Dr. Michael Messino felt a gut punch when he read Asheville Watchdog’s report that the cancer group bearing his name would be halting acute leukemia chemotherapy at Mission hospital.
“I was pretty angry that it was going to happen,” the retired physician told The Watchdog in an exclusive interview recently, describing his reaction to the news that conditions at the hospital had prompted the move.
Messino’s former colleague, Dr. Martin Palmeri, a lead oncology doctor at Messino Cancer Centers and president of the North Carolina Oncology Association, wrote Mission on Sept. 20, notifying it of “system failures” that he said were risking patient harm and that the group had asked hospital leadership to fix for years.
Messino wrote his own letter and sent it to Buncombe County commissioners, Asheville City Council members, the state’s Department of Health and Human Services, North Carolina Gov. Roy Cooper, and Attorney General Josh Stein, prompting a meeting with the attorney general office’s general counsel days later.
“HCA and (its North Carolina Division President) Greg Lowe define success as ruthlessly running roughshod over anyone who gets in their way,” Messino wrote. “HCA has sold the people of Western North Carolina a lemon and now the Department of Justice is stepping in.”
Doctors are stepping in, too.
Messino is one of now 123 local physicians who signed onto a letter condemning HCA’s profit-oriented management and saying it had “gutted the heart and soul of our community healthcare system” since it purchased the then non-profit Mission system in 2019 for $1.5 billion.
“HCA’s failures have had devastating repercussions on the patients of Western North Carolina,” Messino wrote in his own letter. “Medicine is about putting patients first and not dominating the marketplace.”
Messino Cancer Centers treats patients in Mission’s facilities through practice privileges, and its work there is separate from Mission Health SECU Cancer Center.
Responding to a series of questions about Messino Cancer Centers and Messino’s letter, HCA spokesperson Nancy Lindell referred to a July 19 letter Lowe sent to the attorney general’s office detailing the history of oncology services at Mission since 2019.
“As we addressed in our July 19 letter to the Attorney General’s office, Mission Health is committed to continuing to provide top-tier oncology services to the residents of Western North Carolina; and we are achieving that in addition to having more oncology providers on our medical staff than we did in January 2019,” Lindell said.
Reached for comment on Messino’s letter, Palmeri said, “Dr. Messino has been a pillar of oncology in the community. He supported oncology patients in Western North Carolina for 30 years. I think he’s a strong voice for cancer patients.”
Messino, 70, a medical oncologist and the founder of the Messino Cancer Centers, which was previously called Cancer Care of Western North Carolina, recognized the cancer center’s move as the end of an era. He started his practice more than 30 years ago.
“We were unique because most private practices don’t treat leukemia because it’s labor intensive, and you’ve got to have a lot of support,” he said.
Messino’s letter adds to a flurry of correspondence involving health care in Western North Carolina as HCA Healthcare is under investigation by the North Carolina attorney general’s office for violating commitments it made as part of the 2019 purchase, specifically related to its emergency department and oncology services.
The attorney general’s office has threatened legal action if HCA doesn’t fix the violations by Dec 10.
“The root cause for this decision is the inability of HCA to guarantee the support needed for these patients, such as specific laboratory services, pharmacy support and adequate nursing staffing with trained individuals familiar with the treatment for these patients,” Messino wrote of Messino Cancer Center’s decision to stop providing some acute leukemia therapies. “Now patients will need to travel long distances to receive their care for these treatments,” echoing a concern raised in Palmeri’s earlier letter.
The closest cities they can get this kind of care are in Charlotte, two hours from Asheville, and Durham, three and ½ hours away.
His letter made recommendations for how the hospital can improve — along with cost estimates — to help leukemia patients. He recommended:
- A chemotherapy trained pharmacist for an estimated $100,000 per year.
- Four additional oncology nurses for an estimated $400,000 a year.
- A dedicated care manager for an estimated $40,000 per year.
- Enhanced laboratory services for an estimated $500,000 per year.
And his final hiring recommendation: “Administrators who know how to deliver coordinated oncology care — priceless in this current environment.”
Despite its problems, Mission has excellent physicians, nurses, and staff, Messino said. “We want to support them and we want them to keep working because they are the ones that are holding things up,” he said. “And those are the people that are going to take care of us.”
Last week, more than 80 Mission doctors and healthcare workers signed their own letter rebutting the one signed by Messino and 122 other physicians. Messino told The Watchdog repeatedly he didn’t want those workers to feel as though they were under attack from doctors who had criticized HCA.
It’s the system and HCA’s takeover, he contends, that are putting patients at risk.
“I feel obligated to do something here”
In retirement Messino has become a kind of activist – writing letters, speaking at four public meetings this fall hosted by the independent monitor of the HCA/Mission sale, and meeting one-on-one with the attorney general’s office just hours after he sat down with The Watchdog, where, he said, he discussed emergency room and oncology issues that had been previously brought to the attorney general’s attention.
“I feel obligated to do something here,” he said. “I mean, Western North Carolina is my home.”
Mission, too, was Messino’s home before the HCA purchase, which physicians learned about six months before the finalized sale in 2019, he said.
That year, his whole group of physicians — then called Cancer Care of Western North Carolina — left Mission after contract negotiations fell through. The group then opened an independent practice and named it after Messino, a choice he said he initially opposed.
The cancer doctors didn’t leave Mission because HCA’s offer was bad, Messino said. His team had researched HCA when it found out about the impending sale, he said, and discovered that the company’s model frequently involved downsizing.
“They were going to take our employees,” Messino said. “The first thing (HCA) would have done was they’d have decimated the employees and we would have been stuck without enough people to do the work.”
HCA leaders didn’t think the oncologists would leave, Messino said, because the mass departure meant the physicians would need to find new offices in short order.
Within months, the group found offices and was up and running again by January 2020, transformed from CCWNC to Messino Cancer Centers.
Today it has locations in Asheville, Brevard, Franklin, Marion, Spruce Pine, and Sylva. The group is part of the American Oncology Network, which has $65 million in new capital from AEA Growth, a New York private equity fund.
Lindell did not respond to questions about whether HCA would have laid off cancer staff if Messino’s group had decided to renew its contract.
“In 2020, Messino joined AON, a private equity-backed company that recently went public, for their own financial reasons,” she said. “This and the other details that you’ve asked about are also covered in the numerous responses we’ve sent to the Attorney General in 2023.”
A plan doomed from the start
Nearly four years later, Messino remembers upheavals that came as Mission tried to recover from the loss of the 14 cancer doctors in his practice.
“The thing that we noticed (after departing) was that there was less staff,” Messino said. “There was less housekeeping staff, clearly. We had a really nice staff of nurses on the oncology floor and slowly they started to leave. You had all these people who had been in the system for years; they were leaving.”
HCA engineered a plan to mitigate the cancer physician losses. Messino attended a Mission medical staff meeting just after his group opened the doors of its independent practice. Lowe told gathered staff that Mission was going to hire 14 medical oncologists and “compete with that group that left us,” Messino said.
“I sat there and I mumbled under my breath, ‘It ain’t gonna happen,’” Messino said.
Lindell did not respond to questions about the details of the meeting.
According to a letter Lowe sent the attorney general’s office in May, Mission had hired six medical oncologists since 2020. According to another letter Lowe sent Oct. 4, the last of these and the last remaining medical oncologist on staff, Dr. Michael Burke, will leave Nov. 26, which Burke confirmed to The Watchdog in a recent interview.
Lindell would not say whether plans remain to build a large team of medical oncologists, whether the hospital had hired any medical oncologists recently or whether there would be any medical oncologists working after Dr. Burke’s departure.
Lowe’s plan upset some of the Messino group’s doctors, Messino said.
“Asheville Hematology and our group had always given care in that institution. And to think that you could just go out and pick up a bunch of oncologists was ludicrous,” Messino said.
That’s partly because “there’s not enough of us anymore,” he added, referring to a nationwide shortage of medical oncologists.
Messino said HCA’s own cancer institute, Sarah Cannon — which partners with Messino for exclusive patient trial privileges — has recommended to Mission administration multiple times that the hospital should work with Messino Cancer Centers.
That has never happened, Messino said.
Lindell, also a spokesperson for Sarah Cannon, did not answer questions about the recommendations.
From physician to patient
Last year, months before he retired, Messino became a patient at Mission.
A test revealed an abnormality in his abdomen, which he later learned was benign. Over three weeks he underwent an MRI, a CT scan, a cardiac catheterization, chest surgery and abdominal surgery, he said. Then, in September 2022, he was in a hospital bed.
The “horror stories” about staff shortages, he said, were true.
His wife was his daytime nurse, his daughter his nighttime one, he said.
Two weeks later, he was back at work.
“I had people I had to see,” he said. “I was getting my last four months done trying to see everybody I needed to see.”
On Dec. 30, 2022, he retired. He’s been spending time with his grandchildren, working on house repairs, honing his metalcraft hobby, canning tomatoes for sauces, working on a cookbook and advocating for improvements at Mission.
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.
Does the city have no say at all about hospital services? If the hospital had been sold to McDonald’s would they have remained as silent and uninvolved as they were? What can the governor, NCDHHS or AG do to rid Asheville of this hospital no one here wants? Could enough people boycott HCA Mission to make them unprofitable?
Many have boycotted already. Those who have the ability and resources to leave town for care have. The fact is that in an emergency most of us could end up there, which is terrifying. I have a sign up in my house, not to take me there ever. I can’t unsee what I’ve seen there. It’s not a hospital by any stretch of the definition.
This is the question. City “leaders” seem to be interested in overdeveloping all the beauty out of our home, making buckets of money from their real estate related businesses. Meanwhile, we (rightly) focus on HCA and Dogwood Trust failing to live up to the sale contract, which was pushed as far as he could by Josh Stein, and his warning to the board which approved the sale did not change any votes. So, focusing on the harm to residents, the community, destroying already existing and functioning cooperative high quality systems in ruthless and unrelenting march for total control and obscene profits is where we have to find a way. If HCA were a restaurant, they would be better regulated to protect us from food borne illnesses. We must insist we no longer be treated as the inevitable casualties of a vicious march of a corporation which appears ill equipped to manage health care anywhere. Certainly not here. We must insist our legislators protect us. I suspect this will require many of them be voted out of office in favor of legislators who will serve their constituencies needs.
Wasn’t November 9th the deadline for HCA turning over the 41 documents requested in Stein’s Investigative Demand? Will we ever know if they turned it over and get to see it if they did?
Thanks watchdog, your latest article answered my question. Not surprised they didn’t comply.
Thank you for continuing to shine a light on problems with Mission since HCA has taken over. As a former hospital employee, I’ve seen first hand what these managed care companies do to destroy patient care to save a dime. They then give $30 million to their CEO.
Thank you Dr. Messino and Andrew Jones for shining a real light on HCA. If our community only sees the ads on WLOS from HCA, I hope they never have a need for cancer services at Mission.
Prepare to go elsewhere. I’d love to have help from knowledgeable people, like the amazing Dr Messino, building a date set of all the way any and all of us can avoid HCA for routine care, emergency care, so we can each prepare to know what out of town providers are in network for our insurance plans, where else to go to avoid the dreaded emergency department conditions, etc. If enough of us systematically refuse to do medical business with HCA and their business affiliates and services, is there a chance there are enough of us to move the needle? I’m doing it privately and think there is value in compiling information accessible to the community about strategies for avoiding them, and when it’s medically ill advised to go anywhere but HCA.
HCA is the worst thing that EVER happened to Asheville/WNC.
So wished the staff could come together and buy Mission back as a life long investment .😉
I was in the hospital when HCA tried to keep Messino and heard the nurses talking. HCA wanted to limit patient visits to 10 minutes and restrict the drugs they could use.
My brother has been with Messino for over 4 years. He recently passed away. In the last year HCA took away the direct admit for cancer patients, no money if they didn’t go through ER. He spent 48 hours in the hallway one time before getting admitted to a room, being exposed to everything that come in the E R. It was a joke up there. Hopefully for others the situation will get better. Thank you for Dr’s that still care enough to try and help.
Thank you, Asheville Watchdog!
Winston-Salem has an outstanding leukemia program at Wake Forest-Baptist Medical Center.
Living 1.5 hours west of Asheville, if I needed leukemia care at Wake Forest it would mean a 7 hour round trip drive. Does that sound appropriate to you?
Absolutely! Many of my family members will agree!
God Bless Dr Messino for starting Messino Cancer Center. I was a CCWNC patient. I followed my oncologist to Messino and have nothing but praise for them. I spent 3 weeks Mission before the HCA take over. I was a direct admit from the Cancer Center and received excellent care. My husband was hospitalized at Mission three times last year. I was amazed at how much the hospital has gone downhill since HCA took over. Just getting admitted is a nightmare. The short staffing is ridiculous.
Mike Messino is a hero! Josh Stein, who constantly contacts me for my vote and a contribution, needs to fix this mess. It’s unfair and even tragic that at my age I have to consider traveling several hours to receive quality medical care when only a few years ago it existed right here in my hometown. Mike is right. We were shafted by Ron Paulus and his minions. Fix this, Josh!
David Westling
My family member was there for a good bit of time. The nurses tried their best but were incredibly short staffed! The place was filthy!! When she first arrived in the ER and was checked into a “room,” there was dried blood all over the floor and odd splatters elsewhere, trash on the floor! If you have ANY other option, choose another facility!!!! Shocking conditions!
Please keep continuing to publish the names of the Mission Board who “sold out” Asheville by selling to HCA. They need to be accountable.
Mission directors during the time of sale:
John Robert Ball, MD, JD (chairman)
Janice W. Brumit (past chair)
Daniel A Casse, joined board 1/1/2018
Suzanne S. DeFerie, joined board 1/1/2018
Bridget A. Eckerd
Kristy Elliott, joined board 1/1/2018
Winston Leon Elliston, MD
Paul “Chris” Christopher Flanders, MD
John William Garrett, MD (vice-chairman)
William S Hickman
Lynn Kieffer
Thomas A. Maher
Robert M. Moore Jr., left board 12/31/17
Thomas Allen Oreck
Peggy (Margaret E.) O’Kane, left board 12/31/2017
Anne Ponder
Kenneth G Racht
Jeffrey “Jed” E. Rankin
Robert C. Roberts, left board 12/31/2017
Robby Russell
Lavoy Spooner Jr., joined board 1/1/2018
Wyatt S. Stevens
Agreed, there should be accountability for these infidels. But what about the current board of this poor excuse for a hospital? Do they not have some responsibility over hospital oversight, more than merely counting the dough HCA is raking in? I realize some are HCA insiders but others are not.
Current Board of Trustees:
Chad Patrick (HCA)
Shantelle Simpson
Greg Lowe (HCA)
Melanie Wetmore (HCA) Chief Nursing Officer
Terry Bellamy
Larry Harris
Lynn Keiffer
Paul Christohpher Flanders, MD (staff)
Alex Schneider, MD (staff)
Laurie Hayes (HCA)
Anthony Spensieri, MD (staff) Chief Medical Officer
William Shillinglaw, MD (staff)
Ken Kramer
Thank you for this information! Very hard to suss out and now we have taken names and better able to hold them responsible. Shame on every one of them, and the doctors signing the ridiculous defensive letter from HCA over many of their doctors. If they know better, shame on them. If they don’t, not the kind of doctor I think is qualified to care for us. Deep sympathy for good doctors who felt like they had to sign or lose their jobs and ability to support their families.
What a powerfull story by reporter Andrew Jones and Dr. Michael Messino.
Thanks so much to both of you for bringing this sad,and dangerous, situation to light. HCA has done so much damage to Mission that was once so highly regarded for excellent staff and patient care. Their motto is apparently ” Profit over Patients. “
Dr Messino is a class act. It’s individuals like him that know and understand the improprieties that have emerged with HCA , and how it has devastated the confidence of the people of WNC. With his involvement and understanding of the true needs , not just oncology services, but the poorly run ER, and ancillary staff shortages, etc ,maybe he and others can get some resolution to this critical mess our community is in with the “Profit over Patient “ mantra of HCA.
Thank you Dr. Messino, we need you involvement.
This is a sad story about one man’s hubris* – Ron Paulus- and his sychophant board that just fell in, WHILE KNOWING THAT IT WAS A BAD DEAL FOR BUNCOMBE COUNTY. And the AG’s office also knew it was a bad deal as has been shown by Watchdog reporting. A lot more pressure could have been exerted on the Board by the AG to reconsider – he asked the Board to reconsider to but that was it, NO PRESSURE. One purpose of the AGs office is to oversee the charitable organizations in NC and the AG chose to allow the Board to put personal loyalties to Paulson ahead of the people of WNC and sell WNC health care down the river.
And many of the key player Board members have now been rewarded for their dereliction of duty by seats and control over the Dogwood foundation and its 1.5 billion. Sad.
How about a revolt to replace every board member at Dogwood Trust with informed, qualified, uncomprised locals? There is plenty of experience, brainpower, and and energy right here. Just get rid of the connected and tainted.
Healthcare for profit is immoral.
“Medicine is about putting patients first and not dominating the marketplace.”
The only real shock here is that anyone expected anything different from HCA. For-profit ownership of medical care has always, is, and will always be an abomination. Add it to the list of reasons our current version of democracy is going up in flames…
I became aware that HCA had problems when a few years ago I “googled” and realized that this was not the hospital to go to. I was fortunate that when I did have to go there in September of 2021, that I had good nurses on my floor at that time. And I still had good doctors for what I needed. Now, however, since right about January of 2022, the care has spiraled downward. I doubt if anything will be done to correct what is wrong, as most medical care in hospitals has developed “protocols” which have more to do with money, and the bottom line and investors (stockholders) who want a good return on their money. Thanks for the good, truthful article.
Well done Andrew Jones and Watchdog!
I have nothing but thanks and admiration for Dr Messino and his outstanding team at Messino Cancer Center. Medicine should not be a for-outrageous-profit service: the people who let this happen to Mission, from Ron Paulus down, have done Asheville and its people an irrdeemable disservice and we shoud consider ourselves fortunate that ethical providers such as Messino Cancer Center are there for us.
Dear Watchdog…please also shine a light on the relationship between HCA and Dogwood Trust. As I understand it, Dogwood is responsible for oversight on how well HCA abides by the purchase agreement. There are lots of unanswered questions there. For example: Why did Dogwood select the Nashville firm that was cozy with HCA to be the monitor? Thank you!
Thank you Dr. Messino and to all your staff. You saved my daughter thru this time. She was diagnosed Sept 2021 and we have seen the decline of care at Mission, thru many ED admissions. She is a fighter and the best advocate.
A long time Mission ONC nurse initiated the unionization of nurses at Mission. She saw the decline in care for our oncology patients. Dr. Messinos group were the only physicians that supported our cause. The only group of physicians with opened eyes and morals to speak up on behalf of their patients. We ALL must keep pushing hard against this immoral corporation for our Asheville community.
Well said. The other doctor’s that are just going along to get along are reprehensible. You don’t risk patients lives for your own gain. We all have bills to pay, but to stay silent for your own benefit, I cannot get on board with that. If it was a widget factory maybe, but we are talking about human lives.
Living in Franklin, we have struggled with the healthcare on many levels . But I want to thank Dr.Michael Messino for looking into the future and putting together his team that have saved my life for 7 years and now also treating my husband as well as myself..I truly believe in the stand that he has taken that it’s for the welfare of all oncology patients and certainly not just to pad his own pockets. I have been a patient at Mission and like any hospital it has problems but those in administration need to be held accountable for the results of their decisions that affect so many patients and employees..Thank you Dr. Messino for your compassionate advocacy for all of us .
As a longtime oncology nurse on the Mission/St.Joseph campus,we were dedicated to our patients and there well being. We studied, joined professional organization, on our own time. and strongly supported by Dr Messino and Cancer Care. HCA has thwarted all of this. Not only that but they have also taken out the middle person with out which, a unit could not run efficiently. SocialWworkers are divided between floors. Nursing assistants.dietary aids, lab tech. housekeeping, unit secretaries etc. seem to be HCA ‘S forgotton people.
,
Many thanks to you, Dr. Messino, for the years and for still fighting for good medical care for Cancer patients. Zeb Weaver would be pleased with your fighting spirit and ongoing serious care for patients (rather than profits). I worked with him in setting up Cancer Care of WNC so many years ago and you have done a great ongoing practice of medical care for so many folks. All the best.
My oncologist is with HOPE Cancer Center (part of Mission). I had surgery in spring 2019 to remove ovarian cancer. The surgery was at Mission & I spent a week inpatient. I received wonderful care. That was shortly after the sale & there was still ample staffing.
I’ve had cancer 3 times. I worry now about any future cancer-related post-op hospital stays at Mission. What is the current situation with HOPE? With no designated patient oncology floor or one that has little staff (I’m still unclear which it is), where are cancer inpatients being put post-op? Are they in the care of an oncology team?
Thank you Asheville Watchdog for keeping our community up to date with the many issues with HCA.
Wishful thinking, but is there any way hospital could be forced to sell ?? Love to see a University or nonprofit take it over…anyone decent…
Hmm, let’s see. Do I believe all of the commenters who are/ have been patients and the staff members (current and past) who are sounding alarm bells. Or should I believe ” The Hospital Corporation Of America”. The answer is easy. No contest.