NC AG Stein considers 'civil investigative demand' against HCA/Mission's cancer care

ASHEVILLE - At Urban Orchard, a crowded South Slope cidery, North Carolina Attorney General and gubernatorial candidate Josh Stein kept his focus on the state during his Oct. 11 stump speech, rather than focusing on local issues, like the care Western North Carolina patients receive at Mission Hospital.

HCA Healthcare, a publicly traded for-profit company, bought Mission Hospital in 2019, a deal that Stein ultimately allowed to go through but had limited power to dictate.

Stein’s staff ran microphones to prospective voters once he finished speaking. The first question he received was about Mission Hospital.

“You mentioned health care,” a woman in the crowd said. “A big issue for those of us in Buncombe County and Henderson is the deterioration of services from the HCA takeover from Mission. What can you do to help us?”

Since February, Stein’s office has been trading letters with HCA’s North Carolina Division President Greg Lowe about the cancer services the hospital provides. In a June 20 letter Stein’s office chided Mission for employing a single medical oncologist.

The latest letter, sent by Lowe Oct. 4, revealed that the last staff medical oncologist working at the hospital, Michael Burke, would end his stint Nov. 26.

HCA spokesperson Nancy Lindell said that the hospital offers various cancer specialties including breast, colorectal and pediatric.

“We continue to recruit for and welcome new physicians and care providers to our team,” she added.

Stein’s office has questioned whether the condition of the hospital’s cancer services have violated the terms of its 2019 agreement to purchase the Mission Health system. As part of that agreement, Mission Hospital had to provide “inpatient and outpatient cancer services, radiation therapy, surgery, chemotherapy, and infusion services” for 10 years following the sale.

Despite the news of Burke’s departure, local physicians who have criticized Mission’s cancer services believe Stein’s focus is misaligned. It is also unclear whether Stein’s office will bring an enforcement action against the hospital, and what that action will be.

Many of the doctors who work at Messino Cancer Center, a local physician group, have provided medical oncology for the region for the past three decades, according to Martin Palmeri, who leads the group’s cancer treatment at Mission entities and is the president of the North Carolina Oncology Association.

Palmeri believes that Stein’s office should focus its inquiries on the services necessary to provide high quality cancer care.

“If the Department of Justice can see that it’s not a numbers game as much as it is the ancillary resources you need to safely and adequately deliver the right care, I think you would see that there is a deficiency there,” Palmeri said.

He pointed to low staffing levels among oncology department nurses and chemo-trained pharmacists, as examples.

Messino Cancer Centers decided to stop providing treatments at Mission Hospital for certain complicated cancers due to inadequate staffing. Patients will need to receive their treatments at facilities hours away.

Stein told the Citizen Times after the campaign event that the letters were a fact-finding effort.

“We want to know what has happened,” Stein said. “How many oncology doctors have left Mission, whether they’re still providing services, the ones that are there, what services are they providing of the various types of oncology so that we can make an assessment whether they’re in violation of the asset purchase agreement.”

Stein added that the action his office would take is a “full-fledged investigation.” He said that his office would issue a “civil investigative demand to get more information.”

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More: NC Attorney General reprimands HCA/Mission Health for providing inadequate cancer services

Nazneen Ahmed, a spokesperson for the Attorney General’s Office, explained in an Oct. 11 email that this would “require the person/organization to respond to investigative requests for documents and records. If they do not provide those, our office could take legal action. That’s one of the potential next steps we’re looking at, but nothing has happened yet.”

The state attorney general said his office is considering opening such an investigation.

According to the agreement to buy the hospital system, Dogwood Health Trust, the nonprofit formed to receive the proceeds of the Mission sale, is tasked with enforcing HCA's obligations to comply with the terms of the sale. Stein's office can enforce the agreement if Dogwood fails to correct a violation within 40 days of becoming aware of it. Dogwood becomes aware of these violations through an annual reporting process coordinated between HCA, Dogwood, Stein's office and an independent advisory firm that provides recommendations to Dogwood about compliance issues.

Dogwood Health Trust last took action to enforce the sale agreement in 2021, informing HCA that it violated the contract by closing an operating room at Highland-Cashiers Hospital without obtaining requisite consent. Stein's office agreed with Dogwood's decision in a letter.

In 2022 and 2023, Dogwood Health Trust did not report any compliance issues with the agreement.

Independent monitor meetings

The independent advisory firm tasked with reviewing whether HCA has adhered to the commitments it made as part of its agreement to buy the Mission Health system will be holding meetings for the public in the coming weeks.

Gibbins Advisors, a Nashville, Tennessee-based firm, provides recommendations to Dogwood Health Trust about compliance issues with the agreement.

Meeting times and places:

• Transylvania County (re: Transylvania Regional Hospital). Oct. 17 at 5:30 p.m. Thomas Concert Hall, Brevard Music Center, 349 Andante Lane, Brevard.

• Buncombe County (re: Mission Hospital, CarePartners and Mission Children’s Hospital). Oct. 19 at 5:30 p.m. The Scenic Hotel Cypress/Maple Room. 184 Hendersonville Road, Asheville.

• Macon County (re: Angel Medical Center). Nov. 1 at 5:30pm. Macon County Library Meeting Room. 149 Siler Farm Road, Franklin.

• Macon/Jackson County Meeting (re: Highlands-Cashiers Hospital). Nov. 2 at 5:30 p.m. Cashiers/Glenville Recreation Center. 355 Frank Allen Road, Cashiers.

• McDowell County Meeting (re: Mission Hospital McDowell). To be scheduled early 2024. Details yet to be announced.

• Mitchell County Meeting (re: Blue Ridge Regional Hospital). To be scheduled early 2024. Details yet to be announced.

Register at surveymonkey.com/r/2G3H6X7.

Mitchell Black covers Buncombe County and health care for the Citizen Times. Email him at mblack@citizentimes.com or follow him on Twitter @MitchABlack. Please help support local journalism with a subscription to the Citizen Times.

This article originally appeared on Asheville Citizen Times: NC AG Stein considers 'civil investigative demand' against HCA Mission