers comp to pay for neck surgery and to make up for the lost wages. It was during this time that house payments started to escalate. The company that financed their house had a clause in the contract that allowed the note to be sold over and over and for the interest rate to vary.
The Tophams had been scammed.
For a while, the couple held on, stretching Lynda's Wal-Mart salary to pay the mortgage and praying for that workers comp settlement. Even after the surgery and Greg went on disability, they somehow managed. Greg would take his guns or Lynda's jewelry to a pawn shop and get a payday floater at 10 percent interest; the owner was a friend of his.
"But you're always paying backward. So eventually I'd go in and sell him the stuff outright and then, when I could, buy it back," Topham says.
"It has a grinding effect on you. There were many nights of not sleeping, of trying to find a way to make it, to make life better for my wife and these kids. For a long time, I thought about suicide. But when you start thinking like that, then pretty soon you're talking to another doctor and more bills are mounting up."
When the payments reached $1,380, the couple declared bankruptcy to save the house. But Topham knew the reprieve was temporary. Eventually, they fell behind and let the bank take the house. Another Chapter 13 soon followed. The third bankruptcy came in December 2003, after Topham had a tumor removed from his back and the medical bills overwhelmed them.
Today, they survive on his disability and her wages at Wal-Mart.
"I always looked for some happiness in my retirement and I just don't see that happening," Topham says. We're probably going to exist just like we are."
And yet, Topham has dreams of buying land near his hometown of Paragon. You know, live off the land, he says. "I could put up a modular home there on 10 or 15 acres and be self-sufficient, raise a couple of calves, grow my own vegetables," he says. "But my wife's afraid. After going through all of this, I don't blame her."
lfantin@sltrib.com
