It was Easter weekend in 2007 when a police car pulled up to Joe Vasquez’s home in rural Kansas.
A doctor had filed a lawsuit against him and his wife over an unpaid $4,561 bill from her emergency hysterectomy three years earlier. They had missed a court date, and the doctor’s lawyers asked the court to issue an arrest warrant.
Police took the couple into custody as their grandchildren prepared for an egg hunt, Mr. Vasquez said. They spent two days in jail before their son could borrow the money to post bond.
“We had no money to pay,” said Mr. Vasquez, now 68. At the time, his wife was working at a manufacturing plant and he was on disability, he said.
The doctor who sued the couple was Roger Marshall, now a senator from Kansas. Mr. Marshall, a Republican who is seeking re-election this fall, filed lawsuits against more than 700 patients with outstanding bills during his decades-long career as an obstetrician-gynecologist, according to a New York Times analysis of Kansas court records.
Patients were arrested in 81 of those cases for missing court dates, the record show. In an additional 13 lawsuits, Mr. Marshall’s lawyers sought warrants but it is unclear whether an arrest occurred.
They also garnished patients’ paychecks and bank accounts. They routinely charged patients an 18 percent annual interest rate.
The unpaid bills ranged from several thousand dollars to as little as $101. About half the lawsuits were filed under Mr. Marshall’s name and the rest by Heartland Regional OBGYN, the medical practice he solely owned from 1998 to 2012 and then co-owned with another doctor from 2013 to 2019.
Some facing lawsuits were new mothers with outstanding bills from their deliveries. Most lived in Barton County, a rural area with above-average uninsured and poverty rates. Some patients the Times spoke with lacked insurance; others had health coverage but were responsible for part of their bill.
“I had every intention to pay, I was just struggling,” said Kellie Clutts, whom Mr. Marshall sued in 2015 over a $129 bill. Ms. Clutts said the charge was from a postpartum visit shortly after her daughter’s birth.
Mr. Marshall sued Ms. Clutts when her baby was 9 months old and eventually garnished her bank account.
“I was recently divorced, trying to do everything on my own,” said Ms. Clutts, 45. “I told them I could make partial payments, but it seemed like no matter what I said, they wanted the full amount at once.”
In response to detailed questions from the Times, a spokeswoman for Sen. Marshall said that he spent decades caring for patients regardless of their ability to pay.
“Judges issue warrants when people repeatedly miss court dates, not doctors,” the spokeswoman, Payton Fuller, wrote in a statement.
Court records show that Sen. Marshall’s lawyers repeatedly requested arrest warrants, including in Mr. Vasquez’s case. They filed dozens of briefs arguing that warrants were needed because the of the defendant’s “refusal to obey Court orders.”
Steven Johnson, a lawyer who often represented Mr. Marshall in debt cases, defended the warrants and ensuing arrests as necessary to ensure that debtors attended court dates.
“If defendants were allowed to appear only when they wanted to without any consequences the court would get no business done,” he wrote in a text message.
He said that Mr. Marshall was “no different” than his other clients in allowing his law firm to take the steps they felt were necessary to pursue an outstanding bill. As a client, Mr. Marshall was not involved in decisions about when to seek warrants, arrests, or garnishments, Mr. Johnson said, but did set the 18 percent interest rate in a contract he had patients sign. Mr. Marshall’s office did not respond to a question from The Times about who set the interest rate.
Doctors have wide discretion in how to handle unpaid bills. They can decide when to involve a debt collector, file lawsuits or drop the debt entirely if a patient seems unable to pay.
“There is a lot of variation,” said Barak Richman, the co-director of the health law program at George Washington University who has studied medical debt litigation in three states. “There are a lot that do bring lawsuits but also a whole lot that don’t. It’s not because they’re in a different position, they’ve just decided they’re not going to do it.”
Some hospitals and doctors have increasingly relied on litigation as insurance deductibles have risen, leaving patients responsible for a great share of their bills.
Even so, wage garnishments and arrests of patients are “definitely on the extreme side,” Mr. Richman said.
Neale Mahoney, an economist at Stanford University, has conducted research in one state finding that lawsuits against patients are relatively rare, with about 1.7 percent of hospital stays resulting in litigation.
“It’s not surprising there are outliers but this does seem to be an extreme case,” in terms of how far a doctor went to pursue debt, Mr. Mahoney said.
Federal law made debtors prisons illegal centuries ago but many states’ laws allow for arrests when the defendant in a debt lawsuit misses a court date.
The Times interviewed eight people Mr. Marshall sued between 2003 and 2015. Most described themselves as living paycheck to paycheck, often deciding between paying medical bills or buying groceries. Two said that the bills Mr. Marshall pursued in court stemmed from late miscarriages that required surgery.
Mr. Marshall stopped practicing medicine after winning election to Congress in 2016. But some of his collection work continued during his time serving in the House of Representatives, from 2017 to 2021, The Times found.
‘Doc Marshall’
Mr. Marshall spent more than 25 years practicing obstetrics before running for Congress in 2016. In campaign materials, he frequently trumpeted his work delivering babies and the financial success of his medical practice. Both his Senate and his campaign websites refer to him as “Doc Marshall.”
“For 5,000 Kansans, life began here, in the trusted hands of Dr. Marshall,” an ad during his 2020 campaign for Senate said, showing the senator holding two newborns.
His current campaign website says that he was often “the only OB-GYN in the area” in his largely rural region of the state. He has also highlighted his care of low-income patients. Sometimes, he said in 2017, women drove “over a hundred miles” to see him because he accepted Medicaid, the public health benefits program for the poor.
In 1998, he and eight other doctors opened a four-bed surgical center in Great Bend. It steadily grew into a full-service hospital generating tens of millions of dollars in revenue. He served as the hospital’s board chairman, and his family remained co-owners of the hospital until March 2017, two months after he was sworn into office.
Mr. Marshall earned salaries both from his obstetrics practice and the hospital. In 2015, his combined earnings from the two was about $780,000, his 2016 financial disclosure report shows. His current worth is between $3 million and 9.8 million, according to his most recent financial disclosure report.
Great Bend Regional Medical Center also filed hundreds of lawsuits against patients during the years Mr. Marshall was either an investor or board chair.
More than a dozen of those lawsuits occurred while Mr. Marshall served in Congress and before he sold his ownership stake in the hospital, according to Kansas court records and Mr. Marshall’s financial disclosures.
Ms. Fuller, Sen. Marshall’s spokeswoman, said that the hospital “provided millions in uncompensated care” and “used the exact same billing and outside collection procedures as every other business or hospital in Kansas.”
She added, “Sixty days before an election, The New York Times has decided that a rural doctor keeping the hospital’s lights on is some kind of scandal. Kansans know better.”
When Mr. Marshall was elected to Congress, he quickly parlayed his experience as a doctor and health care investor into a central role in Republicans’ 2017 attempt to repeal the Affordable Care Act, the sweeping health care law enacted under President Barack Obama. “I may be the only physician in Congress to help run a hospital,” he said.
In July 2025, he introduced legislation that would prohibit hospitals from suing patients if they did not publicly post their medical prices.
One Patient, Three Arrests
The first time Meischa Zimmerman was arrested for missing a court date related to a C-section bill from Mr. Marshall was in 2011. She was home with her 2-year-old, and eight months pregnant.
“I asked them quietly: Can you not handcuff me in front of my daughter?” said Ms. Zimmerman, 44. “I explained to my daughter I was going for a ride.”
Ms. Zimmerman was arrested twice more, in 2013 and 2016, each time posting $200 bonds that would go toward paying down her debt, according to receipts The Times reviewed. Court records indicate that she was hand-delivered notices of the hearings she needed to attend, but Ms. Zimmerman said she did not receive such documents.
Her last arrest occurred the week after Mr. Marshall won his first congressional election.
Ms. Zimmerman was uninsured during the earlier pregnancy, in 2009, but had explored enrolling in Medicaid. All states offer Medicaid coverage to low-income women during pregnancy and for a short period after. But states set their own income caps, and Kansas has long had one of the lowest in the country, limiting the benefit to women who earn less than 150 percent of the poverty line.
Ms. Zimmerman was not working at the time and thought she might qualify. She made an interview appointment at her local Medicaid office but went into labor the night before, so didn’t show up and never completed the paperwork. Five months later, with her $3,596 bill for the delivery still unpaid, Mr. Marshall sued her.
“I had to choose whether I’d pay my electricity or pay $50 to a doctor who didn’t need it,” she said.
Ms. Zimmerman said she set up a $50 monthly payment plan in 2010 but sometimes could not keep up. Mr. Marshall’s law firm was charging 18 percent interest on her bill, and she recalls being told that it had ballooned to over $7,000 with interest.
Ms. Zimmerman is among 81 patients whose court records indicate that an arrest occurred. Their debts ranged from $114 to $4,683. In some cases, efforts to collect a debt would continue for over a decade and lasted into Mr. Marshall’s congressional career.
Most patients did not attend their original court date, which led to a default judgment. Four of the eight patients The Times interviewed said they never received their summons, which court records indicate were typically delivered by mail. Some sent in handwritten letters asking for leniency.
One, whom Mr. Marshall sued in 2004 for $1,200, asked that she not be held liable for care she received “for me and my twins (who I lost).” She was still found responsible for the bill.
Another hired a lawyer, who wrote a brief protesting a $520 bill for a surgery to remove placenta that remained in a patient’s uterus after childbirth.
“The service that the plaintiff seeks payment for should have been part of the original birthing services for which the plaintiff has already been paid,” the lawyer argued. That case was dismissed.
Mr. Vasquez said he did not recall receiving a summons for his lawsuit or a notice of his court date in 2007. Court records indicate both documents were delivered.
The couple had health insurance, he said, but believe something went wrong with the billing. Mr. Vasquez recalls Mr. Marshall’s office offering a $250 monthly payment plan that he could not afford.
“Every little bit of money we were getting went for rent and bills,” he said.
Mr. Vasquez was recovering from surgery, with fresh stitches in his arm, when the police arrived at his house. Because of that, he was not handcuffed and was kept in a solitary cell.
“It was just me in that itty-bitty room,” he said.
After the arrest, the Vasquezes worked with a law firm to roll this and other debts into a payment plan. Eight years later — 11 years after the emergency surgery — in November 2015, Mr. Marshall’s lawyers filed a letter with the court releasing the judgment against them.
Susan C. Beachy and Stella Raine Chu contributed research.
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