For-profit means not for you
Please indulge this local story. It’s not as local as it first seems.
Ever since for-profit HCA Healthcare Inc. bought our local nonprofit hospital system in 2019, patient and staff complaints about understaffing have soared. Hundreds of veteran doctors and nurses have resigned. N.C. Attorney General Josh Stein, Democratic candidate for governor in 2024, has faced repeated questions from locals for approving the deal. Stein had limited authority to halt the $1.5 billion sale, his office says, so long as legal I’s were dotted and T’s were crossed. Stein, however, negotiated additional concessions in the purchase agreement and has has since sued HCA for failing to live up to its standards for patient care.
Asheville Watchdog, an online investigative site staffed by “retired” local reporters (some, Pulitzer winners), has leaned into the story:
Mission Hospital risks losing Medicare and Medicaid funding because of deficiencies in care that were so severe, state inspectors concluded last month, that they “posed immediate jeopardy to patients’ health and safety,” Asheville Watchdog has learned.
“Immediate jeopardy” is the most serious deficiency possible for a hospital. The North Carolina Department of Health and Human Services has recommended that Mission lose its participation in Medicare unless it quickly corrects the deficiencies, according to a letter obtained Thursday by The Watchdog.Failure to correct the deficiencies could threaten the financial viability of the hospital system. The majority of patients in Western North Carolina are on Medicare, Medicaid or uninsured.
Locals warned this would happen. A longtime friend has sued Mission over his wife’s inadequate care during their son’s birth (Sep 26, 2022):
In an attempt to seek justice for “egregious acts of medical and corporate negligence,” Canton’s first family‚ Mayor Zeb Smathers, his wife, Ashley, and son, Stone, are taking on the most powerful healthcare system in America.
In the medical negligence and medical malpractice court action filed Sept. 23 in Buncombe County, the Smathers family is demanding a jury trial in the case against HCA Healthcare Inc, its corporate structures and Mission Hospital. The family is represented by the Raleigh law firm Zaytoun Ballew & Taylor, PLLC.
The lawsuit details a grisly account of how a joyous couple expecting their first child entered Mission Hospital at 6:10 p.m. March 19, 2020. Baby Stone wasn’t born until 3:54 a.m. March 21.
By that time, Ashley Smathers was “on the brink of death,” and baby Stone had experienced permanent hypoxic brain damage, the lawsuit states.
These are friends. I was horrified.
Here’s a more recent headline: Lawsuit: Mission Hospital negligent post-op care led to patient death. The patient was admitted for what Columbia University Medical Center considers a low-risk spinal procedure.
The Watchdog continues:
The Dec. 19 letter from NCDHHS to Mission CEO Chad Patrick cites nine incidents over 19 months that highlighted deficiencies in care and states that “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, including labs and telemetry.
“ED nursing staff failed to assess, monitor and evaluate patients to identify and respond to changes in patient conditions,” the letter states. “The hospital staff failed to ensure qualified staff were available to provide care and treatment for patients who arrived in the ED. The cumulative effects of these practices resulted in an unsafe environment for ED patients.”
Mission Hospital and HCA spokesperson Nancy Lindell did not immediately respond to requests for comment.
The Centers for Medicare & Medicaid Services’ regulations define immediate jeopardy as noncompliance that “has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death…[It] is the most serious deficiency type, and carries the most serious sanctions…An immediate jeopardy situation is one that is clearly identifiable due to the severity of its harm or likelihood for serious harm and the immediate need for it to be corrected to avoid further or future serious harm.”
The clousure of rural hospitals, especially in states that reject ACA Medicaid expansion, has received lots of attention. Corporate consolidation of remaing hospital systems has received less.
NCDHHS investigators visited the hospital over three weeks in November and December in response to complaints, the letter states. The investigation “resulted in an Immediate Jeopardy identification on December 1,” as a result of seven incidents from April 2022 to October 2023.
The investigation identified immediate jeopardy again on Dec. 9 as a result of two incidents in November, including one that occurred the week inspectors were at the hospital.
The details of the nine incidents are not yet public. CMS is reviewing the state inspectors’ findings and will issue a “statement of deficiencies.” At that point, Mission has 23 days to respond.
Union nurses at Mission and doctors who have left the system after HCA purchased it in 2019 say that the hospital corporation has purposefully understaffed the hospital and gutted it of resources, leading to risks and patient harm.
Mission nurses have sent formal complaints to NCDHHS since 2022, The Watchdog reported in late August. At that time, NCDHHS had not visited the hospital, citing its own staff shortages.
Over the border in Tennessee, angry residents are still protesting a hospital merger that gave Ballard Health a monopoly in that part of Appalachia. This story is from September:
Five years ago, rival hospital companies in this blue-collar corner of Appalachia made a deal. If state lawmakers let them merge, leaving no competitors, the hospitals promised not to gouge prices or cut corners. They agreed to dozens of quality-of-care conditions, spelled out with benchmarks, and to provide hundreds of millions of dollars in charity care to patients in need.
Today, Ballad Health’s 20 hospitals remain the only option for hospital care for most of about 1.1 million residents in a 29-county region at the nexus of Tennessee, Virginia, Kentucky, and North Carolina. But Ballad has not met many of the quality benchmarks nor provided much of the charity, spurring discontent among those with no choice but to rely on Ballad for their care.
Two dozen states, from Florida to Washington, have at some point passed so-called COPA laws that allow hospital systems to merge into monopolies, disregarding warnings from the Federal Trade Commission that such mergers can become difficult to control and may decrease the overall quality of care. In the case of Ballad, the nation’s largest-known COPA deal, public records suggest that is exactly what happened.
Rural organizer and activist Dani Cook has been a thorn in Ballard’s corporate backside over the merger. Ballard blocked her last summer on Formerly Twitter.
This is for-profit medicine under hospital monopolies. Caveat emptor.