In Washington State, all hospitals are legally required to determine whether patients with low incomes qualify for charity care, a safety net that ensures hospitals provide treatment for free or at reduced cost. Despite this, hospitals across Washington State are not providing struggling individuals and families adequate access to charity care, according to a new report from Columbia Legal Services.

Without financial assistance from programs like charity care, those who are uninsured or who have low incomes can be "locked in poverty" thanks to medical debts from hospital visits, Ty Duhamel, an attorney with CLS's Basic Human Needs project, told The Stranger.

Many of the people who aren't provided the opportunity to receive charity care live under the federal poverty line in more rural areas of Washington. A bulk of the people CLS talked to regarding charity care are employed as hotel, restaurant, and farm workers—"people who don't have insurance or don't have adequate insurance," Duhamel said. About 522,000 Washingtonians are uninsured, according to the report.

Without financial assistance, patients may eschew medical treatment for fear of their debts can go to collections, resulting in lawsuits and garnished wages.

"People with limited or no ability to pay are asked to pay the highest rates for medical care at hospitals," Duhamel said. "Everybody needs hospital care. It's not something that is a luxury or an option to choose."

People who speak Spanish are disproportionately at risk of not being informed of charity care, according to the findings. In testing hospitals across the state, CLS and the Equal Rights Center found that 28 percent of Spanish-language calls to Washington hospitals "failed to elicit any information from the hospital about financial assistance, although that information was relayed 90 [percent] of the time to English speakers."

Along with a failure to provide interpreters, the report identified 12 hospitals, including Seattle's Virginia Mason Medical Center, as having charity care policies that violate state or federal law and providing "consistently low charity care amounts."

Rather than taking initiative to screen patients who might qualify for charity care, Virginia Mason officials require patients to apply for financial aid, Duhamel said.

"It appears that Virginia Mason’s patients need to know that charity care exists, obtain an application, know how to fill it out, and then submit it," the report stated.

"Virginia Mason has a robust charity care policy and provides millions of dollars’ worth of free and discounted care every year," Gale Robinette, the hospital's media relations manager, wrote in an e-mail. "Our organization also supports numerous programs that benefit people throughout our community."

Given the CLS report's findings, Robinette said hospital officials "will thoroughly review the report...and evaluate the accuracy of its conclusions about our organization."

Across the state, hospitals failed to offer charity care to patients, even when they showed "obvious flags" like being uninsured, not having sufficient income to pay, or being unable to work, according to patients' accounts to CLS.

"Any of these facts should have alerted hospital staff to possible charity care eligibility," the report reads, "yet the hospitals did not perform any screening or provide information."

In a statement, CLS attorney Tony Gonzalez urged hospitals "to correct their illegal or insufficient practices immediately."

This post has been update to include comment from Virginia Mason Medical Center representatives.