HCA hands itself a clean bill of health for Mission sale agreement


HCA Healthcare maintains it has fulfilled all the promises it made when it bought Mission Health for $1.5 billion five years ago, according to the annual compliance report it sent to N.C. Attorney General Josh Stein’s office and obtained by Asheville Watchdog.

The 13-page report, filed April 30, runs counter to allegations made by Stein in his 2023 lawsuit against HCA that mismanagement by it and Mission contributed to the loss of emergency department and oncology services, breaching HCA’s Asset Purchase Agreement (APA). It makes no reference to the litigation.

HCA’s attorneys have denied the allegations in Stein’s lawsuit, claiming in their first response that the company never committed to providing quality care, a point it repeated verbatim in its latest set of arguments against the lawsuit, filed May 6.

“The contractual language, as well as the underlying negotiations, demonstrate that Mission’s Hospital Service Commitments are not promises to meet subjective healthcare standards,” HCA said in that filing.

The report comes just months after findings by the U.S. Centers for Medicare & Medicaid Services (CMS) of numerous deficiencies in emergency services at Mission.

In February, the N.C. Department of Health and Human Services (NCDHHS) and CMS chronicled 14 incidents in 2023 of patient death or endangerment at the hospital, which the agency determined violated federal standards. CMS placed Mission in immediate jeopardy, the most severe sanction a hospital can face, that month. While immediate jeopardy has been lifted, Mission remains under threat of losing Medicare and Medicaid funding.

“As documented in our report, Mission has and continues to meet and/or exceed the commitments in the Asset Purchase Agreement,” Mission Health spokesperson Nancy Lindell said Friday.

The attorney general’s office declined to comment.

HCA has been required to send an annual compliance report to the attorney general’s office each year since its purchase. This year’s report was obtained by The Watchdog through a public records request.

HCA’s compliance reports typically are posted to a website run by the independent monitor of the Mission sale. But since Dogwood Health Trust, which is responsible for enforcing HCA’s compliance with the APA, hired a new monitor on April 1, that website has been down.

Affiliated Monitors Inc., the new independent monitor, expects to have an updated website go live early next month, Dogwood spokesperson Erica Allison said.

This year’s report from HCA states that it has complied with its APA commitments, including those to keep services at the same level for 10 years after the sale. Its language is nearly identical to previous annual reports’.

Throughout 2023, the report stated, “(HCA) did not discontinue the provision of the services set forth on Schedule 7.13(a) of the Purchase Agreement at the Mission Hospital Campus Facility, the Community CarePartners Facilities or the Mission Children’s Hospital Reuter Outpatient Center.”

In a 2023 impact report, HCA N.C. Division President Greg Lowe lauded the hospital’s achievements since 2019.

“As we mark the five-year anniversary of Mission Health joining HCA Healthcare, this year’s report proudly reflects the array of achievements that have provided profound benefit to our communities during that time,” Lowe wrote.

Lowe did not mention the federal finding of immediate jeopardy nor the Stein lawsuit, but referenced challenges in 2023.

“Our emergency rooms have seen an influx of patients that have regularly stretched our capacity,” he wrote. “Mission Health has worked diligently to recruit and retain our staff, investing more than $20 million in annual raises for our direct patient care colleagues.”

Mission Health facilities in Asheville have lost hundreds of registered nurses over the past two years and faced a staffing deficit of more than 450 nurses in mid-October, according to data obtained by Asheville Watchdog. Union nurses continue to demand HCA do much more to hire and retain full-time nurse and ancillary staff, instead of relying on short-contract travel nurses.

Dogwood will file its own annual compliance report with Stein’s office in July.

Stein, the Democratic candidate for governor, filed the December 2023 lawsuit against HCA and Mission on behalf of Dogwood.

“Dogwood will notify the NC Attorney General of our conclusions once we have had a chance to conduct our review of the report and work with the IM to engage in community meetings and conduct site visits,” Allison told The Watchdog.

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email arjones@avlwatchdog.org. The Watchdog’s reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/donate.


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One thought on “HCA hands itself a clean bill of health for Mission sale agreement

  1. Voirdire

    Deny, deny, deny… it’s the standard MAGA defense. And HCA Mission and the controlling Frist family of Nashville TN is as MAGA as they get. Just to be clear about it all.

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