North Carolina Attorney General and gubernatorial candidate Josh Stein came to Asheville Thursday to announce that he is suing HCA Healthcare and its Mission Health system for violating the asset purchase agreement regarding cancer care and emergency services at Mission Hospital.
“For-profit HCA has broken its promise to the people of western North Carolina and to my office,” Stein said in announcing the lawsuit, which he filed on behalf of Dogwood Health Trust, the foundation created with assets from the $1.5 billion sale of nonprofit Mission Health to HCA nearly five years ago. “Quality health care is too important – in some cases, a matter of life and death. But HCA apparently cares more about its profits than its patients.”
Frequently citing reporting by Asheville Watchdog, the complaint asks a judge to declare that HCA has breached the purchase agreement, to issue a permanent injunction to restrain HCA from committing such breaches in the future, and to require HCA to continue providing emergency and trauma services and oncology services at the level they were provided in the six-hospital Mission system before HCA took over.
“My complaint alleges that HCA mission has failed to provide quality consistent care in the emergency services department and in cancer services for patients here in western North Carolina,” Stein told a crowd of elected officials, medical professionals, supporters and media gathered at the county’s administrative building in downtown Asheville.
HCA responded, “We are aware of the announcement Gubernatorial Candidate Stein made in Asheville today.”
Nancy Lindell, director of media and public relations for HCA’s North Carolina Division, which includes Mission Hospital, stated: “We remain confident that we continue to meet, and often exceed, the obligations under the Asset Purchase Agreement that the Attorney General approved at the time of our purchase, and we intend to defend the lawsuit vigorously. Importantly, the Independent Monitor confirmed our compliance with that agreement during its most recent review.”
Gibbins Advisors, the independent monitor hired by Dogwood Health Trust to monitor HCA’s compliance with the terms of the sale, said in October that it had found no compliance violations in its review for the calendar year 2022. But the monitor stressed that results for 2023 — the focus of Stein’s investigations —have not been reported yet.
This lawsuit will not have any impact on our commitment to the community we are proud to serve.
Nancy Lindell, director of media and public relations for HCA’s North Carolina Division
Lindell’s statement continued: “Though there have been challenges, some of which we are continuing to address as we work to expand our capacity, we remain committed to serving our community. Despite the state not allowing important expansions at Mission Hospital, we will continue to fight for critical access to healthcare services for the people of Western North Carolina. As the Attorney General acknowledged, this lawsuit is no reflection on the dedication of our doctors, nurses and colleagues who serve our patients every day. This lawsuit will not have any impact on our commitment to the community we are proud to serve.”
Dr. Susan Mims, CEO of Dogwood Health Trust, the entity responsible for ensuring HCA’s compliance, said that “within the past 40 days, Dogwood has engaged in direct conversations with the Attorney General’s Office and with HCA, and facilitated a joint meeting with them both. In the course of those discussions Dogwood offered to fund an independent, skilled facilitator to help address these complex issues of care in hopes of a timely and productive outcome for our region.”
“The Attorney General’s Office is pursuing litigation to address access to specific services,” Mims continued. “Our desire to encourage and support facilitated discussions concerning these or other issues related to the Asset Purchase Agreement remains. We will continue to do all we can to foster open and constructive communication with and between the Attorney General’s Office and HCA, while also fulfilling our obligations as outlined in the Asset Purchase Agreement.”
Complaint Centers on Asheville’s Mission Hospital
With scathing language, the lawsuit alleges that “HCA has broken its promise and breached the APA,” or asset purchase agreement.
“Mission Hospital’s once efficient and orderly emergency department is now significantly degraded and unable to meet patients’ needs. Doctors and nurses are forced to treat patients in the waiting room, without even the bare minimum equipment or patient privacy protections, let alone adequate staff. Surgeons lack sterile equipment because HCA refuses to pay staff to clean surgical instruments,” the complaint alleges.
“The unacceptable conditions are not limited to the emergency department. Mission has discontinued certain essential oncology services that it provided before HCA acquired the hospital and has fewer available oncology beds overall,” the complaint contends.
“Responsibility for this downward spiral rests entirely with HCA,” the lawsuit alleges.
Stein’s “letter of non-objection” to the sale of nonprofit Mission to for-profit HCA came only after he demanded greater consumer protections than were included in the terms unanimously approved by Mission’s board of directors at the time.
Stein’s conditions included the hiring of an independent monitor to oversee HCA’s compliance with the agreement; enforceable commitments to maintain current levels of service at all six hospitals in the Mission system, not for the five years the Mission board agreed to in some cases, but for 10 years; and requiring HCA to adopt what he viewed as Mission’s more generous charity care obligations.
The conditions did not include maintaining quality of care, which the lawsuit filed today seeks to address.
More Than 500 Complaints
Stein, who was scheduled to appear at a campaign fundraising event in Hendersonville later Thursday, was flanked at Thursday’s announcement by Mission union nurses, physicians and a cancer patient.
“I want to be extremely clear,” Stein said, “HCA Mission is violating the agreement, not the hardworking doctors, nurses and other professionals who work at this facility. In no way does this lawsuit reflect on them or their dedication. In fact, it underscores their commitment because they are treating patients without adequate support from hospital administration.”
“Since 2019, my office received more than 500 complaints about the care at HCA facilities, including about emergency services, and oncology services,” Stein said. “We have 16 signed affidavits from patients and providers attached to our complaint to underscore the frequency and seriousness of these allegations,” Stein said.
On Oct. 27, Stein’s office issued an investigative demand to HCA for 41 sets of documents related to oncology services at the hospital, patients who came to Mission but did not receive care, emergency services, canceled surgical procedures, complaints about sterilization of surgical equipment and more.
On Oct. 31, Stein’s office sent notice to Dogwood Health Trust that HCA Healthcare has violated the asset purchase agreement regarding cancer and emergency services at Mission Hospital and threatened to sue if the problems were not resolved within 40 days, by Dec. 10.
Instead of sending the documents requested, Mission retained the giant international law firm Latham & Watkins, which wrote a letter denying Mission had violated the asset purchase agreement and calling the demand for documents “legally improper.”
HCA has settled similar lawsuits
Stein filed the lawsuit in the North Carolina General Court of Justice’s Superior Court Division. It will be one of a handful of lawsuits filed against HCA and Mission since late 2021. Buncombe County, Madison County, the city of Asheville, the city of Brevard, citizen plaintiffs and others alleging malpractice have sued the hospital system in the past two years.
In 2015, HCA was ordered to pay $433 million to the nonprofit Health Foundation of Greater Kansas City for violating the charity care and capital improvement provisions of its $1.3 billion purchase of Health Midwest in 2003. HCA settled the case for $177 million in 2017, the year it began discussions to acquire Mission Health.
HCA also has received significant backlash from Mission nurses who say the hospital is purposefully understaffing the hospital, and from doctors who recently told the independent monitor in a letter that HCA had “gutted the heart and soul of our community healthcare system.”
Stein’s legal action comes as Mission is facing other investigations from accrediting organization The Joint Commission and the North Carolina Department of Health and Human Services, which is inspecting Mission on behalf of the Centers for Medicare & Medicaid Services.
Mission has made numerous changes to its emergency department during these investigations, according to previous Watchdog reports.
“They can fix this immediately”
Hannah Drummond, a union nurse who attended the meeting, said HCA has the ability to fix the issues if it wanted to.
“Based upon how they’ve responded while being under investigation by the Department of Health and Human Services and Joint Commission, they have the ability to staff us up immediately,” Drummond said. “I got a lunch break two weeks ago, which I’ve never seen the likes of, ever. It is a manufactured crisis that they choose to line the pockets of their administrators and shareholders. We can and should have good staffing. So if HCA decides to snap its fingers, they can fix this immediately.”
The attorney general’s office could also come to some agreement with HCA.
“My hope is that we don’t need to get to final judgment,” Stein said. “There’s absolutely nothing that would prevent HCA from engaging our office substantively and addressing these issues today. They can do it today.”
Barring such an agreement at any point during the lawsuit’s lifetime, a judge could set the measures it would take for Mission to come back into compliance. But that judge would first have to decide whether HCA has indeed breached the agreement.
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 please visit avlwatchdog.org/donate.
Who could’ve seen this coming from a huge corporation focused on squeezing out every bit of profit they can from a hospital.
Didn’t Stein endorse the sale to HCA?
He, within the limits of his authority, required changes which include some of the things he is now suing over. He brought to the board’s attention deficiencies on HCA operations elsewhere. Ultimately, the board ignored him except where they couldn’t, and went through with this behind closed doors sale, no competitive bids allowed, sweetheart deal for Paulus who went to work for big bucks for HCA days after the sale was consummated. So, it’s the board’s fault for making such a bad deal for the region with a known criminal enterprise–HCA. If not for the changes in the agreement Stein was allowed, by the scope of his job authority, to make, the deal the board was prepared to take was even worse. If we want the AG to have more power to protect us, we need to expand the authority the position allows. Asheville Watchdog has published the names of board members who allowed this in past articles. They should be held accountable, and all the NDAs should be voided so we can get a clearer picture of who brought this disaster to the community.
He said he didn’t have the legal authority to stop it, only to raise specific objections, which he did. HCA claimed to have conceded to some or most of them, I believe, but it had the upper hand and knew it. Personally, I think the sale was the biggest scandal in the history of Western North Carolina and everyone who had in a hand in should be ashamed.
Yes but they should be giving quality care but they don’t at all!
I think they should look into EVS housekeeping because we can’t keep no employees because of how we get treated and disrespected by our managers and a supervisor we all work our butts off everyday well some of us do some employees can get away with not doing nothing. especially on 2nd shift. If it wasn’t for us EVS workers no areas much less discharged rooms would be clean.I believe if you respected us better and paid us better EVS would keep employees especially on 2nd shift we don’t have a lot enough employees in second shift and they are killing the ones that are there.
Thank you to EVS housekeeping. The hospital needs to pay you all a living wage which I’ve read is $20.10 an hour. I hear that people cleaning Airbnbs are making more. I hope pay and staffing improves for housekeeping for so many reasons. Can you share what the pay is for EV now? I hear it’s around $15 to $20.
If AirBnB’s make more – that’s all well & good, but do those people have insurance & other benefits? Curious.
I think the bigger picture is that a hospital CEO makes almost 30 million annually and the Mission Hospital system is the second biggest money maker in the country for HCA, right?
EVS is critical to hospital operations. They are the rate limiting step in the ability to move people in and out of the facility. Patients can’t be admitted until they have a clean room available. Thanks to you and everyone that do this important and often underappreciated work.
Thank you for all you do under horrendous conditions. I hope HCA will be forced to be as responsible as you and other EVS staff are trying to be. What HCA has done to you and other staff should be illegal. Or is it?
So HCA will pay a fine. They will write it off as a business expense and go right on “providing” substandard care. How many times will they have to be sued to make them actually provide reasonable healthcare?
I truly wish the Dogwood and Susan Mims would join Stein in this matter. There is no reason that they need to sit in the fence on this issue. I know a lot of former mission board members are also on dogwood board, they should be furious at HCA
For now, the Asheville saying continues. “If I am not coding, keep on driving.”
As I read the article, Stein is filing on behalf of Dogwood and Mims represents Dogwood. That would mean they are together, with Josh Stein representing Dogwood Trust and the people of the region together in the lawsuit against HCA. What I want to know is how this HCA, who was just weeks out of a lawsuit they lost for acting in the exact same way in Kansas City, was even considered for the purchase of this critical asset of the entire region. A leopard does not change it’s spots, and that leopard HCA had already shown every one of its spots. Mission was a place to brag about just a few years ago. Now our family and community members have to leave the region for cancer care? HCA needs to be expelled and the Dogwood Trust funds used to recreate the community NON PROFIT healthcare system we had before HCA darkened our doors.
Gary, these former Mission board members sitting on the board of Dogwood Trust are not going to turn their backs on HCA. They have no moral compass and as long as their pockets are padded by HCA they will continue to be silent.
Money and greed are in control of both HCA and Dogwood. The amount of money involved can’t be phathomed by average people. It’s staggering. Neither will admit to anything that would endanger their hold.
I agree with this. We need to find a way to get around the NDAs, find out who did this to us, and make sure none of them have anything to do with Dogwood Trust. Fox guarding hen house much?
Sadly, since this lawsuit is only asking for specific performance (and not monetary damages), it will be cheaper for HCA to fight this in court for years than to adequately staff up.
Healthcare for profit is immoral.
A year ago I spent 1hours in the Mission ER in extreme pain. I finally saw
a doctor at 10:45 PM. He was extremely apologetic. Said “this should never have happened.”
CW
Have you considered suing them for pain and suffering? It’s actionable even in North Carolina, I believe
NC is a tort reform state and very little goes to court.
I’m not sure of the details behind the sale of Mission to HCA, but I do know one thing. The best way to explain the current mess is to “follow the money.” Who profited individually from the sale? We know that HCA is squeezing out profits now, but who got rich at the time of sale, or landed a plum job after the sale? These answers could explain a lot. But, they will not provide a fix. Is there a way to undo the sale?
Josh stein said, ” Apparently, HCA cares more about profits than patient care”. A simple google search done BEFORE the sale of mission would have told him that. I feel that if he was not looking for WNC votes, he would not be here at all. What a shame that Mr. stein is apparently the last person in NC to learn of HCA’s long established history of profits first.
You misunderstand how this happened. The board made the decision to not entertain other potential buyers, the board knew exactly who they were selling to–what Dale Folwell, our NC Treasurer calls HCA a criminal cartel. The AG required changes in the even worse than final purchase agreement, but ultimately didn’t have the authority to totally stop the board from selling the hospital. It’s in the details, and way too easy for a heavily R region to blame Stein for every bit of this, and to see his activism on our behalf as nothing but a vote getter. I would vote for him, or Folwell (R) for governor to keep the pressure on these monsters.
Thanks for your comments kathy. I should have also made clear that the silence on this matter from our rep. in congress, Mr. edwards, is deafening and I will also not be voting for him either. My comments had nothing to do with R’s or D’s kathy. thanks again for your response. Bob
Here is a look at HCA stock: YTD the price per share is up 15%. It is up $7.58 just today , after this announcement from stein. (began the yr. at $240 P/S, is currentlyat $275.85.) They had $5.64 billion dollars in earnings. They have a market cap of $73.83 billion,(meaning the total value of all shares.) They are rated a strong buy with an expected increase to $285 a share in the next yr. HCA’s earnings have been growing at an annualized rate of +111.96%. They had just over $60 billion in revenue. Revenues have been growing at an annualized rate of +104.36% in the last 8 yrs. There short term assets exceed there short term liabilities by almost $3.7 billion. Their largest share holders are the Vanguard group and Blackrock . To put this in english, they are not even going to be a bit afraid of little old Mr. stein and his pesky lawsuit. It is a minor nuisance to them, if even at all. I only say this so people will not get too excited by this lawsuit. Goliath always wins. And this company is a goliath, make no mistake.
Very informative data Bob, thank you for that information.
Watchdog staff, can you do a deeper dive on these aspects? Can Asheville slay Goliath with our activist journalists help? Thank you for all you are doing to shine some light on this issue.
The suit “won’t change HCAs current commitment to healthcare for the community.” I read that to mean they won’t do anything to fix the problems. Ironic statement, eh? They deserve this suit. I know a person who is actually moving out of Asheville because of the deterioration at Mission and the doctor’s practices it acquired.
“Gibbins Advisors, the independent monitor hired by Dogwood Health Trust to monitor HCA’s compliance with the terms of the sale, said in October that it had found no compliance violations in its review for the calendar year 2022.”
Why is it that the offices of both of these entities are within a short chip shot from the home offices of HCA? What is the cross traffic if officials in these organizations? My guess is that there’s a lot of incest going on here. Admittedly that guess is based on nothing more than the way HCA historically does business. I think that this line of inquiry should be fair game for the Watch Dog.
Too much money and “golden parachutes” handed out with this sell. Now it’s like getting the elephant out of the room. Thanks to all the crooks responsible for ruining a good hospital.
How many more verified complaints need to be filed against the poor HCA health care (“health care” used very loosely) organization before accountability is really enforced? Token fines and slaps on the wrist will not deter further corruption and dangerous patient care. (HCA needs to be out of the picture)
A classic example of voodoo economics was the pretext that a corporation, especially one as rapacious as HCA, could amortize $1.5 billion to take over a nonprofit hospital, assume the property and income taxes that would ensue, and still deliver quality heath care at less cost. We still need a grand jury to inquire whether there was something worse than voodoo economics at work. Stein can’t empanel a grand jury, apparently, since North Carolina law doesn’t allow investigative grand juries except for drug crimes. His lawsuit is welcome news, however.
For years the AVL watchdog has refused to say what really needs to be said. Martin Dyckman correctly stated..”this is the biggest scandal in the history of western NC”. That scandal has only one fingerprint. It belongs to AG Stein who refused to represent Mission Health’s largest customer the State Health Plan in the courts. That plan represents those that teach, protect and serve. The same thing is happening in New Hanover County. Not just a scandal but an enormous transfer of wealth; especially from the lower and fixed income citizens to the cartel.
Dale Folwell,CPA
NC State Treasurer and Chair of the NC SHPlan board.
In the interest of full disclosure, NC State Treasurer Folwell is also a candidate for governor.
My warnings and his denial to represent the taxpayers or do his job occurred years before either one of us were candidates for Governor. I have a pre existing called GWR (governing while republican). That never prevents me from advocating for the invisible. Folks who work multiple jobs who don’t have enough money to underwrite corruption.
AVL watchdog refuses to say this scandal/hoax was avoidable.
That would be substantive full disclosure.
Dale Folwell stuck his neck out way before anyone on this. One example is going on NBC’s Cynthia McFadden’s HCA report to sound the alarm on the conditions at HCA Mission. Lives have been lost and continue to be lost at Mission because nobody would act, including NCDHHS and CMS. From Stein’s Lawsuit: “3 patients found dead in the ER, hours after their death.” Another one admitted to the floor and nobody knew they were dead. This is the tip of the iceberg. Were the families informed of these circumstances? How this place can still retain Level II trauma status or even be allowed to remain open is unfathomable. Plenty of people to point blame at, but Dale Folwell is not one of them.
Treasurer Folwell, your statement “AVL Watchdog refuses to say this scandal/hoax was avoidable” invites a response.
The Watchdog has never refused to report, and indeed was the first to report, that the sale was “rigged from the beginning.” We were also first to report that Mission’s board of directors failed in its duty to seek the best possible partner for Mission Health and declined an opportunity to reconsider the sale to HCA after being informed by the AG’s office of “serious conflicts.”
You seem to be implying that AG Stein had the authority to stop the sale, despite the Mission board’s insistence on it going through, but that Stein for some reason — is this where your “corruption” suggestion comes in? — refused to act to block the deal.
If you have solid evidence of corruption involving the sale, please share it with us. We’ve been reporting on the story for three years and haven’t found it. If your evidence withstands scrutiny, I promise The Watchdog will report the hell out of it.
Without evidence, it’s just reckless innuendo. We have enough of that already in the 2024 campaign cycle.
Perhaps the watchdog could widen their scope on the whole HCA saga. Look at what other cities are grappling with after an HCA invasion. We keep going round and round about Josh Stein and the old board. How ’bout the new board? Don’t they have to answer to what’s going on there? maybe they won’t talk either. Also some fascinating articles coming out of other states about the depths of HCA’s moral depravity. Here’s one to peruse:
https://www.postandcourier.com/news/special_reports/hca-trauma-chippenham-hospital-lawsuit-burn-whistleblower/article_fc0993d8-8310-11ee-8548-a3c8fdc9bfaf.html
Are there other states which have done a better job which NC could use as a model?
HCA Mission makes the national news again.
https://finance.yahoo.com/news/hca-hospitals-person-monitoring-vital-133000517.html
I second Robby Robinson, Is there a way to undo this sale? Obviously HFC should not be running the hospital. Is there no way to take back control of the hospital before it is driven into the ground to make money for stockholders?
Does the Watchdog know why Stein is only going after HCA for breaking promises in emergency services and oncology? There has also been a mass exodus of docs in Mission Departments of neurology, general surgery, etc., etc.
Hal Herzog
Hal, are you implying these docs should be sued? If so, please dive deep and try to understand how healthcare works. These docs are not responsible for the poor system that HCA has set up for the docs and other workers and patients. If the doc can’t take care of a patient based on the poor system that HCA had provided, should they stay and risk patient lives and co-morbidities? Most healthcare workers are broken hearted when they can’t help patients.and yes there are data and studies that prove this,
Excellent questions and important for all of us in Western, NC!
What Stein is doing is just an exercise in futility. A law suit does not scare billionaire elites. Mission is HCA’s holy cash cow, and they couldn’t care less about restoring a properly run hospital. If CMS denied reimbursement for not meeting standards that could be a wake up call. It is so sad that there are some great hospital employees at Mission, but apparently no one will listen to their needs much less to those of us in the community who just want a clean sterile competent and caring healthcare facility.
If AirBnB’s make more – that’s all well & good, but do those people have insurance & other benefits? Curious.
Also – Stein AGREED along with The Board to the sale of the hospital to HCA. WHY are we going through this crap over & over with the negativity? This is THE largest employer in WNC with SO many GOOD healthcare workers inside the walls. People who get up EVERY single day that go to work to DO good & make a difference in not just the life of those who come to the hospital for care, but in their very own life. They want to earn a pay check. Why does the media insist on tearing EVERYONE & everything down. I am SICK of it. It’s old & the story is just worn out. Please take it somewhere else. It’s a funny thing to me that wait times at other facilities are equally long in ERs but you only focus on Mission. I can only imagine if Mission & its sister facilities were not in business what kind wait times & care you would get at Pardee & Advent. Fathom it if you will.
Could someone remind me who on the board voted for this and how much were their pockets padded?
https://sarasota.legalexaminer.com/legal/florida-hca-hospitals-understaffed-and-putting-patients-at-risk/
It seems HCA has a pattern of patient abuse and neglect. These are only the tip of the iceberg in Florida.