Roger Marshall, a Republican senator from Kansas currently seeking reelection, previously filed lawsuits against more than 700 patients over unpaid medical bills during his career as an obstetrician-gynecologist, court records show. An analysis of Kansas court documents indicates that in 81 cases, patients were arrested for missing court dates related to these lawsuits, while in 13 others, warrants were sought though it is unclear if arrests occurred. In addition to litigation, Marshall’s legal team pursued wage garnishments and bank account levies, often charging interest at an annual rate of 18 percent.
The debts ranged from modest amounts, as low as $101, up to several thousand dollars. Approximately half of the lawsuits were filed directly under Marshall's name, with the remainder brought by Heartland Regional OBGYN, the medical practice he operated from 1998 to 2019. Many of the patients lived in Barton County, a rural area characterized by higher-than-average rates of poverty and uninsured residents. Several plaintiffs reported struggling financially, with some being new mothers facing bills from deliveries or postpartum care. Some patients interviewed described being uninsured or having insurance that did not cover all costs, while others said they were committed to paying but found it impossible to meet full demands immediately.
One such case involved Joe Vasquez and his wife, who were arrested in 2007 over a $4,561 bill related to an emergency hysterectomy. The couple spent two days in jail after missing a court date, before their son was able to post bond. Vasquez said they had health insurance but encountered billing difficulties and could not afford an offered $250 monthly payment plan. Other patients, including Meischa Zimmerman, faced multiple arrests linked to unpaid bills from cesarean deliveries. Zimmerman, uninsured during the relevant pregnancy, said that after missing Medicaid enrollment due to labor, she was sued for nearly $3,600 and faced arrears that ballooned with interest.
Marshall’s office defended the practices, emphasizing that courts issue warrants when defendants persistently miss scheduled appearances, not at the doctor’s sole discretion. Payton Fuller, a spokeswoman for Marshall, stated that he provided care to patients regardless of their ability to pay and that billing and collection procedures followed standard practices used by Kansas medical providers and businesses. Meanwhile, Steven Johnson, a lawyer who frequently represented Marshall in these cases, described the use of warrants and arrests as measures to ensure court compliance, not as debt enforcement per se. Johnson added that although Marshall set the interest rate patients agreed to, he was not involved personally in decisions regarding enforcement actions like arrests or garnishments.
Experts on medical debt litigation note a wide variation in how providers handle unpaid bills, with some choosing not to sue patients at all. Increased reliance on lawsuits has correlated with rising insurance deductibles, which shift more financial burden onto patients. However, wage garnishments and arrests in medical debt cases are regarded by some as unusual and severe actions. Economists studying medical debt litigation suggest that suing patients remains relatively rare, although outliers exist.
Marshall, who ceased medical practice after his 2016 election to Congress, has highlighted his service as an OB-GYN in rural Kansas and his care for low-income mothers, including those on Medicaid. He also had financial interests in Great Bend Regional Medical Center, a hospital that filed hundreds of similar lawsuits during his tenure on its board, some continuing while he served in Congress. His campaign materials have portrayed him as a trusted local doctor delivering thousands of babies.
Patients sued by Marshall’s practice described receiving summonses by mail they did not recall or prior notice of court proceedings. Many failed to appear in court, resulting in default judgments. While some cases were eventually resolved through payments or settlements, others extended over years, occasionally continuing into Marshall’s congressional career. One patient’s lawsuit related to a late miscarriage was contested and dismissed after legal challenge, but most judgments stood.
After years of litigation, the Vasquez couple reached a payment arrangement and the judgment against them was released in 2015, more than a decade after the original surgery. The controversy surrounding Marshall's debt-collection record has surfaced amid his current Senate campaign, prompting debate over the ethics and practices of medical debt enforcement in rural, low-income communities.