Written by Andrew R. Jones, Asheville Watchdog.
The North Carolina Department of Health and Human Services is conducting an on-site inspection of Mission Hospital this week following complaints about policies, staffing levels, and quality of care filed by nurses over the past two years.
The inspection begins as Mission and HCA Healthcare are facing an investigation from the office of Attorney General Josh Stein, who is running as a Democrat for governor, and growing public criticism from local physicians who say HCA’s for-profit model has “gutted” the hospital since it purchased it in 2019.
“(W)e are currently on-site at Mission Hospital,” DHHS spokesperson Hannah Jones told Asheville Watchdog on Tuesday afternoon. At least some of the inspectors are from the DHHS’ Division of Health Service Regulation, which monitors North Carolina health care facilities to ensure they are adhering to minimum standards of care. “We cannot comment on ongoing DHSR surveys.”
Mission spokesperson Nancy Lindell characterized the visit as routine.
“Surveys from agencies that govern hospital quality and safety occur regularly and are welcome at Mission Hospital as they offer our community continued confidence in the care we provide,” Lindell said. “As always, we are working together with those surveyors to get them the information they request.”
Despite nurses sending multiple complaints to DHHS in 2022 and 2023, no one from the agency had visited the hospital as of August, The Watchdog previously reported. DHHS spokespeople had cited staffing shortages for the agency’s year-long delay of inquiry into the nurses’ concerns.
The Watchdog asked Lindell when the last such DHHS visit happened, what questions inspectors were asking, whether they contacted the hospital before they arrived, how many of them were there and how long the inspection would take. She did not provide answers.
Mission vascular access nurse Mark Klein, who has filed nurse complaints to DHHS since last year, told The Watchdog, “I have spoken with a NCDHHS Nurse Consultant and … multiple NCDHHS personnel are here to investigate the complaints filed by the nurses union’s Professional Practice Committee about quality of care issues at HCA.”
Klein has worked at Mission since 1999 and is a member of the Professional Practice Committee (PPC), a group of unionized nurses at Mission designated to raise nursing concerns with hospital leadership.
The PPC sent complaints in 2022 and 2023 to the DHHS regarding emergency department handoff procedures, issues detailed in an August investigation by Asheville Watchdog, which obtained copies of those complaints.
The complaints focused on a lack of regulation around procedures to hand off patients from the emergency room to other areas of the hospital. Nurses said that because the hospital does not require they make a phone call or have a face-to-face conversation during these handoffs, patients were being put at risk and “disappearing” from the emergency department.
“There is a dangerous practice pattern of bringing unstable patients to medical or stepdown floors or patient decline because of improper transport practices,” according to a PPC complaint sent on May 18, 2022 to DHHS. “We request an onsite investigation into this hazardous situation present here at Mission health.”
Mission told The Watchdog this summer that its electronic handoff method was sufficient but also acknowledged it was looking into nurses’ concerns. Lindell did not immediately respond to questions Tuesday about whether the handoff policy had been changed.
The Watchdog also obtained and published parts of one nurse’s complaint about problems with oncology care at Mission.
In that complaint letter, the nurse said there were quality of care issues on Mission’s floor K9, where doctors from Messino Cancer Centers have practice privileges and are supplemented by Mission staff and resources.
Messino recently halted some acute leukemia chemotherapy services at Mission because of “system failures,” noting the hospital had never provided some essential support doctors requested for four years following HCA Healthcare’s purchase of Mission Health system for $1.5 billion in 2019.
“I am concerned about the care patients have received at Mission Health since the acquisition by HCA,” the complaint letter said. “I have explicitly been made aware of patients who received expired chemotherapy and missed doses of chemotherapy. The legacy Mission of old had a nurse-patient ratio of 3-1 on the oncology floor. Now that ratio is 5-1.”
The PPC has sent monthly recommendations to the hospital chief nursing officer about how patient care can be improved since it formed its union in 2020, registered nurse and PPC member Elle Kruta said.
“Unfortunately, the CNO has not adequately addressed our concerns, resulting in negative patient outcomes,” Kruta said. “Nurses filed complaints, which eventually led to the NCDHHS investigation. Hopefully, going forward, the CNO will listen to bedside nurses and make meaningful changes to protect our patients.”
DHHS’ visit to Mission follows recent scrutiny from the attorney general, whose office declared HCA has violated parts of the purchase agreement it made when it bought Mission.
Stein’s office gave Dogwood Trust, which was created from the proceeds of the sale to ensure that HCA remains in compliance with the purchase agreement, until Dec. 10 to correct the violations or HCA could face a potential lawsuit.
Stein’s office also issued an investigative demand, requesting HCA turn over 41 sets of documents related to oncology and emergency department services.
An attorney representing HCA sent a Nov. 7 letter to Stein’s office that the request was “legally improper” and that HCA had not violated the purchase agreement.
Stein’s office said it would respond soon, adding to what has turned into a heated exchange of letters this year between hospital administration and the attorney general, who is running for governor.
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 avlwatchdog.org/donate.