Asheville Watchdog

They chose Asheville to live out their retirement years, drawn to the area not just for the mountains, the food, and the culture, but also for the safety net of a healthcare system considered one of the best in the country.

The flagship Mission Hospital provided a level of care that helped put Asheville on national lists as one of the top places to retire. One in five Buncombe County residents is now 65 or older. As recently as 2018, for the sixth time in the previous seven years, Mission Health was named one of the nation’s Top 15 Health Systems by IBM Watson Health.

But also in 2018, in a surprise decision, Mission’s board of directors voted to sell the successful nonprofit to HCA Healthcare — the largest for-profit hospital chain in the U.S., with a reputation for cost-cutting and skimping on staff.

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One nurse on a surgical floor at Mission Hospital reported “patients lying in stool for an unknown amount of time,” pain medications and insulin being administered late, and “irate family members.”

A nurse caring for the sickest patients on a surgical floor at Mission documented “delayed and missed medications due to RNs having 7-8 patients … Inadequate staffing led to patient fall.”

Still another nurse on an intensive care and cardiac care unit reported an “inability to care for critically ill patients at appropriate high level,” resulting in an increased risk of possibly serious harm to patients.

The alarming concerns were reported by nurses on forms known as Assignment Despite Objection (ADO), a formal complaint system developed by the labor union representing Mission nurses to document unsafe assignments that, in their professional judgment, put patients at risk. The forms are completed only after the nurses have informed their supervisors with no resolution.

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The North Carolina attorney general’s office had “great concerns about how HCA was selected” as the purchaser of the Mission Health System, including that “the deck had been stacked in its favor from the beginning” by then-CEO Ronald A. Paulus and his advisor Philip D. Green, according to a 2018 internal document obtained by Asheville Watchdog.

“[W]ith no outside advice other than Phil Green,” whom the investigators wrote had an undisclosed “prior business relationship with HCA,” Mission Health’s board of directors decided not to issue requests for competitive bids or to hold an auction before agreeing to sell Asheville’s flagship hospital system to HCA Healthcare for $1.5 billion, according to the document, prepared in advance of a meeting between Department of Justice lawyers and HCA representatives on Oct. 30, 2018.

Instead, as Paulus “coached HCA behind the scenes on how to best present its case to the Mission Board,” the board invited only one other healthcare company — identified in other documents as Novant Health of Winston-Salem — to present a formal offer. 

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