Doctors aren’t the only ones witnessing a rise in patients who can’t pay: social assistance agencies also report an increase in medical arrears.“We have certainly seen an increase in clients coming in with debts of all kinds — but unpaid medical bills is a major one,” said Nicola Feldman, director of the Coalition for the Protection of Children.Her remarks came in the wake of complaints from one local practice that bill-dodging has soared since 2011 as the economic downturn asserted itself in Bermuda. The Coalition reported that the debts they confronted were typically not for unpaid visits to the GP.Ms Felman said debt-burdened mothers tended to fall into difficulty over “more specialised treatment — or even childbirth, which is not cheap in Bermuda”.“Often the bills are children’s medical bills, again for specialised treatment of some kind.“These services can result in huge debts, which burden families who already have a difficult time making ends meet.“I think more often our clients avoid going to the doctor altogether due to the expense, as most are not employed and therefore are not insured. So if anything, their visits tend to be a result of an escalated problem that might have been prevented had the individual had access to more preventive medical care.”Ms Feldman acknowledged that some people took advantage of the recession to plead poverty.But she said the “vast majority” of Coalition clients who weren’t paying their medical bills were genuinely unable to make ends meet. “People are really struggling. We know of families where the most tremendous sacrifices are being made so that a child can be treated overseas.”Some of the stories she encountered were “truly heartbreaking — and, to be honest, just not fair”.“Of all people, children deserve to get the medical care they need without it having to destroy the family.”The Coalition director conceded that, in some cases, people “could be making different choices to help their own situations”.However, she continued: “But these decisions are exactly the types of things we try to work on with our clients.“What good is it to just blame individuals who do not make responsible choices? That doesn’t change anything and it doesn’t help their children. The entire community owes it to the children to try and work with individuals we believe need to make better choices, in making better choices.”Ms Feldman said it was crucial for the Island to move on from “this punitive culture that we currently live in, which does a disservice to Bermuda’s children”.Boosting assistance to meet rising demand depended on obtaining funds — which she described as “currently very low”.“The more the community supports us, the more we can support our clients. But as an organisation, we are also affected by the economic climate.”Donations can be made online at www.coalition.bm.