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Dogwood Executive Departs; CEO Search Continues

William Buster // Dogwood Health Trust

William Buster, senior vice president at the Dogwood Health Trust in Asheville, has been named chief executive officer of the $1.3 billion New Hanover Community Endowment Inc. in Wilmington, NC.

Just as the Dogwood Health Trust arose from the $1.5 billion sale of Asheville’s nonprofit Mission Health System to HCA Healthcare, the New Hanover Community Endowment was formed from the sale of the previously county-owned New Hanover Regional Medical Center to Novant Health. Dogwood Health and the New Hanover Community Endowment each instantly became two of the largest healthcare endowments, per capita, in the United States.

Buster joined the Dogwood Trust’s Impact Team, responsible for grant-making and program-related investment activity, in November 2020. His departure after 14 months comes as Dogwood continues its search for a permanent CEO. Susan Mims, a physician and former member of the senior leadership team at Mission Hospital, has held the title of Interim CEO since the abrupt and as-yet unexplained departure of Antony Chiang as CEO after less than a year at Dogwood.

Dogwood announced its search for a new permanent CEO in October, with plans to announce the new leader “in early 2022.” Buster will assume his new job at the New Hanover Endowment in March. — Peter Lewis

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Mission Hospital Gets an “A” In Latest Safety Grading

Mission Hospital in Asheville received an “A” grade in the latest national rating of hospitals for its performance in preventing medical errors and harms to patients, in what its chief medical officer called “a tribute and credit to all the people on this team who have been working so hard through all the challenges we’ve faced during the pandemic.”

And for the eighth straight time, AdventHealth Hendersonville also received an “A” grade from the Leapfrog Group, an independent, nonprofit organization that measures patient safety and assigns a letter grade to hospitals based on how well they prevent medical errors, accidents, injuries, and infections that kill or harm patients.

But Pardee Memorial Hospital in Hendersonville slipped to a “B” rating in the Leapfrog Fall 2021 ratings, which were announced today. Pardee had scored “A” the previous three gradings.

Also receiving “B” grades in the Fall 2021 period, released Nov. 10, were Haywood Regional Medical Center in Clyde, Mission Hospital McDowell in Marion, Rutherford Regional Medical Center in Rutherfordton, and Harris Regional Hospital in Sylva.

Nationwide, 32 percent of all hospitals reviewed by Leapfrog received “A” grades, and 26 percent got “B” grades. And among all states, North Carolina ranked No. 2 nationally for the highest percentage of “A” hospitals.

Mission Health, owned by HCA Healthcare of Nashville, is by far the biggest hospital in Western North Carolina and the region’s only Level II trauma center. It was downgraded to a “B” in the Spring 2021 Leapfrog safety ratings before rebounding in the current period. Grades are updated twice yearly.

“Compassionate care and safety are our highest priorities at Mission Hospital and I am incredibly proud of our team and their commitment to the patients we are privileged to care for,” Chad Patrick, CEO, Mission Hospital, said in a prepared statement. “The entire team’s dedication to the highest level of care for our patients — especially during the challenges of a pandemic — is proven with this safety grade A from Leapfrog.”

The Leapfrog Hospital Safety Grades surveyed 2,901 hospitals nationwide and assigned them point scores on more than 30 categories, including infections, surgical problems, safety problems, practices to prevent errors, and medical staff.

Jay Kirby, chief executive of Pardee, asked to comment on his hospital’s downgrade, told The Watchdog: “Our focus is, and always will be, to provide exceptional care to our patients. A rating score from Leapfrog in no way diminishes our commitment to safety across our organization. Nor does it take away from the very hard work and determination exhibited by our team throughout this past year and the six-month review period for this particular rating. “

“I am very proud of the work we’ve accomplished, the lives we have saved, and the deaths prevented as a result of our efforts,” Kirby said.

Dr. William Hathaway, Mission’s chief medical officer, told Asheville Watchdog that the hospital’s success in the latest scoring came in part from improved information management. In particular, he cited Patient Safety Indicator 90, a composite measure that tracks patient safety (or “avoidance of harm”) during the delivery of health care.

Mission Hospital received an “above average” positive score for having “enough qualified nurses” to care for patients. The hospital has been criticized repeatedly by National Nurses United, the labor union representing registered nurses at Mission, for what the union calls unsafe levels of staffing.

Mission was scored “below average” for “communication with doctors,” “communication with nurses,” and “responsiveness of hospital staff.” — Peter Lewis

Stein joins effort to halt hospital merger … in New Jersey

NC Attorney General Josh Stein

Nov. 9 — North Carolina Attorney General Joshua H. Stein, who approved the 2019 sale of nonprofit Mission Health System to for-profit HCA Healthcare, giving HCA a virtual monopoly on healthcare in Western North Carolina, today signed a legal brief in support of a district court’s ruling that halted the merger of two hospital systems in New Jersey.

Stein joined 24 other state attorneys general in filing the amicus brief with the United States Court of Appeals for the Third Circuit, arguing that hospitals facing less competition have the ability to charge higher prices without providing improvements to the efficiency or quality of care.

Asked by Asheville Watchdog to comment on why he entered the out-of-state legal fray over the proposed merger of Hackensack Meridian Health and Englewood Healthcare Foundation, his office responded:

“North Carolina, like other states across the country, has seen a wave of hospital consolidations over the past few years. While our office has a limited role in reviewing transactions related to consolidation, we are concerned about what they mean for North Carolinians’ health care.”

“Filing this brief is part of our continued efforts to do everything in our power to make sure that North Carolinians have access to affordable, quality health care, especially in rural and underserved areas in our state,” Stein’s statement to The Watchdog read.

But in the brief, Stein joined the other attorneys general in writing: “Mergers that substantially increase provider market share in local markets lead to increased healthcare costs in local communities and raise the overall cost of healthcare within the States . . . without any substantial improvements in quality for consumers.”

The $1.5 billion purchase of the six-hospital Mission Health System gave HCA a monopoly on healthcare in Western North Carolina. HCA raised prices by 10 percent six months after the sale, and in 2020 Mission Hospital ranked second among HCA’s 183 hospitals for the highest net patient revenues. The hospital’s safety ratings declined in the most recent ratings period.

Stein’s office has received hundreds of complaints from citizens and health care providers about rising costs and declining quality of care at Mission Hospital since he approved the sale to HCA. Stein has said he is “very concerned” about the reports.

In an interview with Asheville Watchdog in late August, Stein said that state law limited his ability to halt the sale of the Mission system to HCA despite “conflicts” uncovered by his investigation of the proposed transaction. Stein has not responded to The Watchdog’s questions about the nature of the conflicts his investigators reported finding.

Because of the law’s restrictions, Stein said in August, he would have no choice but to make the same ruling today as he did in 2019, when the 20 members of Mission Health’s volunteer board of trustees voted unanimously to sell to HCA, despite considering only one other bid. — Peter Lewis

[This post was updated to include a response from the attorney general’s office.]

Dogwood Trust Is Searching For New Chief Executive

Susan Mims, MD

[UPDATED Oct. 29] Dogwood Health Trust is looking for a “seasoned, collaborative and humble executive” to be chief executive officer of the $2 billion private nonprofit healthcare foundation, Dogwood announced Oct. 4. The Asheville-based trust is currently led by Interim CEO Susan Mims.

Dogwood announced plans to interview finalists for the position in December and to select a permanent replacement by early next year. Asked if Sims was a candidate for the permanent CEO position, a Dogwood spokeswoman said, “Out of respect for the confidentiality of all candidates, Dogwood Health Trust will not make that information public.” 

Mims, a physician and public health expert, is a former member of Mission Hospital’s leadership team. She was appointed Dogwood’s interim CEO in October 2020 to replace Antony Chiang, who abruptly left the trust in September 2020, less than a year after he was hired with great fanfare and minutes before he was scheduled to speak at a news conference in Asheville.

In the year since Chiang’s departure, no one on Dogwood’s leadership team has responded to Asheville Watchdog’s repeated questions about Chiang’s sudden departure, and Chiang has not responded to requests for comment.

The Dogwood board selected Chiang from among 125 candidates to become Dogwood’s first chief executive. Witt Kieffer, the Massachusetts-based executive search firm that handled Chiang’s hiring, will once again conduct the search for the next CEO.

The Dogwood Trust was created with proceeds from the sale of the Mission Health System to HCA Healthcare in 2019. The Trust’s mission is to “dramatically improve the health and well-being of all people and communities across 18 counties and the Qualla Boundary in Western North Carolina.”

In general, a private foundation must distribute 5 percent of its net assets each year to maintain tax-exempt status. Claiming $2 billion in assets this year suggests that Dogwood intends to distribute at least $100 million a year to support housing, education, economic opportunity, and health and wellness in the region. — Peter Lewis

[This news item was updated and corrected Oct. 29 to remove an erroneous assertion that Susan Mims planned to step down when a permanent replacement is chosen. The Watchdog regrets the error.]

Developers Withdraw Charlotte Street Request

After nearly a year of intense opposition from community activists, the developers of the proposed 101 Charlotte Street development formally withdrew their application to the City of Asheville for special permission to exceed current zoning restrictions along the near-northside Asheville corridor.

The out-of-state developer, RCG of Massachusetts, and its local landowner partner, Killian Chestnut Residential Properties, planned to tear down and replace a dozen century-old homes with a new apartment complex, parking garage, retail space, office space, condominiums and rowhouses on the nearly seven-acre 100-block of Charlotte Street.

On Friday, the development team withdrew its request for a variance from the city that would have allowed buildings along Charlotte Street to be five stories tall, significantly taller than current zoning regulations allow. The withdrawal means that, at least for now, development will proceed under current zoning guidelines intended to prevent over-development.

Opponents, including the Preservation Society of Asheville and Buncombe County (PSABC) and the Charlotte Street Neighborhood Association, cheered the news, but said their fight to save the existing homes was not over.

“While we are very pleased that the developers are no longer moving forward with the project, the future of this block remains uncertain and there are a number of complicated zoning issues at play,” the PSABC wrote on Facebook. “We will continue to monitor the situation and to encourage the developers to work with us and the community towards a project we can all support.” — Peter Lewis

Not-so-happy Labor Day: Study ranks North Carolina “worst” for working women

For the second straight year, North Carolina ranks last overall in the United States for meeting the needs of working families, and especially in meeting the needs of working women, according to an annual study by Oxfam, the international anti-poverty organization.

The study, called the “Best and Worst States to Work in America 2021,” found that North Carolina “provides no support for workers’ rights to organize, does not exceed the federal minimum wage, and has very few worker protection policies.” In ranking North Carolina at the bottom for working women, Oxfam cited the lack of a mandate for paid leave, no accommodation for pregnancy, and no protection against sexual harassment.

Oregon topped the list of “best places to work,” which surveyed working conditions in all 50 states plus the District of Columbia and Puerto Rico.

Unlike many other states, North Carolina has not raised its minimum wage beyond the federal minimum wage of $7.25 an hour, a level not changed since 2009, or the federal minimum tipped wage of $2.13 an hour, which has not increased in 30 years. In theory, employers of tipped wage earners are legally obligated to ensure that tipped employees earn at least the state minimum wage if tips fall short. However, the Oxfam report said, enforcement of this mandate is “paltry at best.”

Notably, women make up 69 percent of the tipped minimum wage workforce, and 36 percent of them are mothers, half of whom are single mothers, according to the report. 

Asheville-based nonprofit Just Economics, which studies wage and cost of living issues in western North Carolina, put the 2021 “living wage” for the Asheville metro area at $17.30 an hour. The figure is calculated using the Universal Living Wage Formula, which is based on a 40-hour work week, the Fair Market Rent for Asheville determined by the federal Department of Housing and Urban Development, and another HUD guideline that no more than 30 percent of a person’s gross monthly income should be spent on housing. 

HUD determined that the Fair Market Rent for a safe apartment in Asheville is $1,255 including utilities for a two-bedroom apartment. The statewide average for North Carolina is $919.

The 2019 Bowen Report on housing needs for the City of Asheville found that 46.8% of renters were cost burdened, meaning they spent more than 30 percent of their income on housing, and 19.4 percent were severely cost burdened, paying more than 50 percent of their income on housing. And that report was completed before the latest surge in Asheville housing prices. 

In a meeting Sept. 2, the city’s Affordable Housing Advisory Committee noted that no houses were for sale in Asheville for less than $275,000. In August 2021, the real estate company Redfin reported, Asheville home prices were up 22.1 percent compared to last year, selling for a median price of $428,000. — Barbara Durr

Cawthorn targeted by panel investigating Jan. 6 attack

[Sept. 5] Western North Carolina Rep. Madison Cawthorn is among the Republican members of Congress whose records are being targeted by the special committee investigating the fatal Jan. 6 attack on the U.S. Capitol, The New York Times is reporting.

The committee has asked technology firms to preserve the phone and social media records of 11 far-right members of Congress, including Cawthorn, Lauren Boebert of Colorado, Matt Gaetz of Florida, Marjorie Taylor Greene of Georgia, and Jim Jordan of Ohio, the newspaper reported.

“These are the individuals who have been publicly supportive of Jan. 6 and the people who participated in the insurrection on Jan. 6,” Rep. Bennie G. Thompson, Democrat of Mississippi and the panel’s chairman, told The Times.

“We need to find out exactly what their level of participation in this event was,” he said. “If you helped raise money, if you provided misinformation to people, if you served on a planning committee — whatever your role in Jan. 6, I think the public has a right to know.”

Cawthorn rallied the crowd at a pro-Trump protest just before the attack on the Capitol. During the attack, while hiding in the basement, he called a right-wing radio show to say the rioters were “paid by the Democratic machine” and that he had carried loaded weapons into the Capitol.

At a recent GOP meeting in Macon County, Cawthorn said people arrested for their roles in the attack are “political prisoners” and warned of “bloodshed” over a “rigged” American election system. Among a number of provocative and misleading statements at the Macon rally, Cawthorn said in response to a question that “we are actively working on” plans for another similar protest in Washington.  — Sally Kestin

Mission Nurses’ Union Calls for Public Protest, Citing Patient Safety

[Sept. 1] The labor union representing registered nurses at Mission Hospital said nurses will stage a protest Thursday morning to call attention what it called “patient safety and unsafe working conditions” at Asheville’s flagship hospital system.

Among other complaints, the National Nurses Organizing Committee of National Nurses United asserted that HCA Healthcare-owned Mission Hospital scheduled symptomatic, COVID-positive nurses to work at the hospital, and failed to provide nurses with adequate masks, gowns, gloves and other personal protective equipment.

In a statement, Hannah Drummond, a registered nurse in Mission’s emergency department, said hospital administrators have ignored “months” of staff complaints about safety standards, including staffing. “We have a duty to the Asheville community to provide optimal care, and we will continue our advocacy until Mission is a safe place for our patients,” she said.

“We’re disappointed that the labor union would attempt to pull people away from patient care for a rally during COVID and not follow the mutually agreed upon process that they requested as recently as July,” JC Sadler, Vice President for Communications and Community Strategy at the North Carolina Division of HCA Healthcare, said when asked by Asheville Watchdog for a response to the union’s statement. “Caring for our patients and employees safely is our priority. We have ample PPE for our colleagues, require universal masking, and follow CDC protocols for returning employees to work.”

The protest is scheduled for 8 a.m. Sept. 2 at the corner of Biltmore Avenue and Hospital Drive.  — P.L.

Pardee Hospital Requires All Staff to be Vaccinated

Pardee UNC Health Care in Hendersonville on Monday became the first hospital in western North Carolina to make COVID-19 vaccinations mandatory for all staff, according to a memo sent Aug. 23 to employees by the hospital’s president. The announcement came within hours of formal approval of the Pfizer vaccine by the federal Food and Drug Administration.

Despite a local surge in COVID cases related to the highly contagious delta variant of the virus, vaccinations remained voluntary on Monday for healthcare workers at Mission Hospital in Asheville and AdventHealth Hendersonville. The vast majority of COVID infections, hospitalizations, and deaths nationwide are among unvaccinated people.

James M. Kirby II, president and CEO of Pardee, set a Nov. 12 deadline for all workers to be vaccinated, but his memo did not specify the consequences for noncompliance. “As with the flu vaccine, we will review requests for a medical or religious exemption to this requirement,” he wrote. “Full policy details will be shared by the end of this week.”

Hospitals nationwide are struggling with staffing shortages, especially among nurses and nursing assistants, and hospital administrators elsewhere have said they fear staff will quit if required to get vaccinated.

“We hope that the FDA approval of the Pfizer vaccine encourages those who were previously hesitant to decide to get the vaccine,” said Nancy Lindell, director of public and media relations at HCA Healthcare North Carolina Division-Mission Health. “Our infectious disease experts as well as those at the CDC are strongly encouraging vaccination as a critical step to protect individuals from the virus, but at this time our colleagues are not required to be vaccinated for COVID-19.”

“AdventHealth has not mandated vaccines for our team members,” Victoria Dunkle, director of communications and public relations at AdventHealth Hendersonville, told The Watchdog on Monday. “Based on scientific evidence, COVID-19 vaccines are safe and effective at reducing the risk of severe illness, hospitalization and death from COVID-19,” she said. — P.L.

Local Residents Sue HCA, Alleging Overcharging at Mission Hospital

Since being acquired by the giant for-profit hospital chain HCA Healthcare, Mission Health and its Mission Hospital flagship have become the most expensive hospital system in North Carolina for many procedures, with prices often double the state average, according to a class-action lawsuit filed Tuesday against HCA Healthcare and its Mission Health subsidiary in Asheville.

The 87-page lawsuit, filed in Superior Court in Buncombe County by a group of local residents, alleges that Nashville-based HCA illegally used its effective monopoly market power in the region to raise prices while reducing the quality of care at the six hospitals and multiple clinics it operates in Western North Carolina, harming doctors and consumers.

“Once we have been served with the lawsuit, we will respond appropriately through the legal process,” Nancy Lindell, division director for public and media relations for HCA Healthcare North Carolina Division and Mission Health, said in a statement. “Mission Health is committed to the health and well-being of every person who comes to us for care, and we are proud of our dedicated hospital teams that are facing the many challenges of this pandemic and the exceptional care they have provided to our patients.”

Many of the allegations against HCA and Mission Health were first reported by Asheville Watchdog.

The plaintiffs in the class-action suit include Katherine Button, Faith Cook, and Will Overfelt of Asheville, Richard Nash of Candler, William Davis of Clyde, and Jonathan Powell of Morganton. The complaint was prepared by the law firms Wallace & Graham of Salisbury, N.C., and Fairmark Partners of Washington, D.C. — P.L.