News

Mission faces deadline to fix deficiencies

By Grace Vitaglione, Carolina Public Press, Published: February 24, 2024

HCA Healthcare-owned Mission Hospital in Asheville laid out plans to fix deficiencies in a Centers for Medicare and Medicaid Services report made public Feb. 15 after regulators found violations that posed “immediate jeopardy” to patients’ health and safety.

The hospital was directed to rectify those issues by today or risk the loss of federal funding, according to the letter CMS sent Feb. 1 to Mission Hospital CEO Chad Patrick. Surveyors are currently onsite at the hospital, according to a state health department spokesperson.

The CMS report also details the deficiencies found by regulators, including four patient deaths.

In a case that occurred Oct. 17, paramedics took a 66-year old man to Mission Hospital with chest pains and shortness of breath. He did not receive an EKG until more than an hour after arrival. He experienced cardiac arrest and died less than three hours after his arrival, after what inspectors described as delayed care.

In an interview with inspectors about the incident, paramedics said “waits had gotten more common recently and it seemed like a staffing issue.”

Surveyors found nurses at Mission Hospital failed to “triage upon arrival, assess, monitor, and provide care and treatment as ordered” in 11 of 35 emergency department cases, according to the report.

Nursing staff also failed to administer medications as ordered and failed to monitor the medications’ effects on emergency department patients in several instances, regulators found. Staff also failed to document incidents to track medical errors in several cases.

HCA’s plan of correction for Mission Hospital involved solutions like implementing a timestamp system to track the time from when patients arrive at the ER to when nurses triage them, or prioritize patients based on their condition. The plan also includes getting patients to EKG faster and educating staff around problem areas.

Mission Health was a nonprofit operating hospitals and clinics across a multicounty region until 2019, when its acquisition by Tennessee-based for-profit HCA was completed. In addition to Mission Hospital and other facilities in Asheville, HCA-owned Mission Health continues to operate across the region.

Changes at Mission Hospital so far haven’t been great, according to Tucker Richards, an emergency room nurse and union member who’s worked at the hospital for almost a year.

Management assigned more staff to the emergency department and brought in more travel nurses, who are typically temporary, which is positive, Richards said. But new managers started “micromanaging” the staff, he said.

Part of that entails frequent reminders to complete tasks. If nurses at Mission Hospital miss a task, such as not completing an assessment on time, they have a one-on-one meeting with a manager who has them admit they made a mistake, he said.

“A lot of us have been very frustrated about that because it really feels like they’re trying to shift the blame onto us,” he said.

Nurses are pushing for management to hire permanent, more experienced nurses, and more support staff, such as certified nursing assistants to help with tasks nurses can’t get to.

Management has been doubling down on meeting time limits such as getting a patient to an EKG within 10 minutes, Richards said, but there’s still not enough staff to meet that. That’s why he and other nurses are pushing for a technician whose sole responsibility is to do EKGs, he said.

The emphasis on educating Mission Hospital staff in the plan of correction also feels “incredibly insulting,” he said, because the nurses already understand what’s expected of them.

Nursing staff were not asked to provide input on the plan of correction to Richards’ knowledge, he said, and leadership did not share the plan with them when asked. He said part of the issue with retention at the hospital is the culture.

“The way that we’re regarded by hospital administrators really feels as if we’re disposable,” he said. “We don’t feel valued.”

Even with the influx of travel nurses, staff are worried this is a temporary fix, Richards said.

“The general feeling among all of us nurses is that we are going to have maybe a month or two of being fully staffed,” he said. “Then, as soon as the attention is off the hospital, as soon as the government steps away, as soon as the media steps away, we will go back to the way things were.”

A coalition of advocates, including N.C. Sen. Julie Mayfield, D-Buncombe, and current and former physicians, said in a press conference Feb. 22 that the plan of correction fails to address the root cause of insufficient staffing at Mission Hospital.

Instead, according to a memo the coalition wrote to the state deputy health secretary, HCA focuses on “bureaucratic solutions” of process, education and documentation.

Leadership should have specific targets for nurse-patient ratios, increasing support staff and hiring more experienced nurses, the coalition said.

To address staffing, the plan of correction includes adding financial incentives for staffers to pick up more shifts and hiring more travel nurses.

The financial incentives were only in place when state surveyors were present at Mission Hospital, Richards said, and once they left, management no longer offered the incentives regularly.

The coalition pointed to HCA withholding documents from surveyors in the report and called for higher target compliance levels than the 90% that HCA proposed. Advocates also pushed for regulators to monitor the hospital for longer than the planned five quarters while conducting “frequent, unannounced inspections.”

Company spokesperson Nancy Lindell said in a statement via email that Mission Hospital began changes based on inspectors’ initial findings in December.

“We are pleased to hear from our EMS partners and patients that those actions are yielding positive results, including decreased wait times for care,” Lindell wrote. “Again, these findings are not the standard of care we expect, nor that our patients deserve, and we are working diligently to ensure Mission Hospital successfully serves the needs of the Western North Carolina community.”

A spokesperson for NC DHHS wrote in an email that Chief Deputy Secretary for Health Mark Benton received recommendations about the plan of correction and shared it with his regulatory team.

The federal district court for Western N.C. ruled Feb. 21 that a lawsuit by the cities of Brevard and Asheville, Madison County and Buncombe County against HCA for monopolistic practices may move forward, Mayfield said in the press conference.

Mission Hospital nurses protested against what they said were staffing shortages and unsafe pandemic-era conditions in 2020, and voted to approve a union.

After years of receiving complaints about whether HCA was meeting its obligations when from the acquisition approval to sustain health services across the area, Attorney General Josh Stein announced a lawsuit against the company in December 2023.

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Grace Vitaglione, a reporter for Carolina Public Press, can be contacted at gvitaglione@carolinapublicpress.org.