HCA Healthcare kept watchdogs waiting for months for information that would determine whether the company was in compliance with the state-mandated terms of its purchase agreement for Asheville-based Mission Health. When the company relented, it kept control over what could be made public about the performance of hospitals in the Mission Health network.
The delays and secrecy seriously undermined accountability, says the independent monitor in charge of assessing HCA’s compliance.
The perceived resistance to oversight and lack of cooperation comes as HCA is found to be potentially not in compliance with its purchase agreement of Mission Health for the second year running.
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Tennessee-based for-profit HCA purchased formerly nonprofit Mission Health, Western North Carolina’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 and Affiliated Monitors are charged with monitoring HCA’s compliance with the purchase agreement and publishing annual assessments.
This year, Affiliated Monitors says the monitoring process was frustrating, unproductive, and at times, unacceptable.
HCA successfully avoided answering questions about staffing levels, charity care and availability of protected services by invoking the North Carolina Trade Secrets Protection Act and the Hospital Licensure Act. The company used other tactics as well, claiming that it does not track data to the level of detail requested, that the APA doesn’t require the production of requested information, or that developing a response would be extremely burdensome.
Because of the acts HCA invoked, the monitor would have had to get HCA’s approval before transferring any protected information to a third party.
“We asked if they could take a second look at some of the information, because a lot of it, we thought, should be public,” Jerry Coyne, spokesperson for Affiliated Monitors, told Carolina Public Press.
“They suggested, as an alternative, that we would submit our report to them, and they would identify any information they wanted taken out of it. That was unacceptable to us. Giving HCA editorial control over the report does a disservice to anyone who’s reading it.”
Even so, Affiliated Monitors didn’t use any information that HCA claimed was proprietary in the 2024 compliance report, which it released in July 2025.
In addition to withholding information from the public, HCA was responsible for major delays in the production of information, according to the compliance report. These delays further handicapped the monitor’s effectiveness.
In February, Affiliated Monitors requested supplemental information from HCA that would inform the monitor’s annual May visit to each of the hospitals in Mission’s network. The monitor uses that information to ask better questions on the tours, according to Coyne. HCA promised to produce the information by May 1, but didn’t respond until May 22.
By then, the hospital visits were over.
“That limited the value of our visits,” Coyne said. “It was a frustrating experience this year. It was not as smooth or productive of a process.”
When HCA did finally release the requested information to the monitor, they included a disclaimer that claimed much of it was proprietary and privileged. In other words, it was not to be shared with the public.
Coyne believes HCA was caught off guard by the questions asked by Jeff Brickman, a retired hospital systems executive who works with Affiliated Monitors. As a subject matter expert, “he has the ability to review a lot of the data and ask very pointed and specific questions,” Coyne said. That put HCA on the defensive.
As for HCA, the company maintains that it is actually in compliance with the purchase agreement, despite the findings of Dogwood and Affiliated Monitors. Hospital management appeared frustrated by the report.
“We are confident in our compliance with the terms of the APA.,” HCA spokesperson Nancy Lindell told CPP. “The issues the Dogwood Health Trust raised have already been addressed, which is why we were found to have zero deficiencies at the conclusion of the June survey done by CMS.
“We won’t be distracted by the rehash of outdated information contained in the report and are moving forward to serve the growing health care needs of Western North Carolina.”
Community groups, on the other hand, see HCA’s delays and confidentiality claims about key information as serious breaches of trust.
State Sen. Julie Mayfield, D-Buncombe, leads Reclaim Healthcare, a coalition of physicians, nurses, elected officials, business leaders, clergy and advocates. The coalition’s 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.
“HCA’s lack of transparency and accountability isn’t surprising or new,” said Aaron Sarver, spokesperson for the coalition. “The Independent Monitor and our community deserve this crucial information about staffing levels and other metrics. HCA would share it if they were a true community partner and had nothing to hide.”
Dogwood is sitting down with HCA this month to discuss how to avoid these same issues next year when they look at the health system’s compliance for 2025.
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