Will Mission community meetings allow public comment?

By Andrew R. Jones, avlwatchdog.org

Six public meetings meant to give Western North Carolinians a chance to give feedback on how well Mission Health hospital system is complying with its purchase agreement after its 2019 sale to HCA Healthcare may not allow attendees to ask questions or comment in front of the entire audience.

Organized by Gibbins Advisors, the Nashville-based firm hired by Dogwood Health Trust to monitor Mission Health’s compliance with a 10-year, 15-commitment purchase agreement after its $1.5 billion sale to HCA, the meetings will begin this week and have been billed as an opportunity to “ask questions and provide feedback,” according to notices sent out last month.

The first meeting will be held at 5:30 p.m. Oct. 17 at Brevard’s Thomas Concert Hall. The second will be held at 5:30 p.m. Oct. 19 at Asheville’s Scenic Hotel. Others are planned for Macon, Jackson, McDowell, and Mitchell counties and will stretch into 2024.

Gibbins co-founder and managing director Ronald Winters would not answer direct questions and multiple follow-ups from Asheville Watchdog whether the meetings would allow traditional public comment during which people could address Gibbins and all other attendees.

Sen. Julie Mayfield, D-Buncombe, said when she spoke to Winters recently, he told her there would be a PowerPoint presentation and tables where people could express concerns and get information, but there would be no time for attendees to address the room, as is standard in public comment periods and was the case when Gibbins held its first public meetings in early 2020.

The Watchdog asked Winters a number of questions, including:

• Will there be a public comment portion of the upcoming IM (independent monitor) meetings this fall and winter — that is, a time in which people can speak publicly for the whole room to hear?
• Will there be a public Q&A session?
• Has the IM decided to change the format of the meetings to allow for public comment and/or Q&A?

“Our team will, of course, take questions and concerns specific to the [purchase agreement], including those about oncology services at Mission,” Winters said, noting representatives from the North Carolina Department of Health and Human Services were invited. He did not answer whether the questions and answers would be available for the entire room to hear.

Mayfield told The Watchdog that she told Winters emphatically that “I thought they needed to set aside time for public comment.”

“I said, ‘Even if it’s just an hour, and you limit people to two minutes, it’s just really important for this community to have that opportunity,”’ Mayfield told The Watchdog.

Mayfield said Winters told her he would take her recommendation back to Dogwood Health Trust, who also will have representatives at the meetings. The Watchdog asked Winters directly if this were the case, and he didn’t provide answers.

In presentations to the North Carolina attorney general’s office and Dogwood, Gibbins has said its annual compliance review process includes a 75-day period beginning in April when, among many actions, it would hold public meetings. Those weren’t announced until September this year. The attorney general’s office criticized Gibbins about the lack of meetings in a June 20 letter, which alleged the firm had a “poor relationship with the public.”

“Today, however, Gibbins Advisors only offers meetings to individual community groups at its convenience. Public engagement is essential to maintaining the public’s trust,” the June 20 letter said. “We urge Gibbins Advisors to conduct semi-annual, announced meetings with the general public.”

The attorney general’s office also on June 20 sent a letter to Mission leadership expressing concern the hospital’s SECU Cancer Care Center had only one medical oncologist on staff after having 14. The Watchdog recently reported the doctor would leave Mission by late November.

A representative for the attorney general’s office will attend all or most of the meetings, according to spokesperson Olivia Weidie, who deferred to Gibbins on a question about public comment.

In emails to The Watchdog, Winters repeatedly pointed to Gibbins’ limited ability to address community concerns.

“[M]embers of the community had concerns and issues outside of the Asset Purchase Agreement and that went beyond our role as IM to review and evaluate compliance of the 15 [purchase agreement] commitments,” Winters said of Gibbins’ first public meetings in 2020.

Gibbins since has organized smaller meetings with local organizations, and hospital advocates helped Gibbins narrow focus to issues related to the purchase agreement, Winters said.

“The meetings moving forward are continuing that practice and are designed in a way to allow people to more effectively share concerns pertinent to those matters,” he said. “We understand the community’s frustration with patient care, safety and other services outside of the APA, and we believe that the most effective way to encourage positive action is by direct conversations with those who have the authority to address community concerns.”

Community members still want more from Gibbins, Dogwood and the attorney general’s office.

Brevard Mayor Maureen Copelof recently was part of a group of Transylvania County residents who surveyed their community in 10 public meetings and created a report on the quality of care at Transylvania Regional Hospital, part of Mission Health’s network. The effort was not part of the formal asset purchase compliance process.

Copelof has met with North Carolina Attorney General Josh Stein, Dogwood, and Gibbins, but said she doesn’t know how much power the three have to make effective change because of the purchase agreement’s limitations.

Stein told The Watchdog in a recent interview that he was investigating Mission Hospital for potentially not adhering to the purchase agreement after recent deficiencies in cancer care services.

“My concern is … that the scope of what [Winters] looks at is limited to what’s in the asset purchase agreement,” Copelof said. “But I do think it’s important that he understands, that he hears from the community that there was a lot of discontent, that we have a lot of loss of trust, that an awful lot of our people are now going elsewhere for their health care.”

The six upcoming meetings may not have happened at all without a letter from the attorney general, which questioned why the firm wasn’t pursuing more public interaction in the June 20 letter.

“[The letter is] what prompted Gibbins and Dogwood as our determination to schedule the meetings at this time,” Winters said.

A delay in public meetings

A recently published summary of Gibbins’ Aug. 31 meeting with Dogwood and Stein’s office suggests it should have held public meetings long before October.

In its monitoring role, Gibbins completes an annual compliance review, which is supposed to last 75 days from the end of April and includes receiving reports, reviewing documentation, visiting Mission facilities, and seeking input “from key stakeholders,” according to the summary.

The process includes public meetings, according to the monitoring timeline Gibbins presented to Dogwood and the attorney general’s office at the Aug. 31 meeting.

But no public meetings were announced between April and July this year, meaning the latest compliance report was created without community feedback.

“Even though public meetings are not a requirement of the asset purchase agreement – which guides our work – we held public meetings in 2020 and 2021,” Winters said. “And while we did not hold public meetings in the timeframe you reference, they are a part of our plan for the rest of 2023 and 2024.”

Winters would not say why Gibbins did not hold public meetings during the 75-day period even though the review process he presented to Dogwood and the attorney general said such meetings were part of that process.

Dogwood, which also will send representatives, declined to answer questions about why the meetings did not happen earlier in the year, deferring instead to Winters.

The summary of the Aug. 31 meeting was posted to Gibbins’ HCA/Mission health monitoring website because of the attorney general’s criticism of Gibbins in the June 20 letter, Winters said.

The summary details for the first time publicly how the three entities involved in the  Mission purchase accountability process work together.

No other Gibbins-Dogwood-attorney general meetings notes have been published.

“To date, meetings held among Dogwood, the IM [independent monitor] and the AG’s office have been held on an as-needed basis,” Winters said in an email to The Watchdog. “Because of the nature of those meetings, an expectation to post meeting summaries did not previously exist.”

Winters said that, at the attorney general’s request, Gibbins recently moved to a more formalized schedule for meetings and will now post all summaries to its website. The Aug. 31 meeting was the first of these “more formal meetings,” Winters said. The next meeting among Dogwood, Gibbins and the attorney general’s office is Dec. 5.

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.