Mission Hospital patients, staff, decry poor care to HCA Healthcare independent monitor
ASHEVILLE – On the bottom floor of Asheville’s Scenic Hotel at Biltmore Village, current and former Mission Hospital patients, nurses and local physicians gathered in a windowless grey conference room to air their frustrations about the hospital they once loved. More than 50 people attended.
Since HCA Healthcare purchased the hospital system in 2019, concerns about quality of care have mounted. Mission Health and its corporate owner are embroiled in a series of lawsuits, ranging from multiple anti-trust cases to medical malpractice lawsuits, including a suit brought by a Canton family for a botched cesarean section. The Citizen Times reported earlier this year that wait times for patients arriving at the hospital in ambulances have grown since HCA bought the hospital, leading to delays in care and back-ups for taxed emergency systems.
The meeting Oct. 20 was the second in a series of six public sessions across Western North Carolina to be held with representatives from Gibbins Advisors, the Nashville-based firm tasked with reviewing whether HCA violated the commitments it agreed to as part of its $1.5 billion acquisition of the Mission Health System. The first session was Oct. 17 in Brevard to discuss Transylvania Regional Hospital.
North Carolina Attorney General and gubernatorial candidate Josh Stein negotiated these commitments. Stein touted at a recent Asheville campaign event that he “stretched” his authority to create them but noted that he had little power to dictate the acquisition. The evening would prove Stein’s commitments had little power to improve care that many in attendance said has deteriorated since the corporate purchase.
Gibbins is known colloquially as the Independent Monitor, a definition created by contract to purchase the hospital, for its work reviewing these promises. Its work in this area is funded by Dogwood Health Trust, the nonprofit created out of funds of the sale. Gibbins provides recommendations to Dogwood Health Trust about compliance issues with the commitments in the agreement.
Chad Patrick, HCA’s chief executive officer of Mission Hospital, Dogwood's CEO Susan Mims and Holly Jones, a senior policy adviser from the state attorney general's office, all attended the session.
A presentation from Ronald Winters, co-founder and managing director of Gibbins Advisors, began the session by explaining his firm’s role overseeing the contractual obligations, grouped into four categories:
Retaining hospital services
Investing in facilities
Investing in community wellbeing
Miscellaneous.
“The commitments don’t include certain things that people are concerned about,” Winters told the crowd. “It doesn’t include quality care metrics. It does not include billing. It does not include employees.”
He later added, “our influence as Independent Monitor is limited to the (contract).”
There were printouts on each of the tables detailing agencies and offices where people could convey their concerns about quality of care.
Winters turned the microphone over to the audience to ask questions. He asked that speakers limited each comment to two minutes, but ew complied and Winters then allowed anyone with the microphone to continue as long as they pleased. The public comment period lasted around 90 minutes.
Deteriorating care
Robert Kline, 72, a primary care doctor who held several leadership positions at Mission Hospital from the late 1990s to the early 2010s, including serving on its board, read a letter signed by 48 doctors; eight signed anonymously.
“Many of the for-profit-driven changes that HCA has wrought, despite advocacy and protests from multiple sectors, have gutted the heart and soul of our community healthcare system,” Kline read.
He later said: “We ask that hospital leadership look at economics as if people mattered. With our many hundreds of years on the front line of patient care, we know what a fully resourced system looks like. We don’t see it now.”
Kline expressed disappointment that quality of care was outside Gibbins' purview.
Allen Lalor, 59, a retired Mission Hospital emergency department physician, helped put the letter together and recruit signers. He told the Citizen Times that no doctors currently working within the system signed the letter openly, fearing retribution from HCA. Lalor was one of the plaintiffs in a False Claims Act lawsuit that asserted HCA was cheating the government by systematically ordering superfluous tests. It was originally filed June 22, 2022.
Stein and the U.S. Department of Justice had opportunities to take the case on, but neither did. The case was dismissed following a motion from Lalor and his co-plaintiff, Scott Ramming, a current emergency department doctor.
Mark Klein, a nurse with the hospital who is part of the nurse’s union, read a letter signed by eight nurses, representing the 1,500 nurses who work at the hospital, spelling out the departmental cuts that he said violated the commitments HCA made.
Klein listed the 10 services provided at Mission Hospital that HCA shall, in the words of the contract, “not discontinue,” for 10 years following the purchase of the hospital, reading how HCA has made significant deterioration in each area. The services are:
Behavioral health
Cardiac
Emergency and trauma
General medicine
Imaging and diagnostic
Neuro trauma
Obstetrical
Oncology
Pediatric
Surgical
He detailed how HCA diminished each of the services, listing staffing reductions and unit closures as evidence of each. But reductions do not necessarily mean HCA is discontinuing the services.
“Mission can once again be the revered health care institution it once was,” Klein read. “HCA is the largest health care company in the world. The resources are available. They simply choose not to invest them in our community.”
Jessica Clements, 40, was diagnosed with acute leukemia in September 2021. Upon her diagnosis, she said she received constant treatment for four weeks in Mission’s cancer unit. Her doctors work at Messino Cancer Center in Asheville, a physicians’ group that uses Mission facilities.
More: Mission Hospital ambulance patient wait times lengthen while Buncombe mulls solutions
More: NC AG Stein considers 'civil investigative demand' against HCA/Mission's cancer care
Messino announced that they would stop providing care for patients like Clements because the doctors with the group believe the resources at Mission facilities are inadequate for providing high-level care. Specifically, the doctors at Messino are frustrated with high staffing ratios, lack of constant pharmacy support with oncology-trained pharmacists and growing lab turnaround times.
“Messino Cancer Center has the oncology staff, they have the team to treat acute leukemia patients,” Clements said. “They simply do not have the hospital to do it.”
Lauren Preston, a social worker who was working in Brevard asked Winters whether he would receive treatment at the Mission Hospital emergency department.
“If I needed treatment, I imagine so,” he said. “A lot of people go there. Why wouldn’t I go there?”
“Are you listening?” she asked, getting laughs from the crowd.
Winters later expressed his sympathies but reiterate that there wasn't much Gibbins could do.
Who will fix the issues?
Following the session, Winters told the Citizen Times that he did not think anything he heard violated the compliance agreement.
“We take every piece of information we get,” he said. “I didn’t hear any bright line violations tonight.”
Patrick, after witnessing the crowd decry the state of care at the hospital he presides over, declined to speak to the Citizen Times.
The Citizen Times requested a response from Patrick in an email to spokesperson Nancy Lindell, who provided a statement attributed to herself.
"We are pleased that the Independent Monitor acknowledges Mission Health has continued to honor our commitments in the Purchase Agreement," she said in the Oct. 20 statement.
Lindell pointed to oversight entities responsible for monitoring the care delivered by the hospital. She also laid out internal processes to monitor quality of care, ranging from soliciting patient feedback to leaders attending shift huddles to anonymized surveys.
More: HCA's $15.9 billion in 2nd quarter revenue: What does that mean for Asheville's Mission?
Jones, who is not a lawyer but was the representative from the attorney general’s office at the meeting where many discussed conditions they believe infringed on the legally binding commitments HCA made, said she could not comment if anything she heard violated the agreement. Jones formerly served on Asheville City Council and Buncombe County Board of Commissioners.
Mims encouraged Gibbins to investigate some of the “areas of potential noncompliance” that emanated from the session in an Oct. 20 statement to the Citizen Times. She also suggested people share their stories with other governing bodies.
Dogwood becomes officially aware of violations through an annual reporting process coordinated between HCA, Dogwood, Stein’s office and Gibbins. It has 40 days to correct a violation once Dogwood becomes aware of it. Dogwood last enforced the agreement in 2021.
Independent Monitor meetings resume Nov. 1 as follows:
Macon County (re: Angel Medical Center). Nov. 1 at 5:30 p.m. Macon County Library Meeting Room, 149 Siler Farm Road, Franklin.
Macon/Jackson County Meeting (re: Highlands-Cashiers Hospital). Nov. 2 at 5:30 p.m. Cashiers/Glenville Recreation Center, 355 Frank Allen Road, Cashiers.
McDowell County Meeting (re: Mission Hospital McDowell). To be scheduled early 2024. Details yet to be announced.
Mitchell County Meeting (re: Blue Ridge Regional Hospital). To be scheduled early 2024. Details yet to be announced.
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: Mission Hospital patients, doctors nurses decry care in Asheville
