NBC Nightly News HCA report highlights Mission nurses, hospital conditions, patient safety

Andrew Jones
Asheville Citizen Times
Mission Hospital in Asheville and nurses who work there were highlighted in Jan. 12 reporting on NBC Nightly News with Lester Holt.

ASHEVILLE - A Jan. 12 NBC Nightly News with Lester Holt segment and accompanying report highlighted Mission Hospital and former and current nurses there as part of a larger investigation into working and patient conditions at HCA Healthcare.

The nearly four-minute segment and long-form report — penned by NBC’s senior financial reporter Gretchen Morgenson, investigative producer Natalie Jimenez Peel and senior legal and investigative correspondent Cynthia McFadden — investigated working conditions at HCA-owned facilities in the face of massive profits.

Readers can rewatch the segment and read the story at nbcnews.com/health.

HCA, the largest hospital company in the United States, purchased Mission Health and its six local hospitals in 2019 for $1.5 billion, shifting health care services from a nonprofit to a for-profit model.

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More:Mission health care workers demand safer working conditions, join national nurses action

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That shift has rankled employees who say it has hurt Western North Carolina patients, medical providers and workers ever since.

Along with interviews with Mission and HCA officials — North Carolina Division Vice President for Quality Jodie Becker and HCA corporate spokesperson Harlow Sumerford — NBC also spoke to some nurses including former Mission employee, Kelley Tyler.

Tyler, 58, a member of the recently-formed National Nurses United union at Mission Hospital in Asheville, worked there for 37 years and left in April 2022. She still keeps in touch with current employees and confirmed in an interview with McFadden that patient care had been “jeopardized” by short staffing.

Kelley Tyler talks about her work as a Mission Hospital nurse during a July 14 online forum hosted by Take Medicine Back and the Mountain Maladies Facebook group. The forum was created to discuss bids by three hospitals, including Mission, to expand services in Buncombe County.

“I think it's very important right now for the public and communities and patients to know that this is a national crisis,” Tyler told the Citizen Times Jan. 13, talking about the issues addressed in NBC’s reporting. “It's not just locally, I mean, we got caught up in it with the buyout from HCA. But this is something that's happening across the nation. And it's a very sad time in health care right now.”

NBC’s reporting cited a Service Employees International Union report published January 2022, a damning review of HCA hospitals across the nation that stated the company “staffs its hospitals at very low levels, typically about 30% below the national average, according to analysis of Medicare cost report data.”

More:Mission nurse on HCA fallout during merger hearing: Shocked and horrified

Nurses locally and across the nation are holding HCA accountable for the staffing “crisis” while the company points to conditions brought on by the COVID-19 pandemic as a primary culprit.

"What we're seeing is Mission Hospital is facing the same challenges across the country," Mission Hospital Assistant Chief Nursing Officer Michelle Nelson told the Citizen Times Jan. 13, 2022, as nurses gathered outside Mission Asheville for what would be the first of several rallies that year, demanding better working conditions.

Mission Health and HCA in September increased salaries for WNC employees by a total $22 million. 

More:Without delays, Mission employee $22M pay raises go live, union claims ‘big wage victory’

“These increases are a part of HCA Healthcare’s continued effort to support and invest in our greatest asset: our people,” Mission Health/HCA Healthcare North Carolina Division President Greg Lowe said at the time. “Compensation and benefits for hospital roles and positions are at the forefront of operations and ensure a commitment to current employees that they are heard and valued.”

But nurses both in the NBC segment, online and in communications with the Citizen Times say some days are still very hard.

“Forty patients (are) on the list to transfer to outside hospitals to be admitted because we don’t have staff to admit them upstairs,” one Mission Asheville nurse said in a text just days after Christmas and in the heat of Asheville’s recent water crisis that saw thousands go without water for days because of infrastructure that failed after a cold snap.

Reached by the Citizen Times after the NBC Nightly News segment aired, HCA and Mission spokesperson Nancy Lindell responded in part by criticizing the reporting for relying on the SEIU report, which she characterized as singling out the hospital company for something that was happening to hospitals across the nation.

"We strongly disagree with the NBC News story, which was driven by a misleading labor union report," Lindell said in an email Jan. 13. "We are facing the same challenges hospitals across the country are facing and we are doing everything possible to recruit and retain staff as evidenced by our recent $20 million increase in colleague salaries, robust sign-on bonuses, investment in nursing education, and ongoing recruitment events.

Lindell added it was "disappointing this news outlet chose to manipulate the story to fit such a negative union agenda. The short, edited clip used from our VP of Quality, Jodie Becker, ignores her compassionate call for nurses to share their concerns directly with leadership through the processes established by our nursing councils." 

'I can walk and chew gum at the same time'

Mission has seen pressure not only from national reporting like NBC’s and Fortune Magazine’s in March 2022, but from residents and local governments in two antitrust lawsuits filed in 2021 and 2022.

Online, people in the 13,800-member Mountain Maladies Facebook group constantly discuss, promote information and tell stories about Missions’ changing presence in WNC.

They also try to hold leadership accountable.

More:Mission Health’s 2022, fraught with resistance, was shaped by these 10 groups, people

When Democratic state Sen. Julie Mayfield, who represents a portion of Buncombe County, attended a ribbon-cutting for the newly opened Galen College of Nursing in Asheville — an HCA-owned nursing school — she saw backlash online.

“Regardless of how you feel about for-profit education and/or Mission, we need more nurses and this school will provide them,” Mayfield posted on one of her Facebook pages Dec. 15.

Julie Mayfield at the Democratic Election Day party at the Orange Peel November 8, 2022.

Mountain Maladies responded by reposting Mayfield’s comment, calling it “disappointing.”

Group administrator and creator Will Overfelt said in a statement to the Citizen Times he was “deeply saddened and disappointed to see state Senator Mayfield’s post supporting HCA’s Galen School of Nursing.”

Overfelt — who is a plaintiff in one of the antitrust lawsuits — talked about what he called HCA’s “unbridled control of our health care lives,” and framed the establishment of a local Galen College hub as increasing that control. 

“Mayfield was one of the first politicians to call out HCA and praise our antitrust lawsuit," he wrote. "If she believed that HCA is engaging in monopolistic practice in the provision of healthcare as her previous statement’s would imply—doesn’t it make sense to also oppose them taking greater control of healthcare training programs in WNC?”

Mayfield wrote her Facebook comment in the Mountain Maladies group, which she referred to when the Citizen Times asked if she wanted to respond to Overfelt.

“Like most people, I can walk and chew gum at the same time,” Mayfield said. “I say that not to be flippant, but to say that I can celebrate the expansion of the nursing pipeline AND continue to advocate with HCA that they do better by their staff and our community.

“I am working on legislation related to hospital consolidations, as well as with NNU on other policies we might advance here (like nurse-patient ratios). So I’ve not gone soft on HCA.

“Do I think them owning the school is best? No. I don’t like for profit education and wish they had instead invested in vastly expanding our less expensive public nursing programs — which are full. But we allow for profit schools and people can make their choices about what’s best for them. The students I met that night were incredibly excited to be on the path to their degrees — and the stats show the vast majority of them will be successful.”

Overfelt was still pessimistic.

“You can walk and chew gum at the same time but you can’t have your cake and eat it too on this one. It’s so bizarre to me that the only senior politician showing any righteous indignation on any of this is a Republican Treasurer. We don’t need ribbon-cutting picture opportunities here—we need to see a little fire in your belly over the most vulnerable members of this community losing their dignity in a money-making scheme of a hospital.”

No longer a 'beacon'?

HCA's revenue in 2021 was more than $58.7 billion, according to company reports, which included profits of nearly $7 billion. A significant portion of that comes from Asheville.

According to a recent analysis by Definitive Healthcare using data up to June of 2022, Mission Hospital in Asheville brings in the second highest net patient revenue for the company at more than $1.2 billion.

Data from a Definitive Healthcare analysis shows Mission Hospital in Asheville was the second highest earning patient revenue hospital for HCA Healthcare in the nation.

The Republican treasurer in question, Dale Folwell, has thrown his support behind those demanding change from HCA and Mission. Along with Attorney General Josh Stein, Folwell as an individual filed a friend-of-the-courts brief supporting plaintiffs in the antitrust lawsuit.

He spoke at an online event hosted in part by Mountain Maladies, condemning for-profit hospital systems as “cartels” in North Carolina, language he’s used in multiple state-wide reports on hospital systems his office published in 2022.

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Folwell also appeared in the NBC segment and report, reiterating what nurses and reports suggested, namely that HCA continued to put “profits over patients.”

Though nurses like Tyler believe the now nationally publicized local fight for better care by union members has been strong, she still worries about what her former co-workers and neighbors will face if HCA doesn’t do better by patients in the coming years.

“I lived in this area my entire life, and it's always been a beacon and you felt safe getting care and knew that you were getting top notch care,” Tyler said. “And it's kind of heartbreaking right now.”

Andrew Jones is an investigative reporter for the Asheville Citizen Times, part of the USA TODAY Network. Reach him at @arjonesreports on Facebook and Twitter, 828-226-6203 or arjones@citizentimes.com. Please help support this type of journalism with a subscription to the Citizen Times.