Nurses at Mission Hospital in Asheville are conducting a strike vote this week, the results of which will be tallied after 8 p.m. Thursday.
The strike decision comes as parent company HCA faces increased pressure over its management of Asheville hospital and others across Western North Carolina in the Mission Health chain.
North Carolina Attorney General Josh Stein‘s office announced late Wednesday that he agrees with earlier findings by an independent monitor that HCA is in violation of the terms it agreed to when the Tennessee-based for-profit company was allowed to acquire previously nonprofit Mission Health in 2019.
Stein is already suing HCA over previous alleged violations of the agreement. Multiple local governments have also sued HCA, over alleged monopolistic practices at its hospitals in the mountainous region around Asheville.
Carolina Public Press has also learned that the North Carolina Department of Health and Human Services is looking into multiple complaints about Mission Health.
Mission nurses strike vote this week
The nurses union has been negotiating with HCA on a new contract since April. Asheville nurses have worked under an expired contract with the hospital system since early July.
The union has expressed concerns about issues like staffing levels, workplace violence, compensation, benefits, recognition of federal holidays, patient safety and meal and rest breaks.
All nurses at the hospital, regardless of whether they’re union members, can place an anonymous ballot in favor of or against a strike, according to Jeanne Mould, a nurse at Mission Health.
If they do vote in favor, and decide to go ahead with a strike, the union must provide the hospital with a 10-day work-stoppage notice.
The union’s bargaining team spent Tuesday discussing the terms of the contract with HCA.
“We are still far apart on our ideas of what we think would attract and retain nurses working at Mission Hospital,” Mould told CPP.
“We’ve reached some tentative agreements, and even rescinded some proposals in the spirit of bargaining, but there are several proposals that HCA is just continuing to reject and hold onto current contract language.”
A vote in favor of a strike does not necessarily mean a strike will occur — it simply authorizes the union to announce a strike.
“We are still bargaining, and giving HCA the option to resolve our contract issues, but if we reach an impasse, a vote in favor means that we have the ability to call a strike,” Mould said.
“As long as the contract has still not been ratified, that strike vote is current. It’s hard to know what the outcome of the vote will be, but I am hopeful.”
The next scheduled bargaining session is September 9.
“Mission Hospital will continue to bargain in good faith, as we have done for months,” HCA spokesperson Nancy Lindell told CPP in an email.
“That process has resulted in a very significant wage proposal from the hospital, a number of agreements on topics such as parking, uniforms and technology, and significant progress on health benefits, health and safety, education support and other areas. We hope that we can conclude these negotiations and move forward together in caring for patients.”
Nurses at Mission Hospital originally voted to organize a union in 2020, a year after HCA acquired the chain. The Asheville facility remains the only unionized hospital in North Carolina. Nurses at other Mission Health facilities are not part of the union.
Attorney general’s decision on HCA
Assistant North Carolina Attorney General Llogan Walters notified Dogwood Health Trust in a letter Wednesday evening that his office agrees with Dogwood’s findings from late July: that HCA has potentially violated its agreement to purchase Mission Health in three key areas.
Dogwood Health Trust is entrusted with ensuring that HCA remains in compliance with stipulations placed by the Attorney General’s Office, and agreed to by HCA, when he allowed the company to acquire Mission Health.
Dogwood Trust itself is a result of the $1.5 billion that HCA paid to nonprofit Mission Health in order to buy it out. Dogwood Trust is tasked with hiring an independent monitoring company to help make judgments, but is totally independent of HCA.
Dogwood found violations based on HCA’s annual report that were in keeping with the findings of independent monitor Affiliated Monitors based on its independent investigation.
The issues of potential noncompliance that Affiliated Monitors identified are as follows:
- Provision of emergency and trauma services and oncology services at Mission Health
- Failure to remain “enrolled and in good standing” in Medicare and Medicaid
- Issues with uninsured and charity care policies
Now that Dogwood has identified three more areas of potential noncompliance, and Attorney General Stein’s office agreed that these areas deserve further attention, either Dogwood or the attorney general must notify HCA of any noncompliance by Oct. 27.
Stein is already suing HCA over previous allegations of noncompliance, discontinuation of emergency services and cancer care due to major reductions in physician staff.
Affiliated Monitors identified the same concerns as a potential area of noncompliance in its report, but indicated that it will leave this issue to be decided in the courts through ongoing litigation, rather than in discussions between Dogwood and HCA.
One of the potential violations of the purchase agreement that Affiliated Monitors identified in its report stems from action by a federal regulatory agency. The Centers for Medicare and Medicaid Services delivered a letter in December notifying HCA that its Asheville hospital was in Immediate Jeopardy due to nine instances of patient harm or deaths in 2022 and 2023.
Immediate Jeopardy is the most serious citation CMS can deliver to a hospital. Affiliated Monitors determined that because of this, HCA could no longer be considered “in good standing” with CMS.
In his Wednesday letter to Dogwood concerning the Attorney General’s agreement, Assistant Attorney General Walters commented on this issue as it relates to the office’s suit against HCA:
“We further note that HCA’s Annual Report conflicts with representations HCA has made to the North Carolina Business Court in our pending litigation,” Walters writes.
“HCA reported that it complied with Section 7.13(h) of the APA (Asset Purchase Agreement), which requires all facilities to ‘remain enroll and in good standing in the Medicare and Medicaid programs.’ … Unless HCA misstated its position on Section 7.13(h) to the Business Court, it should have self-reported noncompliance with Section 7.13(h) in its Annual Report.”
HCA maintains that it is in good standing with CMS, and that any issues of noncompliance were resolved earlier this year, according to HCA spokesperson Lindell.
“Mission Hospital is in compliance with governing regulations and at no time was the hospital suspended from treating Medicare or Medicaid patients,” Lindell wrote.
“We value the work of the Independent Monitor and are confident that we continue to be in compliance with the terms of the Asset Purchase Agreement.”
DHHS investigations into Mission
State Sen. Julie Mayfield, D-Buncombe, told CPP that the state’s Department of Health and Human Services (DHHS) visited Mission Health in Asheville in the first week of August to investigate six different patient complaints. Two of these complaints were submitted by Mayfield herself on behalf of patients.
“We don’t know whether they’ll be another finding of Immediate Jeopardy or if it will be something less severe,” Mayfield said. “But this confirms that things are not all hunky dory at the hospital.”
DHHS’s Department of Health Service Regulation conducts routine surveys of hospitals and complaint investigations, both of which are unannounced to the hospital.
Complaints made to the department are confidential and DHHS staff cannot comment on them or their accompanying investigations, according to DHHS press assistant Hannah Jones.
If surveyors did identify noncompliance during their early August visit to Mission, they will write a Statement of Deficiency report. Mission Health would then have to provide DHHS with a plan of correction for each problem cited in the report.
If this plan is deemed insufficient, the hospital has to re-submit a more complete plan until it is approved. Then, surveyors return to the hospital unannounced to ensure that the plan is in place and working.
According to HCA, DHHS found no deficiencies during its August visit, but DHHS could not confirm this.
Affiliated Monitors’ return trip to WNC
Affiliated Monitors conducted public meetings at each of Mission’s six hospitals in Western North Carolina to listen to the public’s concerns about HCA in June.
Low attendance numbers resulted in concerns about inconvenient scheduling and scarce advance publicity for the events. Brevard mayor Maureen Copelof, whose community is served by Transylvania Regional Hospital, brought these concerns to the attention of CPP.
Following the release of their report identifying three areas of potential noncompliance in late July, Affiliated Monitors’ project manager Gerald Coyne announced that his team would make a return trip to the area this fall. The details of that visit have not yet been ironed out, according to Coyne.
“Several people suggested that there were some groups out there that may not feel comfortable discussing their concerns at a public meeting,” Coyne told CPP. “We’re waiting to see who is available when so that we can hit the most people.”
This article first appeared on Carolina Public Press and is republished here under a Creative Commons license.
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