Mission Hospital was required to submit its detailed plan to address numerous deficiencies in care by Feb. 6, according to a U.S. Centers for Medicare and Medicaid Services letter obtained by Asheville Watchdog.
CMS’ letter, dated Feb. 1 and addressed to Mission CEO Chad Patrick, is the federal agency’s official notification to the HCA Healthcare-owned hospital informing leadership that it is in immediate jeopardy, the most serious deficiency possible for a hospital.
The letter also starts a 23-day clock for Mission to fix the problems or risk losing its Medicare and Medicaid funding, which would threaten its financial viability.
“(U)nless the immediate jeopardy conditions are removed within 23 days from the date of this notice (February 24, 2024), the Medicare provider agreement between Memorial Mission Hospital and Asheville Surgery Center and the Secretary of the Department of Health and Human Services will be terminated,” the CMS letter stated. “In order to do so, you must submit a Plan of Correction (PoC) by no later than 5 days from the date of this notice (February 6, 2024), describing in detail the specific corrective measures taken to resolve these deficiencies. Should we not hear from you, we will assume that the situation has not been corrected.”
As The Watchdog was first to report, HCA Healthcare North Carolina Division President Greg Lowe announced the finding of immediate jeopardy in an email to Mission’s staff Feb. 2. The letter stated “now that we have the report from CMS, we will submit our corrective action plan by their deadline.”
If CMS does not accept Mission’s plan, the hospital would be forced to revise or rewrite its initial submission.
The notification came 44 days after inspectors from the North Carolina Department of Health and Human Services, on behalf of CMS, recommended the hospital be placed in immediate jeopardy, citing nine deficiencies related to incidents occurring over 19 months. The Watchdog was first to report the recommendation Jan. 11 and the news that NCDHHS’s inspections had led to two immediate jeopardy identifications, one on Dec. 1 and another Dec. 9.
Those two identifications of immediate jeopardy were based on nine incidents that happened over 19 months between April 2022 and November 2023.
The specifics of the incidents have yet to made public. However, the CMS letter mentions six conditions in which Mission failed to meet standards: governing body, emergency services, nursing services, patients’ rights, quality assurance, and laboratory services.
When asked Monday evening if Mission had sent its plan of correction to CMS, Mission Health spokesperson Nancy Lindell reissued the statement she had sent Friday to The Watchdog after it exclusively obtained Lowe’s letter.
“There are no excuses for our patients receiving anything other than exceptional care, and Mission Health has already taken action based on the preliminary findings shared last month,” Lindell said.
“We are pleased to hear from our EMS partners and patients that those actions are yielding positive results, including decreased wait times for care. We respect the process of these surveys and will submit our corrective action plan to CMS by their deadline. Again, these findings are not the standard of care we expect, nor that our patients deserve, and we are working diligently to improve.”
In his Feb. 2 letter, Lowe told the staff that Mission had received the CMS report the previous day.
“As the initial findings of the survey were shared last month, steps were taken immediately to address them,” Lowe wrote in the email. “Significant HCA Healthcare resources were deployed to assist with our response. We brought in additional staff who are working in our emergency department and, on our busiest days, we have repurposed space on the Memorial Campus to accommodate additional patients.”
He also wrote that the hospital would “continue to reeducate our teams and refine our processes in these areas to strive to always do better for our patients. We continue to work toward resolutions on any identified issues and are confident that we will be in compliance when surveyors return to Mission Hospital.”
Nurses for years have said HCA has purposefully understaffed numerous departments and refused to provide necessary resources for the hospital to function safely.
“These findings validate the concerns the nurses have been voicing for years now. Since HCA has taken over,” said Jeanne Mould, a registered nurse who works on the third floor of Mission’s heart tower and a member of the hospital’s nurses union. “We know that nursing is one of the most trusted and respected professions and if management can’t listen to the concerns of nurses who are working at the bedside, then they run the risk of patient harm and poor patient quality or poor outcomes.”
Mission nurses have sent formal complaints to NCDHHS since 2022, The Watchdog reported in late August. At that time, NCDHHS had not visited the hospital, citing its own staff shortages.
The NCDHHS inspections occurred on behalf of CMS the weeks of Nov. 13-17, Nov. 27-Dec. 1, and Dec. 4-9. Beginning Nov. 14, while inspectors were at the hospital, The Watchdog reported, Mission offered extra shifts to doctors in the emergency department and on Nov. 20, halted some patient transfers from other hospitals, which would have reduced the burden on staff.
And on Dec. 2, a day after the first immediate jeopardy designation, Mission’s chief of staff and chief medical officer sent an email to roughly 800 doctors with seemingly obvious expectations for patient safety in the emergency department: They were to respond when alerted to a patient’s loss of consciousness or “emergent” condition, and to stop to stabilize patients at risk of dying.
Courtney Gordon, a union member and registered nurse who works on a vascular access team, said nurses have gone for years without enough staff, supplies, and support from administration.
“We don’t have enough supplies. We don’t have enough staff. Personally, we don’t have the leadership that listens to us,” Gordon said. “We’ve been saying this for years. These complaints have been coming out and we just keep getting brushed off by management.”
Mould, her nursing colleague, vowed that the nurses will continue to “do the very best we can for our patients.”
Throughout 2023, North Carolina Attorney General Josh Stein investigated Mission. Stein, a Democratic gubernatorial candidate, announced Dec. 14 that his office was suing HCA and the hospital, contending they have violated the asset purchase agreement regarding cancer care and emergency services at Mission. That agreement was signed when Nashville-based HCA bought Mission Health for $1.5 billion in 2019.
When Stein announced his lawsuit, union nurse Hannah Drummond stood at his side and said the understaffing issue was something the hospital system had the power to fix immediately.
Nurses have committed to pushing until that happens.
“We’re not going away,” Gordon said. “We’re going to keep standing up for them. Because they are ultimately what matters.”
Immediate jeopardy is rare, according to a 2021 study from the National Library of Medicine, which reviewed 30,808 hospital deficiencies between 2007-2017. Only 2.4 percent or 730 of those resulted in immediate jeopardy, according to the study.
Sen. Julie Mayfield, D-Buncombe, said Monday that she and other elected officials, nurses, and advocates would hold a news conference on the CMS findings at 9 a.m. Tuesday at the Buncombe County government building.
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 go to avlwatchdog.org/donate.
My honest, cynical reaction is this:
Do you think they give a damn? HCA made $1.6 billion in net profits just this past quarter, which is $100 million more than they paid for Mission in the first place. Just above the fine they had to pay for ripping off Medicare and Medicaid 10 or 12 years ago.
These people are corporate rip-off artists; that’s who they are, and what they do. Like D.J.Trump, they’ll delay, delay, delay, and finally pay a fine and call it the cost of doing business. Then they’ll raise prices to recover that cost from us.
Thank god for nonprofit Greenville Hospital (Prisma Org.) and Advent.
Hey Reed:
What does DJT have to do with all of Missions issues?
Please enlighten me!
Try this. He didn’t say that DJT had anything to do with the issues at Mission. What, in reality, he did suggest was that HCA, like DJT, employs the tactic of delay, delay, delay in an effort to avoid accountability.
I’m hopeful that this will make Mission better, not great, but better.
Possible correction 4th paragraph,
perhaps January? Thank you for keeping us as informed as possible. HCA should reconsider their PR tactics. What is said is useless, rarely true, rings hollow & is frankly, insulting. It is apparent how desperately we need legislative interventions to prevent this level of corporate malfeasance in an industry where citizens often do not have a choice, or are not provided with enough transparency to perform due diligence. Chuck Edwards demonstrated perfectly what is wrong with our government and its lack of sense of responsibility in terms of healthcare and the malicious capitalism with his recent interview. Anyone who does not know, understand, or care to remedy what HCA has done to Mission Hospital has no business claiming to care about the citizens of WNC. We have to keep reporting issues to proper regulatory agencies and our responsible media members to do our part to seeing correction actions taken, rather than empty, gaslighting spokesperson statements.
Hello Christine. The February dates are correct. Paragraph four of this story is pulled directly from page two of the CMS letter.
At last. HCA must stop treating their finest assets – doctors, nurses, patients- like numbers. We are humans, not dollars
Julie Mayfield has said that it would be “catastrophic” if medicare was withdrawn from HCA Mission. That suggests we have no choice and are forced to go along with Mission no doubt half-hearted and insincere remedies given their track record. But what is what is the process if the hospital is closed? Could the National Guard medical corps operate it until a sale could be effected?
I also wonder what would happen if they lose there Medicare/medicaid payments. Is there a mechanism or a plan in the event that the hospital can not take care of a large portion of WNC residents anymore? And if they did close the hospital (unlikely, but possible) is there a plan for someone/anyone to step in to fill that void? I can not think of a more important story happening in WNC than this one. Thank you watchdog for your continued outstanding coverage of this nightmare. And it is a nightmare, make no mistake about it.
CMS isn’t kidding when they send a notice like that. Failing to comply got Haywood’s hospital banned from Medicare and Medicaid (and consequently private insurance plans) until they did comply.
The CEO of Mission, prior to the acquisition by HCA, appears to twisted the Board around his finger by asserting that Mission was quickly coming to bankruptcy. The Board gave him the task to seek offers from appropriate hospital systems who would be interested to buying Mission. According the what I’ve read he had valid offers from two nonprofit hospital systems, and HCA. It’s unclear whether he shared all the offers with the Board, but it’s obvious that he pushed the Board to believe that HCA was the only savior for Mission. Perhaps the CEO was doing his best to inform the Board, however, it’s difficult for me to imagine that he wasn’t complicit in HCA’s desire to make the purchase. Did he receive compensation for that influence? Did he later join HCA at another of their facilities? If so, is he being paid more or less than would be typical for such a position? There’s enough smell to lead me believe there’s a rotting in the process.
That rotting process has lead us to today where the operation of the hospital is being called to account for the inappropriate operation of the hospital by HCA’s management. As Julie Mayfield says, Mission is the single place where people in all of WNC can receive types of care provided there. Ms. Mayfield is more optimistic than me when she seems to believe that CMS will allow HCA additional time. Mission (HCA) has had time. They’ve gotten complaints for the entire time that HCA has owned and managed Mission. Individuals whose services have been substandard have spoken up to the hospital, the state, the press, and their friends. Doctors have left the hospital, and they’ve spoken out as to why they are leaving. Based on how I’ve observed Mission (HCA) operate, I believe they will obfuscate by not responding appropriately. But if CMS recognizes HCA’s technique, it would seem appropriate that either HCA is ordered to continue operating the hospital until an appropriate organization can be found to purchase the Mission Health System. If CMS sees a more significant problem with HCA, I would think that they could request the Surgeon General to provide management for the interim period.
HCA has pending against it a lawsuit by the North Carolina Attorney General for failure to comply with the purchase and sale contract. There is also a class action suit pending by a group of WNC citizens who claim that the services being provided are deficient as compared with the contract and/or with good standards. HCA can stall and make legal maneuvers for years, but hopefully all parties will see this for what it is. HCA made a bad investment, and it’s been made worse by HCA’s poor management and operation of the system.
We in WNC could be put in a terrible position if CMS was to pull the plug. It must be made known to all stakeholders and regulators that this is the case. It’s time HCA. Time for your company to leave WNC with the realization that your incompetent management has ruined your reputation and your ability to even regain it. It’s also time for CMS, the Attorney General, and all interested parties to realize that, because of the overwhelming power and influence that was wielded by the prior Mission CEO over the Board, that a terrible decision was made to sell the gem of healthcare in WNC to a profit driven company with no ties to the area, and with an interest in ringing all the money possible from Mission. We, the people of WNC and HCA are at a place where I’m sorry to say the breach between us cannot be repaired. I don’t believe that there’s anything that HCA could do, even if it repaired all cited deficiencies, to secure the trust of the citizens it serves.
I’m sure HCA will do the bare minimum, along with smoke and mirrors, to avoid the loss of Medicare/Medicaid payments.
I see comments and talk with people who prefer to avoid Mission but Buncombe County EMS will not transport them to alternative hospitals. This was my experience with Buncombe County EMS. My wife drove me to Pardee.
While technically individuals are free under Buncombe County EMS policy to choose transport to a hospital outside the county, the written policy has multiple exceptions that effectively leave the decision of destination to the EMS supervisor and ambulance crew.
The county commissioners should investigate revising EMS policy so people have final say on the hospital they are taken to.
well whew…. HCA Mission came up with a plan before the deadline. Now that was close! Lol. Anyone who thinks this is “progress” …and will lead to meaningful and lasting changes over there at the hospital needs a serious reality check. Just saying.
Immediate jeopardy is an extreme finding, representing 2+% of CMS inspections. Terrible! Of this small group what percentage are HCA hospitals or other for profit hospitals make up this group? What is the short and long term financial advantage for such companies to tank their ratings and put patients at risk?
Note to Medicare investigators: I am just back from an MRI at Mission Hospital because of a misread ultrasound that flagged a non-existent mass. How much did that cost the taxpayer? I’m the third person I know of that this has happened to recently.