AG Stein hears WNC leaders on Mission sale fallout, says he's eyeing merger law changes

ASHEVILLE - North Carolina Attorney General Josh Stein sat down with elected officials, medical professionals and community members April 28 at Buncombe Health and Human Services department to learn more about the impact of HCA Healthcare's 2019 acquisition of Mission Hospital.

The feedback was not good.

In the space of one hour, Stein heard a litany of frustrations expressed about what HCA had done to Western North Carolina's health care system.

It's not just WNC that has complaints about the health care giant.

Stein has held several other roundtables throughout the state, hearing how medical mergers have changed North Carolina communities.

"Between 200 and 2016, North Carolina had the fifth highest number of rural hospital mergers in the nation," he said, using a series of illustrative posters.

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Today, 74% of the state's general hospitals belong to health systems, a percentage higher than 46 other states, Stein said, adding that people in areas with hospital monopolies pay 12.5% more than those in areas that have four or more hospitals.

Stein wants to change these numbers and told those in attendance April 28 that he was exploring legislation to give his department more oversight.

"It's about understanding with more nuance what the consequences are when one health system gobbles up another," he said. "Too often the price is higher costs and worse care. That is not in the interest of North Carolina patients."

After many of a group of nearly 20 told Stein about their experiences and gave him specific examples of what oversight needed to be in place, he said these matched what he'd heard in other counties.

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"What I heard today reinforces many of the concerns that I have sensed and come to the conclusion myself," he said. "What we've identified is that state law is inadequate in empowering me or any other state actor to review these transactions on the front end."

Stein's office reviewed and approved the 2019 deal in which HCA purchased Mission Hospital for $1.5 billion.

His responsibility was to see whether HCA paid a fair price, he said, and whether Dogwood Health Trust — the nonprofit created from the hospital's sale — would be separate from HCA and representative of the community it served.

“I am absolutely certain that the involvement of my office dramatically improved the asset purchase agreement to the benefit of the people of Western North Carolina," Stein said.

"That said, many people are frustrated with the outcome. And I want to underscore that I’m frustrated with the state of North Carolina’s law as it relates to my authority to conduct reviews like this of hospital conglomerations. The ability for me to review these transactions is both inadequate and inconsistent."

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As he listened to medical professionals and elected officials talk about how state law could change to make big medical mergers less detrimental to the communities they served, many said the community should have been more involved in the HCA decision.

Buncombe Commission Chair Brownie Newman and Asheville Mayor Esther Manheimer

both noted that, during the merger, HCA officials were very aloof, in some cases not replying to requests to come and speak to government boards about the deal.

Mission Health employees came to the meeting and listened to the discussion but did not participate.

"We appreciated the invitation this week from the Attorney General to observe the discussion, yet we would have welcomed the opportunity to participate on the panel and share our perspective on ways to improve these transitions in the future," HCA and Mission Health spokesperson Nancy Lindell said.

"While it is disappointing that those who did participate on the panel felt unsatisfied with their care or experience, the objective reports Mission Health receives demonstrate that we have increased quality and services at our hospitals. Mission Hospital received an A Grade for safety in the fall from Leapfrog and it is anticipated that our spring grade will be the same."

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'We've got to stop playing games'

The HCA deal's impact is hurting community members as well, doctors and nurses said.

Dewayne McAfee, a member of Buncombe Ad Hoc Reappraisal Committee focused on racial equity in property assessment, came as a concerned resident, the only one at the roundtable.

"If we have these issues in the overall community, my community is in really critical condition," he said. "I just want to make sure that everyone in this room is aware of that."

McAfee said in an interview after the meeting his brother died at Mission during the Christmas holiday.

"For five days he was doing well. The next thing we know, on Christmas day, they're telling us he had an episode," McAfee said. "What was the episode? Were they understaffed?"

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Nurses and medical professionals who worked inside Mission have repeatedly emphasized issues with understaffing since the merger and especially during the heat of the COVID-19 pandemic. State Sen. Julie Mayfield noted during the roundtable Mission may not have had the resources to make it through the pandemic without HCA.

Mayfield also convened the roundtable and helped invited many of the experts.

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"We've had these things going on in our community forever," McAfee said. "So when the general community is concerned, we're in crisis. And who doesn't already know that? We've got to stop playing games."

Elle Kruta, a registered nurse who works in Mission's case management department and a member of National Nurses United, reiterated concerns nurses have expressed in multiple actions since the deal.

To her, the meeting was bittersweet.

"Some of it made me want to cry," she said of the roundtable discussion. "Especially when the doctors were talking. This is our community. These are our loved ones. This is our passion."

One doctor, Martin Palmeri of Messino Cancer Center, said when he was exiting Mission, he was told that HCA "owned" his patients.

That struck Kruta.

"If I'm a patient there, they don't own me," she said.

Kruta felt Stein's roundtable allowed medical professionals to be heard.

"To me it felt like a big moment in history," she said.

Andrew Jones is Buncombe County government and health care reporter for the Asheville Citizen Times, part of the USA TODAY Network. Reach him at @arjonesreports on Facebook and Twitter, 828-226-6203 or arjones@citizentimes.com. Please help support this type of journalism with a subscription to the Citizen Times.

This article originally appeared on Asheville Citizen Times: NC Attorney General hears medical community, officials on HCA fallout