A new independent monitor of HCA Healthcare encouraged the Franklin community to report the good and bad about the hospital as part of their review process.
The sparsely attended meeting took place in the conference room at the Robert Carpenter Community Building on Thursday, June 20. The lights were turned off to show a PowerPoint that people in the audience could barely read. And with nothing to cover the multitude of windows, the brightness of late afternoon sun pierced the stuffy room.
Angel Medical Center CEO Clint Kendall and HCA Media Relations Coordinator Nancy Lindell sat in the back of the room but did not speak.
The event was the last in a multi-county tour by Affiliated Monitors. Dogwood Health Trust recently hired the organization to oversee the stipulated terms in the 2019 HCA Healthcare purchase of Angel Medical Center and Mission Health System.
Dogwood CEO Susan Mims said Dogwood conducted a “very comprehensive and thorough search” for a new independent monitor.
“We put out an [request for proposals], interviewed many candidates,” Sims said. “And Affiliated Monitors really stood out to us because of their focus and experience in monitoring. This is really their core business. It’s what they do.”
Sims said each year, the independent monitor reviews the compliance with the previous year, through HCA’s report, additional data, site visits and community feedback. The completed report is sent to the N.C. Attorney General’s office.
”We take this work very seriously, and our role in this work because we care deeply about the communities where we are serving,” Sims said.
In late 2023, N.C. Attorney General Josh Stein sued HCA Healthcare, alleging the company was not providing emergency services and cancer care as stipulated in the 2019 sale, which he signed off on to approve the sale. Most of the allegations centered around Mission Hospital in Asheville. That lawsuit is ongoing.
The last contracted independent monitor, Gibbins Advisors, held a listening session in Franklin in November 2023. At that meeting, held at the Macon County Public Library, several locals vented their frustrations with HCA Healthcare, which in 2019 purchased Angel Medical Center and other hospitals in the region, including Mission in Asheville.
When asked why Dogwood changed independent monitors, Mims said in a statement that “in response to listening to our communities and through collaboration with the Attorney General’s Office, Dogwood recognized that additional responsibilities were needed that went beyond the original scope of work for the independent monitor.”
Leading the Affiliated Monitors team is Gerald Coyne, director of State Monitoring Services for Affiliated Monitors; Denise Moran, director of Healthcare Monitoring Services; and Jeff Brickman, a former hospital administrator with over 40 years of experience in the field.
Coyne said one of the frequent questions is how they will be different as monitors. The answer was emphasizing community engagement and listening. Coyne said they try to talk with local government and EMS leaders when going to an area.
Coyne said EMS people told them many past problems relating to hospital response times have been “vastly improved.”
“There has been a lot of attention paid to that issue and it has, the service time and return time to the communities has gotten a lot better,” Coyne said.
Coyne said one of their company pillars is staying independent and starting with a clean slate.
“When we start any engagement, it is most important that we come to that engagement with no prejudgment,” Coyne said. “We don’t have people monitor who have worked for the company being monitored. We don’t have people who serve on the team that have any kind of personal interest or personal conflict in the case. So we have no prejudgments when we start a case. We don’t presume that a company is in compliance and leave it to the company to prove it or leave it to somebody to prove that they are not. And we don’t assume that a company is not in compliance until they prove otherwise.”
Coyne said their focus will be the 15 primary commitments. Coyne noted HCA has already fulfilled 10 of those commitments, one of which was building the new Angel Medical Center, which opened in 2022.
“Our view is that if at the end of the day, a term is important enough to be put into that document, it’s important enough for us to make sure it’s compliant,” Coyne said.
Two of the remaining five commitments involve charitable care policies and remaining eligible with Medicare and Medicaid.
Coyne talked about the quality of health care, which isn’t in the agreement. Quality of care was the public’s major point of contention at the November 2023 meeting with Gibbons Advisors.
“The issue has been raised of what happens if a service has been diminished to a point where it’s just not available to the same level,” Coyne said. “At what point does a reduction in service become essentially what would be a discontinuance of it? And there is no clear answer in the APA on that. We cannot look to the APA on that answer. So we will be reporting on those services, but I can tell you that in both those areas and also in order to participate in Medicaid and Medicare programs, there are very clear quality standards that are being met.”
Moran said Affiliated Monitors has been working for around 10 weeks and will return for further community meetings this fall.
“We would ask you to continue to report concerns. It is really vital that you report your concerns to us, especially because we do a reflective look at the years of things that are going on now,” Moran said. “We really want to hear about those so that we can do some monitoring along the way to take us into the next year…we would like to hear both positive feedback and your negative comments as well.”
Moran said people with immediate concerns should first contact Industry Standards, then Mission’s Quality Care Team or Mission’s Quality Team office.
Dr. Michael Messino, the founder of Messino Cancer Centers, was the only public speaker.
Messino said the technical aspects of the hospital are still good but pointed to the 2019 agreement and HCA continuing specific services for at least 10 years.
“If you look at Angel Medical Center, you need to have emergency services, surgical services and acute medicine services,” Messino said, noting other services have “diminished significantly.”
“Where do you go when you have a cerebral hemorrhage? Or where do you go when you have severe heart failure and you need a good cardiologist and an interventional oncologist,” Messino said. “You know, most people used to just go right to Mission. So now the question is, where would you go?”
In September 2023, Messino Cancer Centers announced they would no longer provide certain oncology services at Mission Hospital in Asheville due to HCA’s alleged failure to adequately staff and provide resources.
“Our situation is that we did not get enough support from the administration to be able to continue the services at Mission Hospital,” Messino said. “So now people have to go to Wake Forest, to Johnson City, down to Greenville, South Carolina.
Messino’s other concern was with emergency services at Mission, where he claimed almost 240 physicians left.
“They leave because of dissatisfaction, for the most part,” Messino said. Those kinds of things are not at the level they were before. We’re down to one neurologist at Mission Hospital now.”
For those who wish to comment to Affiliated Monitors, the email address is mission@affiliatedmonitors.com and the website address is independentmonitorsmhs.com.