NC Attorney General Sues HCA After Quality of Care Complaints

North Carolina Attorney General Josh Stein is suing HCA Healthcare for failing to comply with an asset purchase agreement it executed when it purchased Mission Health System in 2019. The case alleges HCA has not provided consistent, quality emergency and cancer care for western North Carolinians.

HCA is one of the largest operators of healthcare facilities in the US, with 183 hospitals and approximately 2,300 sites of care in 20 states and the United Kingdom. In 2019, the company bought Mission, a six-hospital system in Asheville and western North Carolina at the time. Mission’s former president and CEO said the $1.5 billion sale “provided for the long-term sustainability of high-quality healthcare and secured special protections for our rural communities.”

That never quite materialized for certain service lines, according to the complaint from Attorney General 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. But HCA apparently cares more about its profits than its patients,” Attorney General Stein said in a statement.

Physicians, nurses, and other clinicians at Mission HCA “have worn themselves to the bone trying to care for patients without the necessary resources or support,” he continued.

“They deserve our gratitude, but they and their patients also deserve better. I’m taking HCA to court to make sure it lives up to the agreement it made when it bought non-profit Mission in 2019. That’s what the people of western North Carolina deserve,” Attorney General Stein stated.

North Carolina law required the attorney general’s office to conduct a limited review of the purchase of non-profit Mission because HCA operates as a for-profit company. Attorney General Stein raised concerns earlier that the transaction could potentially impact care delivery in the region, so he negotiated some healthcare protections in the asset purchase agreement, including that HCA would not discontinue certain service lines through 2029. Some of those service lines included oncology and emergency and trauma consistent with Mission’s role as a level II trauma program.

HCA allegedly violated the asset purchase agreement by discontinuing certain emergency and oncology services, including level II trauma-center-level services.

Attorney General Stein also accused HCA of regularly exceeding patient-to-nurse ratios in the emergency department and ICU. Staffing issues have also contributed to long wait times for emergency care and laboratory services, the complaint stated.

Additionally, the complaint said that Mission no longer has medical oncologists compared to five employed in 2021. Without oncologists, Mission has had to cancel 45 appointments in the first half of 2023, the same number the health system canceled in all of 2020, Attorney General Stein explained.

The attorney general’s office received several complaints earlier this year from cancer patients at Mission, raising concerns about the quality and consistency of cancer care services at the health system and in western North Carolina.

Attorney General Stein said concerns increased later this year when Messino Cancer Group announced it would no longer provide treatment at Mission Hospital because HCA failed to provide adequate staff and resources.

The office said it had received more than 500 complaints about HCA.

Attorney General Stein is calling on the court system to order restoration of emergency and trauma services, as well as oncology services, to the level Mission Hospital provided before HCA purchased the facility.

An attorney representing HCA said in a six-page letter obtained by “Asheville Watchdog” for Mountain Xpress that the company did not breach the asset purchase agreement and the attorney general’s investigative demand is “a bald attempt to obtain prelitigation discovery.”