Mission Health at a critical crossroads

Mission Health at a critical crossroads

By Jane Winik Sartwell

Carolina Public Press

July could serve as an important turning point in the saga of HCA and Mission Health.

Affiliated Monitors’ series of public meetings concerning HCA’s hospitals across Western North Carolina wrapped up recently. The deadline for Dogwood Health Trust to deliver its opinion to the NC Attorney General’s office about whether HCA breached its Asset Purchase Agreement is fast approaching. 

Less than a week remains until the contract expiration date of Mission Health’s nurses.

Mission Health is a group of six hospitals and related medical facilities in Western North Carolina, the biggest of which is in Asheville. The other five hospitals are in small towns in nearby mountain counties. 

HCA, which stands for Hospital Corporation of America, bought Mission Health from its previous nonprofit owner in 2019 for $1.5 billion. The Tennessee-based for-profit corporation’s operation of the hospitals has garnered much criticism.

HCA’s acquisition of Mission Health resulted in the creation of the Dogwood Health Trust, to hold the $1.5 billion HCA paid to the nonprofit, for use in philanthropic endeavors in Western North Carolina. Dogwood was also tasked with hiring an independent monitoring company to assess whether HCA is abiding by the purchase terms it agreed to back in 2019. 

A new monitoring company, Affiliated Monitors, came on board earlier this year. The previous monitoring company, Gibbins Advisers, deemed HCA compliant each year, even as tensions between HCA and its employees, as well as the communities which it serves, rose to a boiling point.

Potential Mission nurses strike 

After their first rally in early June, the Asheville nurses’ union went back to the bargaining table with HCA. This session resulted in agreements on updated uniforms and expanded health care benefits for LGBTQ+ nurses, Elle Kruta, Mission Health nurse and member of the union’s bargaining team, told Carolina Public Press.

However, this agreement did not fully satisfy union members.

“The hospital is still refusing to budge on really any of the demands that nurses have to make our hospital safer,” Chris Letts, a Mission Health nurse who identifies as nonbinary and uses they/them pronouns, told CPP. 

The nurses’ union in Asheville, which is part of the nationwide organization National Nurses’ United, staged a second rally outside of Mission Health on June 19.

“We will keep working at the negotiating table even after the contract expires, but nurses are fired up and ready to use everything at our disposal, and that could include a strike if we need to,” Letts said after the second rally.

“We want to keep our patients as safe as possible, and our patients are unsafe now. So if we need to strike to make our patients safer, that is what we will do.”

If a plan to strike does materialize, the bargaining team will announce a strike authorization vote. If nurses vote in favor, the union must provide a 10-day notice to management before any work stoppage.

Letts works in the step-down floor of the hospital, where they provide intermediate intensive care for Asheville’s sick. 

The American Nurse Association’s proposed federal nurse-to-patient ratio on step-down floors is 1:3. “The hospital acknowledges (safe staffing ratios), but routinely walks all over them,” Letts said. “What we are demanding is for the hospital to face consequences when they short-staff units.”

“HCA listens to money, so we’re asking HCA to pay nurses extra when we are forced to take additional patients.”

In addition to safe-staffing protocols, nurses are demanding the hospital network address workplace violence in the new contract. 

Patients tend to physically lash out at nurses — by scratching, biting and punching — more often when they don’t get their needs met. These oversights, such as failure to provide pain medication on time, happen more often when nurses are dealing with many patients at once, Letts said. 

One way nurses are asking HCA to mitigate the risk of violence from their patients is to install metal detectors and require searching of patients’ belongings at check-in. 

“We have literally found loaded guns without safeties on patients who have been in the hospital for weeks,” Letts said.

“We would be disappointed in National Nurses United leadership if they made the decision to strike,” HCA spokesperson Nancy Lindell told CPP in an email.

“It is absolutely unnecessary, given the serious efforts we have invested in bargaining since mid-April. In addition to our current wage increase proposals, Mission gave a $20 million increase in annual wages outside of the current contract and above and beyond that agreement.

“However, if the NNU leadership does choose to strike, Mission Hospital will remain open.” 

The contract expires on July 2.

Monitor’s meetings with public

The day following the nurses’ rally, HCA’s new independent monitor, Affiliated Monitors, selected by Dogwood Health Trust to ensure HCA’s compliance with the purchase agreement laid out when HCA purchased Mission Health in 2019, wrapped up its first year of public meetings at the six hospitals in Mission Health’s network.

“I don’t even know if we’ve heard anything critical about a community hospital (at our meetings),” Gerald Coyne, managing director of Affiliated Monitors’ state monitoring services told CPP. “The people just really are very supportive of their community hospitals.”

The final meeting, which concerned Angel Medical Center in Franklin, took place at the Macon County Community Facilities Building. Out of the 12 people in attendance, only one shared a comment. 

This was Mike Messino, a retired medical oncologist and founder of Messino Cancer Centers in Asheville. 

Messino said Angel Medical Center provides emergency services, surgical services and acute medicine services. 

“Those are the three things that people are going to look for at Angel,” Messino said. “But where do you go when you have a cerebral hemorrhage or severe heart failure and you need an interventional cardiologist? 

“Most people used to just go right to Mission,” said Messino, referring to Mission Hospital in Asheville. “Now, the question is where would you go? Some of these services have diminished significantly.”

“Almost 240 physicians have left (Mission Health),” Messino said. “They leave because of dissatisfaction. Our neurosurgeons are down to only three neurosurgeons and only a couple neurologists …. We’re down to one urologist at Mission Hospital.” 

Messino is a member of a coalition of physicians, nurses, clergy members, politicians, and advocates, which state Sen. Julie Mayfield, D-Buncombe, told CPP she plans to launch in the coming weeks. Mayfield has publicly called on HCA to sell Mission Health back to a nonprofit organization.

But Mayfield is concerned that these public meetings will not result in change at the hospitals. 

“There is nothing new that is coming forward in these meetings,” she said. “They’ve heard every single one of these complaints before, starting with the first round of these meetings (under previous independent monitor) in February 2020. (HCA) has chosen to ignore them all.”

Attorney general’s lawsuit over Mission Health

Last year, North Carolina Attorney General and Democratic gubernatorial candidate Josh Stein sued HCA for the loss of quality cancer and emergency care at Mission Health, which would be considered a breach of HCA’s purchase agreement.

“The IM (independent monitor) will share their findings with Dogwood so that we are able to deliver a summary of our conclusions and findings to the NC Attorney General’s Office in late July,” Susan Mims, CEO of Dogwood Health Trust, told CPP in an email.

For HCA’s part, it is projecting optimism. “We look forward to working with the new independent monitor,” wrote Lindell. “And we are confident that we have been and will remain in compliance with the Asset Purchase Agreement.”
This article first appeared on Carolina Public Press and is republished here under a Creative Commons license.

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