They chose Asheville to live out their retirement years, drawn to the area not just for the mountains, the food, and the culture, but also for the safety net of a healthcare system considered one of the best in the country.
The flagship Mission Hospital provided a level of care that helped put Asheville on national lists as one of the top places to retire. One in five Buncombe County residents is now 65 or older. As recently as 2018, for the sixth time in the previous seven years, Mission Health was named one of the nation’s Top 15 Health Systems by IBM Watson Health.
But also in 2018, in a surprise decision, Mission’s board of directors voted to sell the successful nonprofit to HCA Healthcare — the largest for-profit hospital chain in the U.S., with a reputation for cost-cutting and skimping on staff. Soon after taking over, HCA raised prices across the board, and complaints about staffing and quality of care began rising as well. Many retirees and former patients said they were angered and disillusioned.
Some local residents, including those who spent their careers in medicine, are now traveling to other cities or even other states for their health care.
This is Part 3 of Asheville Watchdog’s series “Mission: Doctors, Nurses, Patients.” Read Part 1 here. Read Part 2 here.
Mission’s stellar reputation attracted Henrietta Cutler, a former vice president of nursing at Westchester Hospital in New York, and her husband to Asheville in 2009. “It was the best decision we made,” she told Asheville Watchdog. “But I’m not sure I’d do it again because of the change in healthcare.”
After being diagnosed with breast cancer in December 2019 and hearing of bad patient experiences at Mission from friends and news stories, Cutler said, she opted to go to New York for treatment at Memorial Sloan Kettering Cancer Center. “I shouldn’t have had to go to Sloan Kettering,” she said.
“Healthcare is a huge issue” for most retirees, Cutler said, and questions about Mission’s quality of care “are going to start affecting whether people move to Asheville.”
“It is always disappointing to find that any individual was unsatisfied,” Nancy Lindell, director of public and media relations for HCA Healthcare’s North Carolina Division, said, adding, “Quality patient care is Mission’s top priority and it is our goal that each of the more than 2 million patient encounters we have each year are positive ones.”
“We welcome direct feedback so that we can continually improve,” Lindell said.
Ken Zamkoff, a retired hematologist/oncologist in Asheville, told Asheville Watchdog he would not go to Mission for elective hospitalization. He said he’s dissuaded four families with elderly relatives from moving to Asheville. His advice to one, a fellow physician with a 78-year-old mother: “Don’t come here.”
“I’m incensed by what’s happening,” Zamkoff said. “I am a physician and I think people are suffering, and their lives may even be unnecessarily at risk, from inadequate staffing.”
Lindell noted that Mission Hospital received an “A” rating for safety in the most recent grading by the nonprofit watchdog organization Leapfrog, earning the top score for protecting patients from accidents, injuries, harm, and errors.
In 2021 Mission Hospital was also named by IBM Watson Health as one of the 50 Top Cardiovascular Hospitals in the nation, providing better clinical care more efficiently than their peers. Mission did not make the list in the 2022 rankings, but four other North Carolina hospitals did: Atrium Health Carolinas Medical Center in Charlotte, UNC REX Hospital in Raleigh, Atrium Health Pineville, and The Moses H. Cone Memorial Hospital in Greensboro.
Other Local Hospitals Rank Higher
In surveys of patient satisfaction, however, Mission ranks below other local hospitals in the most recent ratings by the federal Centers for Medicare and Medicaid Services (CMS), earning just two out of a possible five stars, compared to four stars at both AdventHealth Hendersonville (formerly Park Ridge Health) and Pardee UNC Health Care in Hendersonville.
In the CMS ranking of overall hospital quality, Mission received four stars, compared to five for AdventHealth and four for Pardee.
Jim McAllister, a retired sales executive who is now a Woodfin town commissioner, said he chose the Asheville area in large part because of Mission’s reputation. Last summer when he had Covid, McAllister said he “had wonderful care” in two visits to Mission’s emergency room. But when he needed surgery recently, he went to Davie Medical Center in Bermuda Run, NC, part of Atrium Health Wake Forest Baptist Hospital.
“Mission makes me nervous,” McAllister said.
A two-time cancer survivor, McAllister followed his oncologist, formerly of Mission, to the Messino Cancer Centers and said if he experiences a recurrence, “I won’t go to Mission, knowing what I know, not for chemo or anything else.”
Buncombe County Commissioner Al Whitesides, a former banker in Asheville for 40 years, said retirees come to Asheville for “two things: the environment and medical care.”
With so many fleeing Mission, he said, “I personally wonder how it will take its toll.”
‘Ruined a fabulous hospital’
Dr. Tom Parker, an internationally known nephrologist who retired to Asheville six years ago and had been associated with a prestigious, academic medical center in Dallas, said he knew “what A plus care was.”
Parker said he had poor experiences at Mission both before and after HCA bought the hospital, and he and his wife now receive care at Duke University Medical Center in Durham, where they have received better and more prompt care, he said.
Marc Edward Hill-Smith, 71, a heart patient, said he experienced “incredible care” at Mission for bypass surgery in 2015. But during a subsequent hospitalization in October 2020, he said, the quality of care had declined.
Hill-Smith has since switched his cardiac care to Duke and used AdventHealth in Hendersonville. “HCA has ruined a fabulous hospital,” he said.
‘Worth the drive’
Younger patients are also seeking care elsewhere after what they described as bad experiences at Mission.
Violit Hartwell, 42, was hospitalized last year for heart palpitations and losing consciousness. She said a traveling nurse tried to give her medications that she’d already received in the emergency room. During the night, she said, no nurse checked on her, though her mother tried unsuccessfully to find one. She said they had to order dinner from a delivery service when none was provided in her room.
Her discharge plan included urgent follow-up with Mission’s Asheville Cardiology, she said, but she waited six weeks for an appointment. The cardiologist recommended surgery to correct an irregular heart rhythm and prescribed medications that gave her unpleasant side effects, she said.
“I said, ‘Enough is enough,’ ” Hartwell said. She found a doctor in Charlotte, who told her she did not need the surgery and gave her medications that she tolerates.
“I’ve decided to move all my care to Charlotte due to the inadequate, sub-par healthcare in Asheville,” she said. “It is absolutely worth the drive.”
Crystal Salinas MacKinnon, 38, told Asheville Watchdog she had to find a new primary care doctor after HCA closed his Mission-affiliated practice in 2020. She said the referrals she received from Mission, with one exception, were for physician assistants or nurse practitioners, not doctors.
Last year, MacKinnon was hospitalized at Mission after losing consciousness and falling, suffering bleeding on her brain and a broken pelvis. She said she was monitored overnight and discharged with a referral to Mission’s neurology unit.
After waiting over two months for an appointment, MacKinnon said, she was seen by a physician’s assistant, who dismissed her concerns about the cause of her fall. “They were not hearing me,” she said.
She has since signed on with a subscription-based direct care primary practice, unaffiliated with Mission.
10-year-old contracts COVID-19
Evelyn Cholid took her 10-year-old daughter to Mission’s emergency room in October with a high fever.
“I had not seen my daughter this sick,” she told Asheville Watchdog in an email. “We were put in the hallway on a stretcher and we were told they would be doing a strep (streptococcus) test and administering ibuprofen.”
The ibuprofen was not delivered until she asked a nurse. “I was told they forgot,” she said.
After the strep test came back negative, Cholid said, they “waited and waited” for more tests a doctor had ordered.
“I am not confident in this department at all!!” Cholid wrote on Mission’s Facebook page at the time.
Her daughter was discharged, and two days later the hospital called to say she had tested positive for COVID-19.
As a result of her experience, Cholid said, she has switched her primary doctor to one not affiliated with Mission.
“This was the worst Mission visit I have ever experienced in my 37 years living in Asheville,” she said. “I will do whatever is possible not to have to deal with them again.”
Clarification: This story has been updated to include positive experiences Jim McAllister had at Mission last summer.
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Barbara Durr is a former correspondent for The Financial Times of London. Contact her at firstname.lastname@example.org.