Messino Cancer Centers to stop providing acute leukemia chemotherapy at Mission

by Andrew R. Jones, avlwatchdog.org

Messino Cancer Centers will no longer provide chemotherapy for dozens of acute hematology cancer patients at Mission Hospital because of concerns over “ongoing system failures,” which it says were going to ultimately harm patients.

Asheville Watchdog obtained a Sept. 20 letter to Messino doctors and Mission leadership and staff in which Martin Palmeri, head of Messino’s cancer department working at Mission facilities, announced the decision, which will likely force more than 50 patients to seek care outside of Asheville.

“With heavy hearts, the physicians at Messino Cancer Centers cannot with good conscience continue to provide inpatient complex hematology care,” the letter stated.

“The doctors at Messino Cancer Centers have decided to no longer treat complex hematology cancer patients — acute leukemias requiring induction therapy and primary [central nervous system] lymphomas — in the inpatient setting,” the letter said. “For patients currently on treatment, we will complete their course of therapy if the patients prefer to remain at Mission. Otherwise, we will be transferring these patients to academic medical centers for their care.”

The letter noted Atrium Health and Duke Health “are not facing the same struggles that Mission is.”

Atrium and Novant Health have hematology services in Charlotte, roughly two hours from Asheville. Duke Cancer Center is in Durham, nearly three and a half hours away.

While it cited the stresses the COVID-19 pandemic wreaked on the health care world and praised nurses and pharmacy members on the ninth floor of Mission’s K9 oncology floor, — where Messino oncologists provide cancer treatment —  Palmeri’s letter said Messino’s ability to care for patients was negatively affected by “issues that need hospital leadership and resources to succeed.”

Messino has identified and prevented errors “that could have ultimately led to patient harm,” but “problems still persist,” wrote Palmeiri, a Messino Cancer Centers oncologist and president of the North Carolina Oncology Association.

The letter listed several resources and procedures that it said Messino doctors have told Mission for four years are necessary to prevent future errors:

• 2:1 or 3:1 nurse-to-patient for complicated hematology patients on intensive chemotherapy in areas where they are moving to less intense care
• Two chemotherapy trained pharmacists that can support each other and provide medication double checks and consistent weekend coverage
• Dedicated care management support for oncology patients to reduce inpatient stays and safely transition these patients home
• Oncology support services — pathology and laboratory — that can provide timely services
• Management that understands drug and laboratory supply chain management so that patients’ care is not interrupted and their well-being put at risk

The letter said Messino will still provide guidance and direction to Mission hospitals “in hopes of one day being able to resume access to complex hematological care in Western North Carolina. … We will continue to be honest and forthright with the community regarding our capabilities and as soon as we feel this service can be successfully and safely restarted, we will gladly proceed.”

Palmeri declined to comment about Messino’s decision, saying, “As the oncology service line leader that was elected by the oncology community in Western North Carolina, I’m not at liberty to make a public comment at this point.”

He did, however, give a statement regarding Messino’s ongoing services in the area. Messino will still be providing other cancer services at Mission.

“As a representative of Messino Cancer Centers, I can say that we have a robust outpatient oncology service in the outpatient setting,” Palmeri said. “Messino Cancer Centers has the ability to provide advanced cancer care for all cancer types. We have doctors who specialize in hematologic cancers with an expertise in lymphomas, leukemias and multiple myelomas. We are expanding our research portfolio in order to provide cutting-edge therapies. We have strong working relationships and collaborate with our regional academic institutions to further enhance the care of our patients locally.”

A Mission spokeswoman did not answer specific questions about  Messino’s decision.

“The team at Mission Hospital stands ready and willing to care for any patient that comes to us,” Mission spokeswoman Katie Czerwinski said. “If there is anything that needs to be communicated to our patients, we do so directly.”

Concerns raised five months ago

Messino’s decision not to provide acute hematology chemotherapy at Mission comes five months after a National Nurses United union nurse flagged concerns about potential cancer patient harm to the North Carolina Department of Health and Human Services.

“I am concerned about the care patients have received at Mission Health since the acquisition by HCA,” a complaint letter, obtained by The Watchdog, says. “I have explicitly been made aware of patients who received expired chemotherapy and missed doses of chemotherapy. The legacy Mission of old had a nurse-patient ratio of 3-1 on the oncology floor. Now that ratio is 5-1.”

Czerwinski said nurse staffing is based on patient volume and acuity and is revisited every four hours. “Resources are shifted as needed,” she said. “We take concerns brought directly to Mission Hospital leadership by our teammates very seriously and leadership takes all feedback and addresses those concerns directly with our colleagues.”

The complaint letter describes chemotherapy shortages at Mission, an issue nationwide, according to recent reports.

“Regarding the past national methotrexate shortage, Mission Health experienced the same delays in acquiring this drug as the rest of the country’s health systems,” Czerwinski said. “However, there is no longer a supply concern. The Mission team communicates frequently with our providers about critical drug stock, lab and pharmacy updates, equipment downtime, and other relevant updates.”

The complaint letter is heavily redacted to hide information on specific cancer patient incidents, but says they are “snapshots” of what was happening on Mission’s oncology floor.

“No one can quantify the significance of missing these chemo doses and their effect on mortality,” the letter stated. “Please investigate Mission HCA because people are going to die. These patients need not die unnecessarily.”

Though the NCDHHS sent a letter acknowledging the complaint had been filed, it has yet to send investigators to the hospital, according to nurses.

“Conditions have continued to deteriorate under HCA’s profit-motivated management,” said Elle Kruta, a registered nurse and a member of the Professional Practice Committee, a group of unionized nurses at Mission designated to raise nursing concerns with hospital leadership. “This is why union nurses have been speaking out about patient care, safety, as well as safe staffing. Nurses will continue to advocate for our community to ensure that our patients get the kind of care that they truly deserve.”

Mission has emphasized Messino relationship

The Messino Cancer Centers’ shift away from hematology chemotherapy care at Mission comes on the heels of the North Carolina Attorney General’s office sending letters to Greg Lowe, CEO of HCA’s North Carolina Division, earlier this year demanding answers about a potential depletion in oncology services.

In a June 20 letter, the North Carolina Attorney General’s office cited Mission’s sharp reduction in cancer services, consisting of just one physician “where it once had as many as 14.” It warned Mission that it needed to “restaff the medical oncology department immediately” or risk litigation.

In his response to the attorney general, Lowe emphasized that, although Mission was struggling to recruit oncologists, it was working closely with local groups, including Messino.

In May, Mission spokeswoman Nancy Lindell pointed to Messino as a partner, saying that although Mission was down to a single medical oncologist, the hospital “work[s] very closely with other programs in the area such as Messino Cancer Center and GenesisCare Surgery, who continue to operate every day at Mission Hospital.”

Messino treats patients in Mission’s facilities through practice privileges, and its work there is separate from Mission Health SECU Cancer Center.

Messino broke away from Mission following HCA Healthcare’s $1.5 billion purchase of the nonprofit hospital in 2019 and established an independent practice in January 2020.

Editor’s note: In the initial version of this story, Mission Hospital did not immediately respond to The Watchdog’s questions regarding a chemotherapy shortage. We’ve updated the story after Mission provided comment.

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. To show your support for this vital public service go to avlwatchdog.org/donate.