Doctors Practicing at Mission Reject Proposed Bylaws and Policies By a Single Vote

Written by Andrew R. Jones, Asheville Watchdog.

Proposed bylaws and policies that some doctors who practice at Mission Hospital feared would have muzzled them from criticizing the hospital or owner HCA Healthcare were recently voted down by a single vote.

According to an internal email signed by Mission Hospital Chief of Staff Ansley Miller and obtained by Asheville Watchdog, 403 of 871 active medical staff cast an electronic ballot in the vote: 201 voted “yes” and 202 voted “no.”


A handful of votes were ineligible.

The tally came after some doctors widely shared concerns that existing language and proposed changes to the bylaws and policies would prevent doctors from speaking out about systemic issues at Mission. The hospital was bought by HCA Healthcare in 2019 for $1.5 billion and has seen increasing criticism over its management and quality of care.

Options for next steps will be presented to the Medical Executive Committee for review on Dec. 1, according to Miller’s email.

“We are pleased with our physicians’ engagement in participating in this process and vote,” Mission Health spokesperson Nancy Lindell said. “With just a one-vote difference in the final tally, there will be no changes to our current bylaws at this time.”

“The hospital views the collaborative review and approval of bylaws as a confidential process and out of respect for the medical staff, will not comment further,” Lindell said.

Lindell did not respond to The Watchdog’s request for an interview with Miller.

The vote followed several emails sent to doctors by Martin Palmeri of Messino Cancer Centers, which has practice privileges at Mission.

“The current set of bylaws and policies contain both new and grandfathered in language that in my mind empowers the hospital to exert even greater control and oversight over the medical staff,” Palmeri said in one of several emails obtained by The Watchdog. “There is language in the bylaws and policies that is vague and is open to interpretation when it comes to what constitutes a code of conduct violation.”

Palmeri, president of the North Carolina Oncology Association, would not comment on the email, but spoke broadly about the implications of bylaw changes and their impact on medical communities across the U.S.

“I think doctors need to take a more active role in self-governance, and not leave it to these larger hospital systems to come up with their bylaws,” Palmeri said. “Bylaw changes are occurring nationwide. There’s a lot of things occurring as large conglomerates and organizations are taking over hospitals.”

Those conglomerates are affecting the self-governance of doctors within their hospitals, Palmeri said.

“I think that this is just an opportunity for medical staff to become engaged and to really understand what’s going on within their institutions and to know that doctors do have some power in terms of how these bylaws are constructed and the rules that govern them,” Palmeri said.

Palmeri’s email specifically referenced a part of the proposed bylaws which he feared contained language so vague it could lead the hospital to fire a doctor “for any reason.”

The section read:

“All Practitioners are subject to termination or modification of their medical staff Membership and/or Clinical Privileges by the Board of Trustees (BOT), based on factors deemed relevant by the Board of Trustees. Actions taken by the Board of Trustees are expected to substantially comply with the medical staff Governance Documents, subject to the Board of Trustee’s retained right to rescind and delegation of authority and with the understanding that strict compliance is not required.”

Another section in the proposed bylaws, obtained by The Watchdog, outlined rules around “inappropriate conduct” and said one example of such conduct is  “degrading, demeaning, or condescending comments regarding patients, families, nurses, Practitioners, Hospital personnel, the Hospital or any other health system or private practice. Professional and constructive feedback, however, is valued, and can be brought forward through Medical Staff Leadership, Administrative Leadership, or the Quality and Patient Safety department.”

Palmeri argued this language could be seen as muzzling doctors.

“What the hospital feels is demeaning or degrading can have a lot of latitude,” Palmeri said in his email. “Violation of these policies may not result in formal action against a doctor, but COULD result in an action. Again, doctors could feel threatened by this language.”

Allen Lalor, a retired emergency room doctor who joined nearly 130 physicians in signing a letter condemning HCA’s profit-driven management of Mission, said he took the Hippocratic Oath to protect patients, not the hospital. The proposed bylaws put the hospital first and the patients second, he said.

“I think that is morally wrong.”

North Carolina Attorney General Josh Stein has been investigating Mission and HCA since the beginning of the year, focusing primarily on emergency department and oncology issues. He recently issued an investigative demand, calling for 41 sets of documents from the hospital.

Two days before the vote on the bylaws, the North Carolina Department of Health and Human Services began an on-site inspection of Mission Hospital related to numerous nurse complaints about mismanagement in the emergency department and cancer care services.

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email [email protected]. To show your support for this vital public service please visit