At their annual meeting on Thursday, HCA Healthcare shareholders voted down a proposal from NC Sen. Julie Mayfield, D-Buncombe, which would have required the Tennessee-based health system to examine the negative community impacts of its hospital acquisitions, including Mission Hospital in Asheville.
The 22-minute virtual meeting also featured HCA Healthcare CEO Sam Hazen directly addressing patient safety concerns at Mission, which was purchased by HCA in 2018 and has since struggled to remain in good standing with regulators.
Mayfield, whose district includes Mission, didn’t expect her proposal to pass. She put forward the same proposal last year and won just 12% support after the HCA board recommended that shareholders vote it down.
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In an interview with Carolina Public Press, Mayfield said she hoped to garner at least 15% of the vote this year. That’s the minimum threshold needed for her to bring forth the proposal again next year, per Securities and Exchange Commission rules.
She’s not sure yet whether the proposal reached that threshold. The final vote tally will be recorded in a SEC filing sometime next week. Even if it didn’t hit that mark, Mayfield said she was glad to see Mission at the center of conversation during the meeting.
“Success, at a different level, is simply knowing that the HCA board and institutional investors and any media that are present are aware of what’s happening,” she said.
“Hopefully (they) will understand, perhaps better than I presented it last year, the risk to shareholders,” she added.
Mayfield purchased $25,000 worth of HCA stock in 2024 for the express purpose of putting forth a proposal at the annual shareholders meeting.
The proposal, if passed, would have required HCA’s board of directors to publish a report “describing the health care consequences and impacts its hospital acquisitions in the last decade have had on impacted communities.”
The report would include information on:
- the number of physician departures post-acquisition
- a comparison of pre- and post-acquisition patient satisfaction ratings
- a comparison of the number of staff per occupied beds pre- and post-acquisition
- an assessment of the impacted community’s perception of HCA and response to the acquisition
Mayfield invoked issues at Mission in her statement in support of the resolution.
The embattled facility plays a key role as the only tertiary care hospital and trauma center in Western North Carolina, but it’s struggled to comply with federal safety standards in part because of a shortage of nurses and physicians since HCA’s acquisition.
An exodus of hundreds of nurses forced the hospital to rely more heavily on traveling nurses, which now make up a third of the hospital’s nursing staff, Mayfield said. Likewise, traveling physicians have also become more commonplace at the hospital after more than 200 left in the years since HCA’s takeover, putting further strain on the facility.
The number of full-time staff per occupied bed at Mission reduced from 6.0 before the sale to 3.7 in 2021, according to a report authored by Wake Forest Law professor Mark Hall last year. The statewide average during that time was 5.1, meaning that the hospital went from having above-average staffing levels to well below average after the sale to HCA.
In her pitch to shareholders, Mayfield framed the issue as a financial liability.
“Investors should not ignore the reputational risk Mission presents to HCA,” she said.
“The disconnect between HCA’s brand promise and its actual operations, and Mission’s well-publicized operational reality, has likely caused permanent brand damage in key markets and has definitely limited its ability to expand in North Carolina.
“Patient safety failures, regulatory censure, multiple lawsuits, clinician attrition, limitations on expansion and community backlash are leading indicators of future financial underperformance, not secondary concerns,” she said.
The HCA board of directors published a statement of opposition to Mayfield’s proposal ahead of the shareholders meeting.
“We believe the report called for in this proposal is neither practicable nor a good use of Company resources given its broad scope,” the statement read.
“If adopted as proposed, the proposal would result in unnecessary expense and burdens with limited benefit to our stockholders.”
The board’s statement also defended Mission’s track record of quality of patient care, pointing out that it’s received the Healthgrades America’s 50 Best Hospitals Award for 11 years straight. That includes the years prior to the takeover by HCA as well as those since.
However, several academic studies have illustrated how hospital rankings can be misleading. One 2024 paper found severe discordance in the rankings produced by four major hospital rating organizations, including Healthgrades.
Another group of researchers and medical doctors, who in 2019 “rated the raters,” gave Healthgrades an overall grade of D+ with particularly low marks for transparency and use of flawed measures.
For context, U.S. News & World Report gave Mission one out of five stars for “patient experience.” Leapfrog, another major hospital rating organization, dropped Mission’s “safety grade” from an A to a B in 2024 with notable demerits for poor communication and responsiveness among staff.
“Patients can and do receive excellent care at Mission, but two things can be true at once,” Mayfield said, “and serious execution deficiencies clearly persist.”
After the proposals had been voted on, HCA opened the meeting up to questions submitted by shareholders. There were only two, both of which concerned Mission Hospital.
One questioned why Mission was such an outlier in regards to compliance when compared to other hospitals owned by HCA. The other, directed toward Hazen, asked whether he would commit to going to Asheville to speak with elected officials about the community’s concerns regarding Mission.
“Let me start off by saying Mission Hospital is a great hospital,” Hazen said in response.
“We recognize the important role and special responsibility it has in Western North Carolina.… But we still have more work to do.”
Hazen also said he “frequently” travels to Asheville and visits with community leaders and key stakeholders, and said he plans to continue to do so.
Mayfield, however, was skeptical of Hazen’s characterization of his visits to Asheville.
“I am not aware that (Hazen) has met with any elected officials since early 2023, and I am not aware of any community leaders that he’s met with,” Mayfield told CPP.
“People in our community know about the advocacy that I do on HCA, and I feel like any community leader who shares the concerns about Mission Hospital would let me know if they were getting a meeting with Sam Hazen,” she added.
One stakeholder Hazen has yet to meet with is Reclaim Healthcare HCA, the nonprofit organization founded by Mayfield with the goal of holding HCA accountable for its operation of Mission.
“If Mr. Hazen regularly visits (Western North Carolina) then we look forward to sitting down with him,” Reclaim spokesperson Aaron Sarver said in a text message.
“Surely he wants to meet with a coalition of nurses, physicians and staff who want to improve conditions at Mission.”
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