Attorney General Josh Stein Works for Quality Health Care in Western North Carolina

Attorney General Stein is deeply concerned about HCA and its effect on health care in western North Carolina. As described below, the Attorney General has taken significant steps to protect patients in western North Carolina. This work is ongoing, but so far includes:

• Making the most of his limited authority to review non-profit asset transfers to protect patients in western North Carolina from the worst consequences of HCA’s acquisition of Mission Health. As part of his review of HCA’s purchase of Mission, the Attorney General:
• • Negotiated significant revisions to the purchase agreement between Mission and HCA. Specifically, the Attorney General secured a legally binding commitment from HCA to keep Mission’s multiple facilities throughout the region open and to continue to offer important services through 2029, instead of 2024. Additionally, the Attorney General secured HCA’s promise to build a new facility for Angel Medical Center and to build a 120-bed inpatient behavioral health hospital in Asheville. More information can be found here.
  • Required that the board membership of the Dogwood Health Trust better represent the full diversity of western North Carolina.
  • Insisted that an Independent Monitor oversee HCA’s compliance with the terms of the purchase agreement, and working with the Independent Monitor and Dogwood Health Trust to ensure that HCA satisfies the purchase agreement’s requirements. More information about the Independent Monitor can be found here.
  • Discovered and notified the Mission Health System Board of Directors of an undisclosed potential conflict of interest regarding the vote to sell to HCA and requiring the Board to re-vote after it was made aware of the conflict.

• Investigating HCA for potential violations of the purchase agreement, including:
  • After HCA likely violated the APA by closing an operating room in Highlands-Cashiers Hospital for several months, the Attorney General insisted that HCA remedy the potential breach by committing to keep the operating room in Highlands-Cashiers open for an additional five months beyond the end of the APA’s 10-year commitment.
  • The Attorney General is investigating recent reports that HCA is failing to meet its obligations to continue providing oncology services at Mission Hospital. Attorney General Stein has demanded information from HCA about oncology services at HCA to respond to his concerns that HCA is violating the APA.
  • The Attorney General’s concerns were exacerbated by recent reports that Messino Cancer Center determined that it could no longer safely provide certain treatments for adults with leukemia and by reports that GenesisCare oncologists who provided treatment at Mission Hospital were laid off following GenesisCare’s bankruptcy.

• Urging the Independent Monitor to step up its oversight of HCA and its engagement with the western North Carolina community. As a result of a letter the Attorney General sent to the Independent Monitor this past summer, the Independent Monitor has:
  • Scheduled four community listening sessions, the Independent Monitor’s first such listening sessions since April 2021.
  • Updated its website to include documents relating to the Independent Monitor’s oversight of HCA from the past year.
  • Published the dates of upcoming quarterly meetings between the Independent Monitor, Dogwood Health Trust, and the Attorney General’s Office, and added summaries of those meetings on its website.

• Proposing new legislation that will give the Attorney General authority to review proposed hospital mergers for their effect on access and affordability on healthcare. The proposed legislation also provides a process by which the Attorney General could seek to block harmful hospital mergers before they are consummated by taking into account the transaction’s impact on cost and quality of care.

• Successfully opposing HCA’s Certificate of Need application for additional acute care beds in western North Carolina to promote more competition. Instead, the North Carolina Department of Health and Human Services awarded the Certificate of Need to a different provider, who will supply much needed competition. You can read more here.

• Filing amicus briefs urging state and federal courts not to dismiss allegations that HCA is violating antitrust laws. A state court agreed with Attorney General Stein that plaintiffs’ case should proceed in one lawsuit, Davis v. HCA Healthcare, Inc., 2021-CVS-3276 (N.C. Business Ct. 2022). A decision from a federal court is imminently expected in the other lawsuit, In re Consolidated Mission Health Antitrust Litigation, 1:22-cv-114 (W.D.N.C. 2022). You can read the Attorney General’s brief in Davis v. HCA Healthcare, Inc. here.

• Remaining engaged with the community’s concerns about HCA. The Attorney General has met with many community organizations in western North Carolina about their concerns with HCA’s management of Mission Health, and held a roundtable on healthcare consolidation in Asheville in 2021. Additionally, the Attorney General has assigned a Consumer Protection Investigator to receive and review all complaints related to HCA. As a result, the Attorney General has written HCA several letters to address and resolve complaints on behalf of the people of western North Carolina about topics like staffing shortages, quality concerns, and access to OB/GYN services. Some of those letters can be found here.

How to file a complaint about HCA

As Attorney General Stein continues his investigation, he’s asking North Carolinians in western North Carolina to file complaints with his office if they are being affected by the lack of certain cancer treatments for adults with leukemia and lymphoma at Mission Hospital in Asheville. One of NCDOJ’s Consumer Protection specialists has been assigned to review all complaints that people submit on this matter. File a complaint below.