HCA chased Mission doctors away and made a ‘debacle’ of emergency department, draft academic report says
By Andrew R. Jones
Asheville Watchdog
A new working draft study out of Wake Forest University is the most comprehensive analysis of the personnel crisis at Mission Hospital to date, using hundreds of interviews, documents and media reports to tell the story of a mass exodus of doctors, a poor working environment for nurses and a dangerous situation for patients, all brought on by profit-centered management.
The 49-page report, titled “Changes in Patient Care Following HCA’s Purchase of Mission Hospital,” and its accompanying 30-page appendix of sources comprise the first academic summary of Mission’s staffing tumult since HCA Healthcare bought the Mission Health system for $1.5 billion in 2019.
It consolidates years of public information, including Asheville Watchdog’s reporting, and new interviews with dozens of unidentified individuals who work at Mission, who have previously worked there or who have inside knowledge about how the hospital is run.
The report, written by professor Mark Hall, an independent academic researcher and a member of the National Academy of Medicine, reaches three conclusions about what happened after HCA’’s purchase:
Doctors left Mission because of quality-of-care and financial issues and have been replaced by less experienced staff. Today some specialties are severely depleted or gone, including otolaryngology (ear, nose, and throat), urology, rheumatology, orthopedics and neurology, according to the report.
HCA’s management slashed staffing among nurses and other personnel vital to patient care.
Understaffing has caused “a multi-faceted debacle” in Mission’s emergency department, one that in 2024 drew federal scrutiny, which threatened the hospital’s Medicare and Medicaid funding.
Mark Hall is a member of the National Academy of Medicine and the author or editor of 20 books. // Photo credit: Wake Forest University
“I think one question I would have as a member of the community is to what extent HCA and the hospital administration is willing to own up to this accumulation of very troubling indicators,” Hall said. “The extent and the longevity of these troubling signs I think is revealed by accumulating all this information in one place.”
Mission Health spokesperson Katie Czerwinski criticized the report, saying, “This is yet another ‘study’ written by the same academic who is taking money from an out-of-state advocacy group that is currently funding litigation against Mission Health.
“It is neither serious nor impartial, and is filled with recycled news and opinion. The regulatory concerns to which it refers have been addressed and formally cleared. Once again, the author disregards that third-party independent organizations continue to rate Mission’s clinical care as best in the nation. The author unnecessarily spreads fear in the community and should stop doing so.”
Hall’s report relies on nearly 50 “key informants,” including clinicians, people management or on the board at Mission Hospital at some point, government officials and others who work in health care policy.
Comments from these sources are often scathing. One physician said hospital administration “was seemingly incapable of addressing physician concerns …. Physicians were routinely left out of any of the decision-making processes. Although physicians were given titles of medical director, service line leaders, and committee chairs, they were frankly powerless and often ignored/sidelined in the decision-making process.”
Another — Dr. Bruce Kelly — is quoted from an Asheville Citizen Times opinion column saying, “[t]here’s a deep sense of loss so many of us feel since HCA has taken over. Their corporate-driven changes are not only antithetical to our way of being, they dismantled what we’d worked so hard for. They’ve erased our institutional memory. … HCA brought with them a culture that has undermined trust, alienated many and harmed the collaboration and collegiality that’s defined who we’ve been.”
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According to a 2022 Watchdog investigation, more than 200 doctors had fled Mission as of early that year. Many more have since left or are in the process of leaving.
The report also focuses on understaffing of nurses and other employees who care for patients and the effect on morale and quality of care. Not only has HCA chosen to reduce some patient care staff, it also has struggled to hire and refused to offer more competitive pay. Nurses in forums online have urged others in the field to avoid Mission, as recounted in the report.
This has led to poor patient care, delayed procedures and more risk for patients, especially in the emergency department, according to the report. A large portion of the report details what it calls a “debacle” in the emergency department, one that could have been avoided.
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“In any event, this ER debacle did not occur due to HCA Mission’s lack of awareness or inadvertent neglect,” the report stated. “Instead, several key clinicians said they repeatedly raised these various problems with hospital leaders and recommended improvements.”
In early 2024, the U.S. Centers for Medicare & Medicaid Services (CMS) placed Mission in immediate jeopardy, the harshest sanction a hospital can face. A CMS report in February found breaches of federal standards of care, mainly in the emergency department, led to the deaths of four patients and the endangerment of dozens of others.
Though HCA and Mission management, along with some doctors, have pushed back on the narrative that HCA has failed the region, the report emphasizes that there were always red flags.
“[E]ven granting that views in the current medical community are somewhat divided, it should be a clear red flag that a few hundred well-respected physicians in the community openly say there are serious problems at HCA Mission,” the report stated. “Not all canaries need to choke before realizing that the mine shaft isn’t safe.”
Hall, the author or editor of 20 books, has published several draft research papers on Mission Health after HCA’s purchase, all of which are available at the Wake Forest University Law website.
He recently wrote other draft reports that said HCA significantly decreased charity care for lower-income Mission patients since its purchase of the hospital and that examined the discrepancy between Leapfrog and Healthgrades quality ratings at the hospital and the recent finding of immediate jeopardy. Another preliminary study published in late April showed how, while Mission’s profits soared in 2021, it was also making serious cutbacks in bedside nursing staff.
Hall’s work is funded through an Arnold Ventures grant to Wake Forest.
Arnold Ventures is a philanthropic group headquartered in Houston “working to improve the lives of all Americans by pursuing evidence-based solutions to our nation’s most pressing problems,” according to its website. “We fund research to better understand the root causes of broken systems that limit opportunity and create injustice.”
Arnold Ventures is helping fund Fairmark Partners — a group pursuing antitrust lawsuits against “hospital behemoths in Wisconsin, Connecticut, and North Carolina,” according to the group’s website. Fairmark attorneys are representing plaintiffs in a western North Carolina antitrust lawsuit against HCA and Mission Hospital.
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 [email protected]. The Watchdog’s 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/.
The post HCA chased Mission doctors away and made a ‘debacle’ of emergency department, draft academic report says appeared first on North Carolina Health News.
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