Former Mission Health CEO Ronald A. Paulus and his longtime strategic advisor Philip D. Green were quietly negotiating a possible sale of Mission with senior HCA Healthcare executives as early as April 2017, according to an email obtained by Asheville Watchdog as part of a public records request from the North Carolina Department of Justice.
On April 18, 2017 — five months before the Mission Health board of directors voted unanimously to authorize Paulus to begin to identify and negotiate with potential partners for the Asheville-based nonprofit healthcare system — Green wrote to HCA executives:
“Ron liked the going forward plan — how you think about the valuation, any ideas about job preservation, preservation of services, etc. Nothing formal needed.”
Charles J. “Chuck” Hall was at the time National Group president of HCA Healthcare, responsible for the operations of 96 hospitals across 13 states. Hall reported directly to the chief executive officer of the then $46.7 billion company. Michael A. “Mike” Marks is HCA’s senior vice president for finance. On HCA’s investor earnings call Tuesday, Marks was named HCA’s chief financial officer.
The “going forward” conversations among Paulus, Green, and HCA in April 2017 were followed by a visit by Paulus and Green to HCA’s Nashville headquarters in July, the exchange of confidential business information, and by HCA presenting detailed term sheets outlining proposed deals in August. These events were not included in a timeline of the sale process submitted to the office of the attorney general (OAG) by Mission.
It would be unusual for an executive of a not-for-profit hospital system with $2 billion in annual revenue to initiate a possible transfer of ownership to a for-profit hospital, exchange confidential business information, and to request term sheets, without the knowledge or approval from the leadership of the system’s board of directors.
Coming Thursday: A former top executive deeply involved in Mission Health’s search for potential partners writes that the sale to HCA was a mistake both for the community and for HCA itself.
It was not until more than five months later, at a Sept. 28, 2017, Mission Health board meeting, that the directors authorized Paulus to begin exploring options for a possible merger or acquisition with “numerous parties” — and put Paulus in charge of identifying potential partners.
“Mission decided, with no outside advice other than Phil Green, not to put out a request for bids or hold an auction,” the attorney general’s chief investigator wrote later in a memo obtained by The Watchdog. “Dr. Paulus coached HCA behind the scenes on how to best present its case to the Mission Board.”
Marty Martin, an attorney in Raleigh who specializes in nonprofit board governance and ethics, told The Watchdog the Mission board “should have been getting professional advice outside of them [Paulus and Green] either through counsel, or through a financial investment banker that’s independent of the transaction.”
In the end, only two companies were invited to make formal presentations to the board: Nashville-based HCA, the largest for-profit hospital company in America, and Winston-Salem-based Novant Health, a regional nonprofit.
Novant’s offer was “equal or superior” to HCA’s offer, multiple sources confirmed to The Watchdog, but the Mission board rejected it quickly in favor of HCA.
The sale became final on Feb. 1, 2019. Paulus announced his resignation from Mission Health two weeks later and joined HCA as a strategic advisor.
There is no indication that HCA did anything illegal in pursuing or negotiating the deal with Mission.
Consolidation
It was routine for Paulus, as CEO, to be approached by other healthcare systems exploring possible deals. The overarching trend in national healthcare was, and continues to be, consolidation. Paulus told the Asheville Citizen Times in 2018 that such conversations happened nearly every year since he joined Mission Health as CEO in 2010.
The Watchdog has been unable to determine who initiated the discussions between Mission and HCA in April 2017. Green, Paulus’s longtime personal friend and advisor, at the time had business dealings with HCA that were not disclosed to the Mission board, according to the documents The Watchdog obtained from the OAG.
Citing the “perpetual” nondisclosure agreement Mission’s legal department required them to sign covering all aspects of the transaction, Mission board members contacted by The Watchdog declined to discuss details of the sale. The Watchdog was unable to ask them whether they were aware of or approved the early interactions involving Paulus, Green, and HCA, or knew that Paulus already had offers from HCA in hand.
“In a conflict of interest analysis, which is clearly one of the things that should have been going on … the primary issue is how the board chooses to handle that conflict of interest,” Martin told The Watchdog after reviewing its previous coverage of the sale. “And the first thing that you’d have to do is have full disclosure at the earliest possible stage.”
In a conflict-of-interest analysis, which is clearly one of the things that should have been going on … the primary issue is how the board chooses to handle that conflict of interest. And the first thing that you’d have to do is have full disclosure at the earliest possible stage.”
Marty Martin, an attorney who specializes in nonprofit board governance and ethics
According to documents from the attorney general’s investigation, Paulus — who had a seat on the board — offered to recuse himself from further negotiations and voting, but the board determined that it was not necessary. Whether other board members were aware of Paulus’s and Green’s early talks with HCA is not known.
“If the board became fully knowledgeable about all of the issues that you sort of laid out,” Martin told The Watchdog, “then I think the board made probably its worst mistake, or its major mistake … instead of stepping back and saying, wait a minute, this is a flawed process from the very beginning.”
The Watchdog reached out repeatedly to both Paulus, who now lives in southern California, and Green, who lives in the Washington, D.C., area. The two, who met and first worked together in Pennsylvania before Paulus came to Asheville, until recently shared an office manager for their consulting businesses. No responses were received by deadline.
The Watchdog sent messages to RAPMD Strategic Advisors — RAPMD is an acronym for Ronald A. Paulus MD — whose website lists several former Mission senior executives on its roster, and to General Catalyst, a California-based venture capital firm that currently lists Paulus as an advisor. Emails sent to PDG Consulting — Philip D. Green’s consulting business — were not acknowledged.
“HCA Healthcare actively engages with other organizations in the ordinary course of business and the process regarding Mission Health, from our standpoint, was similar to what one might expect for any acquisition,” Nancy Lindell, director of public and media relations for HCA’s North Carolina division and Mission Health, wrote in response to a Watchdog request for comment.
A trip to Nashville
On July 11, 2017, three months following Green’s “Ron liked the going forward plans” email to top HCA executives, Paulus and Green traveled to Nashville to meet in person with them.
In late July, records provided to the attorney general by HCA and acquired by The Watchdog show, Mission Health System and HCA Management Services LP signed a confidentiality agreement, allowing the two parties to exchange proprietary business and financial information — and backdated the agreement to cover Paulus’s and Green’s visit.
“At the time the parties entered into the Nondisclosure Agreement dated July 11, 2017, the parties had not yet decided on any particular transaction but had agreed to explore possible relationships,” an HCA attorney wrote to the OAG later. “The agreement was executed in late July 2017, but was made effective as of July 11, 2017 (the date that Dr. Paulus and Mr. Green had visited Nashville) so as to cover any information that had been shared in the intervening time period. The agreement was not in fact entered into on July 11, 2017.”
“As of the date the NDA was signed, the individuals who were involved on behalf of Mission in discussing any such possible relationship included Mr. Phil Green, Dr. Ron Paulus, and Ms. Ann Young,” HCA informed the OAG as part of its inquiry.
Ann Young at the time was senior vice president and general counsel of Mission Health. She is now a senior advisor to the Dogwood Health Trust, the foundation created with assets from the $1.5 billion sale to HCA. A Dogwood spokeswoman told The Watchdog last week that Young was traveling and not available to comment.
The confidentiality agreement, also known as a non-disclosure agreement or NDA, would have been required in order for HCA to prepare a term sheet. A term sheet is a nonbinding agreement outlining the basic terms and conditions under which an investment will be made. When used as part of a merger or attempted acquisition, typically a term sheet would contain information regarding the initial purchase price offer and the assets included in the deal.
On Aug. 12, 2017, Green presented Paulus with two preliminary offers — term sheets — from HCA: One for a 50-50 joint venture that would have allowed Mission to take advantage of HCA’s economies of scale while still retaining local control, and another, the $1.5 billion offer that would allow HCA to take control of the entire Mission system outright.
A small “working group” of Mission executives and board members traveled to HCA’s Nashville headquarters for meetings on Sept. 17 and 18.
On Sept. 28, a Mission spokeswoman told the Citizen Times, the Mission board unanimously authorized Paulus to begin a search for potential partners. The following month, at an Oct. 26, 2017, board meeting, the directors created a “strategic planning committee” for “the further exploration of potential partners.”
It was at a “strategic planning retreat” on Jan. 17, 2018, that the Mission board authorized Paulus to limit the search to two potential bidders, later identified as HCA and Novant. Paulus had already informed the board that a proposal from Carolinas HealthCare System, a municipal hospital authority based in Charlotte, was inadequate.
The following year Carolinas announced plans to merge with Wake Forest Baptist Hospital and Wake Forest Medical School and to rebrand itself Atrium Health.
Others attending the board retreat, records show, included Green, Mission board chair Dr. John R. Ball, a consultant from the international consulting firm McKinsey & Company, Mission Health chief operating officer Jill Hoggard Green, and chief financial officer Paul McDowell.
Paulus introduced Green to the strategic planning committee at that January 2018 meeting. A transcript of his remarks, marked “CONFIDENTIAL TRADE SECRET” by Mission’s lawyers and obtained by The Watchdog, quotes Paulus as saying:
“I’d like to take a moment to introduce you to Phil Green. Many of you have heard or seen Phil, but few fully appreciate his background and what he brings to Mission.”
Paulus then said, “[H]aving had several large scale commercial joint ventures with HCA, he has considerable personal and professional history with many members of HCA’s top management which allows for transparency and fast-tracking which otherwise would not be available.”
“This experience facilitates insights which allow him to help Mission maximize relationships with potential suitors like Carolinas or Novant,” Paulus said. Carolinas HealthCare Systems later renamed itself Atrium Health.
“Because Phil is compensated on a fixed-fee basis, he has no financial incentive for any particular outcome and is able to serve as an honest broker.” Paulus’s introduction of Green concluded, “We are very fortunate to have him on our team.”
Paulus’s remarks do not mention that he and Green already had term sheets in hand from HCA, or that Green was at the time involved in discussions with HCA on a separate business deal.
The attorney general’s investigators later characterized the asset purchase agreement negotiated by Paulus and Green with HCA as overly favorable to HCA — and, according to Special Deputy Attorney General Jennifer T. Harrod, the lead investigator, one that became even more favorable to HCA after the Letter of Intent was signed.
Letter of intent
Less than two months after the board retreat, in March 2018, Mission announced it had entered into an exclusive Letter of Intent (LOI) to be acquired by HCA and to transition to a for-profit system.
The timing for a deal with HCA was right, Paulus said at the time, citing a recent outside consultant’s report showing that Mission would have to cut costs continuously in order to remain independent. HCA, Paulus said, was nonpareil in cost efficiency.
Paulus told a local business group in May 2018 that under HCA, Mission would still have “the exact same people and exact same doctors and exact same nurses providing all the care.” What would be different will be the efficiency of back-office functions like billing and purchasing, he said.
Rowena Buffett Timms, Mission’s senior vice president of government and community relations, told the Citizen Times that people served by Mission Health would have to trust that system leaders made a good choice when they agreed to the sale to HCA.
“Many misunderstand or are confused by how HCA is able to pay taxes, garner a return for its shareholders and yet maintain quality and access,” Ball and the board’s vice chairman, John W. Garrett wrote in an opinion column in the Citizen Times. “But the reason is simple: HCA has significant economies of scale and concomitant expertise unavailable to Mission Health that will result in very significant cost savings and care enhancements.”
The LOI triggered an investigation by the attorney general, who, under North Carolina law, is required to evaluate the sale of nonprofit businesses to for-profit businesses, to make sure, in this case, that the community’s investment in nonprofit Mission — including hundreds of millions of dollars in tax abatements — was preserved.
As part of its investigation, the OAG requested records of phone calls, emails, and face-to-face meetings between Paulus and Green and HCA.
As reported first by The Watchdog, the OAG’s investigation uncovered “significant conflicts of interest” in the deal by both Paulus and Green.
In an Oct. 30, 2018, memo to members of the attorney general’s office, obtained by The Watchdog, Special Deputy Attorney General Harrod wrote in advance of a meeting with HCA lawyers:
The fact that Phil Green used to be HCA’s business partner, that this was never disclosed to Mission’s board, that he worked behind the scenes to maximize HCA’s role, and then was a primary negotiator for an HCA-friendly APA [asset purchase agreement] seems pretty unassailable to me. Do you think there is any chance that HCA doesn’t know at least as much as we know, if not more?
In response, W. Swain Wood, General Counsel in the Office of the Attorney General, wrote:
“[I]t might be better to say “Phil Green” and “Paulus” as our concerns.”
Later that day, Harrod met with four representatives from HCA, including senior vice president and chief development officer Joseph A. Sowell, vice president Chadd Tierney, assistant vice president Will Caldwell, and outside legal counsel Robert Saunders. Her meeting notes read:
At the same time we have great concerns about how HCA was selected to be the entity that purchased Mission. Further, we have concerns about how the negotiations for the APA unfolded after the LOI was signed. Here are the facts as we currently understand them:
- Phil Green, a longtime friend and associate of Dr. Paulus’s, also has a prior business relationship with HCA. When the time came for Mission Board members to visit HCA, Dr. Paulus and Mr. Green both thought it was critically important for Mr. Green to attend that meeting to ensure its success. Mr. Green’s prior relationship with HCA was never disclosed to the Mission board, even as of our meeting with the chair and vice chair last week.
- Over the next few months, Mr. Green and Dr. Paulus steered the process by which other bidders were identified. Mission decided, with no outside advice other than Phil Green, not to put out a request for bids or hold an auction. Mission’s board formed a Strategic Planning Committee. Although Dr. Paulus was not a member of that committee, he participated in it as if he were. One large non-profit hospital system with a national presence was dismissed out of hand.
- A regional system was initially included in the bidding. We have learned that that potential partner wanted Dr. Paulus’s role to be Chief Information Officer. Later, that partner was dropped from consideration on grounds that appear pretextual to us. We are aware of course that there are no guarantees that he will have this or any role with HCA, but at this point, that fact is irrelevant. Reading his email exchanges with HCA, an outside observer could conclude that he was working hard to demonstrate his value to HCA. Dr. Paulus coached HCA behind the scenes on how to best present its case to the Mission Board. On two occasions, he pointedly told HCA that Mission’s peers were and would favorably consider being acquired by HCA, now that Mission had made that decision.
- In our opinion, Dr. Paulus’s conduct violated the Mission conflict of interest policy, which requires an officer or board member with even a potential conflict to not merely recuse himself from voting on the matter, but also from advocating for an outcome. Dr. Paulus offered to recuse himself, but was advised that it was unnecessary. The rationale was that since all of the potential partners wanted Dr. Paulus to continue in some capacity, therefore he had no conflict of interest.
- Neither the board nor its advisors seems to have given any thought to the fact that certain transaction partners offered Dr. Paulus greater scope for advancement versus others or versus no transaction at all.
- HCA stated that it could make the system profitable by virtue of its low supply chain pricing and back-office efficiencies. The Board seems to have accepted that proposition uncritically.
- In the end, an outside observer could conclude that HCA rose to the top among a limited number of bidders because the deck had been stacked in its favor from the beginning by Dr. Paulus and Mr. Green.
- As noted, our concerns don’t end there. Dr. Paulus and Mr. Green were principal negotiators of the APA. It appears to us comparing the terms of the LOI to the terms of the APA, HCA improved its position considerably:
a. One of the major inducements for Mission to enter the LOI with HCA was the promise that hospitals and services would be maintained. We and others advised Mission prior to signing the APA, that such commitments needed to be specific and measurable in order to be enforceable. Again, the emails we have seen demonstrate that Dr. Paulus ultimately buckled in the face of resistance from HCA and decided that Mission would just have to trust HCA. Even now, the board believes that HCA has committed to maintaining the current level of services at all six hospitals (subject to different decisions by the local advisory boards, force majeure, etc), even though the APA says no such thing.
b. Despite the experiences of the health care foundation in Missouri, Mission agreed to dispute resolution terms that overwhelmingly favor HCA.
c. Mission agreed to let HCA use its existing charity care policy, even though it appears to us that for most patients, they would be much better off under Mission’s policy.
d. These are examples, not an exclusive list.
The Missouri reference was to Health Care Foundation of Greater Kansas City, a nonprofit formed with assets from the $1.3 billion sale of nonprofit Health Midwest to HCA in 2003.
The foundation sued HCA in 2009 for allegedly not meeting charitable and capital improvements commitments. An original court judgment against HCA, for $434 million, was reduced on appeal to $188 million.
In January 2017 HCA settled the long-running lawsuit for $170 million, on top of an earlier related settlement for $13.5 million.
Harrod left the attorney general’s staff in 2020 and is now senior attorney for the North Carolina Utilities Commission. Reached by The Watchdog last week, she declined to comment.
Attorney general requires board to vote again
Having made the board’s leaders aware of the perceived conflicts by letter, Stein’s office demanded that the board vote again on the sale, this time without Paulus in the room.
The board met on Dec. 13 and Dec. 20, 2018, and conducted “extensive deliberations regarding specific factual circumstances of interest to both the Board and the OAG,” documents show.
The board held another special meeting Jan. 8, 2019, and — without Paulus voting — once again voted unanimously to sell to HCA.
Mission’s General Counsel and senior vice president Donald R. Esposito Jr., then wrote a letter to Stein formally stating that Mission had investigated the attorney general’s findings and found no reason to stop the sale.
In a letter to Stein on Jan. 10, 2019, Ball included a timeline of events in the negotiations to sell Mission to HCA.
Ball’s timeline did not include Paulus’s or Green’s early “going forward” discussions about a deal with HCA in April 2017, nor the trips to HCA headquarters in July and September 2017.
Ball wrote: “Beginning in mid-2017 … I used a small working group to consider and evaluate Mission’s strategic position.”
By then discussions between Paulus and Green and top-level HCA executives were already under way.
On Jan. 16, 2019, Stein — after demanding that the Mission board revise the asset purchase agreement to be less lopsided in favor of HCA, and after demanding assurances from HCA that it would not “invest or otherwise provide funds” to “any entity in which PDG [Philip D. Green] has any direct or indirect beneficial interest” — traveled to Asheville to announce that he would not block the sale.
Stein later told The Watchdog that his powers under state law did not allow him to block the sale if Mission’s board was aware of the Department of Justice’s concerns but voted to complete the sale anyway.
Paulus joins HCA
The $1.5 billion sale of Mission Health to HCA, negotiated by Paulus and Green, and modified by the OAG, became final on Feb. 1, 2019. It delivered to for-profit HCA an effective monopoly on healthcare in western North Carolina.
Within days, Paulus announced he was resigning from Mission and joining HCA as a strategic advisor.
Just a few months earlier, after the LOI to sell Mission to HCA was announced, the Mission board authorized a change to Paulus’s employment contract with Mission to include a change of control provision, applicable if Mission were to be sold to a for-profit entity. Change of control triggered accelerated payouts to Paulus that would not have been allowed if Mission had partnered with nonprofit Novant.
Tax records show Paulus received more than $4 million for the final four months he was at Mission, including a million-dollar bonus from the board.
Terms of his strategic advisor job with HCA are not known. Later in 2019 Paulus was named executive-in-residence at the giant venture capital firm General Catalyst. He is still listed as one of Catalyst’s advisors, and as president of Maribel Health, a General Catalyst company.
In 2021 HCA sold its PatientKeeper software system to Commure, a portfolio company of General Catalyst. Paulus is listed as one of Commure’s principal advisors.
Last week, General Catalyst announced plans to acquire Ohio-based nonprofit health system Summa Health, and its insurance plan, and reestablish it as a for-profit organization, according to STAT, a healthcare news website.
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Peter H. Lewis is The Watchdog’s executive editor and a former senior writer and editor at The New York Times. Contact him at plewis@avlwatchdog.org. To show your support for this vital public service go to avlwatchdog.org/donate.
Just despicable and disgusting. If anyone who lives here knows Paulus personally, I hope you call the sick sellout and give him some grief.
You can look up Paulus Catalyst on the net. There is an option to send him an email. I did asking him how he can sleep at night.
By the wY, according to the former CFO, Mission did not need to sell. Mission was in excellent financial shape and could have lasted another 20 years without taking in another penny.
I hold the Board and Paulus responsible for decimating the former excellent health system I held dear for my family and friends. I don’t know how any of them can sleep at night.
No option for email there.
Hi Sam,
Go to this link.
https://www.generalcatalyst.com/team/ron-paulus
Across from his large name is a smaller title with connect and below that is an icon for email. Good luck. Right now he has a message stating he is out of the country.
Here’s an earlier article about Paulus, with mention of his relationship to board member Wyatt Stevens.
https://www.citizen-times.com/story/news/local/2015/04/18/mission-hospital-asheville-north-carolina-ceo-ron-paulus-says-risk/25944791/
Will someone please alert the Summa Health Community and the Ohio Attorney General of WNC’s current health care state of affairs.
I think the attorney general should sue to unlock the NDA’s and sale agreements to see how much money was paid to whom in the sale of Mission to HAC. This transaction doesn’t seem to pass the smell test. The residents of WNC have really lost a great source of health care.
Seems like a good idea to me…if that’s even an option. Following the money is always smart. Are there other affected parties that might be able to file such a suit?
My question too. How on earth can a corporate entity engaged in the acquisition of a public hospital demand NDAs from the governing board making the decision on the sale of such vital community service as a hospital system? How can those NDAs possibly be binding in court when those members were negligent if not worse, in failing to commission standard outside reviews and assessments of the terms and managerial record of HCA? How can an NDA be binding when there is possible criminal conflict of interest and financial benefit for some those involved in the transaction? There should certainly be civil liability for those who so completely abandoned their public responsibility to perform basic due diligence. There has to be some way to determine a basic level of responsibility and accountability which the NDAs are precluding.
We absolutely agree with all of your points.
It is fairly obvious that the people who sat on Mission’s Board during these “negotiations” were wholly incompetent. Just being rich does NOT qualify anyone to sit on boards of Public entities. This deal was dirty from the start, and the chief culprit was Ron Paulus. But that does not excuse any Board member’s naivety or lack of due diligence.
Seems like there ought to be some way to sue Paulus and Greene for conflict of interest.
I have a better solution. Paulos and anyone else that requires a license to do anything in the field of medicine should have the license revoked and any of their assets taken away. They should be made peniless.
Correction: I forgot the exclamation mark!
Paulus makes me sick. All this greed. How many millions do these people need? What horrible people. They really need to be held accountable. I will NEVER go back to Mission as long as HCA is in charge. My family and I already have a plan to go to other regional hospitals/services even though it means a longer drive.
This stinks to high heaven. The Mission Board of Trustees should be ashamed, and Paulus and Green should be held accountable. Surely, there must be some way to undo the harm that these folks have caused and boot HCA from western North Carolina.
Note to Chuck Edwards: it’s not Obamacare that ruined a well-respected health system in this district. He should go to bat for his constituents.
Note to Summa: run for the hills.
My cousin was in executive management at Carolina health (in CLT) and told me that they had approached Mission about buying them out or merging. He was specifically involved. Mission wouldn’t even entertain discussions. Now we know why.
Just follow the money……a lot more to find I bet.
If this isn’t sufficient legal grounds for the NC State Attorney General to sue to unwind the purchase, I don’t know what is. This deal was a sham from the beginning.
The rich swine can get away with anything.
Dr. Evil and the Grim Reaper worked in tandem for pure selfish greed. (And it appears they still are!) Good work Mr. Lewis. The further you dig, the more you find out who benefited. And it wasn’t Asheville. Non-profit hospitals are disappearing and shareholders are getting rich. And I thought my jaw could not drop any further. Keep digging.
Evil and greedy, but very well planned and executed before anyone had a clue.
Yep, we see this time and again from greedy developers with their ‘opportunity zones’, corporate interests hell bent on logging sensitive old-growth forests and even domestic terrorists planning insurrections…they’re all the same damn awful bunch of @%*!…
We have former mission board members and a senior VP who was with Paulus on the dogwood trust board. Dogwood is supposed to oversee HCA. Does this make sense?
Thinking the same thing. Excellent observation. It does not make sense.
If decision makers were deceived or pertinent information on which the could have relied was withheld from them, a criminal fraud may have taken place. The above, combined with backdating of documents and NDAs to hide relevant information only amplifies that possibility. It remains to be seen whether anyone in NC has the guts to pursue that possibility.
Every board member and anyone who has profited from this greedy shameful theft, living or dead, should be held accountable.
please find a way to force sale or build another hospiralwith a bond issue
Excellent information Watchdog!
I feel certain if a gofundme was started for travel fares and accommodations to DC (Green) and So Cal (Paulus) to knock on their doors it would be a tremendous success!
I also meant to say in my comment that I was an EA at Mission St. Joseph’s for 25 years. I have been in healthcare since 1978. This actually started when the other Board chose Joe Damore over David Spillers for CEO when Mr. Burgin’s retired. The Board did not due their due diligence on Dakota either. This information was from a former Board member, too.
Sorry, just checked it should have been “do” their due diligence, and Damore was with rep!aced with Dakota…please forgive these errors.
And to be clear, Mission’ s decline actually started in 2003 when that Board selected Damore over David Spillers who was COO when Mr. Burgin retired. And according to a Board member from that time, Joe Damore’s background was not researched. Damore was hired because he promised to develop an insurance product that would save a few Board members money.
As a regular volunteer at both St. Joe’s and Mission, I knew Ron Paulus was an HCA plant from the beginning. Shame on all involved with bastardizing a once-great hospital system. I hope Karma works!
McKinsey Consulting worked directly with Richard Sackler and Purdue Pharma to provide instruction for increased marketing of oxycontin, train pharmaceutical sales representatives to increase doctor prescribing and educate Purdue on how to avoid FDA Regulation. In other words, they were instrumental in creating the opioid epidemic.
Excellent work again by the watchdog. I hope this opens some new avenues to go after the culprits here. I did send this to a classmate who works at Summa in Akron Ohio so he can pass on to as many physicians and legislatures as he can. They need be aware Paulus and others like him
What makes this story so enraging is that, as the Watchdog continues to peel back the layers of this onion, the nefarious back room dealings become increasingly evident. And yet, the message that we also get is that the deal is done, and the wool was successfully pulled over our eyes, and we just have to live with it. Sad that corporations are “people,” except when it comes to accountability for blatantly bad actions.
Excellent reporting, thank you!
Dogwood Trust should not have any members who were involved with or directly worked for Mission of HCA. This makes me sick! So many failures!
If not for the watchdog, we would have never known the depths to which this whole thing stinks.
Just almost unbelievable… Paulus and Green were HCA’s inside people all along ..and that resulted in this fraudulent “purchase” of Mission Hospital by HCA. Then, the Mission Board gave Paulus a million dollar bonus for good measure. Surely there is a law firm somewhere that is willing to bring a civil lawsuit on behalf of a beleaguered city/county that was ill served by Mission’s board and a victim of intentional fraudulent misrepresentation by Paulus and Green.
The tragedy here is not only the elimination of high quality medical care. That is only one of the thefts.
The second theft is $1.5 billion dollars of the public’s money contributed and invested in Mission over decades but now controlled by a board with ties to Mission and HCA. I assume the bulk of those assets are managed at substantial cost by Cambridge Associates or Commonwealth in New England.
Don’t look for Dogwood’s board, mostly Mission connected or lacking knowledge of healthcare financing, to initiate projects that will disturb the existing medical industrial complex. Too many people enjoy income, perks, and status in our money-driven system. I suspect Dr. Antony Chiang’s brief tenure as CEO at Dogwood had its origins in the board’s fear of his seriousness as well as past success in changing healthcare. That the board did not know that before employing him is telling.
Most of all this is a moral failure on the part of those who accepted responsibility as stewards of public assets. They are among the most privileged of our people and have acted shamefully.
The board voted the sale even after the Attorney General’s office pointed out the stink. Shame on the whole board.
Yes, the fix was in and the level of neglect by the Mission Board in this sorry mess is stunning.
What would it take for this to make it in front of the courts?
The board members claimed to have taken HCA at their word, which explains the first vote. What about the second? How can they justify voting in favor again, after the investigative report by the OAG?
Thank you Avl Watchdog for continuing such in depth and excellent coverage of this impactful issue in our community.
Once again this region is duped by a leader whether it be public or private. There has to be a billboard somewhere with “Asheville is easy prey, come get you some”. May a slow and horrific story follow these people through life.
Yeah, right. Shangri-La, the Bluffs, and on and on…do boards and public officials not know how to conduct simple google searches to sniff out villains and bankrupts?
The level of community outrage here is quite telling. I find it hard to believe that an entity receiving public benefits can be sold under these nefarious circumstances without any recourse. Given the extent of the investigation conducted by the AG’s office, coupled with their findings, surely some of the accountability for the rottenness of this transaction rests with the AG himself for failing to fully protect the public interest.
Paulus was the Pied Piper of Asheville, and the oblivious rats who followed him to HCA Hell him didn’t have a clue.
I think some of them DID have a clue, but were more interested in what “private” benefits were at hand. That is why the NDAs in the first place.
TYVM for taking the time to write this. I sincerely appreciate it.
I was surprised and disappointed that the powers that be would pass over two respected regional health systems and choose a discredited conglomerate like HCA–with its reputation for Rick Scott-led Medicare fraud and corruption–to run Mission Hospital. I am grateful for the Watchdog’s reporting and hope that the NC Attorney General’s office investigates aggressively the conditions at Mission and the Mission-HCA deal. If the AG’s office finds that all this is legal, then either the law is written to encourage malfeasance or the AG’s office has been co-opted by HCA–or both.
Peter and Sally. Western NC is extremely fortunate that you chose Asheville for your retirement when you did! Without your vision (and I hazard a guess a bit of retirement boredom?), this story would have remained buried in graveyard created by Paulus and Green. It’s kismet! Thank you.
I’ve suspected from the outset that Paulus was shilling for HCA. I guess when you consider that MAGA people are willing to overthrow out govt in favor of chaos, a man who willing to sell out one million residents of western NC shouldn’t be a surprise. And yet, it is. How can a person be so educated and yet so utterly devoid of conscience?
Great job AVL Watch Dog! This is beyond disgusting. There has to be a way to hold these people accountable.
I’d sue both Paulus and Green for every penny they got and then some.
Ever smell a dead rat? The Mission-HCA deal stinks worse. As for the outcome, the propaganda that HCA could amortize the deal, pay profits to its stockholders and taxes on what had been a nonprofit turns out to have been the greatest con job since Trump promised to make Mexico pay for a wall. I do not understand how anyone responsible for this deal is not shamed to show their face in public. On the other hand, people who screw the public are usually proud of themselves and admire each other.
And interesting that one of Paulus’s jobs early in life was cleaning rat cages….
Great reportage, Pete!
This sure sounds like the deal was illegal, unethical, or both, and would explain the lifetime NDAs.
Given the appearance that they were asked to sign NDAs to cover shady activity, I would hope some of the former board members would gather the courage to speak up.
Great thorough writing and a great chart of all the main moves.
It seems to me that the Board’s attny is in the hot seat:” Less than two months after the board retreat, in March 2018, Mission announced it had entered into an exclusive Letter of Intent (LOI) to be acquired by HCA and to transition to a for-profit system.”
So can an ethics violation be filed on her as per the NC Bar?
Excellent, invaluable reporting. We saw the train wreck that HCA made of Mission up close. My dearest friend was diagnosed with pancreatic cancer just as the takeover occurred. We went to see a Mission oncologist, and it was a horrible experience. Luckily, we found a wonderful oncologist at Messino. He shared our concerns about the Mission buyout, which is why he left. We had to go to Mission a number of times as my friend’s cancer advanced. We NEVER had a humane, caring experience, and towards the end, a trip to the ER to be admitted to the oncology floor was an absolute NIGHTMARE.
I do not blame the nurses, although the ER nurses were, it seemed, human silos with no idea what anyone else was doing. The nurses on the oncology floor were understaffed and overworked. A few were in tears. It was pathetic.
Please continue to dig. Everyone in WNC deserves the entire truth about this debacle, and perhaps a way back to non-profit status for Mission.