Employees at Asheville’s Mission Hospital say they aren’t shocked to hear that parent company HCA is potentially in noncompliance with its purchase agreement of the Mission Health hospital group for the second year in a row. Neither are the region’s elected officials.
The company, however, maintains that it is in compliance, despite the noncompliance findings of an independent monitor.
Molly Zenker has worked as a nurse at Mission Hospital since 2017. She’s an original member of the nurses union there — the only one of its kind across North Carolina. Despite the ratification of a new contract between the union and the hospital last year, tensions remain high.
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“It’s quite evident every day that Mission and HCA are failing to comply with the standards they were set to hold,” Zenker told Carolina Public Press.
“All their failings get back to not having enough staff to take care of the patients. It’s hard to maintain my own standards of care in that environment.”
HCA purchased Mission Health, the North Carolina mountain region’s largest hospital system, for $1.5 billion in 2019. In allowing the acquisition, the state attorney general’s office placed key stipulations on the purchase, to which HCA agreed. Dogwood Health Trust, which is charged with monitoring HCA’s compliance with the purchase agreement, announced Tuesday that it intends to notify the health system of three instances of potential noncompliance.
Out of the three instances of potential noncompliance that occurred in 2024, only one remains active. That’s the hospital’s failure to maintain emergency/trauma and oncology services.
Local lawmakers say the noncompliance issues reflect a broader pattern of behavior.
“HCA will try to get away with whatever it possibly can,” state Rep. Brian Turner, D-Buncombe, told CPP. “I would not say I am surprised.”
For other lawmakers, it’s a question of accountability and transparency.
“If it’s true that HCA is not compliant with the purchase agreement, then we need to proceed down that path,” state Rep. Eric Ager, D-Buncombe, told CPP. “HCA hasn’t served the people of Western North Carolina as well as it could. If they aren’t meeting their requirements, they need to be held accountable.”
But the biggest critic of HCA in the General Assembly has been Sen. Julie Mayfield, D-Buncombe.
Mayfield leads Reclaim Healthcare, a coalition of physicians, nurses, elected officials, business leaders, clergy and advocates whose goal is to replace HCA Healthcare as owner of Mission Health with a nonprofit hospital system, as Mission Health was prior to HCA’s acquisition. Mayfield is also an HCA shareholder.
“Reclaim welcomes the IM’s findings that HCA is in ‘possible’ non-compliance with the APA,” wrote Aaron Sarver, spokesperson for the coalition.
“HCA has failed to remedy all areas of noncompliance identified by the IM last year and, therefore, continues to provide inadequate emergency and oncology services to the people of Western North Carolina.”
Sarver also points out that in a recent patient survey, the Centers for Medicare & Medicaid Services yielded a two out of five star rating for patient experience at Mission Hospital.
The hospital has a different story to tell about the potential noncompliance findings. For them, the independent monitor’s findings don’t reflect reality.
“While Mission Health values the work of Dogwood Health Trust, we remain confident in our compliance with the terms of the Asset Purchase Agreement,” HCA spokesperson Nancy Lindell told CPP.
“As noted in the report, CMS accepted our corrective action plan more than a year ago and we were found to have zero deficiencies at the conclusion of another survey in June. The report mentions again our improvements to Mission Health’s charity care policy. Since joining HCA Healthcare, Mission Health has not engaged in litigation against patients over unpaid medical bills, including filing liens.
“Mission Health remains committed to serving the community of Western North Carolina and providing the quality healthcare that our patients deserve.”
Zenker occasionally works in the oncology unit at Mission Hospital. In that unit, care allegedly was so diminished that Gov. Josh Stein sued the hospital for breaching their purchase agreement during his time as attorney general.
Regardless of whether HCA is in compliance or noncompliance with the purchase agreement, the situation in oncology remains desperate, according to Zenker.
“There is one nurse to give chemo some days,” Zenker said. “And a lot of times, it’s someone who is coming in extra to do that, because there’s nobody else, not even a pharmacist.
“We had an exodus of pharmacists at HCA. That’s led to not having any chemo pharmacists. If we don’t have a pharmacist to mix the chemo, we can’t give it. After the hospital was placed in Immediate Jeopardy by CMS last year, they came up with a 300-page plan to fix things. Nothing mentioned staffing, because they make their money off of short-staffing the hospital.”
In his lawsuit against the hospital, Stein wrote that Mission Cancer Center no longer employs a single medical oncologist, and that patients with leukemia and lymphoma must travel to Charlotte or the Triangle for care.
CON battle continues amid noncompliance concerns
The noncompliance concerns come as Mission Hospital brings its fight to prevent AdventHealth from building a competitive hospital to the North Carolina Supreme Court.
Advent has already started construction on what would be the region’s second-largest hospital, and one of the only health care options not owned by Mission. But last week, the high court issued a temporary stay requested by HCA as it challenges Advent’s approval for the facility.
Rep. Turner welcomes the hospital competition, saying he is encouraged that there are other health systems looking to invest in Buncombe County. “I want choices. I want Advent. I want Novant. I want options,” he said.
The noncompliance issues only reinforce his view that the region needs alternatives. After Helene, Turner temporarily moved his parents out of Asheville because he was concerned about the care they might receive at HCA if something serious happened.
HCA argues the region would be better served by expanding Mission’s capacity rather than building competing facilities.
“We strongly believe Mission Hospital can best meet Western North Carolina’s growing need for complex medical and surgical care,” Lindell wrote.
“Instead of adding more beds at facilities that are unable to provide the complex medical and surgical care needed, the region would be better served by expanding bed capacity at Mission Hospital. We consider it a privilege to care for our region’s sickest patients but need more beds to do so.”
Zenker agrees that a second hospital could be a good thing for the region’s sick.
“I don’t love Advent either, but a little competition is always good,” Zenker said.
“If HCA is fighting it this hard, it means there’s something they will lose if another hospital is built here. I think that’s a fairly good signifier that it would be good for the community.”
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