From CPP: Independent monitor for hospital merger going public in big way

Mission Health North Tower
The recently completed Mission Health North Tower houses the Asheville hospital’s new emergency room, part of several changes in facilities at the Asheville-based medical provider that was recently acquired by HCA. A state-mandated independent monitor to ensure any changes at Mission comply with promises made when the state approved the HCA deal will conduct meetings with the public to hear of concerns. Photo by Colby Rabon, courtesy of Carolina Public Press

By Neil Cotiaux, originally published by Carolina Public Press. Carolina Public Press is an independent, in-depth and investigative nonprofit news service for North Carolina.

Gibbins Advisors, the independent monitor charged with validating HCA Healthcare’s compliance with the promises it made when it acquired Asheville-based Mission Health nearly a year ago, is taking its efforts public in a big way.

From Tuesday, Jan. 28, to Thursday, Feb. 13, the Nashville, Tenn.-based firm has scheduled seven 90-minute meetings open to the public at locations across Western North Carolina to provide information on its “role and scope” as independent monitor and to get feedback on HCA’s performance.

Gibbins is also launching a website that will provide information on the firm’s activities and enable the public to submit feedback through an online portal at

“We hope during or after the sessions, community members will highlight concerns they have for us to review further,” said Ron Winters, principal and co-founder of Gibbins, in a statement to Carolina Public Press.

“Even if the concerns are outside the scope of our role or HCA’s undertakings, we will channel the information back to the appropriate parties at HCA, ANC Healthcare Inc. (the entity winding down the former Mission system), Dogwood Health Trust and the (hospital) advisory boards,” Winters’ statement added.

Winters and Thomas Urban, the firm’s managing director, are the only scheduled speakers at the seven events.

Gibbins was named independent monitor Oct. 31, when Josh Stein, North Carolina’s attorney general, announced that he had consented to the choice after a monthslong search. The firm had earlier received signoff from ANC and Dogwood.

Stein played a leading role in negotiating numerous service requirements that HCA ultimately agreed to in its $1.5 billion deal with Mission.

In announcing his signoff on Gibbins, Stein attached great importance to the firm’s willingness to interact with the public.

“To be successful, the monitor must take the time to engage with communities in Western North Carolina,” Stein said. “Specifically, I am looking forward to hearing about town hall meetings and other opportunities for the monitor to hear directly from the people who are impacted by HCA’s health care decisions.

“That commitment to engaging with local communities, along with the monitor’s qualifications, led me to direct my office to consent to the selection of this monitor.”

“The N.C. Attorney General’s Office encouraged these meetings, and we agreed with their thinking,” Winters told Carolina Public Press. “We had planned to hold them anyway.”

Gibbins’ higher-profile approach contrasts with the more traditional approach taken by many independent monitors, which focus almost exclusively on inspecting organizations, reviewing their reports, gauging compliance with obligations, conferring with attorneys general and other agencies and offering suggestions for organizational improvement.

“Traditionally, monitors are low profile because the task is not about the monitor but is about objectives of the parties who established the monitorship,” said Jacob Frenkel, a founding director of the International Association of Independent Corporate Monitors and a member of the Washington, D.C., law firm of Dickinson Wright.

But the state-mandated oversight situation with HCA in North Carolina is leading to the novel approach. “Here, ‘public’ input and ‘public’ responsibility is central to the state’s expectations,” Frenkel said.

North Carolina’s attorney general is not the only prominent figure who supports interaction between Gibbins and the public.

Would Dogwood watchdog?

Gibbins, which now reports to ANC, will soon report to Dogwood Health Trust, a nonprofit foundation created in the merger of for-profit HCA and nonprofit Mission Health. Gibbins will be compensated by ANC and Dogwood and is not being paid by HCA.

Dogwood’s CEO, Antony Chiang, was president of Empire Health Foundation in Spokane, Wash., before moving to Asheville. While in Spokane, he had extensive experience dealing with a large health care system. (Editor’s note: Xpress interviewed Chiang in November, soon after he took charge of the trust.)

In 2017, Chiang’s foundation filed a federal lawsuit against Community Health Systems Inc., a for-profit company that owned CHS Deaconess Medical Center and CHS Valley Hospital and Medical Center.

Last Oct. 8, Empire announced a settlement of that suit, which alleged that CHS had “failed to comply with state law and its own purchase agreement in its provision of charity care to patients of Deaconess and Valley,” according to an Empire press release.

Empire had the right to enforce CHS’ contract to purchase the two hospitals and alleged that CHS had “breached its contractual obligation to make ‘reasonable efforts’ to provide charity care to the community at levels that met or exceeded the eastern Washington regional average,” the release states.

The settlement is expected to extinguish as much as $50 million in hospital debt for thousands of former patients.

Whether Dogwood under Chiang could potentially play a similar role remains unclear.

Maintaining a charity care policy that assists patients at up to 400 percent of the federal poverty line is one of numerous promises that HCA made as it acquired Mission.

“I have had some conversations with people at Dogwood, and they had indicated that they want the monitor to have contact with the public and to solicit input from the public as far as what level of quality of service is being provided by HCA,” said Victoria Hicks, a community activist involved in tracking HCA’s performance.

“It is absolutely consistent with everything we have read and heard about him and have heard from him,” Hicks said of Chiang.

HCA’s obligations

HCA’s agreement to maintain a charity care policy is one of many promises it has made.

Other obligations include a 10-year commitment to provide specified services at local hospitals, an agreement not to close facilities or cease providing services unless the independent monitor and a local advisory board agree, opening a new inpatient behavioral health hospital in Asheville and building a replacement facility for Angel Medical Center in Franklin.

As for HCA’s closure of two rehabilitation clinics in Buncombe County last year, “This is an ongoing topic of discussion that both the AG’s office and the independent monitor will be handling in concert moving forward,” said N.C. Department of Justice spokesperson Laura Brewer in response to a question from CPP.

“The monitor’s plan for public hearings is a clear proactive measure to create the broadest opportunity for community input,” said Frenkel of Dickinson Wright.

“This is a thoughtful method for conveying to the state that communication and transparency, particularly to address and alleviate community concerns, is a central component at the onset of the monitorship.”

Winters, Gibbins’ principal, expects the use of independent monitors to become even more commonplace as the health care industry consolidates.

“We expect to see growth in the use of independent monitors, and evolution of the role, supporting health care transactions in coming years.”

Time and place of independent monitor public meetings:

Doors open 30 minutes before each event.

  • Cashiers meeting (Highlands-Cashiers Hospital)
    Tuesday, Jan. 28, 2020 / 5:30 to 7 p.m.
    Cashiers/Glenville Recreation Center
    355 Frank Allen Road, Cashiers, NC 28717
  • Highlands meeting (Highlands-Cashiers Hospital)
    Wednesday, Jan. 29, 2020 / 5:30 to 7 p.m.
    Highlands Civic Center Meeting Room
    600 N. Fourth St., Highlands, NC 28741
  • Macon County meeting (Angel Medical Center)
    Thursday, Jan. 30, 2020 / 11:30 a.m. to 1 p.m.
    Robert C. Carpenter Room, Macon County Community Facilities Building
    1288 Georgia Road, Franklin, NC 28734
  • Buncombe County meeting (Mission Hospital)
    Monday, Feb. 10, 2020 / 5:30 to 7 p.m.
    Blue Ridge Room, Mountain Area Health Education Center
    121 Hendersonville Road, Asheville, NC 28803
  • Transylvania County meeting (Transylvania Regional Hospital)
    Tuesday, Feb. 11, 2020 / 5:30 to 7 p.m.
    Unitarian Universalists of Transylvania County
    24 Varsity St., Brevard, NC 28712
  • McDowell County meeting (Mission Hospital McDowell)
    Wednesday, Feb. 12, 2020 / 11:30 a.m. to 1 p.m.
    Marion Community Building
    191 N. Main St., Marion, NC 28752
  • Mitchell County meeting (Blue Ridge Regional Hospital)
    Thursday, Feb. 13, 2020 / 5:30 to 7 p.m.
    Auditorium, Burnsville Town Center
    6 S. Main St., Burnsville, NC 28714

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