City, county file class-action lawsuit against HCA/Mission

RSVP: Dogwood Health Trust announced Jan. 2 it is seeking proposals to provide independent monitor services to oversee HCA Healthcare. Photo by Jen Castillo

Asheville and Buncombe County filed a class-action lawsuit against HCA Healthcare and Mission Health on July 27 in U.S. District Court. The lawsuit alleges HCA is attempting to monopolize health care in Western North Carolina.

“The Asheville City Council and the Buncombe County Board of Commissioners felt it was necessary to take this step to bring an end to predatory practices that limit HCA Healthcare’s competition and clearly result in overpriced and limited choices in people’s health care,” said Asheville Mayor Esther Manheimer in a July 28 statement announcing the lawsuit. “We believe this lawsuit will not only address the damages sustained by local governments and other self-insured organizations but will also result in a fair and improved health care system for our entire community.”

The city of Asheville has a self-funded health plan utilized by 1,122 employees, the lawsuit says.

In the same statement, Buncombe County Commissioners Chair Brownie Newman said, “On behalf of our public employees and our community, we have a responsibility to challenge these unfair business practices that harm patients and families at a time they are often most vulnerable.”

Buncombe County’s self-funded health plan covers 1,416 employees, and 3,700 people in total, including employees’ families and retirees.

The lawsuit demands a jury trial and alleges HCA/Mission Health operates a monopoly over general acute care in hospitals, including overnight stays, and outpatient care. The plaintiffs allege HCA/Mission Health required health insurance plans to have “all-or-nothing” arrangements with its services and prevented tiered plans that would have allowed insurers to offer less expensive options, among other complaints.

It states, “Defendants’ conduct has restricted competition in the health care markets defined herein, thereby substantially and artificially inflating health care prices paid by plaintiffs and proposed class member health plans. This proposed class action for unlawful restraint of trade and monopolization seeks to redress these harms.”

In an Aug. 3 statement to Xpress, HCA/Mission Health spokesperson Nancy Lindell called the lawsuit “meritless.” She wrote, “Mission Health has been caring for Western North Carolina for more than 130 years and our dedication to providing excellent health care to our community will not waiver as we vigorously defend against this meritless litigation.  We are disappointed in this action and we continue to be proud of the heroic work our team does daily.”

According to the lawsuit, Mission Hospital System merged with St. Joseph’s Hospital in 1995, thus creating a monopoly on general acute care in WNC. However, Mission was able to hold this monopoly due to a certificate of public advantage, which the lawsuit refers to as “a form of regulation in which a hospital is permitted to operate with monopoly power in exchange for subjecting itself to state oversight.” The state repealed the COPA in 2016. HCA, a for-profit company based in Nashville, purchased nonprofit Mission Hospital for $1.5 billion in 2019.

Shortly after HCA’s purchase, both community members and health care providers alleged patient care declined. In February 2020, Manheimer, Newman and state Rep. Brian Turner co-signed a letter to the Asheville Citizen Times stating, “[R]educed care for low-income patients, increased patient risk, and dismissing important practice groups that have provided outstanding service to Mission — are simply unacceptable and must be corrected.”

HCA is defendant in two additional lawsuits: one filed in July 2021 by insured residents of WNC alleging “artificially inflated out-of-pocket costs and health insurance premiums,” and the second filed June 2022 by the city of Brevard.

HCA also has drawn criticism from nurses at Mission Hospital, who ratified their first union contract with National Nurses United in 2021. On June 2, RNs held a rally outside the hospital alleging unsafe staffing levels and an inability to take breaks guaranteed in their contracts due to staff shortages.

Public hearing for CON applications

A public hearing about applicants vying to build a new 67-bed hospital will be held at 9:30 a.m. Friday, Aug. 12, at A-B Tech, 19 Tech Drive, in the Ferguson Building’s Ferguson Auditorium.

The 2022 State Medical Facilities Plan, published by the N.C. Department of Health and Human Services Division of Health Service Regulation, stated Buncombe, Graham, Madison and Yancey counties will have a projected need of 67 additional acute care beds by 2024. To apply to build a facility for those beds, each health care organization must submit a certificate-of-need application.

AdventHealth Asheville, Novant Health Asheville Medical Center and HCA/Mission Health each submitted a CON application on June 15, according to NCDHHS application logs.

For more information about the public hearing, contact the Healthcare Planning and Certificate of Need Section of the Division of Health Service Regulation at 919-855-3873.

Group opposes HCA’s CON application

The State Employees Association of North Carolina, an advocacy group for the 750,000 individuals on the State Health Plan, submitted public comments Aug. 1 in opposition of HCA’s certificate-of-need application. HCA applied to provide 67 additional acute care beds in coming years.

In a 66-page letter to NCDHHS’ Division of Health Service Regulation, Ardis Watkins, executive director of the state employees association, detailed the group’s concerns over HCA’s staffing decisions, access to care for underserved populations, clinic closures and quality of care, among other items. “The applicant does not meet the required criteria and high standard of care that North Carolinians deserve,” Watkins wrote. “Therefore, we urge the agency to deny Mission Hospital’s Certificate of Need application.”

The public comment period for CON applications ended Aug. 1.

VA awards grants locally

Asheville-Buncombe Community Christian Ministry and Homeward Bound of Western North Carolina are recipients of the Department of Veterans Affairs’ 2023 Supportive Services for Veteran Families grants. Funds assist with health care, housing and transportation for homeless and at-risk veterans, and are available Oct. 1. The nonprofits are among 258 nonprofits nationwide served by $431 million in grants.

Health care hiring

Western North Carolina Community Health Services, a nonprofit primary care provider serving a primarily uninsured or low-income population, is holding a job fair Tuesday, Aug. 16, at Minnie Jones Health Center, 257 Biltmore Ave. Positions are open across medical, dental, behavioral health and administrative departments. For more information, call 285-0622, ext. 4416, or email

Mark your calendars

  • Asheville Parks and Recreation Department is hosting a free class on four-season food production and preservation 4-7 p.m. Wednesday, Aug. 24, at Montford Center Edible Park, 30 George Washington Ave. Register at ​​
  • The sixth annual Mental Wellness Walk will take place at 10 a.m., Saturday, Sept. 10, at Carrier Park, 220 Amboy Road. Participants can choose a 2K or a 5K. Funds raised will support All Souls Counseling Center and the National Alliance on Mental Illness Western Carolina, co-hosts of the event. Register at
  • The Race to the Taps 5K will be from 11 a.m.-1 p.m. Saturday, Sept. 24. The race begins and ends at Oskar Blues Brewery, 342 Mountain Industrial Drive, Brevard. Register at
  • AdventHealth Hendersonville, in partnership with the Council on Aging of Hendersonville, will hold a free seminar on depression 5:30-7 p.m. Tuesday, Oct. 11. The seminar will be held at AdventHealth Medical Group Multispecialty at Laurel Park, 1881 Pisgah Drive, Hendersonville. Visit or call 855-744-5433 to register.

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About Jessica Wakeman
Jessica Wakeman is an Asheville-based reporter for Mountain Xpress. She has been published in Rolling Stone, Glamour, New York magazine's The Cut, Bustle and many other publications. She was raised in Connecticut and holds a Bachelor's degree in journalism from New York University. Follow me @jessicawakeman

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6 thoughts on “City, county file class-action lawsuit against HCA/Mission

  1. Voirdire

    Too little too late. You -the City of Asheville… along with your systemic cronyism that created the highly incompetent and clueless {Mission’s} Board of Directors… that literally gave Mission away to HCA- have no one to blame but yourselves. Your class action lawsuit will accomplish, well, pretty much zero… everything HCA does in/ with their egregious business practices is 100% legal… their “monopoly” is intentional and basically bulletproof. Welcome to america …and reality.

    • Voirdire

      and sorry, that should have read: You -the City of Asheville and the County of Buncombe… along with your systemic cronyism that created the highly incompetent and clueless {Mission’s} Board of Directors.. Anyway, sigh…. so very ridiculous…. you got absolutely fleeced, period… no going back with that. Oh, I know, you’ve now have your beloved Dogwood Trust…. what a travesty… basically a billion dollar slush fund for the well meaning…. and well connected. I’ve got an idea… how about bringing forth a long overdue criminal case for the fraud committed by the then CEO of Mission, Paulus?

  2. Barry Kratzer

    Well, well, well, whoda thunkit. Anybody with a lick of sense, could have predicted this. The greedy mayor, and city council, could only see the million and a half dollars HCA was going to give them to waste, as all Dumbocrats are want-to-do. HCA
    is a vile corporation, who’s only mission is money, no matter who suffers.

    • Voirdire

      HCA is about as GOP and pro-Trump as you can get. Get real… I know it’s asking a lot.

      • Barry Kratzer

        So, you are one of those bleeding-heart liberals that think what your party is doing is okay?
        If you are a Brandon fan, you are brain-dead.

  3. MV

    Well, we wouldn’t need so much medical care if our local officials weren’t allowing developers and tourists to destroy our natural world and bring so much sickening traffic….

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