Dr. Michael Frisch worked at Mission Hospital for 15 years, including as chief of staff at the time of its sale to HCA Healthcare. // Watchdog photo by Starr Sariego (left); Credit: Dr. Michael Frisch (right)

Dr. Michael Frisch once held one of the most prominent positions at Asheville’s Mission Hospital, but today he gives the campus a wide berth.

“I do try to avoid driving past the hospital there just because I get upset and depressed when I see it,” Frisch told Asheville Watchdog in an exclusive interview days after the former Mission chief of staff and 49 other doctors signed a letter condemning what they said is owner HCA Healthcare’s “for-profit-driven” management, which, according to the document, “gutted the heart and soul of our community healthcare system.”

Frisch, 55, worked at Mission for 15 years and was the hospital chief of staff from 2019-2020, during the time when Nashville-based HCA bought it and the six-hospital system it belongs to for $1.5 billion.

Frisch said he was proud of the medical community that Mission, previously a non-profit hospital, had built over the years. But, he said, he watched many of his colleagues and friends leave for the same reasons he did: HCA’s for-profit model wasn’t how they wanted to practice medicine.

“It just, in my opinion, destroyed the medical community that was Mission,” Frisch said, adding that “I truly felt like it was a moral injury to be working for them.”

“I just felt dirty”

Frisch talked to The Watchdog for nearly an hour Wednesday, the first time he has publicly discussed the reasons behind his departure. In the wide-ranging interview, he described his early optimism about the hospital’s sale, his realization that care was declining, and his difficult decision to leave.

Frisch had planned to retire at Mission, but he left the hospital in July 2022. He lives in the Charlotte area and works at Novant Health’s Presbyterian Medical Center as an orthopedic trauma surgeon. Frisch said the letter he signed and his interview with The Watchdog did not represent the views of Novant Health. (Novant wanted to purchase the hospital system before its sale to HCA.)

HCA’s patient-care model wasn’t the kind he wanted to provide, Frisch said.

“I just felt like I was being kind of a proxy to it,” he said. “I just felt dirty.”

When asked for comment, Mission spokesperson Nancy Lindell did not address Frisch’s contention that HCA’s for-profit model had destroyed the medical community.

Frisch said his decision to leave followed what he described as a “million little duck bites” that built up over time.

Dr. Michael Frisch, Mission Hospital’s former chief of staff, told Asheville Watchdog he avoids the hospital’s campus when he is in town. “I do try to avoid driving past the hospital there just because I get upset and depressed when I see it,” he said. // Watchdog photo by Starr Sariego

“I was like, ‘Oh, it can’t get worse,’ and then another thing would change or another person would leave,” Frisch said, remembering what a departing colleague told him before he left: “He told me ‘Mike, you’ll be okay with HCA if you’re OK with being OK.’”

HCA, he said, was “OK with being average,” instead of providing good care that potentially would be more expensive for the hospital.

Shortage of Sterile Instruments

Frisch said one of his final straws involved the sterile processing department (SPD), teams tasked with cleaning and preparing medical devices used for surgeries. These teams were rushed, short-staffed, and underpaid, Frisch said, and as a result, they were very behind.

“One of my last weekends before I decided (to leave) it was just a very busy call weekend, and SPD was like 500 operating room sets behind,” Frisch said, referring to collections of medical instruments needed for an operation. “And in every case I was getting a call like, ‘Dr. Frisch, we don’t have any sterile sets for your next surgery.’”

One doctor he talked to, Frisch said, went through five sets of instruments before he found a sterile one.

“I was to the point like, I just don’t really even trust that I’m getting sterile instruments up here to operate and I don’t want to put my patients at risk,” he said.

Frisch said he warned hospital administration about the 500-set backup. “There’s no way we’re ever going to catch up unless we cancel some surgeries,” Frisch said he told hospital administration. “We don’t have to cancel a whole elective schedule, but can we maybe cancel two or three cases a day so we can slowly work our way back up?”

The hospital did not listen to him, he said, adding that it was clear the administration did not want to cancel elective surgeries because of the potential loss of revenue.

He left soon afterward.

Mission CEO Won’t Talk to Watchdog

Lindell did not immediately respond to questions from The Watchdog about the episode that Frisch described but she said that during a two-day period this summer, the hospital had to reschedule 21 surgeries because of SPD issues. She did not answer questions about whether Mission and HCA has been concerned that canceling electives would represent a loss in revenue.

“While there have been staff changes and a subsequent training period within sterile processing for newly onboarded colleagues, the team at Mission collectively worked in multiple ways through these challenges,” Lindell said.

Frisch said he struggled over whether to stay and try to improve things or work somewhere his ability to help patients wouldn’t be hampered. He said he raised various concerns to hospital leadership, to no avail.

“I thought I was in a position where I could talk to (Mission Health CEO) Chad Patrick and say, ‘I really think this is the best decision. I really think this is the way we should go.’ And there were a number of little episodes where I said, ‘This is really, I think, the best course,’ and he would hear me but then do the opposite.”

The Watchdog requested an interview with Patrick through Lindell, but it was not granted. Lindell responded in part that the CEO “is readily available to anyone on his team who has concerns or suggestions and continues to make decisions based on what is best for Mission Hospital and those who work there.”

Early optimism about the sale

When the HCA purchase was first pitched to Mission staff, Frisch thought “it would take us to another level,” he said.

“It was kind of sold to us that we were always on financial straits and this was going to be our ability to continue the programs we had,” he said. Former Mission Health CEO Ron Paulus had a vision not only for a completely integrated health care system in Western North Carolina but one where HCA would enhance and preserve Mission’s already high-performing operation, Frisch said.

“But then after the takeover, it just really came more and more to light to me that HCA was really not about patient-centered care — it was more about revenue generation,” Frisch said.

Staff leadership meetings previously focused on patient-centered care and social determinants of health, he said. After the HCA purchase, those things “didn’t come up,” Frisch said, and were replaced with discussions about metrics.

“I probably should have researched HCA more,” Frisch said, adding that he thought Mission’s board of directors “was sold a bill of goods, too.”

“I can’t speak for all the board but the ones I knew and talked with really thought (the sale) was going to be a good thing,” Frisch said, adding that he doesn’t like people blaming the board for Mission’s post-HCA woes.

Since the sale, the hospital has become focused on profit instead of quality patient care, according to the letter that Frisch signed along with the other doctors, an approach which they contend has been partially responsible for a depleted staff.

“To me, HCA kind of always wanted to get to that staffing level, just as part of their business model, and has used the COVID (pandemic) as kind of an excuse to get there,” Frisch said. “And then they said, ‘Yeah, we’re still functioning. We’re still getting along at this level. We didn’t need that many nurses before. I think they feel like they’re doing fine because they’re still making the money they need and really running on a bare-bones level.”

Nurses, physicians are “holding it together”

Lindell said Mission is not unique among hospitals in facing staffing challenges since the pandemic.

As of August, Mission had 300 more nurses working in the hospital and 300 more support staff than it did a year ago, Lindell said.

Bringing on travel nurses — temporary health care workers who move from hospital to hospital — was one of Mission’s business strategies, Frisch said. When he left, a significant portion of the nursing staff were travelers, he said.

Novant employs travelers, Frisch said, but not as constantly as Mission. 

“And we do have our staffing struggles, but when people complain I’m like, ‘You guys have no idea how good you’ve got it,’” Frisch said.

The Watchdog asked Mission what percentage of nurses at Mission Hospital are currently travelers and what percentage were travelers in mid-2022, when Frisch left. 

Lindell did not provide the numbers, saying only that the number is “lower now,” adding Mission “always had and will continue to have travel nurses” to supplement permanent staff. 

“The people were still there, the nurses, the physicians, I think they’re the ones kind of holding it together,” Frisch said. “I still really respect them. I still have a lot of friends and colleagues who are probably mad that I signed that letter, but it wasn’t addressed to them. A lot of them are incredible physicians and providers. But some are kind of stuck there.”

“My jaw hit the floor

Former Mission emergency department doctor Allen Lalor, one of the organizers of the letter signed by 50 doctors, said Frisch’s signature is one of the most significant on the document. Several more doctors have added their names since Oct. 19, Lalor said, bringing the total to nearly 60. Nine of them — none Mission employees — listed on the letter remained anonymous out of fear of retribution.

“He’s such an important voice in the community,” Lalor said. “When he said he would sign openly, my jaw hit the floor.”

Lalor said Frisch had no reservations about signing the letter, which asked “for the relationships and resources needed for the medical staff, all staff, to function at their highest ability,” and for hospital leadership to “look at economics as if people mattered. With our many hundreds of years on the front line of patient care, we know what a fully resourced system looks like.”

Dr. Robert Kline, a former member of Mission Hospital’s board of directors before the hospital’s sale to HCA read a letter criticizing Mission Hospital at a public meeting hosted by Gibbins Advisors, the independent monitor hired by Dogwood Health Trust to oversee HCA’s compliance with the terms of the sale. // Watchdog photo by Starr Sariego

The letter was read by Dr. Robert Kline, a member of Mission’s board of directors before HCA’s purchase, at an Oct. 19 public meeting hosted by Gibbins Advisors, the independent monitor of the hospital sale.

Ten unionized Mission nurses who attended the Oct. 19 meeting read their own letter detailing similar frustrations. “Since HCA took over, every unit in the hospital that was supposed to have services protected has had services eliminated or has seen staffing cuts so debilitating that care cannot be safely provided,” the nurses’ letter said.

Mission currently is contacting doctors to create a letter responding to the one Frisch and others signed, according to a solicitation obtained by The Watchdog.

“As physician leaders of the Mission Hospital Medical Executive Committee, we do not feel like this letter represents us as a whole,” the document reads, requesting doctors respond by Oct. 24. Fourteen Mission physicians signed the solicitation. The first signature is current chief of staff Dr. Ansley Miller’s.

Lindell, the Mission spokesperson, said she would “let the letter Dr. Miller is coordinating speak for itself as I was not involved in it and quite honestly, have not seen it.” 

Asked about a Mission blog post profiling him in March 2019, Frisch noted there also was an accompanying promotional video of him that April. 

“I keep meaning to call and say, ‘Hey, I really want you to take that down,’ Frisch said. “I don’t really believe what I’m saying in that anymore.’”

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.

38 replies on “Former Mission chief of staff: ‘I truly felt like it was a moral injury’ to work for hospital”

  1. And here we are today with it only getting worse every day. People are literally having to move away from Asheville to be near a hospital system that functions as a hospital and storage bin. HCA is too big to fight and there’s really no one fighting it anyway. Josh Stein is all talk, no action and even the talk will cease when he’s elected governor. NCDHHS obviously isn’t interested. NC just approved another ER location for HCA. Nothing will change. Anyone with serious health issues needs to move to another city. It’s impossible to even get an appointment within a few months at HCA affiliates Asheville Cardiology or Asheville Pulmonology and you truly don’t want to ever be a patient at Mission anyway.

    1. The Attorney General did not have the legislative power to stop the sale. As you have read here, many current and past staff fear retribution, so getting folks on the record is hard. As a patient advocate, I have been trying for YEARS to get staff to go on the record, and they wouldn’t. We are starting to see changes to this in 2023, and my hope is that it catches momentum. This letter is huge, but the first of its kind. I know the AG’s office will litigate as soon as they have enough to do so. The AG only has the powers granted to him in our legislature and the bills have not passed yet to give him the authority to stop sales such as these. We should be angry with our legislators for not passing a bill to give him the ability to take action. I don’t understand why they continue to get further approvals though. I would like to understand that more.

      1. Follow the money. This would note the first time that state legislators benefited financially by “assisting” a corporation getting what it wants.

      2. The problems in SPD are greater than even Dr Frisch knew about and are getting progressively worse! Do NOT have surgery at Mission hospital unless you are comfortable gambling with your recovery!

  2. We moved here in 2019 in part due to the high quality health that Mission had a reputation for providing. Then the buyout was finalized. I have spoken with health care professional around the country that I know. Without exception, when I told them that HCA had taken over Mission they groaned and looked at me with sad eyes. “You’re so screwed.” they commented dryly. It seems that they were correct. They’ve now driven out our last oncologist. Yet they grin that Alfred E Neuman grin out at Asheville and ask “What? Me worry?” And the same goes for our Republican controlled state. Money is the only talk they can understand. Patient care? Get real.

  3. I worked as an RN in an HCA hospital in Fort Pierce, Florida. Prior to their purchase, we were not for profit institution. Those years did not provide for glitz, but they excelled in honest, well thought out patient care. Their business model has not changed after all these years. Mission Hospital was a fine, community minded hospital before their arrival. It is not surprising to me that no one recognizes that anymore. Do your own research. They are making a fortune in Asheville just as it was always their intention to do. The citizenry of every single patient , that Hass to access this facility is paying for it. Thank you Asheville watchdog for your ongoing, highly enlightening work on these treacherous individuals. May it bring enough scrutiny to rid our community of these feckless humans.

  4. I am so proud of these physicians for speaking up. It’s been a long time coming. Their voices are louder and stronger than the rest of ours and it is also their responsibility as medical doctors. HCA thinks they are too big to fail – and perhaps that is true. But it’s blood money they are running to the bank to deposit. I left the medical field for the same reasons, and the number of folks changing fields is alarming still. I have one question: where is our Attorney General as all the medical doctors, and other medical personnel, are screaming for help? Because his empty letters that are simply being ignored by HCA are obviously doing nothing. So glad our tax money is hard at work.

  5. Physicians are trained in health-care provision, not as business people. Any MBA would have known to research HCA, whose headquarters are in TN, regarding their track record. What I’d really like to know is how many of Mission’s management took sweetheart deals to quiet any concerns they may have shared.

  6. Dr. Frisch’s comment about SPD just confirms my experience. I had a total knee replacement about the same time as SPD being 500 kits behind on sterilization and being rushed to process kits. I contracted a MRSA infection in my new knee within 2 weeks of surgery and had to have it redone, go on IV antibiotics at home for 6 weeks and am now on a lifelong oral antibiotic as a result! My surgeon told me there were a cluster of MRSA infections about the same time, different surgeons, different surgeries, different OR rooms. The only common factor was instrument kits. Thanks, HCA.

      1. Honestly how does this facility even have the doors still open.im a native of western NC.Me as well as many other locals are at a …Really Scared State At this point!!!!!! We are neglecting Our own healthcare.because we fear going to the ER for any reason whether it be serious or acute issues.I personally know of three individuals with serious life threatening circumstances who laid on gurneys for days in the hallways.unattended to the issue at hand untill finally released and returned home and told to follow up with their primary!! THIS HAS TO STOP.WE AS A COMMUNITY USED TO HAVE THE UTMOST RESPECT AND CONFIDENCE FOR MISSION HEALTH NOW WE STRESS ABOUT WHERE TO HAVE AN AMBULANCE TAKE US IF ONE NEEDS TO BE CALLED…..SAD!!!!!!!!!!!

        1. Why can’t someone put a stop to what’s not going on? HEALTHCARE,? The Govennor- Federal Gov. ,some one .

    1. SPD problems still happening, April 2023 I had knee replacement revision, 3 weeks later it blew up with staphylococcus aureus infection, while questioning my surgeon if it came from prior health issues, he said no – it definitely came from surgery in the OR. I’m told 2% nationwide get this and I should be glad I caught it fast otherwise it would have gone into my blood and killed me. So, instead my ROM & quality of life is forever ruined. After 6weeks of IV antibiotics, 6 months oral Cipro & Rifampin strong dosage antibiotics, I will need to be on another antibiotic for one year, then ???? Another Revision to remove replacement parts??? Put in a spacer??? HOPE staphylococcus aureus is 100% gone – then another knee replacement revision surgery, and if that doesn’t work – amputation.
      I was an athletic person all my life, hiker, dancer, etc – Now ANGREY

      1. These stories have brought me to tears. I am considering having a medalert bracelet made which states “I do not consent to treatment at Mission Hospital”.

  7. Honestly, the only thing to do at this point is for the Governor to send in the national guard to help save lives. If you have a loved one in there, get them out.
    This is sick. Dr. Ansley Miller defending this is even sicker. They will never admit they are killing people even though the nurses letter clearly states it and those who know, know.

  8. HCA is the same bunch of brigands who had to pay a then-record fine for defrauding Medicare and gave Rick “I know nothing” Scott a golden parachute to go away, whereupon he used it to become Florida’s second-worst governor and then a U.S. senator (The worst governor succeeded him.) Expecting a band of brigands like HCA to run a hospital for anything but excessive profits was the medical equivalent of voodoo economics. In most other countries, hospitals are government or nonprofit. Here, the idea is that you check a patient’s wallet before you check their pulse.

  9. Dr. Michael Frisch’s candid interview with Asheville Watchdog is better late than never. However, justifying Mission Board members and senior officers decisions about the Mission sale because they believed HCA would enhance patient care is fooling himself and misinforming WNC citizens. Board members were in fact experienced, well informed business persons and physician administrators with responsibility for a critical public resource. The complexities of cash flows essential to disguise predatory for-profit medicine are – or should be – well known by anyone with hospital oversight and governance responsibility. It is beyond reasonable belief that board members were hoodwinked. To reduce the betrayal of public trust to that simplistic level is to assure the continuation of separating WNC citizens from their money and their health. Sunlight shone on board members and senior officers is necessary if any change is expected.

  10. Chance for a do over here Asheville.
    When the city is ready for high quality healthcare that serves the people there are many highly skilled, caring healthcare professionals here who can step in and help.
    We had a community wide project focused on that 10 years ago that the city and Mission shut down. Then they sold to HCA which, to me, was an obvious disaster in the making from the start.

  11. Thanks, Asheville Watchdog, for keeping the spotlight on HCA’s disastrous impact on healthcare in WNC. If the public clamor—including from doctors and medical personnel—continues, can we perhaps get some oversight and action before our healthcare system is completely destroyed? I’m grossly disappointed in the failure of our AG to take this issue seriously and effectuate positive change. HCA won’t even respond to his letters in a timely manner. I applaud the individuals still at Mission who are doing their best to provide decent, patient-centered care in spite of management’s best efforts to deny them resources needed to do so. HCA has only been arrogant and unresponsive to multiple demands for accountability. Have we really no mechanism or institution in this entire state to hold their feet to the fire? This has gone on way too long, the failures are well-noted and still there is no positive resolution and the system continues to degrade. What will it take?

  12. Hopefully the Asheville Watchdog investigation will include the lack of concern from Asheville and Buncombe County political leaders leading up to the sell of Mission Health. Were they all blinded by the opportunity to increase the property tax revenues, giving them more money to spend on their pet projects? Maybe it was also the establishment of Dogwood Trust providing even more funding for questionable projects?

  13. The doctor’s moral injury…. Still not enough focus on patients’ harm. I’m about to start recruiting patients and families for a real letter to be written.

    1. In 2022 I had three Back Surgeries in a 6 month span. Collapsing disc due to degenerative disc disease. July to end of October. The last surgery was extensive with pins screws cage to build a foundation for my back, I woke up in pain and rang for a nurse after 45 minutes of waiting the traveling nurse came in and had the audacity to say two to me. This is the back unit everyone’s in pain when I ask him why he hadn’t been in to give me any pain shots. He said I have to call for them. It’s not on your chart that’s a lie he he gave me my pain meds and returned to give me another shot. Long story short when I woke up I felt like I had been in a fight. My chest was so sore they had given me and Narcanm that means someone overdosed me and it wasn’t me. They also had given me the heart massage to get my heart beating again I will never go back to Mission unless it is a dire emergency, and then I will bring a advocate to stay with me the whole time I’m there and watch what really goes on I am so hurt and so distrustful of this hospital I don’t know if I’ll ever regain my confidence. There’s more to tell but no way to express … to long:

  14. Ok Watchdog. Can you do some research and start writing articles about what we as citizens can do since the state of NC can do nothing? Besides a boycott (which is hard when a medical emergency occurs), what other recourses do we have? A massive class action lawsuit? Identifying candidates to do a forced buyout? We all know they don’t care about patient outcomes (only profit) but is our only option to wring our hands?

  15. Dr. Frisch was my doctor for two different trauma surgeries and he is one of the most patient oriented doctors I know. Mission lost a great doctor. I will say the nurses who cared for me were wonderful even though they appeared to be overworked.

  16. I can certainly relate to the issues with the Sterile Processing Department. In March of 2022, I was scheduled for knee replacement surgery. I was prepped (including medication) for the operating room when my surgeon discovered that multiple instrument kits were contaminated and no other kits were available. The surgery was canceled. I was sent to recovery and asked to return two days later. I had my surgery on the second date; but, ultimately received hospital bills for both days. Thankfully, after some haggling, I was able to get the bill for the first surgery date reversed. Needless to say, my experience was quite rattling.

  17. The SPD shortages and backlog are indefensible and terrifying. What better example of a corporation that does not care?

  18. When the sale was announced, I looked up who owns HCA. Private Equity firms. Yes. How did this simple fact escape everyone? Really. I’d like to know.

  19. Given the long term BAD reputation of HCA, nobody should be surprised with this outcome. I am certainly not… As to how did it happen? That one is EASY, HCA BOUGHT the former Chairman of the former Mission Board.

  20. Sounds as if doctors were performing surgery knowing they were likely using contaminated equipment. That’s next level. This place needs to be shut down while they figure this out.

  21. I wonder if that new letter signed by the doctors who think Mission is doing a fine job will ever surface.
    Towing the party line is getting a bit awkward to say the least. And you know HCA is strong arming doctors to sign it. HCA is the medical mafia.

  22. I was recently admitted to MM on an urgent basis. My husband, daughter & son-in-law were with me in the ER and they witnessed very indifferent, thoughtless, angry and dismissive behavior from those in the ER. They were horrified with the attitude of those nurses and people who are supposed to help those who come to MM in an emergency. I was unconsious and remember nothing until I awoke in ICU where I was treated with respect, caring, thoughtful staff. MM has become a very bad hospital and I never want to go back again.Pardee is a better choice. I used to be proud that MM used to have the reputation of being one of the 100 best hospitals in the country. They sure slipped from that honored position.

  23. I do want to begin by saying, how much I/we appreciate the dedicated workforce, at Mission Hospital. But, the ones that are there, are being loaded down like pack mules. As I begin this story, I am sickened by the way our healthcare system has deteriorated, at the hands of HCA. Long before the sale, young folks, coming out of high school, or even college, were chomping at the bits to work for an upstanding healthcare system, like Memorial Mission Hospital. Where are we now, and why would these young adults want to work at that facility? As a public, we’re having to scramble to find a healthcare facility that is not tied to HCA, so we can feel safe. My wife had a very delicate surgery performed on her back, in early August. During the pre op consultation with a very prominent, and well known neurosurgeon, we asked if he could, or would perform the procedure anywhere but MMH. He stated that he has a special team that assists him during these types surgeries, at Mission. So, she elected to take her chances. We are so thankful that the procedure went well, and she can finally walk, without excruciating pain. On another note. After coming out of recovery, to the room, on the 6th floor, it was downhill from that point on, for seven days. If I had not sheltered in with her, she would have been like someone on an island, by herself. I took on the role of CNA, nurse, and janitor, during that time. From day one, I would ring for assistance, to take her to the bathroom, or whatever. “We’ll be there asap”(cricket, cricket). Finally, I had to get her up (a liability), walk her to the bathroom, and when finished, I had to clean her, then walk her back, and help her back in the bed. This went on 85% of the time, until she could get up on her own, later in the week. The med nurse was always on time (morning & evening), and the hospitalist, Dr Ivey, was spot on with her care, each day, and saw that tests were done, when needed….It saddens me to see such a great hospital, that we once had, go down like this. My prayer is for the staff that is stuck there, and that someway, somehow, things can turn around to make our healthcare system back the way it once was.

  24. All staff that stays there without speaking out are not helping the patients. They may think otherwise, but this is an unsustainable sinking ship. You may help one patient but 10 more slip through the cracks and suffer. The union also needs to step it up. They all might want to get on the right side of history before its too late. The momentum is good now, strength in numbers. Safe medical care should not depend on the luck of the draw.

  25. As a Vietnam veteran, I receive all of my medical care at the VA hospital here in Ashville. I recently had a procedure that neccitated an overnight stay at the VA hospital. During that time, I encountered two doctors and four nurses. Each and every one of them said they had transferred to the VA from Mission Hospital. As an old newspaper reporter I had to ask why they’d moved. Almost unanimously they responded, “patient care” and “working conditions”, particularly “understaffing.”

  26. Very sad news ….. particularly since my significant other and myself were planning on moving to Asheville. Both of us seniors, and he with Afib, we choose to be close to a good medical community which would, of course, include a good hospital. I’m having second thoughts as we get close to making a decision about Asheville.

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