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 email@example.com. To show your support for this vital public service please visit avlwatchdog.org/donate.