North Carolina AG sues HCA

North Carolina's attorney general is suing HCA Healthcare, alleging the for-profit hospital operator has cut emergency and cancer care at Asheville, N.C.-based Mission Health System and lapsed on its 2019 purchase agreement in doing so. 

Josh Stein, North Carolina's attorney general, announced his lawsuit against Nashville, Tenn.-based HCA Dec. 14. The move was anticipated after Mr. Stein's office sent a notice of breach in October to Dogwood Health Trust, the nonprofit entity established to oversee the approximately $1.5 billion spent by HCA when it bought Mission Health. 

The attorney general's complaint alleges that HCA has violated the asset purchase agreement for Mission Health by discontinuing certain emergency and oncology services. Under the APA negotiated for the 2019 transaction, HCA must continue providing emergency and trauma services and oncology services at 815-bed Mission Hospital at substantially the same level as Mission provided those services as a nonprofit before the acquisition until at least 2029.

The state's complaint alleges that HCA employs zero medical oncologists at Mission Cancer Center; 45 oncology appointments were canceled in the first six months of 2023, which is the same number of appointments it canceled in all of 2020; and the number of oncology beds at the hospital has fallen from 44 to 24. Related to emergency care, the state alleges that Mission no longer meets the standards of a level 2 trauma center. 

"What was once a top-notch hospital and a source of pride for western North Carolina is now insufficient to satisfy the needs of the region," the complaint states. "HCA is solely responsible for this failure." 

Nancy Lindell, director of media and public relations for Mission Health, shared the following statement with Becker's in response to the announcement of the attorney general's litigation:

"We are aware of the announcement Gubernatorial Candidate Stein made in Asheville today. We remain confident that we continue to meet, and often exceed, the obligations under the Asset Purchase Agreement that the Attorney General approved at the time of our purchase, and we intend to defend the lawsuit vigorously. Importantly, the Independent Monitor confirmed our compliance with that agreement during its most recent review.

"Though there have been challenges, some of which we are continuing to address as we work to expand our capacity, we remain committed to serving our community," the statement continues. "Despite the state not allowing important expansions at Mission Hospital, we will continue to fight for critical access to healthcare services for the people of Western North Carolina. As the Attorney General acknowledged, this lawsuit is no reflection on the dedication of our doctors, nurses and colleagues who serve our patients every day. This lawsuit will not have any impact on our commitment to the community we are proud to serve."

Representatives from 182-hospital HCA have previously disagreed with the attorney general's allegations and inquiries into service reductions, contending that "Mission is providing unparalleled cancer care in western North Carolina." 

HCA closed on its acquisition of Mission Health in February 2019, and the relationship with the attorney general has been tumultuous. Mr. Stein expressed concerns with the hospital's charity care in 2020 and first notified HCA of potential breaches of the APA in 2021.

Mr. Stein is asking the court to order HCA to restore emergency and trauma services and oncology services to the level Mission Hospital provided before the for-profit change of hands. 

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