Mission Hospital: A View from the Inside - TribPapers
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Mission Hospital: A View from the Inside

Photo by Richard Catabay.

Asheville – Mission Hospital recently got itself out of hot water with the Centers for Medicare & Medicaid Services (CMMS), only to find a second finding of Immediate Jeopardy, causing them to again be in danger of losing federal funding through CMMS. All of this is also in the midst of the lawsuit Attorney General Josh Stein has brought against them.

During an interview, two nurses from Mission Hospital, Elle Kruta and Mark Klein, shared their perspectives thanks to the support and protection from the National Nurses United Union.

Elle Kruta

A Nurse Case Manager, Kruta worked for Mission before, but left and only came back after the union was in place.

Robinson: “Why did you leave?”

Kruta: “Before HCA bought Mission, we were the the star of the mountains. Everybody wanted to work at Mission, and it was hard to get a job there because once you got into Mission, nobody left. It had a very robust quality department, which I was part of. We worked on the floors with the nurses, providing the highest quality care for our patients. Every nurse was proud to say they were a Mission nurse. When HCA bought Mission Hospital, they said that they didn’t need quality nurse managers because they had their own quality department. My position was eliminated. When HCA was later taken to court, their lawyers said that they never promised to provide quality care.”

Robinson: Why did you come back?

Kruta: When there was an opportunity for me to come back to a hospital that had such an amazing group of nurses that wanted to bring the union to the hospital, I knew that was the place I had to be. We have to have a strong union, and the nurses have to be the face of our community and our hospital to protect our patients. If the nurses had not spoken up, where would our community be right now?

Staffing Issues and the New HCA Plan

According to Kruta and Klein, staffing and asking nurses to work in departments they are not trained for are the biggest problems. Having too few nurses and nurses working outside of their area of expertise is both dangerous to patients and could cause the nurse to lose their hard-earned nursing license.

The recent agreement HCA made with CMMS was done without seeking input from bedside nurses with their plan of corrective action. Nor was the plan provided when the nurses asked to see a copy before it was sent to CMM.

Mark Klein

An RN and IV specialist, Klein has been at Mission Hospital since 1999 and was elected by his peers to the Professional Practice Committee. This means he presents problems occurring in the hospital to the Clinical Nurse Leader. Just this month, he presented 35 issues happening in the hospital.

Robinson: What was in the plan submitted to Medicare/Medicaid?

Klein: “CMMS, which oversees the Medicare/Medicaid funding, has accepted their plan for corrective action, and a lot of this has been done under the cover of night, in my opinion. Primarily, their remedy seems to be learning modules about various things and trying to pressure nurses into charting things they are not comfortable with. To be fair, they did hire twelve nurses for the emergency department, six on days and six on nights. That’s a pretty significant thing for HCA to do, because even in Immediate Jeopardy they’re still cutting positions. HCA only has about 70% of the staffing of comparable hospitals.”

Robinson: HCA has been in the news a lot.

Klein: “We have a Certificate of Need in place, which keeps us from having meaningful competition. If you look at HCA’s behavior and practice patterns, they like to go into a region and they want to control the region. They’ll try to buy up all the hospitals, which they did here. After they get control of a region, they raise the prices. They have a monopolistic behavior pattern, and they negatively affect health care. That’s why they shut down labor and delivery in Mitchell County. Now laboring mothers have to drive 2 hours, in good weather, to come here and have their baby. It’s the same playbook over and over. If they lost monopolistic control here, it could be they would leave town. That’s what they did in New Orleans.”

What Needs to Be Done to Fix This?

Klein: “Staff the hospital. That’s all it would take. I think THE reason we’re in immediate jeopardy is because of staffing, and the reason we don’t have any staff is because it’s a cheesy business model. I think 95% of the problems at HCA could be remedied with staffing that resembles a legacy Mission Hospital.”

Klein and Kruta state that Mission Hospital is facing staffing shortages as fewer employees are willing to work there. HCA is hiring new graduate nurses at lower costs and blaming the nurses for the hospital’s problems instead of taking responsibility.