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.”

By Nov. 26, the last medical oncologist will leave Mission’s cancer center. 

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 To show your support for this vital public service please visit

21 replies on “North Carolina AG sends investigative demand for 41 sets of documents from HCA and Mission Hospital”

  1. Anyone know the terms that Dogwood trust has with gibbons to oversee HCA? They certainly have not provided much oversight to me

    1. Gibbons is the monitor, Dogwood is supposed to be the enforcer based on what Gibbins tells them. Gibbins signed a confidential contract with Dogwood so we can’t see that either. It’s all been done in the dark.

  2. I heard from a investigator outside NC that serious investigations use subpoena. Are subpoenas being used here and in NC investigations?

    1. I understand from the Attorney General’s statement that a subpoena is the next step if HCA fails to respond to this Investigative Demand.

      I’m sure some legal beagle can clarify that.

    2. After reading the article again, it appears the Investigative Demand has the force of law of a subpoena, and is enforceable by a court order if HCA fails to meet the demands in the letter.

  3. While I applaud the efforts that are now being made by the AG to look into this serious matter, He could have been on “team WNC residents” a lot sooner. I suspect the motive is more about his gubernatorial prospects than anything else, but I guess we will take any help at this point.

    1. Hi Bob. The AG has always been on our side. He can only work with what he gets and until 2023, no one would go on the record. I serve as a patient advocate and have been begging since 2020, so I share his struggle. We cannot fix things based on water cooker talk. He cannot litigate without evidence and testimony. Now that he is receiving the ammunition, have no doubt he will do everything he can to enforce what he can from a legal standpoint.

  4. Unfortunately, it’s likely just window dressing so he can say he “did something” during his campaign for governor.

    1. Which raises the question: what are Chuck Edwards, Thom (with an h) Tillis, and Ted Budd doing about the HCA fiasco.

        1. The same can be said with any partisan govt agenda. Please realize the government is not on the side of commoners.

    2. But he has done something by demanding that HCA produce the documents. Of course, there will need to be much follow up, but you don’t know this is “window dressing.” It just sounds like easy cynicism.

  5. Funny both HCA and Gibbons are headquartered in Nashville TN. Has. Anyone looked in if deep down the two might be intertwined ? I’m smelling a major stink of fish. I’m guessing there’s a business relationship here.

    1. Much of this he’s asking for seems way outside the scope of the purchase agreement as we understand it. I bet HCA doubles down and doesn’t give it up.

  6. I will no longer go anywhere near Mission Hospital and it used to be so wonderful. I personally have had to sign myself out without receiving treatment because I was left sitting for over 5 hours in ER and was far too sick to sit any longer. A friend with a potentially fatal, serious, heart disorder, had to do the same and luckily made it to Hendersonville the next day without dying. Asheville and the surrounding community needs and deserves more competent and reliable healthcare. HCA is a disgrace.

  7. It’s so hard to imagine that it has turned into this nightmare from what it was in the ’80s-’90s when I worked there. Being cut off from Medicaid expansion funds while isolated from the other large health systems in NC and not part of their purchasing/contracting/efficiency clout I can understand how it happened. The amount of work that went into merging w/St. Joe’s in the ’90s to convince the approval agencies that the kind of community damage they are causing now would not happen was astounding.

  8. Your coverage of HCA has been what this community has needed for about 2-3 years. Congratulations. It is a pleasure to read your coverage!!

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