Web of Mission Health litigation grows. Buncombe seeks to join attorney general’s case against HCA.

Mission Hospital's north tower in Asheville, seen in 2019. Colby Rabon / Carolina Public Press / File

Emergency room understaffing at Mission Hospital in Asheville is costing taxpayers by making EMS workers wait longer to offload patients, Buncombe County is claiming in a proposal filed earlier this month to join North Carolina Attorney General Josh Stein’s lawsuit against the hospital’s owner, HCA Healthcare.

The attorney general’s lawsuit, filed in December, claims HCA isn’t providing the level of care the for-profit Tennessee-based company promised when the state approved HCA’s acquisition of the Asheville-based Mission Health System in 2019.

Buncombe County’s proposal, filed April 3, is just the latest development in the web of litigation that HCA faces over its management of Mission Health, which operates hospitals and other health care services in several Western North Carolina counties.

Buncombe County is already a co-plaintiff in a federal antitrust lawsuit against HCA filed in 2022, joining the City of Asheville, City of Brevard and Madison County.

A group of individual plaintiffs also filed a class action antitrust lawsuit against HCA in 2021 in state business court. The plaintiffs alleged they had to pay more for health care services because of what they claimed were HCA’s monopolistic practices.

Buncombe County’s April 3 motion to intervene in the attorney general’s suit offers both to express support for the case and to demonstrate to the courts how the county was affected by HCA’s practices, a county press release said.

The county is seeking $3 million in damages because HCA deliberately understaffed the Mission ER, which led to the county EMS crews experiencing “excessive wait times” while transferring patients there, according to the proposed intervenor complaint. EMS workers had to attend to the patients long after arriving at the hospital, Buncombe County’s complaint claims.

EMS wait times at the hospital increased from around 9:41 minutes in the first quarter of 2020 to 17:41 minutes in the third quarter of 2023, the county’s complaint says.

The time in which 90% of EMS patients were transferred to the ER increased from around 16 minutes to more than 32 minutes, the compaint says, exceeding the national standard of 20 minutes, as reported by the National Emergency Medical Services Information System.

Since early 2020, this has meant taxpayers “provided a benefit to HCA of more than $3 million” because HCA relied on county EMS to treat its ER patients, according to the county.

HCA did improve ER staffing after being sued by the attorney general and a federal regulator’s finding of immediate jeopardy. So far in 2024, HCA decreased the wait times so that 93% of transfers are within the 20-minute standard.

But the county’s complaints says those improvements only came as a result of governmental action. HCA could revert to past practices that endanger patients at any time, the county said.

The longer waits meant EMS crews couldn’t get back out in the community and respond to incoming 911 calls as quickly, Brownie Newman, chairman at large of the Buncombe County Board of Commissioners, told Carolina Public Press.

“There’s both harm to patients’ health and an adverse effect on county taxpayers as well,” Newman said.

While the county would have invested in EMS staff regardless because of the growing community, Newman said HCA’s practices at Mission Hospital ER “stretched our resources further and contributed to the need for additional staffing above and beyond what we would have been doing.”

Buncombe County employed around 160 EMS paramedics for the past five years, according to the complaint, all of which transport patients to Mission Hospital ER.

The county wasn’t required to ask the attorney general’s office for permission to file the motion to intervene, but did communicate with Stein’s office beforehand, Newman said.

The attorney general and HCA jointly submitted a case-management report for the case Feb. 27, which includes each parties’ requested timeline for the case. Stein’s office proposed a seven-month fact-discovery period and three months for expert discovery. HCA asked for a shorter timeline: five months for fact discovery and two months for experts with a trial in late October 2024, according to the report.

HCA spokesperson Nancy Lindell said in an email to CPP regarding the timeline proposal, “We believe we are in compliance with the APA and would like to have this resolved as soon as the court deems appropriate.”

Federal antitrust case

The attorney general’s case involves “related but distinct” issues to those in the federal antitrust case against HCA that Buncombe County is involved in, Newman said.

A judge denied HCA’s motion to dismiss the antitrust case Feb. 21, allowing it to move forward.

Brad Branham, city attorney for Asheville, said in an email to CPP that discovery for the case is just beginning and will likely “take some time.”

The city doesn’t currently plan to file a motion to intervene in the AG’s suit like Buncombe County, Branham said.

The city’s goal in the federal case is to end HCA’s “unfair monopolistic practices” and receive compensation for financial damages, he said.

The City of Brevard self-insures its employees, so HCA driving up prices costs the city more for a lower quality of care, mayor Maureen Copelof told CPP.

Copelof said she’s optimistic about the federal lawsuit against HCA because the judge allowed it to move forward. Federal regulator reports of deficiencies at the hospital also led credence to issues in the case, she said.

“You have cities and counties suing HCA, you have the Attorney General suing HCA, you have individuals suing HCA, so it raises the question, what is going on?” she said.

Apart from the lawsuit, Copelof said she personally would like to see HCA sell the hospital to a nonprofit owner. But when she asked the HCA CEO Sam Hazen almost two years ago whether the company would consider selling, it was a “hard no,” Copelof said.

“The HCA corporate approach is not suited to a rural environment like Brevard, North Carolina,” she said.

State class action suit

The group of five individuals suing HCA for monopolization have health insurance plans ranging from self-funded plans, private group health care plans and policies under the Affordable Care Act. All allege they had to pay higher amounts due to HCA’s conduct.

Plaintiff William Alan Davis, from Clyde in Haywood County, alleged HCA closed down his physician’s practice, which was under the Mission Health umbrella, on short notice. The suit alleged he and other plaintiffs paid “artificially high premiums, co-payments, deductibles, co-insurance payments, and/or out-of-pocket payments not covered by the health plans.”

Another plaintiff, Jonathan Powell, from Morganton in Burke County, claimed HCA caused his physician to quit by overloading him with patients. Otherwise he would still be able to receive care from the physician who was “most knowledgeable” about him and his condition, the suit said.

In response to all three lawsuits, HCA spokesperson Lindell said over email, “We disagree with the allegations and will defend ourselves through the legal process. At Mission Hospital, we are proud of our team and the many accolades from independent organizations, including being one of Healthgrades 50 Best hospitals and our 5 straight Grade As from Leapfrog.”

While those organizations do rank Mission Health highly, the methods behind those rankings don’t always look at the issues brought up in the lawsuits, such as emergency department care.

CPP has previously reported that while Mission has been highly rated by the particular rankers Lindell mentioned, those organizations don’t always look at the same things being addressed in the lawsuits or used as criteria by different rankers, some of whom have not given Mission such a favorable ranking.

This article first appeared on Carolina Public Press and is republished here under a Creative Commons license.


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2 thoughts on “Web of Mission Health litigation grows. Buncombe seeks to join attorney general’s case against HCA.

  1. Voirdire

    So very predictable.. and so lame… “In response to all three lawsuits, HCA spokesperson Lindell said over email, “We disagree with the allegations and will defend ourselves through the legal process. At Mission Hospital, we are proud of our team and the many accolades from independent organizations, including being one of Healthgrades 50 Best hospitals and our 5 straight Grade As from Leapfrog.” The bottom line here… you can sue HCA all you want but it’s basically going nowhere and they know it. What needs to happen is a grand jury needs to indict Paulus, Green and HCA for the fraudulent “purchase” of Mission foisted upon the unwitting Mission Hospital Board of Directors by Paulus and Green ( ..Paulus immediately went to work for HCA officially after the his role in this sham of a sale). Then, and only then, will HCA be motivated to begin to unwind their “purchase” of Mission Hospital.

  2. WNC

    NC Attorney General Josh Stein could have sued before hand in an attempt to block the sale . Instead waiting until it was a done deal and election year ( as he now wants to be Governor).
    Yes the person who approved the one bid sale should be investigated, could it be an offense worthy of prison? Maybe.

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