Maryland district court officials want to give defendants in debt collection lawsuits new access to legal help and change the way that settlement conferences are handled, in response to criticism that hospitals and creditors often have an unfair advantage. The courts are responding to an investigation into hospital debt collection practices published by The Baltimore Sun and a University of Maryland law school study that found defendants are confused by the court process, do not understand that they sometimes have legitimate defenses, and assume that they must accept whatever terms are dictated by hospital lawyers in settlement conferences.