For the second year running, HCA is potentially not in compliance with its 2019 purchase agreement for the Asheville-based Mission Health hospital system.
The repeated compliance issues raise questions about whether HCA is fulfilling its promise to maintain health care services for Western North Carolina residents.
HCA purchased Mission Health, the region’s largest hospital system, for $1.5 billion in 2019. In allowing the acquisition, the attorney general’s office placed key stipulations on the purchase, to which HCA agreed.
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Dogwood Health Trust, which is charged with monitoring HCA’s compliance with the purchase agreement, announced Tuesday that it intends to notify the health system of three instances of potential noncompliance:
- Diminished emergency/trauma and oncology services at Mission Hospital due to staff reductions
- Failure to remain in good standing with the Centers for Medicare and Medicaid Services
- Issues with uninsured and charity care policies
These are the same three instances Dogwood found last year when it found HCA potentially not in compliance. Two of these three issues are no longer active thanks to corrective action HCA took in 2024, according to Dogwood. The charity care policy was updated to explicitly prohibit patient liens, and the CMS standing issue was resolved when federal regulators lifted their Immediate Jeopardy findings in June 2024.
This leaves the continuation of emergency and oncology services as the last outstanding instance of potentially not being in compliance for HCA.
NC lawsuit over HCA compliance
HCA promised in 2019 that it would not stop emergency/trauma and cancer care at Mission Hospital. Current governor and former attorney general Josh Stein believes this promise was broken.
He sued HCA in 2023 for this alleged degradation of care, which he says leads to long wait and travel times and improper and unsafe care. Stein’s suit argues that reductions in staff in both these wings rendered care inadequate or unavailable.
That case remains pending in Buncombe County Superior Court, meaning the instance of potential noncompliance is still active.
Attorney General Jeff Jackson has 30 days to inform Dogwood about whether he agrees or disagrees with the trust’s findings. Jackson has made his position on Stein’s suit against HCA clear: he supports it.
“I know HCA was hopeful that a new attorney general would drop our office’s lawsuit,” Jackson said in a statement earlier this year. “I am the attorney general, and that’s not going to happen.
“HCA broke the promises it made to provide emergency and cancer care services to the people of Western North Carolina. We’ll keep fighting for this case as long as it takes to restore the health care HCA promised to provide and western North Carolinians deserve.”
By Aug. 28, either Dogwood or the attorney general must notify HCA of any area in which the company is not in compliance.
In addition, Dogwood is accusing HCA of “delayed production of documents and blanketed confidentiality constraints.”
However, Dogwood’s ability to hold HCA accountable is limited.
“Under the contract, our only remedy is what’s called ‘specific performance,’” Dogwood’s general counsel Rachel Ryan told Carolina Public Press. “In layman’s terms, that is basically saying that the person has to do what they said they were going to do under the contract. You can’t drag them into court and ask for a bunch of money or anything like that.”
Dogwood will host a webinar on Thursday, Aug. 7, from 12 p.m. to 1 p.m., to provide an opportunity for community members to learn more about the 2024 monitoring report.
But compliance with the purchase agreement isn’t the only legal arena where Mission’s dominance is being tested.
CON issue heading to Supreme Court
Mission Hospital is bringing its fight to prevent AdventHealth from building a competitive hospital to the North Carolina Supreme Court.
Because of North Carolina’s Certificate of Need laws, the state must award hospitals a certificate in order to offer more hospital beds. The state has continually awarded certificates to AdventHealth to fill a need for hospital beds in Buncombe County, but each time, HCA appeals this decision.
HCA is currently one of the largest providers of hospital care in the mountains, especially in the region’s largest county, Buncombe, and the multiple rural counties where HCA operates the only hospital or where no hospitals are located and HCA’s are the closest option. That near monopoly in the region appears to be one that the corporation would like to hold onto.
In June, the Court of Appeals ruled against HCA’s appeal of the state’s decision to grant AdventHealth 67 beds. On Friday, the state Supreme Court granted HCA’s request for a temporary stay on this decision. This will further delay AdventHealth’s project to build a 222-bed facility in Weaverville, a project on which they’ve already started construction.
The Supreme Court has no deadline to decide whether to hear the full case.
Editor’s note: This is a developing story and will be updated.
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