Editor’s Note: As 2023 comes to a close, Asheville Watchdog staffers take you back and inside their most memorable stories and news events of the year.
One day in late September, Mission Hospital surgical unit nurse Claire Siegel got a call from a representative of The Joint Commission, the nation’s largest hospital accreditation organization.
The caller wanted to speak to Siegel about patient handoff procedures – the focus of an Asheville Watchdog investigative story in August – at the HCA Healthcare-owned hospital.
The phone call was one of the first signs that Mission nurses were about to get what they wanted: a formal investigation of the hospital’s emergency department.
Nurses had told me that staffing issues and communication procedures for transferring patients from Mission’s emergency department had jeopardized patient safety, a contention they had shared with the North Carolina Department of Health and Human Services (NCDHHS) in complaint letters over two years. They also told me their complaints to management had been ignored. A hospital spokesperson maintained Mission’s practices were safe and management takes nurses’ concerns seriously.
Despite the nurses’ complaints, no NCDHHS investigators had visited the hospital to examine their concerns.
When I asked the agency to explain the delay, it cited staffing issues.
But something changed. In early November, NCDHHS began inspecting the hospital on behalf of the U.S. Centers for Medicare & Medicaid Services. The inspectors were from the agency’s Division of Health Service Regulation, responsible for monitoring North Carolina health care facilities to ensure they adhere to minimum standards of care.
The inspections came as North Carolina Attorney General Josh Stein’s office also was investigating Mission, requesting 41 sets of documents about its oncology and emergency services from the hospital by Dec. 10.
While inspectors visited the hospital, Mission halted some patient transfers to its emergency department and tried to add more physician shifts. Management also emailed hundreds of physicians on Dec. 2, mandating what should seem obvious: They were to respond when alerted to an emergency department patient’s loss of consciousness or “emergent” condition, and to stop to stabilize patients at risk of dying.
In addition, months after The Watchdog’s report on transfer procedures, Mission updated how some patients are moved from its emergency department to other areas of the hospital, requiring phone calls during handoffs, which the nurses had previously requested.
I know the TJC and the NCDHHS examined scores of patient cases. But it is unclear what the outcome of those inquiries will be.
I’ve talked to nurses and doctors nearly every day, trying to understand what’s happening at Mission. Not everything is clear, but after two years of reporting, I believe that whatever is happening there, it’s seismic.
Signs of brokenness
To have non-routine inspections like the ones conducted by the NCDHHS and TJC signals that things are broken at Mission. The evidence of that brokenness is everywhere.
I heard it at four meetings held by Gibbins Advisors, the independent monitor of the sale of Mission to HCA for $1.5 billion in 2019.
I read it in the letter now signed by more than 130 doctors declaring HCA has “gutted” Asheville’s health care network.
I saw it on the faces of the doctors I’ve interviewed who have left Mission with a bad taste in their mouths, including a former medical chief of staff who said this of his experience working at the hospital: “I truly felt like it was a moral injury to be working for them.”
I heard it in the voices of all the patients who have called me to describe their experiences at Mission.
And I see it spelled out in a scathing lawsuit filed Dec. 14 by Stein, a Democratic gubernatorial candidate, alleging that HCA and Mission broke promises made in 2019 to maintain for 10 years the same current levels of care as were in place at the time of the sale. The lawsuit focused on emergency department and oncology issues and contained sworn affidavits from nearly all the nurses quoted in our August reporting on transfer procedures. At the time of the lawsuit’s filing, Mission maintained it has lived up to its commitments.
Stein’s lawsuit, which seeks a court’s intervention to bring Mission back into compliance, is filled with descriptions of patients abandoned, a depleted medical oncologist staff, chemotherapy running out, unsafe nurse-to-patient staffing ratios and a 30-hour wait for an emergency room patient to be admitted to the hospital.
The lawsuit verifies so much of what I heard when reporting on patient transfers. It also could mark the beginning of what many hope will be drastic improvements to the way that HCA runs Mission.
What stood out to me more than anything else when the lawsuit was announced were the nurses. Two who were quoted in our reporting stood beside Stein as he made his announcement. In talking to me and standing next to the state’s highest-ranking legal official, they put their livelihoods on the line in the service of better healthcare in western North Carolina.
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 please visit avlwatchdog.org/donate.
Thank you for all your support for patients, nurses and physicians who have been trying so hard to be heard. Hopefully there is a “seismic change” coming.
You do good work. Asheville is fortunate to have you.
Excellent reporting! Keep it up, as the staff at Mission need your watchful eye if improvement ever comes. Only holding HCA’s feet to the fire will work, because in reality HCA management only cares about profits for their shareholders.
May seismic change begin ASAP. WNC deserves a hospital they aren’t afraid to go to.
I am so grateful for the work of watchdog! I worked at an HCA facility in Miami, FL. And I could second everything that has been discovered here. I am appalled that this is our sole source of medical care in Asheville. I had heard nothing but good things about Mission prior to its purchase by the money hungry, slash and burn company called HCA! Please, keep up the pressure on them! I commend you for what you are doing!
Joyce Moreno
I reported Mission to The Joint Commission in 2018 related to mismanagement of a cardiac med, Tikosyn, on the cardiac floor causing me to die in my sleep there. The Mission pharmacy department knew that 2 of my meds were never to be given together.
So I filed on the 2 pharmacists with the NC Board of Pharmacy twice with they dismissing the matter. And I filed again with TJC when I understood years later that there is a dedicated “cardiac pharmacist” who would hve specifically been aware of the drug manufacturer’s (Pfizer) protocol for Tikosyn.
Then I bought a lawsuit (Marsha Hammond v Mission Hospital) in 2020 but since the Republicans changed the med mal tort law in 2011 you need a minimum $1,000,000 med mal tort to drive the matter forward.
Mission is the only hospital of its size—maybe in the state of NC— that is not affiliated with Wake; Duke; or UNC CH.
Your experience makes me feel like the whole system is rigged. I am so sorry.
Everything is in systemic failure at Mission/HCA except HCA’s stock price and profit margin. The stock is up roughly 150% since buying Mission in 2019.
I think a law should be passed nationwide that states ALL hospital ownership MUST be for non-profit. Clearly, there is a “conflict of interest” when a hospital is owned by a for-profit organization. On the one hand, there are health care providers wanting the best care for their patients and on the other hand share holders who want to make money. In this country, when physicians graduate from Medical School, they take an oath “to do no harm.”
Thank you for your continued reporting on Mission. My husband was there in February of 2023 and although the nurses were running, they were short staffed and their equipment was constantly breaking down. The food looked like on a plate. It was inedible. After a week of him not being bathed I asked the CNA when he would be bathed and she told me “they don’t do that anymore because they don’t have time.” The only place I felt OK to leave him for any length of time was when he was in the ICU where there was better staffing. Upon admission we spent some time in the ER, which was like being in a horror movie. I can’t even describe it all. People were lined along the walls screaming and moaning with no one tending to them. Our nurse kept apologizing she was not there for my husband, who had suffered a debilitating stroke. He didn’t even receive the medication he needed to stop the bleed until many hours after admission. And finally, when he was eventually admitted to HCA Care Partners Hospice, we couldn’t get the in-home care we were promised and that we sorely needed to keep him comfortable at home. The entire experience was horrifying and I have not even scratched the surface of all that was wrong. Keep up the good work holding them accountable for destroying our local hospital.
I have just transferred to a doctor in the Advent network, visited the closest Advent affiliated Urgent Care, determined that I can ask an Ambulance to take me to Advent instead of HCA (except for serious trauma) and decided not to retire here. Voting with my feet!