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CAPE FEAR MEMORIAL BRIDGE: Updates, resources, and context

New HCA independent monitor selected amid mounting safety complaints at Mission Hospital

A building on the Mission Hospital campus in Asheville.
Felicia Sonmez
A building on the Mission Hospital campus in Asheville.

Dogwood Health Trust has hired a new independent monitor for HCA Healthcare, the for-profit hospital giant that is facing federal scrutiny and lawsuits over the quality of patient care at its Western North Carolina facilities.

In a news release Tuesday, Dogwood said it has hired Affiliated Monitors, Inc., a Boston-based firm that also has offices in eight other U.S. cities. AMI’s first day in the role was April 1, Dogwood said.

“AMI was selected as the Independent Monitor after a thorough and thoughtful RFP process,” Dogwood Health Trust CEO Susan Mims said in a statement. “Their focused experience in monitoring was a distinguishing characteristic that helped inform our selection. … We are confident that our region will benefit from their attention to community engagement and experience serving as the Independent Monitor in matters involving hospital transactions.”

HCA has previously said that state investigators’ findings regarding conditions at Mission Hospital are “not the standard of care we expect” and that the company is “working diligently” to address the problems.

HCA purchased Asheville’s Mission Hospital, which was previously a nonprofit, for $1.5 billion in 2019. As part of the terms of that sale, an independent monitor evaluates whether HCA is fulfilling its commitments to maintain certain facilities and services. The independent monitor is paid by Dogwood, not HCA. Its work includes holding community meetings and issuing a yearly update about compliance.

In the years since the sale, HCA has faced withering criticism as well as an exodus of staff. In December, federal authorities concluded that conditions at Mission Hospital posed “immediate jeopardy” to patient safety, the most serious warning a hospital can receive.

A 384-page report released by the Centers for Medicare & Medicaid Services in February detailed numerous safety issues, including understaffing and delayed treatment. In some cases, the report contends, the problems led to patient deaths.

North Carolina Attorney General Josh Stein sued HCA in December, accusing the company of breaching the terms of its purchase agreement by failing to provide quality emergency and oncology care.

The following month, Dogwood announced it was seeking applications for a newly-expanded independent monitor role. The previous independent monitor, Gibbins Advisors, did not apply for the expanded role.

Despite the multitude of lawsuits and complaints, for each of the past four years, Gibbins has found no issues of noncompliance relating to Mission Health System, leading some to criticize the independent monitor’s oversight as insufficient.

The new independent monitor team includes former Rhode Island Deputy Attorney General Gerald Coyne; AMI Director of Healthcare Monitoring Services Denise Moran; and former hospital administrator Jeff Brickman.

AMI will hold in-person information sessions “in the coming months,” Dogwood said in Tuesday’s announcement.

“We are working to develop a full understanding of the issues that Dogwood, HCA, the North Carolina Attorney General’s Office and the communities served by each of the hospitals have been facing,” AMI President Vin DiCianni said in a statement.

“It will take the dedicated efforts of all parties to make the objectives of the Asset Purchase Agreement successful.”

As part of the purchase agreement, Dogwood is required to obtain the attorney general’s approval for any independent monitor. In a statement Tuesday, Stein said he consents to the selection of AMI.

“A strong, independent, and transparent monitor will go a long way in ensuring that HCA upholds its commitments,” Stein said. “I look forward to working with the new independent monitor to ensure that the people of western North Carolina have access to high-quality health care.”

HCA spokeswoman Nancy Lindell said HCA welcomes the news of the monitor’s appointment and is “confident that we have been and will remain in compliance with the Asset Purchase Agreement.”

Felicia Sonmez is a reporter covering growth and development for Blue Ridge Public Radio.