HCA lawsuit shows WNC health care struggles

By Gerard Albert III

Blue Ridge Public Radio

An “unnecessary” medical process is doubling costs for some rural hospital patients and adding to emergency room overcrowding at Asheville’s Mission Hospital, according to a lawsuit moved to federal court this month.

Buncombe County government leaders initially filed the lawsuit against health care giant HCA – Mission’s owner – in state court on Aug. 6. But the hospital system sought to move the case to federal court as the county seeks to recover expenses caused by alleged ambulance transport delays.

The county claims that Mission has an “understaffed” ER, which has led to county EMS workers having to wait with patients for prolonged time periods.

“As we have stated many times, we disagree with the claims in this lawsuit and will continue to defend ourselves through the legal process,” HCA spokesperson Nancy Lindell wrote in an email to BPR.

While the lawsuit focuses on wait times at Mission Hospital, it also spells out an issue with rural health care in Western North Carolina: Most patients who are transferred from hospitals in parts of the region like Brevard and Highlands must be readmitted through the Mission ER.

Before HCA purchased Mission and multiple other hospitals in the region, physicians would make a joint decision about whether to transfer a patient from a smaller, more rural hospital, according to the lawsuit. The patient would be admitted directly to an inpatient bed at Mission, if doctors decided a transfer was warranted.

However, according to the lawsuit, transfers are now directed to a “transfer center” where the decision is made by a non-physician. If a patient is transferred, they are likely to be “routed through the Mission ER,” the complaint reads.

Lawyers for Buncombe County argue this process adds to HCA profits and contributes to excessive patient wait times at the ER.

“This policy of unnecessary ER admission as a prerequisite to inpatient admission is often accompanied by redundant doubling of medically unnecessary charges and overcrowding of the ER,” the lawsuit states.

The process – coupled with ambulances stalled, waiting to transfer to a busy ER – can put a strain on rural counties like Transylvania, where HCA owns the only hospital, the lawsuit contends.

Transylvania County staffs two ambulance crews, according to the mayor of the county’s biggest city. The trip to Asheville – if there are no delays – takes 1.5 hours, during which time the county has only one ambulance crew to respond to local 911 calls.

“That takes an asset out of the county for a significant amount of time. So the longer they have to wait at Mission to process them in, the longer they are not here providing that service if we need it,” Brevard Mayor Maureen Copelof told BPR.

“That person is under a lot of distress – whatever the medical problem is – and you add to that the fact that they’ve got to go through this bureaucratic process a second time,” Copelof said.

If a patient is being transferred to Mission, they are usually going through a life-threatening medical emergency that smaller hospitals in the region don’t have the resources to handle.

In 2022 the city of Brevard, led by Copelof, filed a lawsuit against HCA, alleging the company engaged in a scheme to monopolize health care markets in seven counties in western North Carolina: Buncombe, Macon, Madison, McDowell, Mitchell, Transylvania, and Yancey.

“Their predatory monopolistic practices are really hurting the ability of a community to get that affordable, available and high-quality health care,” Copelof told BPR in 2022.

HCA is one of the nation’s largest hospital systems and has been highly criticized by communities and elected officials in Western North Carolina since 2019. The Buncombe lawsuit is one of several legal actions taken against the company by local governments and North Carolina elected officials like Attorney General Josh Stein.

“A lot of people are beginning to shift their attention to going to places like Northeast Georgia’s hospital…it’s comparable in size and operation to Mission Asheville, and there’s been kind of a shift of people relying on those services rather than relying on what they can get in Asheville,” Highlands Mayor Patrick Taylor said.

The town of Highlands sits in Macon County, along North Carolina’s border with Georgia.

Two hospitals operate in the county — Highlands-Cashiers and Angel Medical Center — making it somewhat of an anomaly in Western North Carolina. Both are owned by HCA. Their smaller facilities lack some services that only larger hospitals provide.

There are five ambulance crews in service during any given shift – but they are spread out through the mountainous county.

Warren Cabe, director of Macon County Emergency Services, said that the county also gets help from Mission’s Mountain Area Medical Airlift services, both by helicopter and ground transportation.

Still, with so much ground to cover, Cabe said the ambulance crews have to be selective about the patients they send out of the county.

Both of the county hospitals are owned by HCA, which keeps records of the priority of the patient’s needs. Cabe said the county will usually not use their ambulances to transfer patients who are below a high-priority.

“We will decline if we take that transport and it’s going to seriously jeopardize our resources here. We will decline it and make sure we keep enough resources here,” he said.

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