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.
“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.”
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.”
“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 firstname.lastname@example.org. To show your support for this vital public service please visit avlwatchdog.org/donate.