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Q&A With Filmmaker, Rebecca Schanberg

Q: How did you find out about what was happening at Phoebe Putney in Georgia and this story in particular?
A: I have a friend who was working at Kekst and Company, the communications firm which represented Dick Scruggs and the team representing class action lawsuits against 37 health care systems in 26 states. Early in 2005, my friend began telling me about two men in Georgia, Rehberg and Bagnato, who had uncovered overcharging of uninsured patients while working at a practice at Phoebe. I asked her if we could do a film about them, and she set up a meeting for us in the Atlanta airport.

Q: When you learned about this story, how soon were you following the characters and filming the documentary?
A: I first heard about the story in early 2005. It took us about two months after this to set up an initial meeting in the Atlanta airport with Dr. John Bagnato, Charles Rehberg and some of the attorneys involved in the class action litigation. After this initial meeting, our crew was in Albany within three months to start capturing the story on film.

Q: How long did it take you to film the documentary?
A: In total, we filmed for about two and a half years from the initial shoot in mid-2005. We wrapped shooting in January of 2008, and continued to edit for about a year. The timing is actually fortuitous because of the new administration’s focus on health care reform and the attention that has come to the issue.

Q: What struck you the most about this story?
A: That two people totally unconnected to officials and regulators could pull all of this information together in a way that no one had done before. The information was presented so clearly and methodically that their arguments were irrefutable.

Q: The whistle blowers really risked their lives. By the time you started to film, could you still feel the threat to their lives? And when you were filming, was there any risk to you and your crew?
A: Absolutely. We met them before they were indicted, and they were both shocked and stressed out by the way the hospital seemed to be threatening them. Their wives, especially, really opened up to us about how fearful they were. Both of them began to feel that people had been inside their homes — it was a terrible time. Whenever we spoke to someone in Albany, they would tell us to be careful because we were being followed. More than once, security at Phoebe tried to run us off a public street because they didn’t want us filming the hospital’s image in the background.

Q: Which personal stories touched you the most while filming?
A: I was really moved by the story of Chrissy McCormick, a young woman from Champagne, IL, who had gone to a hospital with severe abdominal pain. Rather than do comprehensive testing, the doctor sent her home with Tylenol. Chrissy couldn’t work because of her health problems, and, through testing, learned that she had a cyst on her ovary. But because she couldn’t work, she couldn’t pay off her doctor’s bills. But, the hospital she had gone to wouldn’t allow her to get surgery without surgery without putting down $5000. The catch was that without the surgery, she was in too much pain to leave the house. She was incredibly strong and wanted to do the right thing, but the hospital treated her and the situation horribly. On top of it all, Chrissy had just gotten married, and was worried that the delays had caused her to be infertile. Eventually, she got surgery at a different hospital, and the original hospital lost its non-profit status due to its treatment of patients like Chrissy.

Also, we interviewed a few people who worked at Phoebe that asked to remain anonymous. Their stories were also compelling and upsetting.

Q: In your opinion, how did the people of Albany react to this story? What about folks on the national stage such as Senator Grassley or others you spoke with?
A: Most people in Albany were scared of Phoebe, even though many had had good medical experiences there. The ironic thing was that most of these people also had relatives who worked at Phoebe, some of whom had terrible insurance coverage through their benefits package. Other people in the field knew about the issues for years but were shocked by the extent of what was going on at Phoebe, as Wernick and his crew were so brazen. Phoebe is a particularly bad case because the hospital really owns the town, but most people in the field have fought to bring this forward for a very long time.

Q: Talk about the fallout since the story broke and the ramifications in legislative policy.
A: Strangely, very little has changed in Albany. The hospital got rid of its “Phoebe Care Card”— its response to the negative attention that helped the uninsured get free or discounted care by registering them ahead of time and making the process easier. Phoebe is also still trying to buy other hospitals in the area.

Nationally, legislators are paying a lot more attention. Max Baucus, the new chair of the Senate Finance Committee, is proposing reform legislation, and Grassley is pushing for more oversight, but real change is very slow coming. People disagree about how to change things and the insurance system is so complicated and wrapped up in hospital reform that it’s going to take a lot more than just changing hospital oversight to create real change. This year, The IRS did start to require non-profit hospitals to report executive perks, such as private jets, expensive trips, etc.

Q: Talk about the challenges while filming.
A: Our biggest challenge was not being there all the time. We would go down for big events, but we had to plan each trip very carefully. Not being there also made it hard to get people who were scared of Phoebe to talk to us. Several people did meet with us, as you can see in the film, but not many. We actually flew down once to see a woman who ended up not showing up for an interview. We tried to track her down, but it ended up being a huge mistake — she was furious. She was just really scared and had been through enough already.

Q: Tell us about your crew.
A: The mainstay of the crew was cinematographer, Dana Kupper. She was, in many ways, her own director, picking many of the shots. Dana is amazing with subjects, making people feel very comfortable — an essential quality for documentary filmmaking, especially with a story as sensitive as Phoebe. Dana is an amazing filmmaker, and I learned from her as we took the journey. I was so focused on getting the story on tape and asking questions that there were things along the way I didn’t think about — and Dana helped guide me.

Susanne Suffredin, the film’s editor and co-producer, was my partner in every step of the way. She has been instrumental in the shaping of the story by culling through all of the footage and taking an incredibly complicated and confusing set of facts and making them understandable and interesting. The film couldn’t have been made without her.

Q: How are Dr. Bagnato and Charles Rehberg doing now?
A: They’re doing really well. Phoebe decided to open a competing surgery practice in lap band surgery, so Bagnato is trying to get his privileges reinstated so he can do surgery there. He was physically barred from a meeting there recently, but his business has been doing extremely well, which is why Phoebe wants to compete with him. Charles seems really happy too. He’s much less stressed, and his family is relieved to be out of the spotlight.

Q: What do you hope viewers take away from the film?
A: I think more than anything we want viewers to be as angry as we were when we heard this story — angry enough to get involved and take action at a level that’s fitting for them. At its core, this story is about the fact that our current health care system is based on the wrong principles. Money is the core driving force, rather than great care for all.

It’s very similar to what happened in the banking industry — the profits are built on invented margins — no one needs to pay $5 for an aspirin or $10 for a piece of gauze. If people acted on a grassroots level to encourage disenfranchisement of the insurance companies, hospitals and their suppliers — all of whom benefit from these enormous mark-ups — then we may start to see some real change.





Denise Godoy