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N.C. Attorney General Josh Stein sues HCA Healthcare over alleged breach of Mission Health deal

This story has been updated to include HCA Healthcare's response.

The North Carolina Attorney General’s office on Thursday sued HCA Healthcare, accusing the country’s largest for-profit hospital company of breaching the terms of its 2019 purchase of Asheville-based Mission Health System.

At a press conference Thursday morning at the Buncombe County Government Administration Building, Attorney General Josh Stein said HCA is not providing quality, consistent emergency services and cancer care.

"Patients in Western North Carolina deserve quality health care, and that is exactly why I am taking this action today," Stein said.

As he spoke, he was flanked by state Sen. Julie Mayfield (D) and medical staff holding signs reading, "Staff Up! For Safe Care. End Crisis Care Now."

Stein read testimonies from some patients who complained of inadequate quality of care at Mission Health facilities.

"Today, HCA Mission does not have a single medical oncologist on staff," Stein said, noting that due to the staffing shortage, in many cases "patients have to travel hours to get that treatment."

Stein, who is running for governor in 2024, emphasized that the lawsuit does not reflect on the work being done by staff at HCA-owned facilities. Those workers are doing their best without sufficient support from management, he said.

Stein said the timing of the suit had "absolutely nothing to do with" his gubernatorial bid.

"We're moving as quickly as we possibly can, and it has absolutely nothing to do with an election cycle."

In a statement, HCA spokeswoman Nancy Lindell said the lawsuit "will not have any impact on our commitment to the community we are proud to serve."

"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," Lindell said. "Importantly, the Independent Monitor confirmed our compliance with that agreement during its most recent review."

At Thursday morning's event, Mayfield announced a proposed Senate bill to increase standards, require more public meetings and require distribution of data. The measure is co-sponsored by Senators Corbin and Burgin.

Escalating the issue

The move marks a significant escalation in the long-running battle over HCA’s management of Mission Health facilities.

Stein issued a notice to the health care company in late October. Under the terms of the purchase agreement, HCA had 40 days to correct the issues Stein's office identified.

Until the $1.5 billion sale to HCA in 2019, Mission Health System was a nonprofit health organization. HCA has faced mounting accusations that it has cut costs at patients’ expense, with dozens of current and former Mission doctors signing onto a letter denouncing “many of the for-profit-driven changes that HCA has wrought” as having “gutted the heart and soul of our community healthcare system.”

As part of the 2019 deal, HCA agreed to a set of commitments regarding its facilities and the services they offer. HCA pledged not to discontinue a wide range of services for the 10 years following the sale. It also agreed not to close any of its facilities before 2029 unless a local advisory board and independent monitor agree.

Yet the health care giant has faced a public outcry over quality of care issues since then. Many patients have complained of inadequate staffing at Mission Health hospitals, leading to long wait times for medical appointments and at the emergency room. HCA has also weathered criticism for shuttering two primary care facilities in 2020 and, more recently, for the loss of much of its medical oncology team at Mission Hospital.

In October, Stein sent a letter to Dogwood Health Trust, the foundation that was tasked with handling the proceeds from the sale. In the letter, Stein notified Dogwood of an alleged breach of the agreement and gave HCA 40 days to fix the issues or face another lawsuit. Stein has also requested documents from HCA as part of his office’s investigation.

A lawyer for HCA responded last month by accusing the attorney general of engaging in “a bald attempt to obtain prelitigation discovery, masquerading as a consumer protection ‘investigation.’”

“Mission is now, and always has been, in full compliance with that contract and often exceeds its obligations under the APA,” the lawyer, Alice Fisher of the law firm Latham & Watkins, said in a letter to Stein’s office.

The battle over conditions at Mission Health facilities has played out in an increasingly public manner.

In response to the earlier letter sent by physicians critical of HCA, more than 80 medical practitioners signed onto a letter in late October solicited by Mission Hospital leadership. The doctors defended the hospital’s services and argued that the original letter “does not tell the whole story.”

Nurses call for better conditions

Meanwhile, on Wednesday, a group of unionized nurses at Mission Hospital held a rally where they called on management to address what they said were unsafe staffing conditions. In some cases, the union said, patients soiled themselves while waiting for a nurse to give them assistance in going to the restroom. In other cases, nurses have been forced to care for more than twice the recommended number of patients and have routinely been unable to take their regular meal and lunch breaks.

“We always want to give our patients the best care at all times, and that means we need to be in optimal condition, too, but we can’t take a break when HCA management assigns us too many patients,” emergency room nurse Hannah Drummond said in a statement distributed by the union, which is part of National Nurses United.

Felicia Sonmez is a reporter covering growth and development for Blue Ridge Public Radio.
Lilly Knoepp is Senior Regional Reporter for Blue Ridge Public Radio. She has served as BPR’s first fulltime reporter covering Western North Carolina since 2018. She is from Franklin, NC. She returns to WNC after serving as the assistant editor of Women@Forbes and digital producer of the Forbes podcast network. She holds a master’s degree in international journalism from the City University of New York and earned a double major from UNC-Chapel Hill in religious studies and political science.
Laura Hackett joined Blue Ridge Public Radio in June 2023. Originally from Florida, she moved to Asheville more than six years ago and in that time has worked as a writer, journalist, and content creator for organizations like AVLtoday, Mountain Xpress, and the Asheville Area Chamber of Commerce. She has a degree in creative writing from Florida Southern College, and in 2023, she completed the Craig Newmark Graduate School of Journalism at CUNY's Product Immersion for Small Newsrooms program. In her free time, she loves exploring the city by bike, testing out new restaurants, and hanging out with her dog Iroh at French Broad River Park.
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