It is unclear how long inspectors from the North Carolina Department of Health and Human Services will be at Mission Hospital. // Watchdog photo by Starr Sariego

More than 80 Mission-affiliated physicians and health care workers have signed a letter rebutting a group of 50 doctors who recently publicly condemned HCA Healthcare for “gutting” services since it purchased the hospital in 2019 for $1.5 billion.

“Their version does not tell the whole story, and there are many of us who do not feel that their voice represents us as a whole,” the letter said. “Therefore, we are submitting a response from practitioners in our current clinical community with a different point of view.”

The two-page letter was signed by 72 doctors and 10 physician assistants and nurses. Most are employed by Mission. A handful work for Mountain Area Health Education Center and other health care practices.

The letter was addressed to Ronald Winters, the managing director of Gibbins Advisors, the company hired by Dogwood Health Trust to monitor whether HCA has honored the asset purchase agreement related to the purchase of Mission.

Mission spokesperson Nancy Lindell did not immediately answer questions about how many physicians are currently employed at Mission. Asheville Watchdog also asked Lindell to arrange an interview with a doctor who had signed the letter but was not immediately granted one.

The Mission doctors’ letter comes amid a flurry of investigative activity from the North Carolina attorney general’s office. Attorney General Josh Stein, a Democratic candidate for governor, told The Watchdog recently that his office has been investigating HCA and Mission since the beginning of the year amid growing concerns about deteriorating care at the hospital.

Stein’s office on Tuesday threatened HCA with litigation for violating the asset purchase agreement it made when it bought the then non-profit Mission. The purchase agreement requires HCA to continue services at Mission, including oncology and emergency and trauma care, for 10 years.

Concerns over departing oncologists — part of a larger trend that has seen hundreds of doctors leave Mission after the HCA takeover — surfaced earlier this year when Mission closed a cancer center pharmacy and began to lose the last of its medical oncologists. Its last remaining medical oncologist will depart this month.

The violations of the purchase agreement were related to oncology and emergency department care, according to the attorney general’s office.

Stein’s office said Dogwood, which is responsible for ensuring that HCA remains in compliance with the purchase agreement, had 40 days — which would be until Dec. 10 — to correct the violations or HCA could face the possibility of a lawsuit.

Four days earlier, Stein’s office demanded HCA’s North Carolina legal representatives hand over 41 sets of documents related to hospital care and management, including records about cancer care and emergency services. HCA’s deadline to hand in those documents is Nov. 9.

During an Oct. 19 independent monitor meeting in Asheville, Dr. Robert Kline, a former Mission board member read a letter from 50 doctors condemning HCA’s profit-driven model, which they said “gutted the heart and soul of our community healthcare system.”

The Mission letter — solicited by chief of staff Ansley Miller and other doctors after the Oct. 19 meeting — disputed this decline in quality of care.

“In spite of the claims made in the previous letter, Mission Health’s services have continued to grow to meet the needs of our patients,” the Mission letter said, pointing to six recent renovations and additions to local facilities.

“The implications of the letter that suggest we are not giving the best to patients is offensive to those physicians and advanced practice providers who are showing up every day to provide excellent care to our community,” the letter said. 

The letter pointed to accolades, grades and reviews it said proved its achievements in quality of care, physician engagement and overall performance quality: these included LeapFrog grades and Healthgrades and “unscheduled inspections” by the Joint Commission and the North Carolina Department of Health and Human Services. 

The Watchdog reported in April that medical experts doubt such consumer-facing rating services as Leapfrog truly inform patients, and the New England Journal of Medicine’s NEJM Catalyst gave LeapFrog a low grade in its 2019 analysis of various hospital ranking organizations. 

The letter acknowledged that the Mission Health system purchase brought about tumult.

“As with any big transition, it was not without tension or challenges,” the letter said. “There was turnover within both the hospital and physician leadership which meant new relationships had to be formed. This, no doubt, was emotionally difficult and has taken time for us to heal.”

Mission invited the 50 doctors who signed the first letter to “come to the table to reach out to our current medical staff leadership.”

The number of signatures on the first letter has grown to 123, including 19 who wanted to remain anonymous for fear of retribution, said Allen Lalor, who along with another doctor spearheaded the effort.

Lalor told The Watchdog on Thursday that he admired some doctors who signed the Mission letter.

“I have worked with several of them for 27 years, and I have nothing but the utmost respect for everyone that continues to work: nurses, respiratory therapists, physicians, support personnel, EMS,” said Lalor, who was an emergency room doctor at Mission. “But everyone I talked to has negative things to say about the hospital, and I believe that’s related to HCA prioritization of money over patient care.”

He said recent losses of emergency department doctors and nurses were “emblematic” of that priority.

[Editor’s Note: A letter provided to Asheville Watchdog by HCA-Mission Hospital, signed by more than 80 healthcare providers in defense of HCA’s management of Mission, erroneously listed “William Hathaway MD” as a signer. Mission now says the letter was actually signed by William Hathaway DO, Doctor of Osteopathy at Mission. William Hathaway MD is a former Mission Hospital chief of staff, now CEO of MAHEC, and did not sign the letter.]

[Editor’s note: An earlier version of this story implied that Dogwood Health Trust had 40 days to correct the violations of the purchase agreement or face the possibility of a lawsuit. HCA would be the target of the litigation, and the story has been updated to reflect that.

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email To show your support for this vital public service please visit

38 replies on “Mission-affiliated doctors rebut physicians’ public condemnation”

  1. As the Mission story keeps unfolding, it has become obvious that the letter of the 80 current staff may not represent the views of entirety of the Mission staff. Noticeably absent is the continued understaffing of nurses, CNAs and maintenance staff. During my recent one week stay, my room went 4 days without cleaning, if I called the nursing station (I was immobile), I was lucky if a nurse or CNA came within 1 hour and it was a good day when the I actually received the food ordered. This represents critical staffing shortages that endangers patients.

  2. Good to hear that we are getting all sides of the story. I have spoken with my oncologist about these issues at Mission and while we all know healthcare is a ridiculous “for profit” disgrace in this country, as my doctor has explained to me there are many facets to the bigger picture.

  3. Why not reprint the 2 page letter from the MD supporters of Mission? That would improve this article.

    1. Hi Steve, Keith Campbell here. I’m the managing editor of Asheville Watchdog. We embedded a pdf of the letter before we published the story. You can read the letter in its entirety by clicking on the link that’s directly under the embedded letter.

  4. Wonder how much the signees were “encouraged” to add their name to Mission’s letter, which in my mind does nothing to move the needle in Mission’s favor. Rather, it feels a little thin and desperate.

  5. Sad to say my experience as a physician in the community is a very noticeable general decline in quality of care and functioning of the Mission Hospital System since HCA took over. Some care continues to be great, but I have many complaints and fears expressed by my patients and generally the quality of service is lower. This includes very dsyfunctional communication from Mission related medical offices, totally unacceptable waits for appointments for specialty care and most alarmingly the hospital refusing to arrange follow up care for new urgent medical conditions before discharging patients. That was always a critical part of good medical care. We cannot settle for a ‘Treat them and street them (get them out of here ASAP) mentality. On the oncology side I had a patient go to a follow up visit at the Mission Cancer center and was told his doctor was no longer there. He was not told where is doctor was (in the Asheville community) nor given an appointment with another oncologist at Mission or referred to another oncologist. He told me this at his next appointment with me and I tracked down his previous doctor who resumed his care. That is not defensible by any standard.
    I know we can do better.

  6. At 2 am, I went to the ER with elevated blood pressure – 210/116. After seeing a nurse behind a curtain in the lobby, I was told to wait in the waiting room for a blood draw to check for heart enzymes to see if I was having a heart attack. An hour and a half later, a nurse came to draw blood. I got the results on the portal – no one came to tell me. I asked when I would see a doctor and was told “change of shift”, which was 3 hours away. Around 5 am, I was given a blood pressure pill. At 7:30, a doctor appeared and I asked him if I could go home, and he released me.
    This level of care is unacceptable. And I was not alone. Others were being sent to wait, unattended and unmonitored in the waiting room.

    1. Linda, consider yourself fortunate that you chose to go home. The care doesn’t get better once you’re admitted. In fact, it gets worse.

  7. It’s telling ONLY 82 providers signed this, out of the entire medical staff from all WNC HCA facilities. As the article correctly pointed out, most who signed work for HCA.

    For reference, I’ve been on, and still am on the medical staff at Mission and its affiliates for over 10 years. Anecdotally, a conservative estimate is less than 5% of providers signed this. I don’t have the exact medical staff count. Most are not signing either version (pro-HCA or con-HCA) due to fear of retribution.

    More timeline re: the HCA response letter. It was sent out in draft form asking for our signatures on October 20th, with a deadline of the 24th. Two additional solicitations were made after the deadline on the 26th and 30th, with the latter asking for any advanced practitioners or physicians from the smaller hospitals under HCA, eg. McDowell, Blue Ridge, Transylvania, etc) to be included. I’m presuming to boost numbers.

  8. As a patient, I will vote with my feet and not support any of those health providers who signed the letter in support of Mission Hospital.

  9. Ask the Mission admin if there is a clause in the doctors and PAs contract that prohibits them from saying anything negative about the hospital. I’m sure the won’t answer claiming some sort of non-disclosure excuse.

  10. Updated title for the Watchdog:

    “80 mission-affiliated physicians and healthcare workers subject to the potential for retaliation and professional assassination if they don’t comply sign misleading letter penned by HCA admin under coercive circumstances and conditions of monopolistic labor conditions”

    fixed it…

  11. That new letter has a Patty Hearst kind of vibe to it.
    The patient experiences tell a much different story. HCA’s “staffing shortage” is not equivalent to the rest of the country, HCA’s understaffing is a business model and they cannot recruit because of their horrible reputation. This letter is delusional and self serving and does nothing but gaslight patients, something many doctors have a great tendency to do to patients when they don’t have the answers.

  12. Thank you Watchdog for providing HCA’s promotional letter. Now we know which doctors to avoid at all costs! If they think HCA is providing good care, they obviously do not know what good care is.

  13. Since they won’t even disclose how many physicians are employed by HCA this letter is meaningless and 72 doctors vouching to their overlord ain’t much for 6 or 7 hospitals they own in the area. What’s more telling is the others who didn’t sign it. Or maybe they only have 72 doctors in total now, which wouldn’t surprise me either. What a joke.

  14. AC-T is now reporting McDowell County’s refusal to send patients to HCA because of the disastrous situation in the ER. Still believe everything is swell, HCA?
    “Mr. Patrick’s response to comments to McDowell EMS during this recent WebEx were not only disappointing but appears to illustrate the true disconnect among HCA Leadership and their understanding on what is truly occurring in the emergency room at Mission Hospital in Asheville,” the letter read.

    “HCA’s failure to correct process issues in the emergency department is putting lives at risk unnecessarily, not only in McDowell County but across WNC.”

  15. I would characterize this group of supporting staff as life-threateningly anemic … no CV surgeons, 1 of 20 pulmonary/critical care MD’s, 2 of 30+ Cardiologists, no Nephrologists, no Gastroenterologists, no Oncologists … in fact none of the physician leadership in place when I retired 15 years ago. There is no longer any pride in our healthcare options.

  16. I recently stayed overnight with a friend on a post-op floor. That night there were 44 patients being cared for by two nurses and one CNA. Vital signs are usually done twice per shift, there are routine meds to pass, post op patients need assistance getting to the bathroom, charting has to be done, pain meds may need to be administered, etc. That’s just the minimum. Staff needs some break time, maybe even a meal break. What about a lonely, scared, depressed patient who just needs some comforting? These staffing levels are just wrong.

  17. It is very unfortunate that a region that has been known for great healthcare has become one of the least likely places for any quality care, unless of course, you seek help somewhere besides Mission. Most any person can tell you about inadequate care to themselves or family members. There very well may be folks at Mission who genuinely love caring for their patients. However, they may not have the staff or support to follow through. HCA cut many needed services in rural areas, forcing people to travel long distance to get the necessary care. ie…Maturnity care at Spruce Pine among others.

  18. Here is my experience with Mission since the HCA purchase. About 6 weeks ago I experienced a cardiac issue that could lead to a stroke. My primary care physician sent me to the Mission ER. That was an eye opener. After about 6 hours and some miscommunication, I was sent on my way and told to see a cardiologist. The earliest appointment I could get with Asheville Cardiology (read Mission) was in January. I asked the scheduling person if I stroked out, might they see me sooner?
    I was able to see a cardiologist on Oct 17th by driving two hours away. That cardiologist scheduled me for several tests to help determine the cause of my problem. Those tests were done yesterday, 2 hours away. I should receive the results within the week. One of the nurses administering the tests said that she would love to work at Mission as it is closer to her home but she could not live on the salary offered by HCA. That traveling nurse lives in Tennessee where HCA is headquartered and knew HCA’s reputation long before the Mission buyout. Why was that buyout allowed to happen?
    Relying on Mission/Asheville Cardiology I would still be waiting for another 2 months to begin the diagnosis process … if I was still above ground. Up close and personal proof that HCA is not providing the medical service that Asheville needs.

  19. I find all this interesting. I was a RN Suprv. in Ct/NY. I have had some direct experience of poor patient care at Mission, but I speak medical and make it clear what I know. Most patients can not protect themselves this way. Nor should they have to.
    I did a quick cursory review just now on the Society of Thoracic Surgeons’ website. Here is what I learned. 2 stars
    is defined: ‘as expected’; 3 stars is ‘better than expected’.
    I could also find that Mission (pre HCA) received a 3 star rating in 2014, a 2 star rating in 2020, and got back to 3 star in 2023. To taut the achievement in 2023 as if it is meaningful and not a part of a larger pattern is disingenuous.

    I also did some quick research on Healthgrades and Leapfrog
    and find they are suspect in their field. 2 of the issues that seem to stand out are that they do not share data and are not peer reviewed.

    But US News Health gave me a clue as how to parse the data. (US News got a B to Leapfrog and Healthgrades
    D’s.) US News gave many of the specialties’ procedures 5/5 grades. Yay!
    BUT, in ALL the specialty areas, the ‘patient services’
    were 2/5 or 1/5.
    i.e. Nursing staffing – 1.2/5(Cardiac) Orthopedics – 1.2/5
    How the patient felt about their hospital stay and discharge overall – 2/5. Willingness to recommend – 2/5.
    How promptly help was provided when needed or requested – 1 /5. Satisfaction with hospital room cleanliness – 1/5.

    Repeatedly, the very low scores in ‘patient services’ brought
    down the good or above average scores for execution of
    procedures themselves. Thus, a cardiac department scoring
    5/5 on many procedures, got an averaged score of 25.6/100.

    And this, fellow citizens, brings me back to my initial point.
    Jerry is correct. This represents critical staffing shortages that endangers patients.
    Yes Donna, there are many pieces to the puzzle. Which is why HCA and these signers should stop acting like ‘someone’s?’ stars are ‘proof’ of anything. Address the data.

    Are patients happy, satisfied; do they feel safe?

    The ‘response letter’ I read relied heavily on Healthgrades kisses, the ONE Society of Thoracic Surgeons’ undefined 2/3 star rating, 2 credentials earned. These, I guess I am to believe, are the BEST ‘proof’ of Mission/HCA’s worth – from the ‘bounteous accolades’ in the barrel. Hohum.

    The one I am struggling with is the Magnet status – but there again, that’s tricky. Here’s from the Magnet website (don’t forget, I was an RN Suprv).
    “Magnet hospitals have high levels of employee and patient satisfaction”. WELL, we KNOW that’s not true. So what gives?
    I suggest looking at criteria 5 of Magnet credentialing.
    Empirical Quality Results
    “The foundation of any magnet hospital rests on its impact on its staff, patients, and community. Hospitals must showcase the results of their practices through empirical evidence. Their success is typically evaluated based on three areas — patient satisfaction, nurse satisfaction, and clinical outcomes.”
    Honestly, I need to SEE the data that proved these criteria
    were met!!!!!! Jerry – did you fill out anything that said you loved your treatment?
    Perhaps attention should be focused on how to go ahead and give that 1 or 2 when it is deserved – not on ‘being nice’.
    Weren’t the nurses on strike? Etc.

    But here’s the good news. We could alert the Magnet certifying board……
    “Once a hospital obtains magnet status, the designation is in effect for four years. At the end of the four years, facilities must reapply. ”
    Good call, Avery: “thin and desperate”.

    I get transition. I get choices were made. When some left. More will be made. Some will replace old top dogs. Some will be valiant. Some will hang in. Some will be compromised. I challenge all the Docs who signed the ‘response’ and Mr. Winters to think long and hard about whether a facility, even
    with good docs, can ever be a truly ‘good’ hospital if it is not staffed properly.
    Can it really be a good hospital if patients are afraid of it? Or they don’t feel safe the moment the procedure is completed?

    I saw little in the response that spoke to what the Asheville public feels are the problems with Mission. “Patient care” is
    the whole experience.
    PS. I just saw Pardee has many ‘100 best’ ratings this year. AND Mission was a “50 best hospital” in 2013 AND it is touting it is a “50 best” again (finally?) in 2023! Wow, this must be meaningful. All of this from Healthgrades…. You’re in; you’re
    out; you’re in; you’re out. Let’s ask the people.

    1. This is great. Thank you. Some of the most routinely positive feedback I am aware comes from scheduled surgeries in the heart tower, orthopedics, children’s ER (when they are open), and SOME emergencies when indicated by EMS which qualifies them as a probable heart attack or stroke and are handled more quickly coming into the ED. Lots of measurable good or at least not bad outcomes, proof the hospital can do a good job where staff and attention is focused, and outcomes more easily monitored. Much fuzzier job tying and quantifying significant understaffing to negative outcomes on the floors and the ED. Metrics like the direct link between nurse to patient ratios and death or worse outcomes than with better ratios are more generalized across multiple hospitals, and you can’t measure and compare the negative (or what didn’t happen).

  20. Who actually wrote this second letter? The Mission Hospital PR department I presume. Did those providers who signed it have any choice but to sign it? Whoever wrote it is not listening, is avoiding the real issue or simply drinking the Kool-Aid. No one is questioning the talent or dedication of the incumbent providers, nurses, technicians etc. who are working VERY hard to CARE for patients. That is NOT the issue. The issue is insufficient staff to meet the overall demand. For example, the writer is confusing renovation and expansion of facilities with the need to adequately STAFF those facilities in order to meet basic patient needs and quality of care expectations. Further, to refer to the “challenging” 2019 transition to HCA as relevant…four years later…is ludicrous! No viable corporation would tolerate that performance. Why should we, the residents of WNC accept this? I fully expect that HCA’s initial sales pitch in 2019 was all about the vast resources of their organization and how that would enable them to better serve this community. So how much longer does HCA intend to blame COVID for its staffing woes? What a convenient excuse that has become for excessive cutting of staff to improve profits! Lastly, I encourage the providers who signed this letter to spend a night in the Mission ER…not working, just observing…and then consider how good they feel about Mission’s performance in serving our community!

  21. I’d say that letter backfired and outed the doctors that would defend HCA’s greed and deception over patient care. Did they take an oath to do no harm to HCA?

  22. HCA has lowered the bar of quality to nil trying to gaslight us into thinking this normal. Reems Creek and McDowell County EMS have spoken out. This is a public emergency. The national guard should be deployed that ER or it should be shut down. We need to know the extent of the harm. How many lives have been lost because of this? And the ER doctors who signed that pro HCA letter, please explain. I’ll wait.

  23. Since there is heavy focus on the ER at the moment, can you explore Teamhealth, Inc. and their role in all of this? Are the ER doctors employees of Teamhealth or HCA or both or what?

    1. Good question. I believe the Teamhealth corporation supplies many emergency doctors, so, they are not employed as individuals by HCA. And corporations can’t legally practice medicine in NC (per my understanding from medical practitioners). So, how do they end run this law? How do we hold the individuals responsible for this debacle when they structure and hide behind the corporate shield?

  24. Back in the day we had beat reporters. Now nobody leaves their screen. All you gotta do is go look at the ambulance bays at HCA and see how many are backed up for hours. It’s eerie and disturbing to see it in real time knowing people are suffering and waiting.

  25. Two years ago, I had a scary cardiac event. I woke my wife at 2 am and asked her to drive me to the Mission ER. I had left arm and left mandibular pain, classic cardiac injury symptoms. I was met by a triage nurse and directed to a room where an ECG was performed, moved to an ER room. After a few hours, a hospitalist entered the room, queried my symptoms and ordered serial troponin levels that were not elevated. Whew. I was assigned an Obs bed a few hours later and did a stress echo later that day. All was unremarkable and I was discharged with no follow up or directive to make an appointment with a cardiologist.
    In general, I was pleased with my care (and the outcome). I moved forward and made an introductory / event follow up appointment with a local cardiologist.

  26. Wow! Congrats to all the articulate citizens speaking up and
    keeping the pressure on Mission/HCA’s frighteningly poor
    care. I think John Nicolay and I were getting at the same points from different angles. It makes me so sad to read all the clearly described experiences and observations r/t Mission/HCA’s subpar service. Again, individual staff members trying to and doing their jobs well. THEY deserve
    An idea: Anyone and everyone could copy THESE threads/complaints and send to Mr. Winters AND the ANCC
    Magnet Credentialing Board. OR BETTER YET….
    I have found contact numbers for Magnet Credentialing. Mission/HCA will need to reapply for Magnet status in 4? years. A CALL to:
    Senior Magnet Program Analyst Pamela Petto 301-628-5144 States: DE, FL, NC, SC, VT and/or
    Maureen Lal Director, MagnetRecognitionProgram 301.628.5103
    to restate citizen/community member concern over experiences at Mission/HCA which DO NOT meet the criteria
    for magnet recognition.

    One would THINK the Am.Nrsg.Assoc. would care about this discorrelation and how it reflects on the validity of their Magnet Recognition.
    As a retired RN, I am offended for my fellow nurses at Mission/HCA. They deserve proper staffing and a reduction
    of the harm it causes.

    Following Mr. Nicolay’s idea, why doesn’t Mr. Winters go in disguise and (illegally) use someone elses health id and see what HIS experience of the ER is? Ha ha. Do I have it correct that if he is over 65 and has a small cut on his forehead, but walks in, fully cognizant x 5; he will AUTOMATICALLY be charged a “trauma fee” for walking in? Start there.
    The more “credentialing” bodies KNOW of real community
    experience, the harder it gets for HCA to pretend and fall back
    on these “grades” as a substitute for whole patient care of high

    1. Not only will you get a trauma alert, you’ll also get a sepsis bundle for that little cut on your head if you’re blood pressure is one beat low. When a patient walks in they are merely a commodity to exploit, not seen as human beings. This could not be possible without the doctors going along with it.

  27. Until NCDHHS/CMS does its job and sends in qualified investigators to find immediate jeopardy of patient harm, nothing will make HCA change its ways and admit that they have a big problem there.

  28. To me the letter appears to be coming from the ego in these doctors who signed it. The doctors at Mission are doing the best they can, however, if it was one of them who was treated the way we have been treated in the ER they would feel differently. The issues are too numerous to list and that was just my experience from being there 3 days.

  29. Everybody is still talking about the former board members that were a part of this shady deal. Why not ask current board members, board of trustees, some are doctors within some are outsiders. Get the list and get crackin’. Terry Bellamy, former Asheville mayor sits on the current board of trustees.

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