Mission Hospital faces an exodus of urologists, and five physicians from a local urology group refuse to practice at the HCA Healthcare-owned hospital, potentially reducing the number of specialists in the system to two by summer.
One Mission Urology physician left in October 2023, another was terminated in January, and one plans to leave by July 4, according to documents and emails obtained by Asheville Watchdog.
Urologists from Asheville Urological Associates — located across the street from the Mission campus but owned by GenesisCare — decided to relinquish their own practice privileges at the hospital and began doing so in 2022, said Jeremy Cloninger, the group’s practice administrator. Relinquishing privileges means doctors decided not to provide care there.
The urologists’ departures follow a larger pattern of employee exits over the past five years, as The Watchdog has reported. The medical oncology group at Mission’s cancer center dwindled to nothing last year, numerous hospitalists fled after the HCA purchase in 2019, and others continue to bow out, all part of a growing exodus of more than 200 physicians. Additionally, hundreds of nurses have departed between 2022 and late 2023, two years marked by federally chronicled patient death and endangerment.
As recently as two years ago, Mission had 10 urologists on call, former Mission Urology physician Dr. Brian Cohen told The Watchdog.
Asheville Urological Associates’ urologists now have practice privileges at AdventHealth Hospital and UNC Health Pardee, both in Hendersonville, according to Cloninger and the Asheville Urological Associates website. The group’s newest doctor, who joined in September 2023, relinquished his Mission privileges in early 2024, Cloninger said.
The Watchdog asked Mission Health spokesperson Nancy Lindell several questions about the departure of Mission Urology doctors, including whether the hospital was recruiting urologists, and the decision by Asheville Urological Associates physicians to relinquish their privileges. Lindell did not directly answer the questions.
“As with any job, there are various reasons why people leave,” Lindell said. “ Out of respect for our current and former employees, we do not discuss personnel matters publicly. Mission Hospital has urologists on its medical staff and, with its affiliates, continues to recruit for any open positions.”
As of this week there was one posting for a Mission urologist on HCA’s career portal.
According to a description of Mission Urology’s services on the hospital system’s website, doctors there “bring state-of-the-art care to our patients, including robotic surgery, urologic cancer care, kidney-stone treatment, female incontinence and pelvic surgery, men’s health including erectile dysfunction and penile implants plus a variety of other urologic conditions.”
Cloninger noted many surgical procedures “could in some form require urology services.”
The staff and physicians listed as associated with Mission Health’s urology services serve all six regional Mission Health hospitals in an 18-county area of more than 950,000 people. Lindell did not answer a question about why members of Asheville Urological Associates were still listed on Mission Health’s website as associated with the hospital system. Cloninger also did not know why the doctors remained on the Mission website.
Most urologists The Watchdog reached did not want to discuss their reasons for leaving or halting practice at Mission or did not return requests for comment.
Dr. Quinton Cancel, the physician planning to depart Mission Urology by July 4, declined to comment. Mission recently sent letters to his patients, notifying them of his plans.
On March 21, Cancel sent an email titled “Resignation” to Mission Health CEO Chad Patrick and copied HCA North Carolina Division President Greg Lowe. Cancel thanked Patrick and Mission Urology for hiring him four years earlier but referenced challenges at Mission.
“While I have enjoyed working with my partners and our awesome staff, the current and future state of Urology at Mission is incompatible with my personal and professional priorities at this point in my life and career,” Cancel wrote. “Although this will mark the end of my current contractual relationship with Mission, I am open to working with Mission, in perhaps a different capacity in the future, to help meet the needs of the community.”
One of Cancel’s patients spoke with The Watchdog on the condition of anonymity because he didn’t want to reveal personal medical information. Cancel’s letter was the second one he received in less than a year from a departing Mission physician. The first was from Dr. Michael Burke, a medical oncologist who left in November 2023.
“The awkward part is you really don’t know what the situation is,” the patient said, noting he had moved to the Asheville area because of its reputation for good health care. “You don’t know if it was just a personal choice, or if it’s related somehow to the Mission practice.”
Though the patient said he’s received appropriate and high-quality treatment at Mission, the departures have left him considering whether he should continue getting care there.
“It sort of places a marker in your mind, you know,” he said of Cancel’s departure. “What’s the next thing that’s going to happen?”
Dr. Matthew Young is another urologist who left Mission Urology, departing at the end of October 2023.
“I want to assure you that Mission Urology Asheville is committed to providing the highest quality of care to our patients and to serving the needs of our community,” Young said in his departure letter to patients. The Watchdog reached out to Young for comment, but did not receive a response.
A return of privileges at some point?
Dr. Brian Cohen, who formerly worked at Mission Urology for more than a decade, told The Watchdog that urologists there were having to take on heavier workloads after some Asheville Urological Associates decided to not practice at Mission.
Cohen was terminated without cause in January, meaning he wasn’t given a specific reason.
“I’m pretty sure they just got rid of me because they got sick and tired of hearing me voice my frustrations and voice my complaints,” Cohen said. “I’m not a compliant person. I’m certainly not built for corporate medicine, I can assure you of that.”
More broadly, Cohen said, the situation across departments at Mission was “deteriorating”: There were departures because of pay, issues in the operating room, a heavy reliance on traveling nurses, and especially issues with how HCA was managing the hospital. He expressed concerns to hospital administration, he said, but nothing came of it.
“I would get increasingly frustrated with the situation of, you know, not feeling supported from the… administrative side of things,” Cohen said.
Cohen now works as a locum tenens physician, filling in for absent doctors. He routinely works in Michigan, he said, though he continues to live in western North Carolina.
The Watchdog contacted most current Asheville Urological Association doctors regarding their decision to relinquish privileges at Mission. Only one responded.
“Out of courtesy for physician colleagues within the Mission system I would prefer to step aside of any direct dialogue related to the decision of providers within our group to suspend active privileges at Mission Hospital,” Dr. James Brien said in an email.
Cloninger would not speak directly to the reasons behind Asheville Urological Association doctors’ decision, but noted there were a “host of reasons,” and said “the consensus was just expectations for when they’re on call for the hospital and coverage of multiple hospitals while on call.”
Cloninger said “it was a personal decision for all of them,” adding that the doctors may pursue practice privileges at Mission again, depending on what happens there in the coming months and years.
“Our doctors may get privileges again one day at the hospital system,” Cloninger said. “They didn’t step away with the intention of never coming back. But there has to be some… larger scale changes made to allow them to make that independent decision.”
In February, the U.S. Centers for Medicare & Medicaid Services found Mission to be in immediate jeopardy, the most severe sanction a hospital can face. CMS removed the finding less than a month later, but the hospital still faces the potential loss of federal funding due to numerous deficiencies outlined in a 384-page report.
That report came after a CMS and North Carolina Department of Health and Human Services investigation in November 2023, which found 18 people were harmed or died at the hospital from 2022 to 2023 due to conditions that violated federal care standards.
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. The Watchdog’s reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/donate.
And HCA continues to give itself awesome reviews for its “Mission.”
The tragedy of HCA corporate greed and mismanagement will continue to lurk in the minds of the people in our community. Competent quality healthcare should be the least of our concerns. The safe place we all loved on the “hill” continues its demise.
Corporate greed and intrigue. Suggest that everyone read the novel MERCY by Michael Palmer and Daniel Palmer. It is available for free on NC Digital offered by the Buncombe County public library. Draw your own analogies and conclusions with what has been going on since HCA bought out Mission Hospital.
What next?
How about those patient lawsuits I have mentioned before? When will they start?
HCA is happy to separate from nurses, staff, and physicians who have genuine concern for people and can stand up to the interference of administrators in medical decisions. HCA will replace these professionals with ‘gig docs’ that will make medical decisions based on maximizing profits by denying treatment. These employees will be young and their jobs retained at the pleasure of Mission/HCA. They can be fired easily, quickly, and without legal consequence. Thus, they are easily controlled and have no experience of the norms and standards of care previously practiced. Quality of treatment will erode, as is evident now; prices will increase as will personal bankruptcies caused by medical events.
Mike Reynolds
Since the doctors will be working for profit and agreed for HCA, you might not be able to trust the diagnosis to be accurate because the diagnosis might be based on the most amount of money that mission can possibly get.
Agree.
I for one was so disappointed about losing Dr Cohen as my doctor. I had bladder cancer on his watch and it has been in remission since 2019. Thank you Dr. Cohen.
As a patient of other Mission practices I believe they have really compromised health care to this community and I haven’t seen anything to persuade me they are making any changes other than marketing more.
As a paraplegic I have to use catheters and I have been a patient of Mission Urology for ten years. In the last 18 months I have been assigned to four different members of this practice due to people leaving. It has been very challenging to get my catheters due to fact that every time I need a new prescription I have to go see the new member that I am assign to. The new member can’t write a new prescription without seeing me.
They should have the other practice provider cover your needs if you have been seen within the last year. COC is the Law, and they can’t just keep making you come in for a refill if it is within a year
HCA has got a tiger by the tail. If they think that the local population is going to tolerate their greed and mismanagement of our once outstanding medical facility, I believe they are getting a clue that it is not going to happen according to their scenario. Not only are competent Doctors and Nurses leaving in droves, it is becoming impossible to recruit replacements because of the reputation that HCA has made for itself as a greedy, uncaring corporate monster. The sooner this bunch of ghouls fold their tent and leave town the better for all concerned.
I am a patient of Asheville Urological Association and was happily surprised when I was told they no longer work with Mission.
The funny thing is that they are directly across the street from the hospital, you couldn’t get any closer- and they all want to work with hospitals in Hendersonville.
Let that sink in!
Dr. Cohen was my son’s doctor. He was wonderful! He improved my son’s life. My son enjoyed talking him. Its very sad we lost a very good doctor and many others thanks to HCA!
Will the last person to leave please shut off the lights. I find this whole situation akin to watching a slow speed wreck. You just keep asking yourself, when will it stop.
Bob, hopefully it will end when a more caring hospital takes Mission from HCA such as Duke or UNC. My experiences there have been horrific , both professionally and personally. Western NC deserves better than this.
Totally agree and we had much better with Bob Burgin’s administration until he retired and Joe Damore/Brian Aston took the helm. Their “leadership” lost Mission many experienced folks and opened the door for Ron Paulus and HCA.
Like everyone else, I furiously resent how HCA has decimated the healthcare I depended on for my family and friends!
Personally, I am holding out hope for Advent or UNC to either take over or ramp up their existing services, especially with Advent’s plans for a new hospital in Weaverville.
Dr Cohen was my doctor for many years and he was terrific. I was quite shocked when I received a letter saying he was leaving. Now I read he was terminated. Even more shocked. HCA can be accurately described as a gang of corporate thieves. My next surgery will be at either Pardee or Advent. Playing with peoples health to make millions – no, billions.
Disgusting.
I couldn’t agree more!
Crystal clear HCA’s Mission is a failed operation. Helpful if future related reporting would point to practice alternatives.
All the wealthy retirees moving to Asheville will not realize how few health care choices exist there until after they have unpacked their boxes. These privileged Medicare patients want concierge care from overworked, underpaid physicians. I used to work in health care in WNC until I left for greener pastures.
I find this comment grossly wrong and unfair. Do you think medicare is a privilege? Concierge service, really? From the government? Please, we wait for appointments just like the rest of you, we do not get special privileges. And medicare is not some “privilege, as you seem to think. It is earned through paying into it your whole working life. It is not medicaid, which is given, not earned. And wealthy retirees? a lot of us are just here to try and stretch our retirement money a little further. We are not rich, we are struggling just like you all are. We do not all live in Biltmore forest. We live in places like leicester. If the physicians are overworked and underpaid, please write to HCA about that. Privileged Medicare patients my butt.
Bob,
Thank you for your response. You are absolutely correct, Medicare is earned, like Social Security. Most retirees I know live on a fixed income that is a decrease from their wages when they were working. Like you and many others, I paid into Medicare and Social Security for 45 years before I retired.
Mission Urology has suffered significant losses over the past 18 months. They lost the best Manager and Jessica during that time. I have been a patient for 12 years and never encountered such a dynamic of excellence by the Office Manager, Jessica, and Dr. Cohen. Dr. Cohen’s departure is particularly disheartening. He genuinely cared about his staff, and it was evident that they enjoyed working with him. I also witnessed Dr. Sech’s departure under similar circumstances. It’s puzzling why they let go of two exceptional providers. The practice will now struggle to provide all the services Dr. Cohen and Dr. Sech specialized for our community. Why HCA why? 💰 🤑 💸
when my husband was a patient at Mission a couple of years ago
they lost one of his new and expensive hearing aids. I never could
find out how to file a claim. Cost me $250.
he had both of his hands and one shoulder and could not feed himself.
they just put the tray in front of him. never fed him.
I just had a hip replacement…..at Pardee!
Contrast that with my surgery at UNC Chapel Hill 2019. I left my inexpensive cell phone on the bed when I went to the bathroom and it got caught up in the sheets when the CNA changed my bed. A very nice security guard went to the laundry room and called my phone until he found it. Now that is true care!
“18 people were harmed or died at the hospital from 2022 to 2023”. Curious how the number of these types of deaths at Mission compare with other hospitals with similar patient loads.
What will it take to make Advent a trauma center? From my experience with Advent doctors and their system, they are patient centered and caring.
If we can support Advent change their existing or new facility status, let us know what we can do to support that effort!
Andrew, thank you for your continued in depth reporting on the vital medical care issues adversely impacting WNC healthcare. I’ve never been in a community where there has been so much turmoil regarding a major hospital—where entire specialities leave—doctors and nurses pick up and leave their communities and reported deaths in the ER, resulting in an Immediate Jeopardy status.
But, until recently, I’ve not lived in an area where I had to depend on HCA for my healthcare either!