Attorney General Josh Stein and his staff went to court on Thursday to file a high-profile lawsuit against the owner of Asheville’s main hospital.
The suit alleges that HCA Healthcare hasn’t been living up to the terms of the 2019 agreement that allowed it to purchase Mission Hospital and the other assets of the nonprofit Mission Health System.
The new owner’s management has triggered a “downward spiral” in the hospital’s emergency and cancer-treatment services that’s harming the people and communities of western North Carolina, the lawsuit claims.
Stein and his aides allege breach of contract and are seeking an injunction along with a “decree of order of specific performance” to compel HCA to provide services “at the level they were provided” before it bought the hospital.
“HCA cannot prioritize paying dividends to its shareholders over honoring its legal commitments to provide health care services to the people of western North Carolina,” the suit says.
The mention of dividends was alluded to for-profit and publicly traded HCA’s decision to raise dividends by 17% in 2022, which came as it was also sending money out the door by buying back $7 billion worth of its common stock.
The company — which as of the end of 2022 owned 182 hospitals — recorded net income of $6.8 billion, according its annual report for 2022.
Mission Health spokeswoman Nancy Lindell said in a statement that the hospital remains “confident that we continue to meet, and often exceed, the obligations under the Asset Purchase Agreement that the Attorney General approved at the time of our purchase, and we intend to defend the lawsuit vigorously. Importantly, the Independent Monitor confirmed our compliance with that agreement during its most recent review.”
Lindell added, “Though there have been challenges, some of which we are continuing to address as we work to expand our capacity, we remain committed to serving our community. Despite the state not allowing important expansions at Mission Hospital, we will continue to fight for critical access to healthcare services for the people of Western North Carolina.
“As the Attorney General acknowledged, this lawsuit is no reflection on the dedication of our doctors, nurses and colleagues who serve our patients every day. This lawsuit will not have any impact on our commitment to the community we are proud to serve.”
The specific complaints about service at Mission Health have been covered in the past weeks and months to stories published by Asheville Watchdog, the “virtual newsroom” that since 2020 has been trying to fill in some of the gaps it sees in local-news coverage out west.
Its reporters have written extensively about HCA’s takeover, giving a platform along to the way to doctors and nurses unhappy with what they see as a squeeze in emergency room and oncology services.
The resulting articles figure prominently in the lawsuit’s footnotes, alongside affidavits from providers and patients.
The lawsuit alleges a “significant staffing crisis” in the emergency room that’s left it short of nurses, triggered long wait times for care and prompted the use of a triage system that uses part of a waiting room that lacks both privacy and essential equipment.
If you read HCA’s annual report, you’ll note that the company’s leaders allude a number of times to labor shortages, particularly for nurses. But Stein and his staff say that’s not the issue.
“In addition to being too cheap to adequately staff its emergency department long-term, HCA is also too stingy to adequately staff its emergency department short-term,” they say in the lawsuit. “HCA knows how to adequately staff its emergency department; it just chooses not to.”
They added that HCA has opted to leave some beds unstaffed “in order to boost profits.”
Similarly, the Mission Cancer Center “no longer employs any medical oncologists,” after a number of the ones formerly employed there left because the company wasn’t giving them the support staff they needed to triage patients or handle paperwork.
At the hospital proper, the number of oncology beds has dropped from 44 in 2019 to 24 today, “a woefully inadequate number to address community demand,” the suit says.
There’s also only one chemo-trained pharmacist on staff, and frequent shortages of key drugs and other supplies because HCA prefers stocking its “just in time” supply chain from one of its own subsidiaries.
Perhaps the most interesting section of the lawsuit alleges that the issues at the hospital are harming county EMS and ambulance services when their trucks have to wait around at the hospital way too long for their patients to receive care.
Obviously, when a truck’s at the hospitals, it’s not available to answer calls, and the lawsuit cited complaints about that from a number of agencies, including one from McDowell County EMS Director William Kehler.
In October, Kehler wrote Mission Hospital COO Wyatt Chocklett to say the hospital’s failure to address that problem “is putting lives at risk unnecessarily.
“Our staff continues to go above and beyond to clean beds and rooms in your emergency department to speed up the transition of care,” Kehler said in that letter. “HCA has shown little to no interest in collaborating with EMS agencies and engaging in meaningful conversations to find solutions to these serious issues.”
The lawsuit hammered home the point: “In effect, HCA has coopted paramedics as employees of its own, but stuck local taxpayers with the bill,” it says.
Stein’s aides filed the case in Buncombe County Superior Court. The AG was involved in approving the deal originally because of the state conversion law that governs the acquisition of nonprofits by for-profit enterprises.
