Pro Publica─ the online, Pulitzer-winning investigative web site─has reported on a disturbing trend in Nebraska, where hospitals and collection agencies have exploited low fees and accommodating courts to sue patients and their families over unpaid medical bills. Some of the suits hound the poor for charges as small as $60, and one missed payment can land a family in court.

The Dickensian practices, Pro Publica says, have deluged Cornhusker courts with 79,000 debt collection suits in 2013 alone, twice the number filed in similar sized New Mexico where residents are poorer and more fall behind on their bills.

Although hospitals elsewhere may be more judicious about pursuing patients over bills, the investigation found that Nebraska laws─including low court fees and easy processes to drag defendants into court─have caused collection agencies to flourish, especially working with hospitals and doctors.

Pro Publica found the defendants to be working poor folks, already staggered by illness and surgeries, and then slapped with suits for a few hundred dollars by rural hospitals, family doctors, and specialists. Their already low wages get garnished when they can’t fight the suits, some filed weeks after bills were due. So the poor fall deeper into debt and poverty.

When a state legislator tried the smallest reform aimed at this awful situation, a $1 increase in the fee for filing a lawsuit with sums going to provide more legal services to the poor, he met with major resistance. The legislation eventually passed but the battle over it bodes poorly for lawmakers to do more.