Dive Brief:
- North Carolina Attorney General Josh Stein is suing HCA Healthcare over allegations that the for-profit operator downgraded services at Mission Health’s flagship hospital after acquiring the five-hospital system in 2019.
- The suit filed Thursday alleges that HCA “significantly degraded” emergency department and oncology services at Mission Hospital post-acquisition — violating HCA’s purchase agreement not to close service lines at Mission facilities for at least ten years following the deal’s close.
- A spokesperson for HCA said the health system intends to “defend the lawsuit vigorously” and that HCA has met or exceeded the terms of its purchase agreement.
Dive Insight:
Thursday’s lawsuit comes after the North Carolina Department of Justice received more than 500 complaints about care at HCA facilities across the state, according to a statement from Stein’s office.
In late October, Stein’s office issued formal notice of his intent to sue barring compliance with the 2019 purchase agreement. Stein sent the notice to Dogwood Health Trust, the nonprofit tasked with overseeing proceeds of the $1.5 billion 2019 sale and ensuring compliance with the purchase agreement.
The notice triggered a 40-day clock for HCA to remedy the complaints of reduced access to medical services.
HCA’s legal team hit back in November, denying allegations of wrongdoing. In a letter to North Carolina regulators, HCA said its more than $12.4 million in capital investments allocated to the Mission Cancer Center since 2019 proves its dedication to oncology services.
“As the [attorney general’s office] is aware, the [asset purchase agreement] requires that the Independent Monitor annually confirm that Mission is operating in compliance with its terms, and the Independent Monitor has done so every single year since 2019,” the law firm representing HCA wrote in the letter dated Nov. 7.
Still, Stein filed the lawsuit, citing evidence from doctors, nurses and ambulatory service providers that conditions at Mission Health’s flagship facility have deteriorated since the acquisition.
The complaint, which was filed in North Carolina’s Buncombe County Superior Court, spans nearly 60 pages. It alleges severe shortcomings at the Western North Carolina facility, ranging from lengthy wait times, to bed shortages, to patients being treated in public areas within view of other patients.
In the most extreme instances, "patients have been found dead in emergency department beds many hours after they passed,” the lawsuit said.
The lawsuit also accuses HCA of under-staffing Mission’s emergency department. At times, one emergency department nurse was responsible for overseeing 28 patients, the complaint alleges.
“Responsibility for this downward spiral rests entirely with HCA,” the lawsuit states.
The complaint asks the court to declare HCA in breach of its agreement and to issue a permanent injunction restraining the system from committing additional breaches in the future.
Stein also called for HCA to return emergency, trauma and oncology services at Mission to the hospital's previous levels of quality.
The union representing Mission nurses applauded the lawsuit, telling Healthcare Dive over email that they had filed hundreds of complaints with HCA and with state and federal regulators documenting unsafe staffing and unsafe working conditions affecting patient care since the acquisition.
In a statement released Thursday, HCA once again stressed that an independent monitor hired by Dogwood Health Trust confirmed the operator’s compliance with its purchase agreement in its most recent review.
That review occurred in 2022.
