North Carolina Attorney General Josh Stein has urged state officials to deny Asheville-based Mission Health's application to add 26 more beds in Buncombe County as pressure mounts for HCA Healthcare to give up control of the system.
"Any grant of a certificate of need should promote competition and advance the state medical facility plan's basic principles of safety, quality, access and value. Granting Mission's application would do neither," Mr. Stein wrote in a July 29 letter to the state department of health. "The large market share for acute care services that Mission already enjoys in western North Carolina makes it a poor candidate to promote competition in that region. And Mission is failing to provide safe, quality, accessible and affordable care in the region at its existing facilities."
Two other health systems — Altamonte Springs, Fla.-based AdventHealth and Winston-Salem, N.C.-based Novant Health — are also competing for a CON to expand in the region.
A spokesperson for Mission told Becker's the health system believes it can best meet the growing need for complex medical and surgical services in the region.
"The current utilization of Mission Hospital's services is very high, including services related to the ICU and adult medical and surgical beds. Currently, Mission Hospital accepts thousands of patient transfers from other hospitals across the region," according to a Mission statement. "These transfers reflect a need for the addition of higher acuity beds and services offered by Mission, which will meet the needs of patients in western North Carolina. Additionally, if approved, Mission believes that it can make these beds available on a more expedited timeline than other applicants."
Mr. Stein's letter comes after much criticism of Nashville, Tenn.-based HCA by physicians, nurses and state and local officials.
Reclaim Healthcare WNC, a coalition of physicians, nurses, elected officials and healthcare and community advocates, has launched a campaign to replace HCA with a nonprofit health system, hold HCA accountable for its alleged "harmful culture and practices" and "restore best-in-class healthcare" throughout Mission Health.
The Citizen Times on July 28 published an editorial by leaders of Reclaim who criticized several recent changes at HCA, including:
- The closure of two family medicine practices with only 45 days notice.
- The failure of HCA to maintain long-standing relationships with physician groups including oncology, neurology, ENT, surgical oncology, urology and hospitalists.
- The departure of more than 200 physicians and 600 nurses.
- A decline in the number of staff per occupied bed at Mission Hospital.
- Declining patient satisfaction ratings.
"We are giving voice to the people of this region who are disappointed and angry at the degradation in the quality of care being provided in the Mission system, and particularly at Mission Hospital," state Sen. Julie Mayfield, a founder of the coalition, said in a July 24 news release shared with Becker's. "We are also a voice for the physicians, nurses and staff who work at or with Mission who are not able to speak out due to the culture of fear and retaliation that HCA has created."
HCA also faces a lawsuit, filed in December by the North Carolina attorney general's office, which alleges the health system cut emergency and cancer care at Mission Health and lapsed on its 2019 purchase agreement in doing so.
HCA said it is confident that it continues to meet the obligations outlined in the APA after its $1.5 billion purchase of Mission and intends to defend the lawsuit in court.
"Though there have been challenges, some of which we are continuing to address as we work to expand our capacity, we remain committed to serving our community," Mission said in a statement after the complaint was filed. "Despite the state not allowing important expansions at Mission Hospital, we will continue to fight for critical access to healthcare services for the people of Western North Carolina. As the Attorney General acknowledged, this lawsuit is no reflection on the dedication of our doctors, nurses and colleagues who serve our patients every day. This lawsuit will not have any impact on our commitment to the community we are proud to serve."