Two hundred and one physicians practicing at Mission voted for the new bylaws; 202 voted against them. // Watchdog photo by Starr Sariego

Proposed bylaws and policies that some doctors who practice at Mission Hospital feared would have muzzled them from criticizing the hospital or owner HCA Healthcare were voted down by a single vote Wednesday.

The vote outcome was first reported by the Asheville Citizen Times.

According to an internal email signed by Mission Hospital Chief of Staff Dr. Ansley Miller and obtained by Asheville Watchdog, 403 of 871 active medical staff cast an electronic ballot in the vote: 201 voted “yes” and 202 voted “no.” 

A handful of votes were ineligible.

The tally came after some doctors widely shared concerns that existing language and proposed changes to the bylaws and policies would prevent doctors from speaking out about systemic issues at Mission. The hospital was bought by HCA Healthcare in 2019 for $1.5 billion and has seen increasing criticism over its management and quality of care.

Options for next steps will be presented to the Medical Executive Committee for review on Dec. 1, according to Miller’s email.

“We are pleased with our physicians’ engagement in participating in this process and vote,” Mission Health spokesperson Nancy Lindell said. “With just a one-vote difference in the final tally, there will be no changes to our current bylaws at this time.”

“The hospital views the collaborative review and approval of bylaws as a confidential process and out of respect for the medical staff, will not comment further,” Lindell said.

Lindell did not respond to The Watchdog’s request for an interview with Miller.

Wednesday’s vote followed several emails sent to doctors by Martin Palmeri of Messino Cancer Centers, which has practice privileges at Mission.

Martin Palmeri // Credit: Messino Cancer Centers

“The current set of bylaws and policies contain both new and grandfathered in language that in my mind empowers the hospital to exert even greater control and oversight over the medical staff,” Palmeri said in one of several emails obtained by The Watchdog. “There is language in the bylaws and policies that is vague and is open to interpretation when it comes to what constitutes a code of conduct violation.”

Palmeri, president of the North Carolina Oncology Association, would not comment on the email, but spoke broadly about the implications of bylaw changes and their impact on medical communities across the U.S.

“I think doctors need to take a more active role in self-governance, and not leave it to these larger hospital systems to come up with their bylaws,” Palmeri said. “Bylaw changes are occurring nationwide. There’s a lot of things occurring as large conglomerates and organizations are taking over hospitals.”

Those conglomerates are affecting the self-governance of doctors within their hospitals, Palmeri said.

“I think that this is just an opportunity for medical staff to become engaged and to really understand what’s going on within their institutions and to know that doctors do have some power in terms of how these bylaws are constructed and the rules that govern them,” Palmeri said.

Palmeri’s email specifically referenced a part of the proposed bylaws which he feared contained language so vague it could lead the hospital to fire a doctor “for any reason.”

The section read: 

“All Practitioners are subject to termination or modification of their medical staff Membership and/or Clinical Privileges by the Board of Trustees (BOT), based on factors deemed relevant by the Board of Trustees. Actions taken by the Board of Trustees are expected to substantially comply with the medical staff Governance Documents, subject to the Board of Trustee’s retained right to rescind and delegation of authority and with the understanding that strict compliance is not required.”

Another section in the proposed bylaws, obtained by The Watchdog, outlined rules around “inappropriate conduct” and said one example of such conduct is  “degrading, demeaning, or condescending comments regarding patients, families, nurses, Practitioners, Hospital personnel, the Hospital or any other health system or private practice. Professional and constructive feedback, however, is valued, and can be brought forward through Medical Staff Leadership, Administrative Leadership, or the Quality and Patient Safety department.”

Palmeri argued this language could be seen as muzzling doctors.

“What the hospital feels is demeaning or degrading can have a lot of latitude,” Palmeri said in his email. “Violation of these policies may not result in formal action against a doctor, but COULD result in an action. Again, doctors could feel threatened by this language.”

Allen Lalor, a retired emergency room doctor who joined nearly 130 physicians in signing a letter condemning HCA’s profit-driven management of Mission, said he took the Hippocratic Oath to protect patients, not the hospital. The proposed bylaws put the hospital first and the patients second, he said. 

 “I think that is morally wrong.”

North Carolina Attorney General Josh Stein has been investigating Mission and HCA since the beginning of the year, focusing primarily on emergency department and oncology issues. He recently issued an investigative demand, calling for 41 sets of documents from the hospital.

Two days before the vote on the bylaws, the North Carolina Department of Health and Human Services began an on-site inspection of Mission Hospital related to numerous nurse complaints about mismanagement in the emergency department and cancer care services. 

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 To show your support for this vital public service please visit

12 replies on “Doctors practicing at Mission reject proposed bylaws and policies by a single vote”

  1. Curious if this is the first attempt to change the by-laws since HCA’s takeover? And at least we have a number on how many doctors are on staff and/or have privileges. 871. Less than half voted. Speaks for itself. And the most vocal propagandist among them gets a promotion. The ick factor of all of this gets worse by the minute.

  2. Mission is also asking patients using areas like the sleep center to sign a legal document that you may want to look into.

    1. Let me guess, they don’t have any techs to monitor sleep studies, so if something goes wrong, you’ve assumed the risk.

    2. This current entity is no longer MISSION. That hospital was sold out by the then board of directors who had just earlier had another blow-up with BCBSNC, no doubt over charges that Mission was trying to get past their auditors. That’s my opinion only but the timing seemed a bit more than coincidental.

  3. Good on them! At least a bare majority of the voting physicians demanded that medicine be respected as a profession, not just a job, and that employment by HCA should not be (except in the hospital system’s view) peonage that demands undying loyalty to the corporation.

  4. Where in the world were the other 468 doctors!? Abstention in this case seems a bit like criminal negligence.

    1. I see 3 camps of doctors here:
      1) Hear no evil, see no evil, speak no evil. (468)
      2) Concerned about Patient Care. (202)
      3) Tow the HCA party line because they drank the kool-aid or are job scared or are getting promoted in exchange for selling their souls. (201)

  5. WLOS is now reporting 11 investigators in the ER since last week, looking at more than 40 cases of specific patient harm reported to them by nurses going back 2 years. And FYI rumor has it that covid is rampant there at the moment.

  6. THE COMMENT BELOW COMES FROM AREA RESIDENT JAMES HARRISON IN RESPONSE TO A MOUNTAIN XPRESS NOTICE…6 YEARS AGO…Many of us will continue to fight against bad deals, bad developments, bad politicians, bad TDA policies, bad gun laws…they’re all so much the same.

    The proposed sale of Mission Hospital is an abomination. The Board of Trustees has abrogated its responsibility. They do not own the hospital and I do not have a right to sell it. They hold it in trust for the citizens of western North Carolina.
    There is a long tradition of publicly owned hospitals in North Carolina. There are virtually no private general hospital bed in the state. Rather they are community owned or University hospitals.

    The only person who stands to profit from this is Ron Paulus. He argues Mission is financially untenable. He claims that because of economics of scale Mission will be able to purchase supplies at lower cost if it becomes a part of HCA Inc. He does not mention that this Corporation has a terrible reputation. The lure to the public is the promise that HCA we’ll pay more than $7 million and real estate tax to city and county. However, no one has explained where this large sum of money is coming from if mission is only breaking even at the present time. I suppose it will be done with smoke and mirrors, with higher fees for service and lower quality of care. A far better plan to achieve economics scale would be to propose that UNC hospitals take over the administration of Mission and leave it as a not-for-profit. UNC already assumed that responsibility with the Charlotte system. One of the reasons the Financial crunch is the failure of the state legislature to increase Medicaid. Another is the failure of BC/BS to increase reimbursement rates. I am optimistic that after the elections in 2018 that Congress will begin to phase in Medicare for everyone. When there are no uninsured people in North Carolina , Mission will be able to operate in the black..
    Fellow citizens, Mission is easy to criticize but just wait until it is owned by a for profit. Then you will have something to complain about.

    1. BCBSNC will not willy-nilly raise rates just because a hospital wants them to. My late husband’s job with BCBS was to audit patient records in hospitals, nursing homes to make sure Blue Cross wasn’t being charged for things that didn’t pertain to patient care. This is, or was, how the usual and customary charge was set for hospitals statewide. This is why NC customers didn’t pay NY rates as there were regions in the BCBS system and each region had a usual and customary rate pertinent to that region.
      So far, BCBSNC is still a not for profit insurer but legislation either was or is pending to change that to for profit. You don’t want that to happen. Whenever anyone mentions the fact that BCBSNC has X number of dollars stashed in escrow, as mandated by state law. They have to have enough money to pay off all claims for a certain period of time. So there is a reason to show cash on hand.
      I write this only because that was the way it used to be when my husband was working. No doubt circumstances have changed in the last several years. It’s difficult enough to navigate insurance for the general public but rest assured, HCA is all about its bottom line.

  7. I went into Mission for endovascular stint surgery on Nov 15th. Needless to say my wife and I were very apprehensive due to all the bad press Mission has recently received, so my wife stayed with me the two nights I was in the heart Tower recovering. The nursing team service couldn’t have been better. We are very appreciative of all of them.

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