Doctors decry HCA’s handling of Mission hospital

Doctors decry HCA's handling of Mission hospital

By Andrew R. Jones

Fifty doctors, including a former member of the board of directors of Mission Hospital and a former chief of staff, have written a letter condemning what they say is HCA Healthcare’s “for-profit-driven” management after buying the nonprofit hospital system in 2019 for $1.5 billion.

Dr. Robert Kline, the former board member before the purchase, read the letter Thursday night at a public meeting hosted by Gibbins Advisors, the independent monitor hired by Dogwood Health Trust to oversee HCA’s compliance with the terms of the sale. It was the second of six such meetings planned for western North Carolina.

Map of HCA North Carolina Division hospitals, including Mission Credit: Asheville Watchdog

“Many of the for-profit-driven changes that HCA has wrought, despite advocacy and protests from multiple sectors, have gutted the heart and soul of our community healthcare system,” stated the letter, addressed to Ronald Winters, managing director of Nashville-based Gibbins. “The relationships and deep personal investment that historically mattered to staff across the board have been stifled. Emblematic of this is the loss of over 200 physicians and countless healthcare staff who have left Mission and/or the medical community since the sale.”

Chad Patrick, chief executive of HCA-Mission Hospital, attended the meeting but left quickly without commenting. Later Nancy Lindell, director of public and media relations for HCA Healthcare’s North Carolina Division, which includes Asheville’s flagship Mission Hospital, issued a statement to Asheville Watchdog:

We are pleased that the Independent Monitor acknowledges Mission Health has continued to honor our commitments in the Purchase Agreement.  While quality of care does not fall under the monitor’s role, Mission Hospital is regularly surveyed by officials from The Centers for Medicare & Medicaid Services, The Joint Commission and the North Carolina Department of Health and Human Services to ensure we are delivering safe care. Additionally, other independent third-party organizations have deemed Mission Hospital one of the nation’s best.  

We have numerous opportunities and processes in place for frequent feedback from our patients, colleagues and medical staff. Our Quality and Care Experience teams welcome direct comments about patient care and diligently work to address any concerns during or after a visit. Mission Hospital leaders regularly round on all hospital units and attend shift huddles. There are also multiple professional practice councils, nursing governance, and medical staff committees where we discuss any staff concerns and solutions to address them. Semi-annual employee engagement surveys also provide our teams an anonymous way to use their voice. From these surveys, we have made significant strides in our engagement since this time last year.  

We continue to invest in expanding quality care for the patients we are privileged to serve and are incredibly proud of our teams and their dedication to our community. 

Nancy Lindell, HCA Healthcare’s North Carolina Division spokeswoman

The letter was signed by 42 physicians across a range of specialties, including Dr. Bruce Kelly and Dr. Allen Lalor, a former Mission Emergency Department doctor.

In addition to the 42 named physicians, five initially were listed in the letter as “anonymous” because they were concerned about the possibility of retribution from HCA, Kelly said. By the time of the reading, three more anonymous doctors were added, he said.

“It is difficult, if not impossible, for members of the community to speak with pride about the hospital that has been our healthcare home on the hill,” the letter stated. “It feels like a rental now, the landlord impervious to calls for needed improvements.”

The letter asked HCA leadership to start “meaningful engagement” with doctors, stating that the Nashville-based corporation — the largest hospital system in the U.S. — had shown “little to no interest” in such engagement thus far. 

“We implore HCA leadership to demonstrate substantive collaboration to address the crisis of relationships and resources. We will be forthright and transparent, and we respectfully request the same from HCA,” the letter stated.

Lalor, a plaintiff in a whistleblower lawsuit filed earlier this year alleging fraudulent overcharging by HCA Healthcare, told The Watchdog that the letter writing effort began two weeks ago. 

Asked what he hoped the letter accomplished, Lalor said its intended purpose was “to try and get HCA to behave differently, not as a corporate entity that seems primarily interested in making money, but to run as a hospital system that takes into account the health care of the people in the region … in a way that is not burning out the staff or putting the patients in jeopardy.”

Concerns about quality of care had already surfaced at the first independent monitor meeting Tuesday in Transylvania County, home to Mission Health Transylvania Regional Hospital. Attendees, including Brevard’s mayor, pressed Winters, the Gibbins managing director, for answers on declining quality of care, including the loss of doctors and long wait times at the emergency department. 

An older white man in glasses speaks in front of a podium to a group of people.An older white man in glasses speaks in front of a podium to a group of people.
Ronald Winters, managing director of Gibbins Advisors, listens to an audience member at Thursday’s meeting. // Watchdog photo by Starr Sariego Credit: Starr Sariego

Winters repeatedly responded that many quality-of-care issues fell outside of the 10-year, 15-commitment asset purchase agreement and were matters he couldn’t address.

“We understand that it’s outside the purview of the asset purchase agreement,” Kelly told The Watchdog on Thursday. “And yet, this is an opportunity to have our collective voice heard. It’s an opportunity for us to get that out there, as we continue to build support and represent the voices of physicians across the western region.”

Kelly said the doctors who signed onto the letter will continue to push on HCA, even if nothing changes.

“We continue to build voices that we hope will, at some point, effect some meaningful change,” Kelly said. 

“(The letter) is that it’s just the beginning of hopefully a larger attempt to bring together the community and western North Carolina,” said retired Dr. Mike Messino, founder of Messino Cancer Centers and a signee on the letter. “The independent monitor is not going to do anything and I’m not quite sure where the Department of Justice stands. But if the community knows that there are a number of physicians and other health care people that are really unhappy with the situation, it might bear a little bit of pressure on (HCA).”

An older white man in glasses and a lab coat sits for a portrait.An older white man in glasses and a lab coat sits for a portrait.
Dr. Mike Messino // Photo credit: Mike Messino Credit: Mike Messino

North Carolina Attorney General Josh Stein told The Watchdog in a recent interview that he has been investigating Mission Hospital since the start of the year for potentially not adhering to the purchase agreement after recent deficiencies in cancer care services. Since February, Stein, who is the Democratic frontrunner for governor in 2024, has sent four letters to HCA and two to Gibbins Advisors, seeking information and warning that HCA and Mission face potential litigation if they don’t honor the purchase agreement.

State Sen. Julie Mayfield (D-Buncombe) is supporting Stein. She attended the Tuesday night meeting in Brevard, where she invited audience members to speak with her if they had questions about what the attorney general’s office could do about Mission issues.

“I am glad to see physicians coming together with a collective voice,” Mayfield told The Watchdog on Thursday. “They know firsthand how much the healthcare system and the medical community have been degraded since the sale of Mission. I am encouraged that they now want to collectively dig in and work to repair it.”

The letter echoes a sentiment voiced by unionized nurses at Mission who, according to recent reports from The Watchdogsay HCA has brought a profit-above-all-else mindset to Mission since 2019, which the nurses say is a mindset that is putting patients in harm’s way because of strained staff and rushed procedures. 

“We join the chorus of advocates in asking for the relationships and resources needed for the medical staff, all staff, to function at their highest ability,” the letter stated. “We ask that hospital leadership look at economics as if people mattered. With our many hundreds of years on the front line of patient care, we know what a fully resourced system looks like.” 

“We don’t see it now,” the doctors wrote.

This story has been updated to include a statement from Nancy Lindell, a spokeswoman for HCA Healthcare’s North Carolina Division.

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