North Carolina County Seeks Damages In HCA Mission Lawsuit

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Dive Brief:

• Buncombe County, North Carolina wants to sue HCA Healthcare for $3 million, alleging the for-profit intentionally understaffed the emergency department of its Asheville, North Carolina-based Mission Hospital, which led to increased wait times and higher costs for taxpayers. 
• The county alleges wait times to transfer patients from paramedics to the emergency department at Mission became “excessive” after HCA acquired the hospital in 2019. Times rose from an average of 9:41 minutes in 2020 to 17:41 minutes by the third quarter of 2023, according to the county.
• The county is seeking to join the North Carolina attorney general’s lawsuit against HCA. The lawsuit, filed in December, alleges the health system “significantly degraded” the quality of care at Mission after HCA acquired the Mission Health system.

Dive Insight:

At the heart of the lawsuit is a deal HCA struck with North Carolina attorney general Josh Stein in 2019. In exchange for Stein approving HCA’s $1.5 billion acquisition of Mission Health — a five-hospital, nonprofit health system, serving Western North Carolina — HCA promised to preserve care quality.

Specifically, HCA promised to provide comprehensive rural health services at Mission hospitals for 10 years and keep all facilities open through 2029. 

However, in December, Stein filed a lawsuit alleging HCA had reneged on that promise. The for-profit’s lack of investment in Mission Hospital, the system’s flagship facility, was akin to shuttering services, according to the lawsuit.

The attorney general alleged HCA severely reduced emergency room and oncology services, resulting in lengthy wait times and bed shortages. In some cases, patients were treated in view of other patients. In others, staffing shortages led to patients being found “dead in emergency department beds many hours after they passed,” the lawsuit said.

Now, Buncombe is seeking to join the lawsuit, arguing that long wait times at Mission Hospital drive up costs for the county.

In a proposed intervenor complaint filed on last week, Buncombe said HCA intentionally “understaffed” Mission, forcing EMS paramedics to stay with and care for patients longer than they normally would. Because taxpayers pay for a portion of the county’s paramedic services, Buncombe argues taxpayers foot the bill for care that ought to be performed by hospital employees.

This lawsuit is the latest in a series of critiques centering on HCA’s ownership of Mission. 

In February 2020, AG Josh Stein began investigating HCA’s charity care policies and quality standards. In a letter to the hospital operator, Stein said Mission’s quality had declined from prior to the acquisition. 

Also in 2020, 1,800 nurses at Mission voted to unionize, following clashes with management over staffing levels. The unionized nurses alleged that staffing and quality had deteriorated following the HCA buyout.

The for-profit is facing another lawsuit in Brevard, North Carolina. The city sued HCA in 2022, alleging the operator tried to monopolize healthcare in the region, driving up prices and lowering the quality of care. HCA filed a motion to dismiss the lawsuit, but a judge in February ruled the suit could continue.