HCA Healthcare, the corporate owner of Mission Hospital, maintains it honored its asset purchase agreement (APA) in 2024, the same year the federal government placed the facility in immediate jeopardy because of deficiencies in care in its emergency and oncology departments.

HCA’s report, submitted to the independent monitor of Mission’s sale and obtained by Asheville Watchdog, makes no mention of the federal sanction, the toughest a hospital can face.

The APA, created in 2019 at the time of HCA’s purchase of the Mission Health system, binds HCA to several commitments regarding how it would maintain and expand services throughout the hospital system. HCA is required to submit a report on its compliance each year to Dogwood Health Trust and the independent monitor it employs to ensure HCA is staying in compliance with the APA.

One of those commitments was that the hospital would “remain enrolled and in good standing” with the U.S. Centers for Medicare & Medicaid Services.

“During the Reporting Period, the Material Facilities and the Local Hospital Facilities remained enrolled and in good standing in the Medicare and Medicaid programs,” HCA said in its 2024 report.

But the report did not acknowledge that on Feb. 1, 2024, Mission announced it had been placed into immediate jeopardy after state and federal investigators found 18 incidents in 2023 of patient harm, including four deaths. 

A finding of immediate jeopardy places a healthcare facility’s Medicare and Medicaid funding in jeopardy. HCA and Mission were given 23 days to issue a plan of correction. CMS lifted the sanction after reviewing the plan less than a month later.

HCA and Mission Health spokesperson Nancy Lindell did not respond directly to questions about why the immediate jeopardy finding wasn’t included in the report.

“This is covered in the report you have,” she said. 

This isn’t the first time HCA has given itself sterling marks despite controversies surrounding Mission. 

In its 2023 self-report, HCA maintained that it had honored all commitments in the APA, despite then-North Carolina Attorney General Josh Stein suing HCA and Mission. Stein’s litigation alleged HCA has mismanaged Mission, endangering patients and prompting an exodus of doctors and nurses, and has shuttered or reduced some services, which he says violate the APA. 

HCA countered that it never promised to deliver quality care, arguing that APA commitments “are not promises to meet subjective healthcare standards.”

Last year’s finding of potential non-compliance

Affiliated Monitors, Inc., the independent monitor responsible for assessing HCA’s compliance with the APA, disagreed with the company’s previous self-assessment. In 2024, AMI published a report that found HCA in potential non-compliance for several issues, including the immediate jeopardy finding.

Addressing HCA’s 2024 self-report, AMI Managing Director Gerald Coyne said the company made “a similar claim … in last year’s report (2023), which we analyzed in light of the initial immediate jeopardy findings brought against the company late in 2023.” 

“Our analysis concluded that although the company did, in fact, remain enrolled in Medicare and Medicaid, it did not remain ‘in good standing,’ Coyne said. “That determination was cited as one of the grounds that we concluded that HCA was in potential non-compliance with the Asset Purchase Agreement.”

“This issue was discussed in our recent community meetings in Marion and Asheville. Our review of activities in the calendar year of 2024 is ongoing, but the analysis of this issue we used last year is consistent.”

In a community meeting in Asheville earlier this month, Coyne said that his group is paying attention to quality-of-care issues at Mission. 

AMI is employed by Dogwood, the independent entity created from the proceeds of the Mission sale and responsible for improving health care, education and economic opportunity in western North Carolina. Dogwood also is responsible for holding HCA accountable by reviewing the independent monitor’s recommendations and deciding if the hospital is out of compliance.

“Dogwood wants to honor and follow the established monitoring process, allowing the Independent Monitor to finish its active review of HCA’s annual report,” a spokesperson said when asked about the apparent gap in HCA’s report. “As our advisor, the Independent Monitor will complete their review and submit a report to Dogwood for our review. From there, we will be able to share our findings with the Attorney General and any statements with the public as we have in the past, typically by the end of July.”

HCA has touted its ownership of Mission since Tropical Storm Helene and highlighted the hospital’s response to the disaster.

The company, whose revenue is up $1 billion from the previous fiscal year, showed multiple images of Mission Health staff serving during Tropical Storm Helene response efforts in its annual nationwide impact report. One photo shows Melina Arrowood, COO at Sweeten Creek Mental Health and Wellness Center, hugging HCA CEO Sam Hazen.

HCA was broadly praised for its response to the storm’s impact and aftermath. It provided water, food, gas, volunteer health care workers and other resources badly needed to help weather the hardships brought on by the disaster.

Despite this triumph, Mission still faced physician departures, frustrations from nurses whose pay was cut, the shuttering of the only long-term acute care facility in the region — which was permitted by the APA — and ongoing outcry over a lack of staff.

In February, a patient died in an emergency department bathroom after his call for assistance went unanswered for  several minutes.

Surveyors from the North Carolina Department of Health and Human Services returned to Mission Hospital last week, investigating nurse complaints about staffing and at least one patient death.

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Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email arjones@avlwatchdog.org. The Watchdog’s local reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.

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