// Watchdog photo by Starr Sariego

The North Carolina Attorney General’s Office sent notice Tuesday to Dogwood Health Trust that HCA Healthcare has violated the asset purchase agreement regarding cancer and emergency services at Mission Hospital and could sue if the problems are not resolved within 40 days.

The attorney general “has concluded that HCA Healthcare has failed to comply with its obligation” to the agreement, according to the notice signed by Deputy Attorney General and General Counsel Sarah G. Boyce. “If the failure persists beyond that 40-day window, the Attorney General is authorized to file suit.”

The letter escalates a nearly year-long investigation by Attorney General Josh Stein, a Democratic candidate for governor, amid growing concerns about deteriorating care at the hospital, which was purchased by Nashville-based HCA in 2019 for $1.5 billion.

The sale that put the well-regarded nonprofit Mission Health system into the hands of one of the largest for-profit healthcare companies in the nation was approved by Stein’s office with certain conditions as defined in the purchase agreement.

That agreement required HCA to continue services at Mission, including oncology and emergency and trauma care, for 10 years.

Dr. Susan Mims, CEO of Dogwood, told The Watchdog, “We are reviewing the AG’s letter and look forward to meeting with his office soon to discuss the matter, with an eye towards the best resolution for the community.”

Mission Hospital spokesperson Nancy Lindell said, “We are confident that we have and will continue to meet our commitments under the APA.”

Stein’s office would not comment.

The notice comes four days after the attorney general’s office sent an “Investigative Demand,” requesting HCA provide 41 sets of documents related to medical care at Mission that focused on oncology services but included emergency services, canceled surgical procedures, complaints about sterilization of surgical equipment and more. Stein gave HCA a Nov. 9 deadline to provide the documents.

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.

The attorney general’s office has sent several letters this year to HCA and Gibbins Advisors, the Nashville-based company hired by Dogwood to monitor whether HCA has honored its commitments.

“We are currently investigating issues described in the letter,” said Gibbins Managing Director Ronald Winters.  “We look forward to meeting with the AG’s office together with Dogwood to discuss the matter. We encourage community members with information to contact us through our website form or by email to support our investigation of these concerns.”

In a June 20 letter to HCA North Carolina Division President Greg Lowe, the DOJ cited HCA’s drastic depletion in cancer services. Mission had just one medical oncologist “where it once had as many as 14,” according to the letter, which threatened legal action if Mission did not “restaff the medical oncology department immediately.”

Lowe told the attorney general’s office that five of six oncologists had left Mission medical oncology since 2020. The last remaining medical oncologist will leave on Nov. 26

The nonprofit Dogwood, created from the proceeds of the Mission sale, is responsible for ensuring that HCA remains in compliance  with the purchase agreement.

State Sen. Julie Mayfield, D-Buncombe, was notified of the notice by Stein’s office earlier Tuesday and said she was glad to see “formal legal action.” She said Mission’s oncology services were once highly regarded.

“It is incredibly sad that one of the largest and wealthiest healthcare companies in America cannot seem to find the resources to provide this care to the people of WNC,” Mayfield said. “This is a failure of leadership to foster a healthy hospital culture and to keep patient care, rather than profit, at the forefront of decision-making.”

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. 

20 replies on “State AG threatens litigation over Mission cancer, emergency care ”

  1. Can we please stop calling it mission hospital. The name is Hospital Corporation of America and the name says it all.

    1. How many of the board which approved this boondoggle serve(d) on the Dogwood Board? And, the original leadership of Dogwood Trust (don’t recall his name) disappeared soon thereafter, kind of inexplicably.

  2. Two years ago I needed surgery to remove a cyst in my spine. After attempting to receive care through HCA/Mission for several months, I located a spinal surgery practice in Charlotte, selected a surgeon online and left my contact info. They responded the same day and I had the surgery within 3 weeks. I received excellent care and attention at every step and will seek care anywhere but HCA unless it is an absolute emergency. I miss the former Mission Hospital.

  3. Someone please help us!!!!my mother in law is in her 80’s..after having a stroke and going to this horrific place. She laid in the ER for multiple days before being released.this is a outrage to human dignity.

  4. this is a great reason to involve Sarah Cannon Institute, the premier HCA oncology specialists, in this situation. They could come to Asheville and meet with the Oncologists and a few patients and come up with a plan to benefit everyone. It is important to note, that the Messino Group and Sarah Cannon were involved in working out an agreement to have the Oncologists group integrate their services with Mission at the time of HCA purchase of the hospital. HCA decided instead to hire their own group of Oncologists. That number was initally 5, but now none. Since this PLAN A failed, it would seem that bringing Sarah Cannon officials back and having them meet with the Messino group and others to come up with PLAN B. would lead to a mutually beneficial solution for the community and HCA. What is there to lose ?

    1. Sorry, I don’t trust anything/anyone that’s affiliated with HCA. Nobody worth their salt will work for or with HCA, apparently only those trapped with no other options. And once you work for HCA too long, you’re considered damaged goods to other hospitals because you’ve picked up some bad habits.

  5. Stein is just placating us over HCA issues. Remember he needs our vote….let’s hope he is really a stand up guy.

  6. I agree with BobH… cannot call it Mission Hospital anymore. It is HCA – any hospital bought by that corporation is HCA, always has been, identity/mode of operation/ community priority… no longer, simply HCA. Our community leaders should have researched that.

  7. There are 2 more Gibbins meetings this week. We should be able to watch it live stream. Many important things were said by the public at the last meetings but we were never given the full coverage. Can we get a transcript? Please can somebody live stream or record if you go to the meeting today and tomorrow.

  8. Two experiences in the ER with an injured family member found a good, but overtaxed staff trying to cover too many patients. A number of patients were parked in beds in corridors, waiting for rooms with family members attending them. In both instances we had to do the initial cleanup of the wound, blood etc. ourselves. To repeat, the staff was good, but had to be in too many places at once.

  9. We are normalizing bad care and DIY emergency room medicine by saying the staff was good. When you’re tending to your own wounds in the hospital ER, by definition the staff cannot possibly be “good” under those conditions. I’m sure they did their best, but even their best is not good enough and is not acceptable care.

  10. According to the response stating that the AG Mission/HCA views the request for documents is illegal:
    What part is illegal?

    Let’s say the requests are illegal, why wouldn’t Mission/HCA not want to comply?

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