The North Carolina Department of Justice has demanded HCA Healthcare hand over 41 sets of documents related to medical care at Asheville’s Mission Hospital as part of Attorney General Josh Stein’s escalating investigation into whether HCA is complying with the purchase agreement his office approved in 2019.
Stein sent a 14-page “Investigative Demand” on Friday to HCA Management Services in Raleigh and to Jason Ehrlinspiel, HCA’s senior litigation counsel in Nashville, requesting the documents by Nov. 9.
The investigative demand requests documents between Jan. 31, 2019 — the closing date of the $1.5 billion sale to HCA — through the present day. Twenty six of the 41 sets involve oncology-related information. The remainder pertain to patients who came to Mission but did not receive care, emergency services, canceled surgical procedures, complaints about sterilization of surgical equipment and more.
After Asheville Watchdog reached out to Mission for comment, hospital spokesperson Nancy Lindell said, “Once we have reviewed the document, we will respond appropriately.”
Though the DOJ has sent several letters this year to Mission and Gibbins Advisors, the Nashville-based company hired by Dogwood Trust to monitor whether HCA has honored the commitments it made as a condition of acquiring Mission, the investigative demand is the attorney general’s first legal move and the equivalent of a subpoena. The attorney general’s office’s power to investigate is partially undergirded by North Carolina law regarding monopolies, trusts, and consumer protection.
According to the law, the attorney general could take further legal action against HCA if it failed to provide the documents by the Nov. 9 deadline.
The letter requests Messino Cancer Center or the center’s Dr. Martin Palmeri provide communications, “Regarding Messino Cancer Center’s September 2023 determination that it could not safely provide complex hematological care at MISSION HOSPITAL,” a decision first reported by The Watchdog. It also requested the center or Palmeri provide communications “Regarding nurse staffing or nurse-to-patient ratios for complicated hematology patients at MISSION HOSPITAL.”
Palmeri told The Watchdog that he was “glad” to see the DOJ “taking a closer look at things.”
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.
In a June 20 letter to HCA North Carolina Division President Greg Lowe, the DOJ cited HCA’s drastic depletion in cancer services, consisting of one physician “where it once had as many as 14,” and threatened legal action if Mission did not “restaff the medical oncology department immediately.”
Lowe told the DOJ that five of six oncologists had left Mission medical oncology since 2020. In a letter to Stein in May, Lowe said the hospital was encountering “headwinds in hiring and retaining oncologists.”
Stein, who is running for governor in 2024, told The Watchdog in a recent interview that he had been investigating Mission since the beginning of 2023. He reiterated his investigation a few days later at an Asheville campaign stop.
In his interview with The Watchdog, he expressed frustration with HCA’s and Mission’s slow pace in providing information he had requested earlier. If Mission and HCA withheld data, “then we can make it a formal investigative demand, which is enforceable in court. Our hope is we don’t have to go there, and that they give us the information we need to determine what the situation actually is,” he said.
The investigative demand is signed by Stein and members of his staff, including Assistant General Counsel South Moore and Assistant Attorney General Llogan Walters, both of whom have signed multiple letters of concern to Mission and Gibbins.
DOJ spokesperson Nazneen Ahmed said, “I don’t have anything to add beyond what’s in the CID (Civil Investigative Demand).”
The DOJ action comes as Mission has faced public criticism from local doctors, including about 60 who have signed a letter condemning Mission and HCA for changes that “have gutted the heart and soul of our community healthcare system.” That letter was signed by former Mission board member Dr. Robert Kline and Dr. Michael Frisch, who was chief of staff during the sale. In an exclusive interview this week, Frisch told The Watchdog that “I truly felt like it was a moral injury to be working” for the hospital.
Editor’s note: This story has been updated from the initial breaking news version to include more detail about the investigative demand, comments from Dr. Martin Palmeri and Mission spokesperson Nancy Lindell, and additional background and context.
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 firstname.lastname@example.org. To show your support for this vital public service please visit avlwatchdog.org/donate.