Everybody's Piling on HCA - TribPapers

Everybody’s Piling on HCA

Buncombe County has filed a motion to recover over $3 million it claims to have lost from EMS staff waiting with patients in Mission's overcrowded emergency department.

Asheville – On April 3, Buncombe County filed a motion to intervene in NC Attorney General Josh Stein’s suit on behalf of Dogwood Health Trust. It alleges HCA breached its purchase agreement contract by failing to deliver the same level of services Mission Hospital had prior to its sale.

Stein claims the county is entitled intervention because it may not be able to recoup losses otherwise. He is not running for re-election, and he’s not convinced that “his replacement will vigorously prosecute this action.”

Before the sale, emergency service personnel, including law enforcement officers, had already complained about having to wait excessively long with patients. It was customary for them to wait until patients could be seen by hospital staff, and things were “always” backed up.

The litigation, however, states that average wait times increased from nine minutes and 41 seconds to 17 minutes and 41 seconds following the transition of ownership. Average wait times in the 90th percentile of the normal distribution increased from 16 minutes to over 32 minutes.

According to the National Emergency Medical Services Information System, 20 minutes is the national standard for wait times. The year before acquisition, Mission met the standard 96% of the time; HCA was meeting it 72% of the time.

While waiting, EMS staff tended to patients’ medical needs and also performed custodial and orderly services for the hospital, such as moving waiting patients’ beds around to make room for their charges and sanitizing and outfitting rooms. The county is claiming that Mission knew full well it was getting free labor from the county, while opportunity costs from EMS personnel not being able to answer other calls in the community accrued.

The litigation further alleges that Mission HCA routed patients transferred from other hospitals through its emergency department, even when they could have gone straight to inpatient care. This, the county alleges, was purely a money-making scheme. Although the practice further crowded the emergency department, fees for these labor layovers, presumably, would have been payable to other counties.

Besides being unethical, “deliberately relying on BCEMS to treat Mission’s ER patients rather than adequately staffing the Mission ER” violated the federal Emergency Medical Treatment and Labor Act (EMTALA), the litigation states. EMTALA deems hospitals responsible for the care of patients once they are on hospital property and request is made on their behalf for emergency medical assistance. The litigation asserts that noncompliance stemmed from intentional failure to staff adequate, trained personnel.

In addition to the alleged financial harms, the litigation points out that Mission’s “unjust enrichment” schemes put patients’ health at risk. Stein’s filing on behalf of Dogwood also faults HCA for discontinuing oncological services, which the county has no standing to recoup.

Buncombe’s legal papers assert that the county and others had demanded that HCA improve its practices and filed repeated complaints with the AG. This led to the North Carolina Centers for Medicare and Medicaid Services issuing iterative notices of immediate jeopardy and the airing of multiple “horrific” accounts. Since then, HCA has improved its hand-off times in the emergency department and is now operating with 93% of patients being seen within 20 minutes.

The litigation claims “sources” reported that Mission’s ED had “over 104,301” patients in 2023. If most of them took an ambulance manned by three EMTs paid roughly the county’s average EMT salary of $15/hour, the county’s request for $3 million, or 2% of its operating budget, in reimbursement for expenses and damages is not too far-fetched. (No data was readily available about the percentage of emergency department patients arriving by ambulance, the value of employee benefits, or costs for maintaining and restocking ambulances, for example.)

The county allegedly presented HCA with their $3 million request, but they “did not receive the courtesy of a reply.” The county is therefore asking for an additional $25,000 for injuries sustained by the hospital’s failure to reimburse or “disgorge.” They also want to charge interest.

Buncombe further requested an injunction to prevent the hospital from reverting to its old ways once the heat is off. Court costs, attorney’s fees, and “such other relief as the Court finds to be just and proper” are also requested.

Buncombe County ambulances, of course, have an obligation to work with Mission Hospital. The litigation states that while this monopoly is not illegal, “the willful abuse of a monopoly position is.”

No attempt was made to contact Mission HCA’s PR staff for a statement, as the hospital has made it abundantly clear that they wish to settle these matters via the legal system and not a priori in the court of public opinion.