WNC Leaders Slam HCA for "Immediate Jeopardy" Finding That Threatens Federal Funding
The federal Centers for Medicare and Medicaid Services, saying conditions at Mission Hospital posed "immediate jeopardy" to patients, has threatened to withhold funding if problems aren't fixed.
The nine patients that state inspectors found had been placed in “immediate jeopardy” by conditions at Asheville’s Mission Hospital are not just numbers, Brevard Mayor Maureen Copelof said at a press conference on Tuesday.
“They are individuals who turned to HCA when they needed help the most — when they were sick and injured, when they were in pain, when they were frightened, when they were vulnerable,” Copelof said before concluding with a reference to Mission’s for-profit owner, HCA Healthcare Inc.
“And HCA failed them,”
Copelof’s stand is hardly new. She’s been highlighting what she says is declining care provided by the industry giant since shortly after it bought the holdings of then-nonprofit Mission Health, including Transylvania Regional Hospital, in 2019.
What was different Tuesday was the groundswell of support behind her.
She was backed by the U.S. Centers for Medicare and Medicaid Services (CMS), which sent a Feb. 1 letter to hospital CEO Chad Patrick informing him that state inspectors late last year found that Mission “was not in compliance with the Medicare Conditions of Participation and that the noncompliance posed immediate jeopardy to patients’ health and safety.”
Which in turn, the letter said, has jeopardized the hospital’s main source of revenue.
As first reported by The Asheville Watchdog investigative news site, unless the hospital corrects the dangerous conditions by Feb. 24, it will lose the right to collect payments from Medicaid and Medicare, the letter said.
Copelof was also joined at the Tuesday conference by nine other community leaders and medical professionals, including a retired oncologist, a current nurse at the hospital, Asheville Mayor Esther Manheimer and Buncombe County Commission Chair Brownie Newman.
While praising staff who continue to provide service at the hospital, the speakers pounded HCA’s performance and demanded it dramatically change operations that have placed corporate profits over patient care.
“I think we are building a really strong coalition,” Copelof said after the conference. “We are all on message and the message is, this (healthcare system) is seriously broken and it needs more than a Band-Aid fix. HCA needs to make significant, transformative changes.”
Watchdog reported on Jan. 11 that investigators from the state Department of Health and Human Services, acting on behalf of CMS, had identified nine instances of care deficient enough to immediately threaten patients’ health and safety.
The details of these cases are included in an inspection report that is not yet public, a CMS spokesman wrote to NewsBeat on Tuesday. But a letter to Mission from the DHHS did say “the hospital nursing staff failed to provide a safe environment for patients presenting to the emergency department (ED) by failing to accept patients on arrival, resulting in lack of or delays with triage, assessments, monitoring, and implementation of orders,” Watchdog reported.
Last week, the site published an internal email from HCA North Carolina Division President Greg Lowe confirming that CMS had made the “immediate jeopardy” determination official.
Mission spokeswoman Nancy Lindell wrote in an emailed statement that it will comply with CMS requirements and that it began addressing deficiencies after first learning of them.
“There are no excuses for our patients receiving anything other than exceptional care,” she wrote, “and Mission Health has already taken action based on the preliminary findings (of DHHS). We are pleased to hear from our EMS partners and patients that those actions are yielding positive results, including decreased wait times for care.”
Though the CMS findings cited no deficiencies at Transylvania Regional, HCA’s Asheville flagship is by far the most common destination for local residents in need of intensive, long-term care, according to statistics available on the CMS website.
Medicaid and Medicare patients from Brevard’s 28712 zip code spent 2,207 days at the Asheville hospital in 2022, the last year for which numbers are available, and received $30.2 million in care.
That compares with 1,179 days and $4.8 million in payments from the two programs at Transylvania Regional and 621 days and $6.8 million at Hendersonville’s Pardee Hospital, the statistics show.
Mission’s dominant market share was cited in the city of Brevard’s 2022 federal lawsuit claiming that the HCA holds a healthcare monopoly in the region, resulting in inflated prices and “dramatically worsened facility conditions and patient services.” (HCA’s lawyers filed documents in the case stating that the suit had shown no proof of illegal activity.)
North Carolina Attorney General Josh Stein, a candidate for governor, also sued the company in December, claiming that it has violated the terms of the Asset Purchase Agreement that required specified levels of continued service at Mission facilities.
The suit asked the “HCA to restore emergency and trauma services and oncology services to the level Mission Hospital provided before HCA took over,” according to a statement about the suit from Stein’s office.
“For-profit HCA has broken its promise to the people of western North Carolina and to my office. Quality health care is too important — in some cases, a matter of life and death,” Stein said at the time. “But HCA apparently cares more about its profits than its patients.”
The company pushed back, saying at the time that it was more than meeting the requirements of the agreement and pointedly referring to Stein’s political ambitions.
The Community Engagement Council of Transylvania County, a range of leaders formed to address conditions at HCA-owned facilities, had previously submitted a report to the company citing deficiencies of care at Transylvania Regional and Mission in a report based on the results of several public hearings.
A statement from the Council last week reiterated those earlier findings, noted Stein’s lawsuit and said the findings of “immediate jeopardy” were an indication that care provided by HCA had “reached absolute bottom.”
Or, maybe not, Kerri Wilson, a cardiac nurse at Mission Hospital who represents the National Nurses United union, said on Tuesday.
She traced the long decline in care and mass departures of nurses, doctors and other healthcare professions “because of the moral injury of HCA’s staffing levels.
“I can confirm that the (Emergency Room) has at times resembled a third-world ER,” she said.
But she also said staffing cuts have continued “even now, under the threat of a lawsuit from the state attorney general (and) facing the threat of the loss of Medicare reimbursement.”
Hospital leaders have “been informed that these changes are dangerous,” Wilson said, “yet they are continuing to gamble with patients’ lives to pursue maximum profits.”
Email: brevardnewsbeat@gmail.com
Editor’s Note: While acknowledging that concerns about care at HCA-owned facilities in Western North Carolina is perhaps the most region’s most crucial story, I cannot hope to provide the in-depth reporting provided by Andrew Jones, the Asheville Watchdog reporter covering the issue full time. He has produced a string of blockbuster stories on this situation. Please check out his work at the link above and consider donating to Watchdog.
Counterpoint. I have had, unfortunately, multiple surgeries at Mission in Asheville from 2018 to November 2023. My experience Mission (Asheville) is a far better run and maintained hospital today than it was before HCA. Unfortunately in March of 2018 I had to have a intradural spinal tumor removed requiring a multiday stay in the hospital. I then developed MRSA infection and had to have another emergency surgery causing a 5 day stay at the hospital. 1) I am forever damaged by the MRSA resulting in the destruction of my rhomboid's and trapezes. 2 ) we had to ask the nurses to clean m room and get clean linens. The surgeon's PA told us that they had been demanding an improved protocol for the surgical theatre. The place was disgusting and filthy. Fast forward to Oct 2022, where I had to have an ILR implanted and then a 2 wire pacemaker, followed up in Nov 2023 with a new 3 wire pacemaker. My experience in 2022 and 2023, with surgeries, scheduling, follow up, and administration have been excellent in fact I would say day vs night my previous experience.
So sad to see in what was once the pride and joy of the community 😢