ASHEVILLE – HCA Healthcare is asking a judge to dismiss a federal lawsuit Buncombe County filed against the Nashville, Tennessee-based health care system earlier this year.
In its original complaint, filed Aug. 6 in state superior court and later moved to U.S. District Court for the Western District of North Carolina, the county alleges staffing cuts at HCA-owned Mission Hospital have increased the hospital’s emergency department wait times so much that county EMS workers are forced to treat patients in ambulances, Mission waiting rooms and ER hallways, until Mission can accept them.
The county contends that its EMS workers are “acting as unpaid labor” and that HCA, a for-profit health system, should foot that labor cost, which it claims is more than $3 million.
Earlier this year, the county had attempted to join North Carolina Attorney General Josh Stein’s lawsuit against HCA currently being heard in N.C. Business Court but was denied. Stein’s complaint also highlighted deficient staffing and long wait times in the Mission Hospital emergency department, a “manufactured” bed shortage and the consequences of medical transport services, citing in part Citizen Times reporting as evidence.
Stein was elected North Carolina governor Nov. 5. Jeff Jackson, a U.S. representative, was elected to be the state’s next attorney general.
In its Oct. 25 motion to dismiss, HCA said Buncombe County is merely trying to receive compensation for care it’s already been paid to provide.
“The County seeks to be paid twice for the same care — once by its patients, and once by Mission Hospital,” attorneys for HCA wrote in a supporting brief.
HCA added that the county is required to provide EMS services under state law, paid for by patients – not hospitals – based on rates the county chooses.
“Counties decide how much they will charge for EMS services; they publish those charges; patients must pay those charges,” HCA wrote. “Buncombe County is no exception.”
The county declined to comment on HCA’s motion to dismiss.
More:Mission ambulance wait times decrease; McDowell EMS resumes patient transfers
But in a Nov. 8 response to HCA’s filing, the county said in the years since HCA’s $1.5 billion acquisition of nonprofit Mission in 2019, the hospital system has allowed Mission’s emergency services to “deteriorate dramatically” and that it “intentionally understaffed” Mission’s ER.
As a result, the county contends, HCA has “exploited the county’s obligations” to its EMS patients and is in violation of federal law.
The county said HCA “continued to shirk their responsibility to emergency care” only until Stein filed his lawsuit in December 2023 and Mission was at risk of losing funding from the U.S. Centers for Medicare and Medicaid Services for not complying with federal requirements related to emergency services and other areas.
HCA/Mission declined to comment on the county’s Nov. 8 response, pointing to previous statements it has made regarding the suit.
“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/Mission spokesperson Nancy Lindell told the Citizen Times in September after the suit was moved to federal court.
HCA responds to Stein
HCA filed a separate brief Nov. 7 in N.C. Business Court in response to North Carolina Attorney General Josh Stein’s lawsuit filed against the for-profit hospital system alleging breach of contract.
Stein’s lawsuit, filed in December 2023, claims HCA broke the terms of the amended asset purchase agreement following HCA’s $1.5 million acquisition of nonprofit Mission Hospital when it discontinued certain aspects of Mission’s oncology services and emergency and trauma services, without authorization from the hospital’s advisory board.
After denying the allegations in a court brief filed in February, HCA then filed a motion for partial summary judgment claiming that the amended asset purchase agreement failed to stipulate that HCA must continue to provide the same quality standards for services, along with quantity and staffing standards, Mission provided before its sale.
HCA’s attorneys wrote that Stein’s “complaint does not allege that Mission has discontinued any of the listed service lines” outlined in the Hospital Service Commitments, which is part of the asset purchase agreement.
HCA said a breach of the agreement could only occur if it “canceled” or “ceased” a listed service.
In an Oct. 28 court filing in response to HCA’s motion, Stein claimed HCA didn’t understand the lawsuit he filed against it. He said “the central thesis” of the 2023 lawsuit was that HCA “discontinued” specific services it agreed to maintain within its oncology and emergency and trauma departments.
In a Nov. 7 reply brief, HCA said Stein’s opposition to its motion for partial summary judgment “makes it clear that the Attorney General never had and never will have good-faith legal basis for his breach of contract claim.”
“The Attorney General filed this lawsuit almost year ago, and he still has not offered reasonable interpretation of the key words at issue in his claim ‘shall not discontinue,’” HCA’s attorneys wrote. “Instead, his Opposition offers an interpretation that is both unreasonable as matter of contract law and common business sense.”
The N.C. Attorney General’s Office did not respond to a request for comment.
More:Mission CEO emails to HCA before hospital sale: rural towns have ‘inferiority complex’
More:Patients arrive at Mission Hospital in ambulances, then the waiting begins
Jacob Biba is the county watchdog reporter at the Asheville Citizen Times. Reach him at jbiba@citizentimes.com.
