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Mission Hospital issues forced paramedics to wait with patients at ER, county alleges

A sign outside Mission Hospital in Asheville.
Felicia Sonmez
A sign outside Mission Hospital in Asheville.

Lawyers for Buncombe County government want to sue the owner of Mission Hospital for $3 million, saying leaders "intentionally understaffed" the ER forcing delays in ambulance drop-offs and extra costs to taxpayers.

The county on Wednesday filed a motion to intervene in the lawsuit filed in December by North Carolina Attorney General and Democratic gubernatorial nominee Josh Stein. The case is being heard by the North Carolina Business Court.

Stein’s suit alleges HCA breached the terms of its 2019 agreement to purchase Mission Hospital by failing to provide quality emergency and oncology care. Separately, HCA has also faced scrutiny from federal health authorities; a recent report by the Centers for Medicare & Medicaid Services (CMS) detailed numerous safety issues that in some cases led to patient deaths.

In its filing Wednesday, the Buncombe County government argued that HCA “intentionally understaffed” Mission’s emergency room, forcing EMS paramedics to care for patients long after they arrived. That, in turn, meant that Buncombe County taxpayers were effectively subsidizing Mission Hospital, since EMS employees are paid in part by the county and were doing work that should have been done by Mission Hospital staff.

“For the past five years, Buncombe County has employed approximately 160 EMS paramedics to staff its EMS services, not counting firefighters who also serve as paramedics. All these employees transport patients to the Mission ER. … During some or all of the pertinent times, the County received no additional fees-for-service resulting from excessive wait times at the Mission ER but paid all such costs itself,” the county said in a court filing.

Buncombe County’s filing alleges HCA has “disregarded their statutory, contractual, and common-law obligations” and allowed emergency services at Mission Hospital to “deteriorate dramatically.”

Average wait times for patients to be transferred from EMS to Mission Hospital’s emergency room increased from 9 minutes and 41 seconds in early 2020 to 17 minutes and 41 seconds by late 2023, Buncombe County government said. Additionally, there was a sharp increase in “90th percentile times” – the measure of time in which 90% of EMS-to-ER patient transfers occur, according to the county. The figure increased from about 16 minutes to more than 32 minutes – exceeding the 20-minute standard set by national authorities.

Nancy Lindell, a spokeswoman for HCA Healthcare, said the company has received the Buncombe County motion and “will continue to defend the lawsuit vigorously.”

HCA previously filed a motion to dismiss Stein’s lawsuit, arguing there was no breach of contract because the hospital did not discontinue emergency or oncology services. In a counterclaim, HCA attorneys also said the health care giant never agreed to specific measures of performance in the purchase agreement.

HCA is facing mounting legal woes regarding the quality of care at Mission Hospital. In February, a judge ruled that a lawsuit filed in 2022 by the city of Brevard can go forward. In that lawsuit, the plaintiffs allege HCA engaged in a scheme to monopolize health care markets in the region, resulting in higher prices and a lower quality of care. Buncombe and Madison counties and the City of Asheville joined the lawsuit shortly after it was filed.

Late last year, Mission Hospital received an “immediate jeopardy” designation from federal authorities, the most serious warning a hospital can receive. CMS has approved several of HCA’s proposals to resolve problems at the hospital, and the designation has since been lifted. However, HCA could still lose its federal Medicare and Medicaid funding if it does not pass another inspection by a June 5 deadline.

Felicia Sonmez is a reporter covering growth and development for Blue Ridge Public Radio.