Buncombe County cannot intervene in North Carolina Attorney General Josh Stein’s lawsuit against HCA Healthcare, the NC Business court held this week. The county is already part of another lawsuit but had asked to intervene in Stein’s suit, claiming $3 million in damages.
“The court found that there is no right to intervene and determined in its discretion that allowing permissive intervention would prejudice and delay the existing proceedings,” Buncombe County Communications & Public Engagement Director Lillian Govus said in an email.
In its filings, the county argued that it should be allowed to recover funds it spent from transport delays caused by Mission Hospital’s Emergency Department that impacted Buncombe County’s Emergency Medical Services (EMS).
The Attorney General’s action is limited to “injunctive relief” which means that it would stop HCA’s actions moving forward but not provide support to the county over what has already occurred.
The county hasn’t yet determined next steps, Govus said.
In December 2023, Attorney General and Democratic gubernatorial candidate Josh Stein filed suit against HCA, alleging the health care company failed to meet the obligations required by the 2019 sale of then-nonprofit Mission Health. Those obligations are based on 15 points outlined in the Asset Purchase Agreement(APA) that was established as part of the deal to purchase the six hospitals that are part of Mission Health.
The Attorney General alleges in his lawsuit that HCA has failed to provide enough emergency care, trauma care or oncology services as required by the APA. The lawsuit also alleges that Mission’s emergency department is “purposefully” understaffed.
The lawsuit states that according to state and federal regulators, Mission Hospital’s Emergency Department has a patient wait time averaging 236 minutes. It says this is above the national average of 161 minutes and the state average of 175 minutes.
Buncombe County said these wait times have periodically left the county without an available ambulance.
The ruling said one of the reasons that the motion to intervene was denied was because Buncombe County is not a party to the APA.
The APA lists all of six regional hospitals as parties to the agreement as well as each physician services group, imaging services and other partners such as MH Master Holdings, LLLP, HTI Hospital Holdings, Inc., and Dogwood Health Trust.
The County also argued that the Attorney General does not adequately represent its interests specifically because this is an election year and Attorney General Josh Stein is leaving office, making it unclear whether the underlying litigation will continue.
The Attorney General's office was not immediately available for comment.
The court found that Buncombe County is being adequately represented by the Attorney General’s office.
“Mere speculation that the Attorney General’s office will not continue to vigorously prosecute this action after the 2024 election is insufficient to satisfy the County’s burden,” the ruling said.
Next steps
HCA spokesperson Nancy Lindell said in a statement that the healthcare system is happy about the ruling.
“We are grateful that the trial court refused to allow Buncombe County to intervene in the lawsuit and to delay the proceedings. We remain confident that we continue to meet, and often exceed, the obligations under the Asset Purchase Agreement,” Lindell said in an email.
Buncombe County is also part of another lawsuit filed against HCA in August 2021 which alleges that the health corporation is using its monopoly status in far western North Carolina to charge more while providing poorer quality of care. Brevard, Madison County and the City of Asheville also joined the lawsuit. In February 2024, a judge ruled that the lawsuit can continue to move forward.
The newly hired independent monitor, Affiliated Monitor, said in June that they will now also be considering “quality of care” as part of HCA’s obligation to the community.
Mission Hospital’s “immediate jeopardy” designation that could have taken away federal funding was removed in June. However, Mission Health must still follow CMS recommendations, state officials explained in February. Stein has said his lawsuit is independent of the CMS’ decision.
Mission nurses are currently preparing for a strike as their union contract expired on July 3. Nurses are currently negotiating with HCA through National Nurses United.
Fact discovery in the Attorney General’s case is set to close in September.
