Watchdog event panelists decry HCA, call for improved care at Mission Health

by Andrew R. Jones, avlwatchdog.org

An Asheville Watchdog community event focusing on the crisis of health care at Mission Hospital drew an audience of about 350 on Jan. 23, amid calls for HCA Healthcare to overhaul the way it has managed the hospital system since it bought it in 2019.

The event, titled “HCA-Mission at Five Years: What Can We Do to Restore Better Healthcare in WNC?” was held at A-B Tech as the five-year anniversary of the $1.5 billion sale to HCA approaches.

“Five years ago, Mission’s board of directors sold the system to HCA Healthcare of Nashville, promising that the sale to the hospital giant would lead to higher-quality, more accessible, and lower-cost health care for the people of Western North Carolina,” The Watchdog wrote in its invitation to the event.

“Now, after five years of HCA management, there’s a broad consensus that the exact opposites have occurred. The question now is: What can we, the citizens of Western North Carolina, do to once again have the best-in-class, accessible and affordable health care we used to expect?”

Watchdog Executive Editor Peter Lewis put similar questions to five panelists: Dr. Clay Ballantine; Brevard Mayor Maureen Copelof; Dr. R. Bruce Kelly; patient advocate and nurse Karen Sanders; and state Sen. Julie Mayfield, D-Buncombe.

The event began with a video statement from N.C. Attorney General Josh Stein, who declined The Watchdog’s invitation to attend.

“Like all of you, I am deeply concerned about health care in Western North Carolina,” said Stein, who is running for governor as a Democrat and filed a lawsuit against HCA and Mission last month for allegedly violating parts of the asset purchase agreement it signed as part of the sale, specifically its emergency and cancer care. He reiterated his view that HCA is not living up to the purchase agreement.

Kelly referred to the issue as “a manufactured crisis,” repeating the words of Mission emergency department nurse Hannah Drummond during Stein’s news conference announcing his lawsuit. “It doesn’t have to be this way. [HCA is] making plenty of money, and they could make choices that would bring this health care system back.”

The Watchdog invited several executives from Mission Health and HCA, including HCA N.C. Division CEO Greg Lowe, Mission CEO Chad Patrick and HCA spokesperson Nancy Lindell, to participate in the panel. All declined.

Susan Mims, CEO of Dogwood Health Trust, was also invited. While she declined, she provided a statement, which read in part: “Our community’s distress regarding the quality and accessibility of health care services at Mission/HCA is of great concern to Dogwood; however, our role in monitoring HCA is constrained by the legal parameters of the Asset Purchase Agreement.”

Each panelist gave an introductory statement. All were critical of Mission’s and HCA’s management of the hospital. Some became emotional: Ballantine choked up while describing the exodus of physicians, and Copelof’s voice rose with fury as she described  HCA’s negative impact on Transylvania Regional Hospital, which serves her community.

“Where do we go from here?” Copelof asked the audience. “We are fighting for the truth. We are fighting for something precious. We are fighting for the health and welfare of the people that we love.”

Sanders, who teaches medical practice ethics, addressed the impact that a lack of staff has on nurses.

“We have nurses and physicians and many people working with death by a thousand cuts,” she said.

Mayfield said political leaders, doctors, nurses, religious leaders and others are working as a coalition toward reform and have received numerous stories from patients about issues at Mission.

“The No. 1 thing you can do is continue to share your stories about your experiences at the hospital,” Mayfield said.

Ballentine and Kelly simultaneously praised doctors and nurses while decrying the system under HCA.

“We want to be clear that the staff at Mission are doing heroic work,” Kelly said, speaking for Western North Carolina doctors. “We have the highest respect for those that are working to improve the system from within.”

Ballantine directly connected declines in health care quality at Mission to HCA’s business model, which he said revolves around culling physicians and nurses.

“The overarching trend is Mission makes its money by cutting out staff,” Ballantine said. “When you take a busy medical practice, you’ve got to have staff, and whatever Mission’s had their hands on, they’ve cut the staff and curtailed the availability of those services. Doctors and nurses are perfectly accustomed to working hard. In this setting, though, it’s not because of the jobs that all these people have left. They’ve uprooted their families, they’ve gone to other communities because they have bad management.”

Watchdog has reported extensively on Mission, tracking complaints from Mission nurses regarding quality issues there. In November and December, the N.C. Department of Health and Human Services investigators visited Mission and ultimately recommended that the hospital be placed in immediate jeopardy, the most serious sanction a hospital can receive and a threat to the hospital’s U.S. Centers for Medicare & Medicaid Services funding.

Mayfield said Tuesday that when the hospital submits a plan of corrective action around the immediate jeopardy findings, she and other leaders will review it “with a fine-toothed comb.”

Answering Lewis’ question, “Are we in the worst-case scenario right now?” Mayfield described the potential loss of CMS funding as catastrophic.

“As bad as things are in the hospital, closing this hospital would be 10 times worse,” Mayfield said.

Leading up to the public event and the five-year anniversary of the sale, The Watchdog recently made an effort to speak to all members of the Mission board at the time of the sale, posing the question: Did the sale of nonprofit Mission to for-profit HCA Healthcare turn out the way you hoped it would? Only a couple of members of the board, which had unanimously approved the sale, were willing to 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.