HCA executive responds to attorney general over claim of Mission cancer care understaffing

ASHEVILLE – HCA North Carolina Division President Greg Lowe sent a preliminary response to the North Carolina Attorney General’s office addressing the state’s concerns about Mission Hospital’s oncology services. For-profit HCA Healthcare bought Mission Hospital in 2019.

In a July 19 letter to North Carolina Department of Justice Assistant Attorney General Llogan Walters, Lowe provided information on Mission’s oncology staffing levels and efforts to recruit additional oncologists. Walters initially requested a response by July 3.

“People in western North Carolina need access to quality cancer care,” Nazneen Ahmed, North Carolina Department of Justice spokesperson, said in a statement. “Our office has received concerning information about widespread vacancies among oncologists at Mission Hospital. We’re looking closely at this situation.”

Mission did not add additional comments to the letter.

Lowe’s letter is the latest in a written dialogue between HCA and the Attorney General’s Office about Mission’s oncology services.

In a June 20 letter to Lowe, Walters issued a warning to HCA about its medical oncology practice, which “now includes only one physician where it once had as many as fourteen.” Walters’ letter expressed doubt at whether HCA could serve the public’s oncological needs using a single oncologist. Medical oncologists are primary health care providers for cancer patients. The letter also put into question whether the condition of HCA’s medical oncology department breached the terms of HCA’s 2019 acquisition of Mission.

2023 07 19 AAG Oncology by Mitchell Black on Scribd

Walters requested that HCA provide specific information on Mission’s medical oncology practice. This included the change in staffing levels in the department over time, the identities of each oncologist employed by the practice and statistics on patients seen, appointments, referrals and wait times. Walters also request a detailed description of the additional steps HCA will take to restaff the department.

Lowe’s letter disclosed preliminary information that Walters requested but noted that he did not specifically fulfill all of Walters’ demands.

“We will continue to provide additional information in the coming days,” he wrote. Lowe added that HCA does not track some of the requested information in the “ordinary course of business.” He added that HCA is working to gather “responsive data” and will “provide a supplemental response as soon as practicable.”

Mission’s overall staffing levels have come into question recently. Mission workers and local emergency service leaders have pointed to staffing challenges at the hospital as part of the reason there is a backlog in the Emergency Department. In a May 22 letter to Walters, Lowe disclosed that Mission has a single medical oncologist on staff.

Lowe’s letter disclosed that Mission currently has 39 oncology physicians on its “medical staff” as of June 2023, one fewer than it had January 2019. It also notes that Mission increased its “credentialed mid-level oncology providers” from 28 to 33. According to the Journal of Oncology Practice, mid-level oncology providers are primarily nurse practitioners and physician assistants.

“Medical staff” is a technical term. According to the North Carolina General Statute, physicians who have privileges to practice at the hospital “shall comply with all applicable medical staff bylaws,” meaning that a physician must be a member of the medical staff to practice at the hospital. This does not necessarily mean that the doctor is a full-time staff member at the hospital.

According to the North Carolina Administrative Code, there can be many different medical staff membership categories, including “active medical staff,” “courtesy medical staff” and honorary medical staff. Lowe did not provide any information in the letter to delineate medical staff membership. Lowe also enumerated the physicians in specific subspecialties on Mission’s medical staff.

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“As you can see, Mission’s medical staff has remained consistent across oncology subspecialties,” Lowe wrote.

Lowe also noted that the section of HCA’s agreement to buy Mission Hospital that Walters took issue with “does not require that Mission employ a certain number of oncologists or mid-level oncology providers, but instead focuses on continuing to make oncology services available to the community, as Mission has done and will continue to do.”

In a May 22 letter to Walters, Lowe pinned some of HCA’s staffing struggles on Messino Cancer Center, a group of doctors that worked with Mission through a Professional Services Agreement through 2019. A PSA allows a physician group to maintain its independence while providing services at the hospital. Lowe wrote that physicians did not want to compete against the Cancer Center, writing that it is the “more established group of oncologists in the market.”

Walters speculated in the June 20 letter that “HCA’s treatment of its physicians no doubt hurt HCA’s recruitment efforts. Doctors are understandably reticent to join health systems that limit physician independence.”

Lowe wrote in his July 19 response, “To the extent you may be suggesting that the practice now known as Messino ‘left’ Mission because of HCA’s purchase, that suggestion would be inaccurate. Mission never employed those physicians.”

Lowe then added “Those physicians planned to discontinue that arrangement with Mission before the HCA acquisition. HCA, in fact, worked to maintain the group’s affiliation with Mission for an additional year after the acquisition.”

Dr. Michael Messino, who founded Messino Cancer Center, formerly known as Cancer Care of Western North Carolina, disagreed with Lowe.

“We had no preconceived notion to leave the PSA we had with Mission even when HCA took it over. They wanted to employ our physicians, but we wanted to continue with a professional services agreement. They wanted to control our staff and physicians. We wouldn’t have that,” Messino said to the Citizen Times.

Messino Cancer Center had to set up its own facilities once the group left Mission.

“It was a monumental task to leave and set up six programs in eight months. We had no intentions to leave until it was clear we could not work with them,” Messino said.

Lowe wrote in the July 19 letter that HCA is fighting against “a nationwide shortage of oncologists,” despite its recruiting efforts. He finished the letter by inviting Walters to visit Mission and “see firsthand for yourself what we are doing to provide high-quality healthcare to Western North Carolina.”

Mitchell Black covers Buncombe County and health care for the Citizen Times. Email him at mblack@citizentimes.com or follow him on Twitter @MitchABlack. Please help support local journalism with a subscription to the Citizen Times.

This article originally appeared on Asheville Citizen Times: HCA's Greg Lowe responds to claim of Mission cancer care understaffing