Andrew R. Jones
Asheville Watchdog
A broad coalition of Western North Carolina doctors, patient advocates, clergy and state senators has called on HCA Healthcare to abandon Mission Health Network, decrying the level of care the company has provided since its 2019 acquisition for $1.5 billion.
The group alleges that the five years since HCA, the nation’s largest health care corporation, bought the then-non-profit hospital system were marked by a “significant withdrawal of staff, resources and services,” with hundreds of doctors and nurses leaving and medical practices closing or withdrawing across the region, according to documents obtained Monday. Asheville Watchdog It outlines the group’s intentions.
The coalition, Reclaim Healthcare WNC, also described a “pervasive culture of disrespect, intimidation and fear of retaliation” on the part of HCA.
The coalition’s stated goals are:
- Replace HCA with a nonprofit owner committed to meeting the health care needs of Western North Carolina residents
- Holding HCA Accountable for Harmful Practices
- Restoring best-in-class care across the system
“We do not want the quality of our care to be publicly traded,” one of the documents states. “We want to restore the trust and pride Mission once had in our community and region.”
Watchdog The paper also received an opinion column written by the group, which will be published in the newspaper in the coming days. Asheville Citizen Times.
Watchdog reached out to HCA and Mission Health for responses to the group’s mission. Spokesperson Nancy Lindell said, “On many other occasions when you have reported on the views of this group’s members, we have provided you with the information and responses you need, so you should be able to get the information you need from us.”
HCA is a Fortune 100 company and the largest system in the U.S. with more than 185 hospitals. It has revenue of nearly $65 billion in 2023, with $5.2 billion of that revenue coming in as profits. On Tuesday, the company reported second-quarter 2024 net income of $1.46 billion, sending its shares up more than 7% in premarket trading.
The health insurer giant faces multiple class action lawsuits in Western North Carolina, each of which it has appointed an array of lawyers to, but has remained largely unscathed. Aside from losing a Certificate of Need bid in May to build 67 new beds in the region, HCA has largely failed to achieve its goals and quell opposition in the region.
Key members of the group include Democratic Sen. Julie Mayfield of Buncombe, Sen. Bruce Kelly, former Mission executive Robert Klein before the sale, former Mission emergency department physician Allen Lalor, Messino Cancer Center founder Mike Messino, nurse practitioner Karen Sanders, Brevard Mayor Maureen Kopeloff and Miriam Schwartz.
According to one of the documents, the coalition stressed that nurses and doctors should not be held responsible for HCA’s failures.
“We have deep respect and gratitude for all staff who work at the Mission,” the document states. “Many of the problems are not their fault, and some of the excellence remains thanks to the dedicated efforts of those who work within the system.”
The group’s plan is short on details, but it plans to achieve its goals by increasing its membership, holding HCA accountable through state and local regulators, seeking innovative solutions and publicizing the problem in the media.
Mayfield has been spearheading the organization of the group, and in April he spoke about the effort’s preliminary ideas at a gathering of the Osher Lifelong Learning Institute at the University of North Carolina at Asheville.
“The North Star for our community, and all of Western North Carolina, is quality, accessible and affordable health care,” she told about 175 people who gathered in person and online. “That’s the North Star. HCA doesn’t provide that. There’s no question about that at this point. So the choice is, they provide it or they leave. We’ve come to the conclusion that they’re never going to provide it. So they have to leave.”
Missy Harris, a former missions pastor and coalition member who is also co-pastor at Circle of Mercy Church in East Asheville, said the group is not daunted by the challenges ahead.
“We’re realistic,” Harris said, “we know what we’re up against, and we know the power of community and the power of people speaking up. Our hope is that this group can be a place where we can gather all that support and think strategically about the pressure we put on the system.”
The previously unnamed coalition has been pressuring HCA since late 2023. In October, 50 doctors signed an open letter to an independent watchdog on the Mission sale, saying HCA had “destroyed the heart of our local health care system.” Since then, the list of signatories has grown to more than 250.
As North Carolina Attorney General Josh Stein’s 2023 investigation gets underway, a diverse cross-section of groups have begun banding together, including doctors, elected officials, clergy, nurses, patient advocacy groups and WNC residents calling for HCA to do better.
Stein, a Democratic candidate for governor, filed a lawsuit against HCA and Mission System in December, alleging that the hospitals are not providing the same level of cancer care and emergency medical services as the six-hospital system did before it was bought. Members of the now-formalized coalition stood alongside the attorney general during the lawsuit announcement in Asheville.
HCA disputes Stein’s claims, arguing that the asset purchase agreement, a set of promises it made at the time of its acquisition, did not include a promise to provide quality care.
After the North Carolina Department of Health and Human Services inspected Mission Hospital in late 2023, the department recommended to the U.S. Centers for Medicare and Medicaid that Mission Hospital be subjected to immediate closure, the most severe sanction a hospital can receive, due to numerous violations of federal health care standards.
The 384-page CMS report details widespread failures by HCA and Mission management to provide quality care, documenting delays in care, negligence, long wait times for tests, unapproved and expired drugs and other problems that led to the deaths of four patients and harmed dozens of others.
When CMS followed NCDHHS recommendations in February and Mission presented CMS with a plan to fix the deficiencies, the coalition sent a letter to NCDHHS Principal Deputy Secretary for Health Mark Benton saying the plan was “inadequate” because it didn’t commit to providing hospitals with more full-time nurses.
Now with a name, a contact form and a soon-to-be-launched website, Reclaim Healthcare WNC will take on the enormous challenge of convincing the nation’s largest hospital company to sell one of its most profitable businesses.
“We’re not naive,” Mayfield told OLLI attendees, “and we want to be very clear about that.”
Mayfield said there were two main issues in getting HCA to sell Mission.
“One is, will they sell it? And the other is, will someone buy it,” Mayfield said. “The great thing is there are people who will buy it. If it’s for sale, there are companies that will buy it tomorrow. So we don’t have to worry about that. And the other good thing is those companies are paying very close attention to what’s going on in the area. Whoever buys this hospital knows they’re going to be stepping into an area that they’re watching.”
While Mission Hospital is no longer at risk of losing its CMS funding, anger is still simmering in Asheville’s medical community, where nurses have threatened to strike after the union and Mission Hospital management failed to reach a new labor contract by July 2. In recent months, a small number of nurses have sided with coalition members to support pressure on HCA and demand improved working conditions for employees and patients.
“Why are we even discussing a strike? It’s all about patient safety,” the union nurses wrote in a Facebook post in early July. “We need to recruit and retain high-quality, experienced nurses and ensure we have enough staffing to care for our patients, but HCA believes the status quo is enough. We all deserve better.”
[Editor’s note: This story has been updated with a response from a Mission Health spokesperson.]
Asheville Watchdog is a nonprofit news team producing news that matters to Asheville and Buncombe County. Andrew R. Jones is an investigative reporter for the Watchdog. He can be reached at arjones@avlwatchdog.org.