A pedestrian crosses the street to enter one of the Mission Health hospital buildings last month in Asheville. An independent monitor will oversee the compliance of Mission purchaser HCA with stipulations the NC Department of Justice made for the deal. Colby Rabon / Carolina Public Press

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HCA Healthcare, the owner of Mission Health in Western North Carolina, is holding firm in its claim that it is providing sufficient medical care at hospitals across its system to victims of sexual assaults.

In the wake of a complaint by a representative of the domestic violence and sexual assault nonprofit REACH about the lack of a trained sexual nurse examiner on staff at Angel Medical Center in Franklin — and a demand from Attorney General Josh Stein for answers — HCA is now suggesting that it has no legal duty as part of its acquisition of Mission Health to place such certified nurses on staff at any of its rural hospitals.

In a Feb. 25 letter to Greg Lowe, the president of HCA’s North Carolina Division, the attorney general cited a section of HCA’s asset purchase agreement with Mission, effective Feb. 1 last year, that buyer HCA “shall not discontinue” at Angel any “emergency services” or “acute medicine services.”

In response to Stein’s letter, Lowe has now told him that “a sexual assault survivor who comes to Angel Medical Center receives the same services now that were available prior to HCA’s acquisition of the Mission Health System.”

Who discontinued rural sexual assault nurse examiner staffing?

In his March 4 letter to Stein, a copy of which was obtained by Carolina Public Press, Lowe said HCA has maintained the forensic nursing program for sexual assault survivors begun by nonprofit Mission.

“HCA has not eliminated any FNP nurse position at Angel Medical Center or within the Mission Health system or any services available to sexual assault survivors,” HCA’s regional president wrote.

Andrea Anderson, the executive director of REACH of Macon County, told Carolina Public Press the issue is complicated.

“Angel always — like for years — had an FNP program,” she said on the eve of HCA’s response to the attorney general.

But after Angel affiliated with Asheville-based Mission Health in June 2013, “within a few years, it started dissolving,” and FNP nurses were no longer based at Angel, she said.

“It’s a need that was historically provided for,” she said, acknowledging that it was Mission, not HCA, that withdrew sexual assault nurses from rural hospitals.

Forensic nurse practitioners who work with sexual assault victims are typically certified as Sexual Assault Nurse Examiners either for work with adults or children.

Stein’s letter to HCA specifically used the term “Sexual Assault Nurse Examiner” to discuss this level of certification for the medical professionals whom HCA’s letter describes by the overlapping term “forensic nurse practitioners” and its abbreviation “FNP.”

“We have been told that Angel Hospital no longer has a Sexual Assault Nurse Examiner on staff,” Stein wrote on Feb. 25. “These nurses are trained to provide specialized support in emergency rooms to survivors of sexual assault.”

Service, but where?

Lowe told Stein that in 2019, “HCA provided care to more than 450 patients in Western North Carolina through FNP.

“The team is based at Mission Hospital in Asheville and available to care for a patient at Angel Medical Center or any other Mission Health hospital, twenty-four hours per day and seven days per week.”

Lowe said sexual assault victims across the region are first provided with any necessary medical care by an emergency department physician.

When the patient is “medically stable,” he or she can meet with a SANE nurse.

But where that meeting happens remains a subject of controversy.

A SANE nurse may travel from Asheville to Angel Medical Center, or the patient may travel to Asheville, where a SANE nurse can meet with the patient in an exam room at Mission Hospital or at the Buncombe County Family Justice Center, according to Lowe.

Anderson, the executive director at REACH, told CPP that short of a regular position at Angel, she would like to see these specialized nurses come to Franklin and not have traumatized victims have to make any trip to Asheville.

“We probably have a fundamental difference in what we believe is in the best interests of survivors of sexual violence,” she told CPP after being briefed on the contents of Lowe’s letter.

Traumatized survivors of rape, other sexual assault or strangulation shouldn’t have to wait on transportation to be seen in Asheville, she said.

“We don’t care where they’re based out of,” Anderson said of SANE nurses, as long as victims of such abuse receive care at Angel.

HCA and REACH are meeting Friday in Franklin to discuss the overall issue.

A wider need for sexual assault nurse examiners?

In advance of HCA’s response to Stein, Carolina Public Press had independently confirmed that no certified SANE nurses had been on staff at Angel Medical Center, but also none were at Mission’s other rural hospitals in Highlands, Spruce Pine and Marion.

“It’s been years,” said Jennifer Beaty, the executive director of nonprofit New Hope of McDowell, who is also a court advocate and who has been with New Hope for 14 years.

With the lack of constantly available SANE nurses at Mission Hospital McDowell in Marion, about one dozen rape victims have been unwilling to travel all the way to the ER in Asheville, she said. Some have chosen not to press charges.

“Prosecution doesn’t occur, because they’re upset with the process,” Beaty explained.

Asked about HCA’s statement that trained SANE nurses are available to travel from Asheville to Marion and other rural communities to treat victims there, Beaty expressed surprise.

“It’s absolutely news to me,” she said. “We’ve never been told that at all.”

“It could be possible that no one has just reached out to us with that information.”

Back on the other side of the region, Highlands Chief of Police Bill Harrell, whose department stocks sexual assault kits but has no access to trained professionals to use them, is anxiously awaiting a solution.

“Our chief says he would be OK if between Highlands and Franklin facilities there were two to three (trained) nurses to be on call and share the load,” said Highlands Mayor Patrick Taylor.

“This kind of setup would minimize the need to make long transport of victims, which is simply unacceptable.”


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Neil Cotiaux

Neil Cotiaux is a contributing writer for Carolina Public Press. He is based in Wilmington. Send an email to info@carolinapublicpress.org to contact him.

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