This is a developing story and will be updated.
HCA Healthcare defended its business practices Tuesday, arguing in a new legal filing that North Carolina Attorney General Josh Stein’s allegations of a breach of contract should be dismissed.
“The Hospital Service Commitments are clear and unambiguous and HCA satisfies them,” HCA’s attorneys said in a response filed with the North Carolina Business Court.
The filing asked the court to dismiss the claim because the hospital did not discontinue emergency or oncology services.
“At bottom, though, this legal dispute is about a contract and whether it has been breached,” they said. “The Hospital Service Commitments are simple and clear: they require that HCA continue certain service lines that existed in January 2019. HCA has absolutely done so.”
The response detailed the ways Mission officials claim they have complied with the requirements of the sale to HCA.
“Although Mission cannot control all variables, such as when staff unexpectedly call out from scheduled shifts, Mission strives to minimize wait times in its emergency department, recognizing that wait times for individual patients reflect unique factual circumstances at the time care is sought, including patient volume, the acuity of all patients in need of care, and regulatory constraints on inpatient capacity.”
HCA’s lawyers argued that the company “has continuously demonstrated its commitment to meeting its contractual obligations, delivering high-quality care, state-of-the-art facilities, and advanced clinical services in western North Carolina.”
In a statement, HCA spokeswoman Nancy Lindell said the legal filings "speak for themselves."
"Unfortunately, the lawsuit continues to be a distraction from the important work that Mission continues to do in Western North Carolina," she said.
Stein, who is running for governor as a Democrat, sued the for-profit hospital giant in December. He alleged that HCA had violated the terms of its 2019 purchase of Mission Health System by failing to provide quality emergency and oncology care at its facilities.
Nazneen Ahmed, a spokeswoman for Stein, told BPR that the attorney general’s office is “confident the court will see through HCA’s attempt to evade responsibility for western North Carolina patients.”
As part of its $1.5 billion purchase of Asheville-based Mission Health System, HCA pledged not to discontinue a wide range of services for the decade following the sale. It also agreed not to close any of its facilities before 2029 unless a local advisory board and independent monitor agree.
In the counterclaim, HCA attorneys said the health care giant never agreed to specific measures of performance in the purchase agreement.
“Although the Seller sought to include specific requirements by which to measure HCA’s performance of the Hospital Service Commitments, HCA declined,” the filing said.
The transaction also led to the creation of an independent foundation, Dogwood Health Trust, to manage the proceeds from the sale since it involved the purchase of a nonprofit by a for-profit company.
Growing criticism
In the years since the sale, HCA has faced mounting criticism of the quality of patient care at its facilities, with dozens of current and former physicians at Mission Hospital signing onto a letter last year accusing HCA of having “gutted the heart and soul of our community health care system.”
The public outrage has intensified in recent weeks after federal authorities notified Mission Hospital that conditions at the facility place patient safety in “immediate jeopardy,” the most serious warning a hospital can receive from the Centers for Medicare & Medicaid Services.
At an Asheville press conference last week, elected officials publicly called on HCA to prioritize patient safety or sell Mission Health System to a nonprofit entity.
"If HCA is unable or unwilling to put the health and safety of our people first, then it's time to find a company that will,” state Sen. Julie Mayfield (D) said at the event.
HCA submitted a plan of correction to the authorities last week. If the problems identified by the federal investigators are not resolved by Feb. 24, Mission could lose its Medicare and Medicaid funding.
In defending its business practices, HCA has previously cited positive reports from an independent monitor established in 2019 to oversee its compliance with the terms of the purchase agreement.
Dogwood Health Trust, which hires the independent monitor, recently announced that it is seeking to expand the role to now include engaging with the attorney general’s office and conducting increased community engagement activities.
Gibbins Advisors, the firm that has filled the independent monitor role for the past several years, initially said it was planning to apply for the newly-expanded role before changing course last week, as first reported by the Asheville Watchdog.
In a statement to BPR Tuesday, Ron Winters of Gibbins Advisors said the firm will continue with its remaining work until a new independent monitor is chosen.
“While we were encouraged by Dogwood's board and management to participate in the RFP process, after careful consideration we decided it is a good time to pass the baton to someone new,” Winters said. “We love this community and hope to continue the many good friendships with community members and leaders we made during our time as Independent Monitor.”
