Photos by Eric Brady | The Roanoke Times

Brenda Craft (left) and Brenda Sieman attend the health care group's meeting Tuesday.

Dr. Frank Cotter urged attendees to learn about a 1989 lawsuit concerning Carilion.

Roanoke Mayor David Bowers (left) and Del. Morgan Griffith, R-Salem, attend the meeting.

Angry over the rising cost of health care, and concerned about the market share Carilion Clinic controls in medical delivery throughout Southwest Virginia, about 400 people gathered in Roanoke on Tuesday evening.

In what has been a grass-roots effort to speak out against Carilion's business practices, the gathering was the inaugural meeting of the Citizens Coalition for Responsible Healthcare. The meeting, held at the Ramada Inn on Franklin Road, was used to introduce the newly formed organization's all-volunteer board of directors and reveal the group's plan for shedding light on the impact Carilion has on health care costs and consumer choice.

"The only way we can fight these abuses is to organize, and starting tonight we can," said Dr. Frank Cotter, an ophthalmologist with Vistar Eye Center in Roanoke who was instrumental in organizing the coalition.

The coalition was formed to focus attention on what members say is the negative impact of Carilion Clinic's transformation into a physician-led clinic. Organizers say Carilion is driving up health care costs.

"We want to understand what the effect of alternative choices, or their absence, in health care delivery means both financially and in service availability to citizens," said Ken King, president of the new coalition.

Among those gathered were Roanoke Mayor David Bowers, state Del. Morgan Griffith, R-Salem, and state Sen. John Edwards, D-Roanoke. A legislative aide for state Sen. Ralph Smith, R-Botetourt County, also was present.

Carilion officials have repeatedly claimed that it is misleading to blame Carilion's practices for the rising cost of health care, and have cited data from the Virginia Hospital and Healthcare Association that indicate Carilion charges less than other hospitals in the state.

King asked that people not only volunteer to support the new organization, but also think about handing over copies of their medical bills to help the coalition build a database of medical charges. The coalition will also solicit financial donations through membership fees.

"The coalition will ask providers to share with us their costs charge sheets -- we may not get them -- so that we can begin understanding what procedures they offer and what cost they are to citizens," King said.

Organizers say Carilion's growing footprint of medical services has reduced competition in health care delivery and given the not-for-profit entity greater power to inflate medical costs.

"I don't think it is a case where we are trying to destroy Carilion, but it sure would be nice to have a partner who would sit down and help us control costs here," said Alan Bayse, a member of the coalition board and a health insurance consultant in Roanoke.

Coalition organizers point to previously published differences in the cost of a neck CT scan and a colonoscopy.

A Carilion colonoscopy at the hospital costs $3,260 -- more than three times the cost at the Center for Surgical Excellence, which was independent before Carilion purchased the practice Aug. 28. Similarly, a neck CT scan costs $1,606 at Carilion verses $675 at the Center for Advanced Imaging, which also was independent until Carilion purchased it on the same date.

"Hospital-based services do cost more than independent, free-standing services," reads part of a fact sheet provided by Carilion spokesman Eric Earnhart before Tuesday's meeting. "Hospitals often provide service to the most medically complex patients who need the greatest amount of clinical support. Hospitals are open to all pay classes, including Medicaid, which frequently pay less than the cost of the service received."

The cost of infrastructure and supporting specialty services such as obstetrics and pediatric cancer care also contribute to the higher costs, according to the fact sheet.

Earnhart could not be reached for comment late Tuesday night.

Besides raising concerns about the high cost of care, coalition board members also questioned Carilion's tax-exempt status.

"The tax-exempt status that Carilion receives from all of us taxpayers should be proportionate in a way to the benefits the town receives," said Dr. Larry Monahan, the only physician on the board. "I don't think it is."

Carilion has received about $50 million a year in tax exemptions and gave $42 million in charity care in 2007. Monahan suggested that those two numbers should be equal.

April Fields said she is an example of a patient who has qualified for charity care at independent medical practices, but instead was taken to court by Carilion for unpaid bills.

Two weeks after asking for forms to apply for charity care, Fields said she was taken to collections.

"I'm constantly getting phone calls from Carilion; I even got one asking for $1.86," she said.

Similarly, Sonny Bright said he was stuck with his wife's medical bills after she died.

"They took me to court to make me pay for it," he said. "I couldn't afford it."

He offered to pay $5 a month, then when they wanted more, he said he could pay $10 a month.

Cotter also urged those gathered to familiarize themselves with the 1989 U.S. Department of Justice antitrust lawsuit that tried, but failed, to prevent the merger between Carilion and Community Hospital of the Roanoke Valley.

"You can't understand this unless you understand that," he said of the coalition's campaign.