Posts published in “Healthcare”

By PETER H. LEWIS

The Mission Health system could have been purchased by another nonprofit hospital chain in a deal that would have been at least as good if not better than the $1.5 billion sale that the hospital system’s board ultimately approved to HCA Healthcare in 2018, a former top Mission executive now says.

The sale to HCA was “significantly detrimental” to the community, said Charles F. Ayscue, who was Mission’s top financial executive from 2007 to 2018. Ayscue broke the cone of silence that has surrounded the highly controversial Mission sale by writing a letter in support of Novant Health’s application to be awarded 67 new acute care hospital beds in Buncombe County.

Ayscue is now working for Novant as an independent contractor. 

The letter includes stunning new revelations about the HCA deal,

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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.

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One nurse on a surgical floor at Mission Hospital reported “patients lying in stool for an unknown amount of time,” pain medications and insulin being administered late, and “irate family members.”

A nurse caring for the sickest patients on a surgical floor at Mission documented “delayed and missed medications due to RNs having 7-8 patients … Inadequate staffing led to patient fall.”

Still another nurse on an intensive care and cardiac care unit reported an “inability to care for critically ill patients at appropriate high level,” resulting in an increased risk of possibly serious harm to patients.

The alarming concerns were reported by nurses on forms known as Assignment Despite Objection (ADO), a formal complaint system developed by the labor union representing Mission nurses to document unsafe assignments that, in their professional judgment, put patients at risk. The forms are completed only after the nurses have informed their supervisors with no resolution.

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The North Carolina attorney general’s office had “great concerns about how HCA was selected” as the purchaser of the Mission Health System, including that “the deck had been stacked in its favor from the beginning” by then-CEO Ronald A. Paulus and his advisor Philip D. Green, according to a 2018 internal document obtained by Asheville Watchdog.

“[W]ith no outside advice other than Phil Green,” whom the investigators wrote had an undisclosed “prior business relationship with HCA,” Mission Health’s board of directors decided not to issue requests for competitive bids or to hold an auction before agreeing to sell Asheville’s flagship hospital system to HCA Healthcare for $1.5 billion, according to the document, prepared in advance of a meeting between Department of Justice lawyers and HCA representatives on Oct. 30, 2018.

Instead, as Paulus “coached HCA behind the scenes on how to best present its case to the Mission Board,” the board invited only one other healthcare company — identified in other documents as Novant Health of Winston-Salem — to present a formal offer. 

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Staggered by COVID-19 infections, both among incoming patients and its own healthcare staff, Mission Hospital in Asheville is postponing scheduled surgeries at the main hospital and will admit emergency and critically ill patients only after a case-by-case review, hospital administrators said Tuesday.

“Beginning this Wednesday, January 26, 2022, the Mission operating room and other procedural areas in the hospital (Endoscopy, cath lab, IR, and others) will only proceed with urgent and emergent cases,” Chad Patrick, chief executive of Mission Hospital, wrote in a confidential memo to staff dated Jan. 25.

“We will continue to evaluate daily on a case-by-case scenario,” the staff memo, obtained by Asheville Watchdog, continued. “Any urgent/emergent case where the patient has not already been admitted, but will require a hospital bed, needs approval by multidisciplinary hospital leadership.”

“The ASC will remain open at this time but we will continue to closely monitor and may need to adjust depending on patient needs,” the memo said,

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Nashville-based HCA Healthcare, which operates Asheville’s Mission Hospital and five other hospitals in Western North Carolina, reported Friday that it made $2.27 billion in profits in the three-month period that ended Sept. 30, triple the amount in the same period last year.

The record earnings coincided with the summer surge in COVID-19 hospitalizations caused by the Delta variant. HCA said COVID patients accounted for 13 percent of all admissions to the chain’s 183 hospitals during the period.

Shares of HCA’s stock have also tripled in price since the start of the COVID-19 pandemic more than 20 months ago, creating a financial bonanza for investors and company executives. HCA is the largest employer in Asheville.

Samuel N. Hazen, HCA’s chief executive officer, credited the company’s record profit margins to a “disciplined operating culture.” He said HCA was on track to use its cash to buy back $8 billion in company stock in 2021.

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Two long-time members of the Transylvania Regional Hospital board of directors resigned Monday, saying they were “embarrassed” to have supported the sale of the Mission Health System to giant HCA Healthcare and that they now fear for the future of the Brevard-based community hospital under HCA’s profit-driven management.

In an open letter to The Transylvania Times, the board members, Parker Platt and Mark Weinstein, said they had been sidelined and rendered “powerless” and “voiceless” by the HCA-dominated board. “It is our hope that our resignations might have a more positive influence on the hospital’s future direction than if we remained on the board,” they wrote.

Asked by The Watchdog to comment on Platt’s and Weinstein’s resignations, a hospital spokeswoman said, “We thank them for their service.”

The resignations highlight growing community dissatisfaction with HCA’s operation of the 92-bed,

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