N.C. county files to join attorney general's lawsuit against HCA Healthcare's Mission Health purchase

Updated April 9, 2014

The allegations against HCA Healthcare's Mission Health takeover grew late late week when Buncombe County, North Carolina, filed to join Attorney General Josh Stein's lawsuit. 

The for-profit has been accused of failing to meet quality and access agreements it made with the state in order to secure its acquisition back in 2019.

The county said it "is supportive" of the attorney general's suit, but in a motion to intervene is now seeking more than $3 million in damages its publicly-run EMS crews have shouldered due to deteriorating wait times at Mission Hospital's ED. 

Wait times at Mission rose from about nine minutes and 41 seconds during Q1 2020 to 17 minutes and 41 seconds in Q3 2023 "despite numerous requests and demands from County staff and management to expedite care in the ER," the county wrote in a release describing the filing. Additionally, 90th percentile times rose from about 16 minutes to over 32 minutes—much higher that the National Emergency Medical Services Information System's 20-minute standard, the county said. 

However, Buncombe County wrote in the filing, HCA "continued to shirk their responsibility to emergency care patients at the expense of the County," and only took corrective action after the attorney general filed his lawsuit and the Centers for Medicare and Medicaid Services CMS threatened to pull funding in an "immediate jeopardy" citation (see those stories below).

The long transfer wait times forced EMS personnel to care for ER patients well after they had arrived at the hospital, costing the county's taxpayers over $3 million since 2020 that it now seeks to recoup through the court. 

Buncombe County joins other North Carolina municipalities waging legal battles with HCA over its Mission Health purchase.

In 2022 the city of Brevard (located within Buncombe County), the city of Asheville and Madison County filled class-action complaints alleging that the for-profit had aimed to "exploit" its general acute care and outpatient monopoly power when purchasing Mission Health. In February a federal judge denied the system's motion to dismiss the litigation. 

CMS delivers yet another warning to HCA's Memorial Mission Hospital

March 18, 2024

HCA Healthcare's oft-critiqued Memorial Mission Hospital in Asheville, North Carolina, has received another bout of deficiency warnings from the Centers for Medicare and Medicaid Services (CMS), this time over two violations of the Emergency Medical Treatment & Labor Act. 

The hospital, part of the for-profit health system's acquisition of Mission Health, could have its Medicare funding pulled should it not submit an acceptable correction plan to regulators by March 24 and achieve "substantial compliance" by June 5, according to a warning letter delivered to the hospital's CEO on March 18.

The violations were not detailed in the letter but relate to federal standards for medical screening exams. They were spotted in a November visit from surveyors that was prompted by a reported allegation of noncompliance.

In statements to press, the hospital confirmed its receipt of the letter and said the notice was "expected" in light of a finding during the initial November survey that "was based on a medical screening examination in the emergency department." 

This is the second warning he hospital has received in recent months from CMS regarding deficiencies and Medicare program participation. In February it was issued an "immediate jeopardy" warning notice (see the previous story below) due to continued noncompliance with Conditions of Participation, and has since entered a correction plan with the same June 5 deadline.

"As we continue to state, we take these matters very seriously and have made significant process changes to improve our patient care experience," the hospital said in its most recent statement.

Critics of the hospital's parent company HCA have held these warnings as proof that the large chain has reneged on promises to preserve care services that it made when acquiring Mission Health five years ago.

One of those, North Carolina state Sen. Julie Mayfield, told local ABC affiliate WLOS that the latest warning is "strike three" and said she "would like to see" HCA sell the hospital and leave the Asheville community.

Alongside the regulator scrutiny, North Carolina Attorney General Josh Stein filed a lawsuit against HCA in December alleging that the system has fallen short on care services commitments it made to secure its purchase

Critics of HCA's Mission Health purchase say CMS' warning notice is 'final proof' the for-profit should find a buyer

Feb. 6, 2024

HCA Healthcare's Memorial Mission Hospital in Asheville, North Carolina, has just a few weeks to address deficiencies identified by inspectors or it will lose its Medicare funding, according to watchdog reports and officials.

The hospital, which was acquired by HCA five years ago, has received an "immediate jeopardy" warning notice from the Centers for Medicare and Medicaid Services (CMS), the agency's most severe warning.

The hospital officially received the notice, which outlines failures to meet six Conditions of Participation, on Feb. 1. It gives Memorial Mission Hospital and its Asheville Curgery Center until Feb. 6 to submit a corrective action plan to address specific deficiencies. The immediate jeopardy conditions must be removed by Feb. 24 to avoid termination of the Medicare provider agreement, according to the notice.

Inspectors had made their recommendation to the federal agency and shared their initial findings with the hospital previously, according to materials obtained by The Asheville Watchdog that outlined nine incidents where patients were at risk of serious harm between April 2022 and November 2023. 

In an email sent last week and obtained by reporters, HCA North Carolina Division President Greg Lowe confirmed the receipt of the warning notice and told staff that the hospital plans to submit a corrective action plan by the government's deadline.

“As the initial findings of the survey were shared last month, steps were taken immediately to address them,” he wrote. “Significant HCA Healthcare resources were deployed to assist with our response. We brought in additional staff who are working in our emergency department and, on our busiest days, we have repurposed space on the Memorial Campus to accommodate additional patients.”

CMS' warning notice adds to the heavy scrutiny HCA has faced from local groups and government officials since taking over Mission Health. 

In December, North Carolina Attorney General Josh Stein filed a lawsuit alleging that HCA has fallen short on care services commitments it made to secure its purchase (see below). 

On Tuesday morning, care advocacy groups, citizen groups and local officials—including a representative of the attorney general—held a press conference highlighting the notice and criticizing HCA. 

"The intervention by [CMS] is the final proof, if any was needed, that HCA can no longer be allowed to put at risk the health and welfare of the people it is supposed to serve," Health Equity Coalition said in a related statement. "The Health Equity Coalition [of Western North Carolina] urges HCA in the strongest possible terms to immediately seek a qualified buyer among nonprofit hospital systems. We call on federal, state and local officials to do everything in their power to bring about that result."

North Carolina AG sues HCA Healthcare for breaching Mission Health purchase agreement

Dec. 14, 2023

On Thursday, North Carolina Attorney General Josh Stein made good on his threat to sue HCA Healthcare for allegedly falling short of commitments it made to secure the purchase of Mission Health System.

The 183-hospital system had purchased Mission, then a nonprofit, in 2019 under several conditions related to maintaining certain services for at least 10 years. Those came after “extensive negotiations” with Stein, who has the right under state law to review and potentially block nonprofit deals.

The years since have seen a flurry of watchdog reports and antitrust lawsuits alleging that HCA had used its strengthened competitive position to raise prices along with a dip in care quality and limited patient access.

After months of concerns and investigative demands from Stein’s office, the attorney general has now firmly joined HCA’s critics in alleging that the company’s practices have been “flatly inconsistent” with its commitments.

“For-profit HCA has broken its promise to the people of western North Carolina and to my office,” Stein said in a statement. “Quality healthcare is too important—in some cases, a matter of life and death. But HCA apparently cares more about its profits than its patients.”

In an emailed statement, HCA said it is "aware of the announcement Gubernatorial Candidate Stein made in Asheville today. We remain 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."

In the suit, Stein alleges that the discontinuation of emergency and trauma services at Mission Hospital no longer qualifies it as a level II trauma center, as was required by HCA’s Asset Purchase Agreement. The attorney general also alleges several shortcomings related to the hospital’s staffing, lengthy wait times, bed shortages and impediments to the region’s ground and air medical transport services related to HCA’s operating decisions.

Stein’s other allegations relate to requirements in the Asset Purchase Agreement surrounding inpatient and outpatient oncology services. Here again, the attorney general focused on staffing and bed shortages, noting that the hospital “employs zero medical oncologists” after the specialists left due to burnout and little staffing support.

This means that patients can’t begin chemotherapy treatments at Mission Cancer Center and “have to travel hours to get treatment. Additionally, the hospital’s pharmacy is unable to mix chemotherapy drugs whenever its lone oncology pharmacist is off duty."

Stein said in the announcement that the state’s Department of Justice “has heard from hundreds of North Carolinians about the issues at HCA and received more than 500 complaints,” which often call out Mission’s emergency and trauma services and oncology services.

The complaint filed Thursday petitions the court to declare that HCA breached its agreement, issue a permanent injunction restraining the system from committing such breaches and require the organization to offer the emergency and trauma services and oncology services “at the level they were provided at Mission at the time of the acquisition.”

“The doctors, nurses and medical staff at Mission HCA have worn themselves to the bone trying to care for patients without the necessary resources or support,” Stein said. “They deserve our gratitude, but they and their patients also deserve better. I’m taking HCA to court to make sure it lives up to the agreement it made when it bought nonprofit Mission in 2019. That’s what the people of western North Carolina deserve.”

HCA wrote in its statement that its most recent review with Gibbins Advisors, the deal's appointed Independent Monitor, "confirmed our compliance" with the Asset Purchase Agreement.

"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," HCA said. "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 attorney general’s complaint was filed in North Carolina’s Buncombe County Superior Court.