By Andrew R. Jones
A broad coalition of western North Carolina doctors, patient advocates, clergy members, a state senator and others are calling on HCA Healthcare to give up the Mission Health network, decrying the level of care it has provided since its $1.5 billion purchase in 2019.
The five years since the acquisition of the then-nonprofit hospital system by HCA, the nation’s largest health care corporation, have been defined by “a marked divestment in staff, resources, and services,” the group contends. It describes the exit of hundreds of doctors and nurses and the closure or departure of medical practices throughout the region, according to documents obtained Monday by Asheville Watchdog that outline the group’s intentions.
The coalition, Reclaim Healthcare WNC, also describes “a culture of disrespect, intimidation and widespread fear of retribution,” on the part of HCA.
The coalition’s stated goals are:
- Replacing HCA with a nonprofit owner committed to meet the health care needs of western North Carolina residents
- Holding HCA accountable for its harmful practices
- Restoring best-in-class care throughout the system
“We do not want the quality of our health care to be publicly traded,” one of the documents states. “We do want a restoration of the trust and pride Mission once held in our community and Region.”
The Watchdog also obtained an op-ed column written by the group, which says it will be published in the coming days in the Asheville Citizen Times.
The Watchdog reached out to HCA and Mission Health for response to the group’s mission. “You should have what you need from us as we have provided you with information and responses the numerous other times you have reported on opinions from members of this group,” spokesperson Nancy Lindell said.
HCA is a Fortune 100 company, the largest system of its kind in the U.S. with more than 185 hospitals. It saw nearly $65 billion in revenue in 2023, which included $5.2 billion in profits. On Tuesday, when it reported a net income of $1.46 billion for the second quarter of 2024, its stock price jumped more than 7 percent in premarket trading.
The health care behemoth has remained largely unscathed in the face of several western North Carolina class action lawsuits, each to which it has assigned numerous attorneys. Aside from losing a Certificate of Need bid in May to bring 67 new beds to the region, HCA has rarely failed to achieve its goals and flatten opposition in the region.
The group’s leading members include Sen. Julie Mayfield, D-Buncombe; Bruce Kelly; Robert Kline, a former Mission board member before its sale; former Mission emergency department doctor Allen Lalor; Mike Messino, founder of Messino Cancer Centers; registered nurse Karen Sanders; Brevard Mayor Maureen Copelof; and Miriam Schwarz.
The coalition emphasized that the burden of HCA’s failures doesn’t rest on the backs of nurses and doctors, according to one of the documents.
“We have the deepest respect and gratitude for all the staff working at Mission,” the document stated. “The litany of problems are not on them. There remain pockets of excellence thanks to the dedication of those working within the system.”
The group’s plans are short on specifics, but it intends to achieve its goals by adding members, holding HCA accountable through state and local regulatory agencies, searching for innovative solutions and publicizing issues in the press.
Mayfield has been at the organizing forefront for the group. In April she discussed preliminary visions of the effort at an Osher Lifelong Learning Institute gathering at the University of North Carolina Asheville.
“The North Star in our community, and this is all of western North Carolina, is quality, accessible, affordable health care,” she told about 175 people gathered in person and online. “That’s the North Star. HCA is not providing it. There’s no question about that right now. Therefore, the option is they provide it or they leave. We have come to the conclusion that they will never provide it. Therefore they must leave.”
Former Mission chaplain Missy Harris, a coalition member and a co-pastor for the Circle of Mercy congregation in East Asheville, said the group is undeterred by the challenge ahead.
“We’re realistic,” Harris said. “We know what we’re up against, and we also know the power of community and people using their voices to speak out and our hope is that this group will be a place that can gather all of that support and be strategic about the pressure that we’re putting on the system.”
The previous unnamed coalition has put pressure on HCA since late 2023. In October, 50 doctors signed a public letter to the independent monitor of the Mission sale that said HCA had ”gutted the heart and soul of our community healthcare system.” Since then, the list has grown to more than 250 signatures.
Amid a 2023 investigation by North Carolina Attorney General Josh Stein, disparate parts of the group began to coalesce: doctors, elected officials, a member of the clergy, nurse, patient advocates and WNC residents who want better from HCA.
Stein, the Democratic gubernatorial candidate, filed a lawsuit in December against HCA and the Mission System, alleging they were not providing the same level of cancer care and emergency department services as the six-hospital system did before the purchase. Members of the now-formalized coalition flanked the attorney general at his announcement of the suit in Asheville.
HCA has challenged Stein’s allegations, contending that the Asset Purchase Agreement, a series of commitments it made at the time of its purchase, did not include a promise to provide quality health care.
After Mission Hospital inspections by the North Carolina Department of Health and Human Services in late 2023, the agency recommended the U.S. Centers for Medicare & Medicaid place Mission Hospital in immediate jeopardy, the harshest sanction a hospital can face, for a litany of violations of federal care standards.
A 384-page CMS report detailed widespread failures by HCA and Mission management to provide quality care and chronicled the deaths of four patients and the victimization of dozens of others because of delays in care, neglect, long waits for lab work, unapproved and expired medications, and other issues.
When CMS followed through with NCDHHS’ recommendation in February and when Mission provided CMS with a plan to fix the deficiencies, the coalition sent a letter to Mark Benton, NCDHHS chief deputy secretary for health, calling the plan “insufficient” because it had no commitment to staffing the hospital with more full-time nurses.
Now, with a name, a contact form and a forthcoming website, Reclaim Healthcare WNC will attempt a mammoth task in getting the largest hospital company in the U.S. to sell one of its most profitable enterprises.
“We’re not naive,” Mayfield told the OLLI attendees. “I want to be clear about that.”
Mayfield said there were two main questions in getting HCA to sell Mission.
“One is, will they sell it? And the other is, will somebody buy it?” Mayfield said. “The great thing is there are people who will buy it. There are companies who would buy it tomorrow, if it were for sale. So, we don’t have to worry about that side of the equation. And the other good thing is that those companies are paying very close attention to what is happening in this community now and whoever buys this hospital knows that they are coming into a community that is paying attention.”
Though Mission Hospital is no longer under threat of losing CMS funding, fury in Asheville’s medical community still rages. Nurses are threatening to strike after their union and Mission management were unable to reach a new labor contract by July 2. A handful have stood beside coalition members in recent months, supporting the pressure on HCA and demanding better working conditions for employees and patients.
“Why are we talking about a strike? It all comes down to patient safety,” union nurses said in a Facebook post at the beginning of July. “We need to be able to recruit and retain excellent, experienced nurses and have enough staff to care for our patients. But HCA thinks the status quo is good enough. We all deserve better.”
[Editor’s note: This story has been updated with a response from a Mission Health spokesperson.]
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 [email protected].
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