Six public meetings meant to give Western North Carolinians a chance to give feedback on how well Mission Health hospital system is complying with its purchase agreement after its 2019 sale to HCA Healthcare may not allow attendees to ask questions or comment in front of the entire audience.
Organized by Gibbins Advisors, the Nashville-based firm hired by Dogwood Health Trust to monitor Mission Health’s compliance with a 10-year, 15-commitment purchase agreement after its $1.5 billion sale to HCA, the meetings will begin this week and have been billed as an opportunity to “ask questions and provide feedback,” according to notices sent out last month.
The first meeting will be held at 5:30 p.m. Oct. 17 at Brevard’s Thomas Concert Hall. The second will be held at 5:30 p.m. Oct. 19 at Asheville’s Scenic Hotel. Others are planned for Macon, Jackson, McDowell, and Mitchell counties and will stretch into 2024.
Gibbins co-founder and managing director Ronald Winters would not answer direct questions and multiple follow-ups from Asheville Watchdog whether the meetings would allow traditional public comment during which people could address Gibbins and all other attendees.
Sen. Julie Mayfield, D-Buncombe, said when she spoke to Winters recently, he told her there would be a PowerPoint presentation and tables where people could express concerns and get information, but there would be no time for attendees to address the room, as is standard in public comment periods and was the case when Gibbins held its first public meetings in early 2020.
The Watchdog asked Winters a number of questions, including:
- Will there be a public comment portion of the upcoming IM (independent monitor) meetings this fall and winter — that is, a time in which people can speak publicly for the whole room to hear?
- Will there be a public Q&A session?
- Has the IM decided to change the format of the meetings to allow for public comment and/or Q&A?
“Our team will, of course, take questions and concerns specific to the (purchase agreement), including those about oncology services at Mission,” Winters said, noting representatives from the North Carolina Department of Health and Human Services were invited. He did not answer whether the questions and answers would be available for the entire room to hear.
Mayfield told The Watchdog that she told Winters emphatically that “I thought they needed to set aside time for public comment.”
“I said, ‘Even if it’s just an hour, and you limit people to two minutes, it’s just really important for this community to have that opportunity,”’ Mayfield told The Watchdog.
Mayfield said Winters told her he would take her recommendation back to Dogwood Health Trust, who also will have representatives at the meetings. The Watchdog asked Winters directly if this were the case, and he didn’t provide answers.
In presentations to the North Carolina attorney general’s office and Dogwood, Gibbins has said its annual compliance review process includes a 75-day period beginning in April when, among many actions, it would hold public meetings. Those weren’t announced until September this year. The attorney general’s office criticized Gibbins about the lack of meetings in a June 20 letter, which alleged the firm had a “poor relationship with the public.”
“Today, however, Gibbins Advisors only offers meetings to individual community groups at its convenience. Public engagement is essential to maintaining the public’s trust,” the June 20 letter said. “We urge Gibbins Advisors to conduct semi-annual, announced meetings with the general public.”
The attorney general’s office also on June 20 sent a letter to Mission leadership expressing concern the hospital’s SECU Cancer Care Center had only one medical oncologist on staff after having 14. The Watchdog recently reported the doctor would leave Mission by late November.
A representative for the attorney general’s office will attend all or most of the meetings, according to spokesperson Olivia Weidie, who deferred to Gibbins on a question about public comment.
In emails to The Watchdog, Winters repeatedly pointed to Gibbins’ limited ability to address community concerns.
“(M)embers of the community had concerns and issues outside of the Asset Purchase Agreement and that went beyond our role as IM to review and evaluate compliance of the 15 (purchase agreement) commitments,” Winters said of Gibbins’ first public meetings in 2020.
Gibbins since has organized smaller meetings with local organizations, and hospital advocates helped Gibbins narrow focus to issues related to the purchase agreement, Winters said.
“The meetings moving forward are continuing that practice and are designed in a way to allow people to more effectively share concerns pertinent to those matters,” he said. “We understand the community’s frustration with patient care, safety and other services outside of the APA, and we believe that the most effective way to encourage positive action is by direct conversations with those who have the authority to address community concerns.”
Community members still want more from Gibbins, Dogwood, and the attorney general’s office.
Brevard Mayor Maureen Copelof recently was part of a group of Transylvania County residents who surveyed their community in 10 public meetings and created a report on the quality of care at Transylvania Regional Hospital, part of Mission Health’s network. The effort was not part of the formal asset purchase compliance process.
Copelof has met with North Carolina Attorney General Josh Stein, Dogwood, and Gibbins, but said she doesn’t know how much power the three have to make effective change because of the purchase agreement’s limitations.
Stein told The Watchdog in a recent interview that he was investigating Mission Hospital for potentially not adhering to the purchase agreement after recent deficiencies in cancer care services.
“My concern is … that the scope of what (Winters) looks at is limited to what’s in the asset purchase agreement,” Copelof said. “But I do think it’s important that he understands, that he hears from the community that there was a lot of discontent, that we have a lot of loss of trust, that an awful lot of our people are now going elsewhere for their health care.”
The six upcoming meetings may not have happened at all without a letter from the attorney general, which questioned why the firm wasn’t pursuing more public interaction in the June 20 letter.
“(The letter is) what prompted Gibbins and Dogwood as our determination to schedule the meetings at this time,” Winters said.
A delay in public meetings
A recently published summary of Gibbins’ Aug. 31 meeting with Dogwood and Stein’s office suggests it should have held public meetings long before October.
In its monitoring role, Gibbins completes an annual compliance review, which is supposed to last 75 days from the end of April and includes receiving reports, reviewing documentation, visiting Mission facilities, and seeking input “from key stakeholders,” according to the summary.
The process includes public meetings, according to the monitoring timeline Gibbins presented to Dogwood and the attorney general’s office at the Aug. 31 meeting.
But no public meetings were announced between April and July this year, meaning the latest compliance report was created without community feedback.
“Even though public meetings are not a requirement of the asset purchase agreement – which guides our work – we held public meetings in 2020 and 2021,” Winters said. “And while we did not hold public meetings in the timeframe you reference, they are a part of our plan for the rest of 2023 and 2024.”
Winters would not say why Gibbins did not hold public meetings during the 75-day period even though the review process he presented to Dogwood and the attorney general said such meetings were part of that process.
Dogwood, which also will send representatives, declined to answer questions about why the meetings did not happen earlier in the year, deferring instead to Winters.
The summary of the Aug. 31 meeting was posted to Gibbins’ HCA/Mission health monitoring website because of the attorney general’s criticism of Gibbins in the June 20 letter, Winters said.
The summary details for the first time publicly how the three entities involved in the Mission purchase accountability process work together.
No other Gibbins-Dogwood-attorney general meetings notes have been published.
“To date, meetings held among Dogwood, the IM (independent monitor) and the AG’s office have been held on an as-needed basis,” Winters said in an email to The Watchdog. “Because of the nature of those meetings, an expectation to post meeting summaries did not previously exist.”
Winters said that, at the attorney general’s request, Gibbins recently moved to a more formalized schedule for meetings and will now post all summaries to its website. The Aug. 31 meeting was the first of these “more formal meetings,” Winters said. The next meeting among Dogwood, Gibbins and the attorney general’s office is Dec. 5.
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.
What the public is concerned about is patient care and safety. Ironically enough, those items are not included in the purchase agreement, therefore not under the purview of Gibbins. Finally the mayor of Brevard spells it out to everyone: “The limitations of the purchase agreement.” The agreement does not address quality of care, patient care, safety or other services. I wish people could see through all the nuance that these meetings are nothing but a Dogwood and pony show to cover up a deal that put the health and lives of WNC residents in jeopardy. Dogwood, Gibbins and the rest exist only to support the warped narrative of HCA and can do nothing about the issues that matter because the agreement was drafted to give HCA all the power and unfettered discretion to run this hospital into the ground.
Exactly, well stated. The clear intent is to begrudgingly hold “public” meetings specifically restricted to the terms of the purchase agreement, meanwhile stonewalling any efforts to the public to address patient care issues. Mission executives and the Dogwood board should be ashamed of their performance.
100% correct. This is the whole problem.
and a few people still think Josh Stein is going to fly in with his superman cape and save the day. if you believe that I’ve got a bridge to sell you.
He didn’t have the power to do that from the beginning. We need to go after all the legislators who make the rules which allow this sort of travesty to happen.
The mantra is that Stein had no power over the deal but yet his approval was required. Can someone point to the specific law that says his hands were tied? What was the point of requiring his approval if he had no say in the matter? Doesn’t make sense. Show me the receipts.
You said it. We should DEMAND of our representatives an opportunity to speak.
How come the mayor of Brevard chimed in for your article but not the mayor of Asheville? I know she’s busy with bike lanes, panhandlers and still trying to figure out where the valves are on the water system, maybe that’s why.
She doesn’t give a rat’s ass and is too important to lower herself to addressing one of the main concerns residents have. Bike lanes are much more important.
she sure did fight tooth and nail for those bike lanes.
Brevard Mayor Copelof ought to be commended for her efforts. She’s certainly done more than any other government official. Her community report is alarming to say the least. Y’all would be wise to read the report before you seek care at any HCA facility.
The first two comments say it all…By golly we will have bike lanes, but if you have cancer, too bad.
IMO, the issue is being swept under the rug because Dogwood Trust would be in danger of dissolution. There is a ton of money at stake and they control the money.
When you’re covering up/downplaying malfeasance and incompetence, public meetings are an anathema. If the public asked questions, someone would have to answer them. By the way are NDAs still in force?
the meetings should be live streamed. That should be an option in the zoom culture we live in now. some of us are too old or otherwise can’t get out to attend in person. Can someone make that happen?
This is a must. I’m too high risk for another Covid infection to be in crowded indoor spaces, so, how about an accommodation?
surely Dogwood has the money to set up a zoom, and they and Gibbins are secretly hoping nobody shows up. HCA themselves should have to explain why Mission has become a nightmare of epic proportions and tell us how much money they are raking in by running it on a shoe string.
Mission Hospital is a disgrace. My friend’s husband was there — urine on the floor, dirty trays, dirty sheets, dirty hospital gown, little water provided, insufficient assistance with feeding (a nice way of saying they said they didn’t have time to feed him his whole meal, even though he couldn’t feed himself), multiple billing errors afterwards. If you live through a stay at Mission, you’ve done well.
Reluctance from HCA and its “minders” to commit to open Q and A at these meetings might speak to how much they care about serving our communities.
Attention insurance companies: dig deep into ICD and CPT coding on the bills they send you.
Any facility that this group is involved with is dirty and not a place I would ever want to be. They are famous for being nasty, misdiagnoses and inept staff.