PART 1: Restoring Better Healthcare in WNC | An Asheville Watchdog Forum

The exodus of doctors and nurses, the mountains of complaints from patients, the lawsuit from North Carolina’s Attorney General. Those are just the broad areas of fallout in the five years since HCA Healthcare purchased Asheville’s formerly not-for-profit Mission Hospital.

The Asheville Watchdog is a nonprofit investigative news outlet that has been out front on the local reporting on this. A few hundred people came out Jan. 23 for a Watchdog forum at A-B Tech designed to answer a single question: What can we do to restore better healthcare in WNC?

This episode features the opening remarks from the five panelists: Drs. R. Bruce Kelly and Clay Ballantine, Brevard Mayor Maureen Copelof, nurse and patient advocate Karen Sanders and Democratic State Senator Julie Mayfield of Asheville.

The section of the forum devoted to questions and answers with the same panelists is featured in a separate episode of this podcast.

SPONSOR: Make the most of your time this spring and turn over your housekeeping to Greenland Pro Cleaning. Use the code PODCAST at checkout for free bonus services.

SPONSOR: Satirical comedian Robert Dubac performs “Standup Jesus,” 8pm May 3-4 at the Wortham Center for the Performing Arts.

Transcript

Dr. Bruce Kelly: I first walked into Mission in 1980 as a new doctor to begin my residency training. We'd just taken the Hippocratic Oath, as had all before us, promising to uphold ethical standards, the art of medicine, and act in our patients best interest. It called for us to remember that we were now members of society with a special obligation to all our fellow human beings.

Mission was a relatively small community hospital. It was where the indigent or those without choice would go for care. St. Joseph's was a private facility. Without emergency room access, all admissions were elective. Mission was a safety net anyone could count on. There was a shared sense of pride in caring for any and all, no questions asked.

Only in the prior ten years had the community started to attract the very best physicians out of their training programs. There were limited numbers of all specialists. Everyone admitted their own patients. Rounding in the morning before going to the office and often again at the end of the day.

Returning after hours and through the night was the norm. Mission was home away from home for all of us. We were there to meet the community and region's needs. It didn't need to be advocated for. The Mission didn't need to be defended. We were building a medical community defined by trust and collegiality.

Physicians were in leadership roles across the board, helping leadership prepare for the next future. We were all committed to providing the best care possible. Our relationships supported that end. For members of the community, working at Mission or St. Joe's was something to aspire to, a place to have a career, a place to belong, to feel proud of.

There was a sense of ownership for them as well. Mission over decades grew in stature and reputation. Physicians from the most prestigious programs in the country wanted to come here. The excellence that resulted was hard earned, built by the commitment and sacrifice of countless physicians, nurses, so many others.

Mission defined who we were as a community. It was where we shared a sense of meaning, where we had history, a voice. and where we could strive to be the best we could be. I framed these comments to reflect the deep sense of loss so many of us feel since HCA has taken over. Their corporate driven changes have not only been antithetical to our way of being, they dismantled what we'd built.

They erased our institutional memory. The community and region, too, have experienced loss. Patients have lost experienced providers, services, and for some, access. There's been a loss of confidence and the security of care we'd come to expect. They erased our community memory, too. The exodus of physicians is one marker of this loss.

Practices have been forced to make drastic HCA driven changes. Physicians employed by Mission have had no choice but to accept the HCA way or leave. It's created challenges for practices to recruit. Non compete or non disparagement clauses make it difficult, if not impossible, for many to advocate for themselves or to speak up.

The fear of retribution runs deep. Issues related to patient safety and quality of care have been front and center as they should. They impact every single one of us. HCA has as well brought a culture with them that's undermined trust, alienated many, and harmed the collaborative, and shared purpose that's defined who we've been.

Their manner has been marked by a lack of respect for the decency, ethic, and shared purpose that defined our healthcare community. We've had what feels like a hostile takeover, with decisions influenced more by shareholders than the needs of Western North Carolina. It's a disconnect we want to see remedied.

We applaud the good things that HCA has done, aligned with the Asset Purchase Agreement. There are outstanding physicians who support HCA. Good, if not excellent, care may be more of a norm than we hear about. That said, the drumbeat of stories about negative experiences, Medicare data documenting a consistent overall decline, HCA's refusal to correct resource and staffing issues, and much more is what brings us here tonight.

We want to be clear that the staff at Mission are doing heroic work. We have the highest respect for those that are working to improve the system from within. We're sensitive to not fostering divides, and are cognizant of the impact these controversies have on staff across the board. The corporate driven problems are not on them, and the quality of care that's provided is because of Mission staff's steady efforts.

We hope you'll express your gratitude to them every chance you get if needing evaluation or admission. We applaud the title of tonight's event, Where Do We Go From Here? We all want change marked by a renewed commitment to the best quality of care possible for everybody in the community and region. All of us want stewardship of the Mission system to be in service to the citizens of Western North Carolina, not to HCA shareholders.

The road to that end isn't clear, but we've done it before. Let's make tonight another beginning toward that end.

Dr. Clay Ballantine: I've got to swing around here a little bit because I like to stand up and talk. Sorry about this. My wife's actually running a pool to find out how long it's going to take for Mission to re revoke my privileges after tonight. If you want to get in, just get in touch with her. As Pete said, internal medicine, Dr.

Clay Ballantyne. I'm the only guy you'll ever meet who retired from yachting and went into medicine. This is the he got it right, 1997 I showed up here and started the hospitalist group. There were four doctors then, we grew it to 50 by 2010. In 2010 when I started the private internal medicine practice it was with one person, other person with Jim Cummings.

We now have seven doctors in that group. We are the only remaining primary care doctors who still go to the hospital and see our own patients all the way through the hospital. We see 'em in the er, we admit 'em, we round on 'em, we discharge 'em, and I have been in that hospital for most of the weeks of the past 27 years.

What you're hearing about here, or these are my front row observations about the changes that have come after HCAs arrival. I also want to go. reiterate, I am 100 percent supportive of the doctors, nurses and staff who are still there. I want them to have the resources to do what they do, especially the nurses.

They've really borne the brunt of many of the staff cuts, especially up on the floors. This is a four level problem. You got Mission hospital, you got the satellite hospitals. But you've also got all these primary care and subspecialty practices that are under Missions purview, and they are throughout the region.

And then at the fourth level is patient services like rehab, low cost pharmacies, and medical equipment that people need. HCA has impacted every single level of this system. One of the things that gets lost in this, because we're so focused on the things that are going on in the hospital is that these practices that provide way more patient visits and care through the offices are being hit every bit as hard as what's going on in the hospital.

And there are way more patient visits that happen in these offices than happen in the hospital itself. I'm not saying that to belittle anything about what's happening in the hospital. I want to make you all understand the scope of the problem. Cancer sur or, I'm sorry hospital wide, as of 2022, 3, 500 Mission employees had left, including at that point, at least 200 doctors.

Cancer services, operating rooms, supply problems, and the emergency department are major focal points of concern. In the ER, 40 percent of the doctors and nurse practitioners and PAs left that ER in 2023. We are no longer allowed to do direct admissions. We used to admit people directly into hospital beds when we knew what they needed.

We just put them directly in and get their care started. We have no more direct admissions. admissions inability to maintain nursing staff leads to lots of empty beds up in the hospital. And meanwhile, the, down in the ER, it is overflowing. So now all of our patients have to go through that ER, whether they're coming in from another hospital or coming in from home or off of out of our office.

They all have to go through the ER. So they get ER charges tacked onto their bill that we would not have to deal with in the first place. And they have lengthy delays in getting their treatment started. My patients have compared the ER waiting room to Dante's Inferno. They are not joking. Cardiology.

I'm going to go through some of these practices here. One of the Mission crown jewels. They lost, when HCA took over, they've lost over 10 of their fantastically recruited and excellent top of the top flight cardiologists. Mission Cardiology has been in the top 15 of just about every ranking system that's been done for 20, for the 27 years I've been here.

Those cardiologists have also lost all their a large portion of their staffing and they had contract disputes with Mission. Mission has gutted the staffing in their office. They've because of the doctors who've left, they've actually had to employ temporary employment doctors to keep the hospital service running at certain times.

And they've had difficulty keeping doctors and staff in the satellite offices for cardiology also. That lack of staff has led to empty schedules because nobody was there to make the calls to get the patients in to see the doctors, so the doctors are sitting there with an empty schedule. And recent estimates, they are down 5, 000 clinic visits.

Backlogged. And that was before they've had some additional changes in their manpower over there. My that lack of staff also means that the main office, there are hundreds of phone calls weekly that go unanswered. This is cardiology. One of my patients missed his appointment in the weather the other day.

His reset appointment, April. First available. And it's like that for just about anybody trying to get in there. Mission Neurology had nine board certified neurologists that provided care for this entire 18 county region out here. And Mission offered them some completely untenable contracts. Eight of them left.

Almost all at once, and turned thousands of neurology patients out on the street. There's a smaller private practice neurology group here in South Asheville who's been trying to pick up the slack, but they're completely overwhelmed. They they get, on some days, over a hundred phone calls requesting new patient appointments.

This is a gaping hole for Alzheimer's Parkinson's, stroke care in our aging population. The neurosurgery group is split in half. The doc, half the doctors that we had before are still here. The other are gone, the other group is down south. And in the in the process of that, the same thing happened with their affiliated interventional pain management doctors who were part of that practice.

They've been cut in half also. This is, they're taking care of people who have severe spinal, pain problems, and the waiting times are weeks to months to get in and get seen that people are having to deal with these problems. The internal medicine hospitalists were about 50 doctors when HCA showed up here.

There are three of them left. Some of them have not been replaced either, and some of the people who are coming in here, they're using advanced practitioners who are trying to deal with what are basically the most complicated medical patients and situations in this end of the state. pulmonary and sleep medicine clinic.

Also, severely understaffed. I had two patients, a couple, who were trying to get their pulmonary follow up appointments. They called for three weeks, every day, trying to get through and get an answer back. We're after our appointment, can you call us back? They finally got in the car and drove up here last week, drove 47 miles to walk in that door and see the three people who were at the front desk were so busy.

They waited, they finally talked to them, and they said, Hey, we're trying to get our appointments. The staff there said, We don't have time to return calls. Mission won't let us hire anybody else to return calls or make appointments. They didn't even apologize. It's just the way it was. Our patients stood there, they got their appointments, and they said we better go over and check on your sleep apnea machine we've been waiting on for three weeks also.

So they went over to the sleep lab. Same thing. Mission won't let us hire. to get these orders sent out to the CPAP people. They stood there, they watched them send the order, they went home and later they got their CPAP machine and got everything taken care of. Multiple surgery practices and surgical subspecialists have shifted their practices down to Advent and Pardee or they've just left the area entirely.

The wound care clinic, short staffed, ready to hire another provider. They were in the contract negotiation and Mission without even letting them know in advance. Pulled the funding for the position as they were finalizing the contract to bring her on board. And what that means is, they're remaining short staffed.

So if anybody in that, any of the providers there are out, then they have to start canceling appointments and they don't have any backup. They're treating people with acute wounds and can't get staffing out of HCA. The psychiatry consult service for inpatient psych issues has been curtailed. There's short staffing problems that plague the labor and delivery deck, where the most complicated pregnancies in the region are treated.

There are problems with staffing at the neonatal intensive care unit. The infectious disease travel clinic, some of you all may have even been there in the past. That Infectious Disease Travel Clinic, gone. It's not even there anymore. Then the Olsen Huff Children's Center, another one of Mission's crown jewels.

The three developmental pediatricians there, and multiple other specialized pediatric providers, gone. Some subspecialties don't even come to the hospital anymore. Endocrinology, rheumatology. And ENT, gone. And the services within the hospital have been cut back or impacted as well. Pain management services, gone.

Speech therapy, occupational therapy, physical therapy, have all been curtailed to where now you're lucky if you get two or three visits a week from these people, when it used to be every day. The people who are there are trying as hard as they can. They are working as hard as they possibly can, but they can't keep up because there just aren't enough staff.

Case management and discharge planning services. The most complicated thing we do in the hospital is sending somebody home. They've got to have meds, therapy, appointments, support services, whatever else they need set up for them. Those staffers have been cut back as well, so they don't have the numbers to take care of all the needs for people as they go out the door.

Imagine how you and your family members might feel if you can't get everything taken care of as you head out. The laboratory services at the hospital have been farmed out and there are great delays now. A stat lab is essentially a joke. It used to be those things came back like that. They've shut down large portions of the laboratory facility in Mission and mothballed the machines so that nowadays they send infectious disease cultures to LabCorp.

They process it, they send it to LabCorp, they send it to Burlington. You finally get an answer back. One of my partners last week had a patient in the ICU. They were on their eighth day waiting to get back the cultures to figure out what to do with the antibiotics. sitting at this patient's bedside. And they've stopped even allowing us to get some laboratories that we used to do all the time as a service for patients.

Blood clotting profiles and stuff like that. They've mothballed the machines. Dr. Messino's cancer group got all that set up in the lab to make sure Western North Carolina had that capacity, but it's gone. The inpatient radiology with CT scans, x rays, MRIs, other imaging studies can have long delays, even for stat orders.

I ordered a stat CT on a lady who had internal bleeding. 24 hours later, I was still calling people in radiology and going, get her down there. And it doesn't, it doesn't, they just, they can't do it. They don't have the staff down there. The machines are sitting down there, but Mission has got the staff.

Care partners, hospice, and rehab facility. Another crown jewel. After you stay there, you leave care partners and you've done your rehab. Access to the outpatient rehabilitation clinics, greatly curtailed, essentially gone. The incontinence and bladder function clinic, gone. The lymphedema clinic, gone.

The vertigo and balance clinic, gone. The senior driving assessment program, gone. And for these patients who've been in there and had strokes, major orthopedic issues, and they're trying to rebuild their lives and get a grip on what's happening to them, The psychological services in the facility, gone. And the worst cut of all. Hospice. The Kiever Hospice Center. Grievance counselors, gone. HCA tried to cut the wheelchair cushion clinic for paraplegics. They tried to cut the senior daycare that provides respite for burdened caregivers taking care of their disabled loved ones at home. They try to get rid of the amputee clinic that takes care of the wounded appendages and makes sure they have the right prosthetics.

And they try to get rid of the PACE program, which is an integrated outpatient program to keep people able to live at home or keep them out of nursing homes and out of the hospital. Luckily, the WNC Bridge Foundation and care partners stepped in. and save those programs. In the outpatient world, where I'm working all the time, the labs and x rays and consults that we have tried to get for patients and been able to get as quick as a snap in the past now require multiple attempts.

We send these orders over and over again and we keep hearing back from radiology, from the lab, from the consultants who we're trying to send it to. Oh, it got lost. Which really means, oh, we don't have any staff to take care of these requests as they come in. We spend hours of our day, every day, just advocating for patients, trying to get things set up.

At one point, they were kicking mammograms down the road, three months at a time. Even diagnostic ones, where women had problems on their mammograms and they were trying to get the diagnostic ones. They'd say we don't have we, we just, we can't do that today. Three months, here's your next appointment.

I had one lady who didn't get her diagnostic mammogram for almost seven months. She ended up going down to Charlotte to get it done. And most patients don't have this kind of help, especially the most vulnerable. We're there to advocate for our patients, but the overarching trend is that Mission makes its money by cutting out staff.

And when you take a busy medical practice, you gotta have staff. And whatever Mission's had their hands on, they've cut the staff and it's curtailed the availability of those services. Doctors and nurses are perfectly accustomed to working hard. And in this setting though, it's not because the job's hard that all these people have left.

They've uprooted their families, they've gone to other communities. It's because they have bad management. And I just want to say that since H. E. A. 's arrival here, the breadth and the depth of the health care services available to the people, especially the disadvantaged, has declined across our region.

We're talking about unnecessary worry, suffering, and even death for human beings. This has to change. So thank you.

Brevard Mayor Maureen Copelof: As Peter said, I'm Maureen Kopeloff and I'm the mayor of Brevard, North Carolina. Now Brevard is a little town of 8, 000 people in Transylvania County, a rural county. We have a total of 33, 000 people in that county. And one of the unique things about our county is that we have some of the oldest population.

Our median age is 54. in that county. So what happens when you get older? You need health care. You need access to health care. We also, in Transylvania County, have a lot of areas of generational poverty. That means we have people that need access to health care, but they don't have the resources to go to Charlotte, or Atlanta, or even to Greenville.

They need to get that health care here. So we had this wonderful little community hospital called Transylvania Regional Hospital. It was founded in 1933 by two local doctors in Brevard. And then over the next For decades, that hospital expanded because every week, the people in our community gave money out of their paychecks.

We had a couple of big employers, and it was automatic. You could just have it taken out. We loved that hospital. The people built that hospital. Our regional hospital is a hospital of the community. They were proud of it. It was the centerpiece of healthcare that we relied on. Now, in 19, oh no, I'm sorry, in 2012, our little regional hospital merged with Mission and became part of the Mission system.

And honestly, that went pretty well. We had access to a bigger hospital because we're realist. We understand we will never have the kind of specialties that Dr. Ballantine just went through in our regional area. But being with Mission, it allowed us to access those wonderful services that he mentioned used to exist.

In 2018, I was on City Council and the leadership of Mission came and talked to all of our elected officials. And you know what they told us? They told us how wonderful it was going to be because they were going to be bought by HCA. And it was going to be so good for our community. And they said that because of HCA being so big, that they would have better equipment, we would have up to date diagnostics, we would have better staff, and that they would achieve all of this in a way that was absolutely invisible to the patients.

It would be through administrative consolidation of things like billing. Shame on all of us. Shame on me, because I believed them. I was one of the elected officials that sat there and said, this could be good. A year goes by and it is now basically January of 2020. We've been part of HCA for one year.

And the independent monitor comes out to Transylvania County and holds a town hall meeting. Now, I've been to a lot of town hall meetings as a mayor, and I have never been to one that was packed to the gills with people as upset, people sitting there in tears, crying at this town hall meeting. And I sat there and I said, Oh my God, we are in crisis.

Something is really wrong. And that's when I decided it was time to get involved. Now, Peter mentioned, my background's military. I spent 30 years in the United States Navy. And if I learned one thing in the military, it is when you see something that is wrong, you step up and you try to fix it. And if you need to go from point A to point B you just start marching towards point B.

My community, we decided we were not just going to sit there and watch. HCA, destroy our community hospital, destroy Mission, and endanger the people of my community. So we started meeting with the Independent Monitor, we started meeting with Dogwood Health. And we realized right off that the asset purchase agreement that was negotiated Absolutely had no mechanisms for oversight enforcement.

That it would not give us what we wanted because there is no quality of care metrics that HCA has to be held to. But, we decided, okay, we weren't going to get anywhere. We weren't going to get anywhere with the independent monitor. And in the meantime, things just kept going worse. Everything that you heard the two physicians here talk about was happening at our little regional hospital, too.

And, when you go to a regional hospital and it's mismanaged, first you gotta make your way through all of that sort of maze of emergency room, of getting admitted, of getting looked at, and then, most of the time, you get sent to Mission. So you actually have to go through this mismanaged system twice.

So things were just getting worse and worse. All of our primary care physicians left. We lost almost all of the specialists. The charity care was reduced down. ER delays. The cleanliness of the hospital. Billing issues. The nursing staff was reduced. People were really in tears. They were absolutely Trust was being destroyed.

So what we decided to do was, I met with Sam Hazen. He is the head of HCA. And on May 5th, 2022, after I sent him three letters, he agreed to meet. And what I did was I asked him to please, please change how they were running our regional hospital. Because you cannot apply the same corporate tactics across 180 hospitals and put that in a rural hospital in North Carolina and think you're going to be successful.

What kind of answer do you think I got? What do you think I got? You're right. He did not agree to change any of the corporate practices and try to tailor them to the needs of the community. So then I asked Mr. Hazen a second question. I said, why don't you sell that hospital back to our community? Yeah.

What do you think I got as an answer to that? Yeah, I got a no. However, did I tell you I have 30 years of military experience? Yeah. Being told no by the head CEO of a gigantic, multi billion dollar corporation. That's fine. So I came up with a new strategy. I came up with what our little town of 8, 000 people's been doing now for the last three years.

It's a sort of a multi disciplined approach. First thing we did was the city of Brevard Basically filed a class action antitrust lawsuit in federal court against HCA alleging that they are engaging in anti competitive conduct that resulted in higher prices and lower quality of care.

Now somebody once said to me, you're 000 people. How can you sue HCA? Did I tell you that I have 30 years? We're suing HCA and I am very proud that Brevard was the one that initiated this lawsuit and since then Asheville Buncombe and Madison County have joined in this antitrust lawsuit that is currently still in federal court.

Now part of what they do in this, and part of what they do, and part of what this lawsuit is, they do what we call bundling of care. So I self insure the people in my town. I self insure the hundred employees that I have. Here, I only have a hundred employees. I don't have tens of thousands like HTA. But they all need healthcare.

And so when I go to get insurance for them, if I want to have access to the General Acute Care admission Hospital, which you have to have in any type of insurance policy, Then, I have to have all outpatient services by HCA providers only, or else it's out of network. So every one of my hundred employees are forced to use only HCA providers.

What did we just hear about HCA providers? You can't get appointments with HCA providers. You can't get. To see a neurologist for over 11 months when you call. You can't get an appointment for a mammogram. Anyway, so our lawsuit is going forward. But we also decided it wasn't enough to just hold HCA accountable in a court of law.

We were also going to start dealing with the problems one on one. I was actually appointed to be our healthcare liaison. Now, I don't know the first thing about healthcare. I don't know anything about medicine. But, I know how to pick up my telephone, I know how to say, this is the mayor calling, and try to get answers.

And so what we did was we started one on one having people come to the mayor's office. Because if you don't know how to navigate the healthcare system, You probably know how to find my office. And I started working one on one. And as I started working one on one with the people in my community, I started to see the bigger systemic problems that underlie the individuals.

And I realized that going one by one was never going to get us there. That we had to deal with this in a bigger fashion. So the next thing we did, was that we created a community council made up of community leaders. And we went around our entire county for ten months holding listening sessions to document with anecdotal stories, because that's really the only metrics we could get.

Because when you actually ask HCA for metrics, you know what? It's proprietary. So when I ask, how many actual surgeries did you do in my regional hospital last year? You can't get an answer. That's proprietary. We took the anecdotal stories, and we analyzed them, and we put them in a report, it's like a 28 page report, and we identified what we said were the systemic issues, the problems with the hospital.

Most of which you've already heard from our two physicians. And you know what I do with that report? I send it to Sam Hazen. Sam Hazen, the head of HCA. What do you think happened? Nothing. It was totally dismissed. Then we decide, okay, that didn't work. And in that report, we actually gave HCA three choices.

We said, here are three recommended solutions to the problem. One, you could fix all of the systemic issues that we documented in the report, yourself. Two, you could bring in an independent, outside evaluator, consultant, somebody to just come in and look at the problem and make the changes for you.

Or three, you could sell that hospital back to the community. Those were the three solutions that we actually put in our report. So then we decided, okay, we weren't going to get anywhere with HCA. So we decided we would go to every organization that has regulatory authority over HCA. So we went to the attorney general.

I met with Joss Stein in person. We went to DHHS. We met with them. We. We went to the Dogwood Health. I met with them. We went to the Independent Monitor. We called the Joint ComMission. We started handing our people the number and the phone number to call DHHS and report these problems immediately. And we have basically brought the power of the community, the power of leadership, the power of the courts, This is the multi pronged approach that my community of 8, 000 people has been doing.

And I think we're making forward motion. And I'm happy to see that the Attorney General also has a lawsuit. I am happy to see that, I'm not happy to see immediate jeopardies, but I am happy to see that DHHS took a lot of these stories, these reports seriously and have come out. But tonight is where do we go?

Where do we go from here? Folks, we go forward from here. That's where we go. It's, we basically do what I was taught in the military and, 30 years, sorry folks but this is me. You're taught when you want to get somewhere and you have a campaign. Basically a campaign, a fight that you're going to go forward in.

You analyze it. And one of the things you look for is you look for force multipliers. And what do you think is a force multiplier? I'll tell you what's a force multiplier. A force multiplier is the fact that we are fighting for the truth. We are fighting for something precious. We are fighting for the health and welfare of people that we love.

And I don't care how many billions of dollars HCA has. My force multiplier of the care and the heart that we bring, the allies that we bring that are sitting right here, the other allies that are out there that we are going to bring in. We are going to move forward and we are going to make a difference and we are going to transform and restore healthcare in Western North Carolina.

Thank you.

Karen Sanders, registered nurse: So Many thanks to the hundreds of dedicated professionals and staff at Mission who are working right now in this very difficult situation and horrible conditions. I have been a nurse for 45 years, of which 37 years were working in large tertiary care referral centers in Virginia and North Carolina. My time in hospitals included critical care.

MedSurge, case management, clinical informatics, and nursing administration. For 15 years, I've also worked as a contract educator for the North Carolina Board of Nursing, helping disciplined nurses take the mandatory legal ethical decision making course when they made life changing mistakes. Nurses make catastrophic career ending mistakes.

When they are stressed out at home, or when they're stressed out at work. In North Carolina, registered nurses are held accountable to four pillars of practice. The North Carolina Nurse Practice Act, number two. The American Nurses Association Code of Ethics, number three. The Patient Bill of Rights for each specific hospital, number four.

Standards of practice for clinical performance in specific units. for similar size, similar service hospitals. Nurses working in hospitals become most stressed when they are short staffed. Short staffing means that the acuity of the assigned patient load is too high, or the volume of patients to whom they are assigned is too large, or both reasons.

When there is chronic short staffing, or not enough staff on a unit for days, or months, or years, Nurses become very tired, stressed, and overwhelmed. Nurses succumb to something called moral injury. So moral injury is a deep soul wound that pierces a person's identity, sense of morality, and relationship to society.

And being working in short staffing situations routinely, day after day, are also called routine incessant betrayals. of patient care and trust and are examples of death by a thousand cuts. So we have nurses and physicians and many people working with death by a thousand cuts. When there is ongoing staffing shortages each day for a nurse, he or she feels as if they are not able to adhere to their nursing practice standards, as defined by the North Carolina Nurse Practice Act.

They might say, I am violating my practice act and I'm leaving because I can't give the right nursing care to each patient. I am putting my license in jeopardy. No nurse wants to lose their license. This means they might have a loss of income, an inability to take care of their families, and provide for food and housing.

Nurses are leaving because of chronic staffing shortages at Mission. I started my own practice as an RN patient advocate, a holistic RN patient advocate, to help patients and families navigate our dysfunctional, silo driven, technologically impossible healthcare system with less stress and more peace of mind.

I have worked in this role for the last eight years. I also became a board certified nurse coach. To help nurses who were disciplined find their way back to nursing with peace, acceptance, and purpose without shame, or guilt, or negativity. If we want to make changes in our healthcare system, and which is delivered at HCA Hospital, we all must become advocates.

We all must become advocates. In this room, a patient advocate is someone who stands up and speaks on behalf of a patient or family. If we do not speak up, someone else may or will be making decisions for us. When should we speak up as an advocate? When there is concern, harm to a patient or family in a hospital.

HCA is the first and only hospital. In which I have ever worked that has nine immediate jeopardy issues regarding patient harm or deaths as issued by the Department of Health and Human Services. All of our voices in this region must be the tools we choose to report these unacceptable patient outcomes.

What are the takeaways? What are the things? I want you to know, you must always advocate for yourself or a loved one for healthcare at Mission Hospital. Always have a second person, number two, always have a second person to act as your advocate in the hospital, in the room, with a notebook to document your healthcare, and when asking for help from the hospital staff.

Now, this person can be. a family member, a friend, a neighbor, or a professional advocate. Number three, obtain a copy of your medical records, which is your source of truth for what happened to you in that hospital. Number four, call the North Carolina Division of Healthcare Complaint and Investigation for all patient care complaints that are confidential.

That number is listed on this resource. I have this number in my phone. And I send it to patients. I also volunteer to go with patients to sit in together. And I will be their voice while they add or want to talk to the person on the phone. And fifth is to call the Asheville Watchdog for confidential stories and complaints.

I have referred a lot of patients to the Watchdog. But only asking their perMission, but they, but Watchdog serves as a voice for them. And in conclusion, now I'm addressing any retired nurses in this room. I am forming a Western North Carolina Retired Nurse Corps. If you are interested in learning to advocate for patients and families and retired nurses, please see this person on the front row, Kay.

She's got a clipboard to take your notes. And, just to say, we need everyone. in this community to advocate. Thank you.

NC State Senator Julie Mayfield: I'm gonna talk a little bit, as others have, as how I came to this work, but the main part of what I'm gonna talk about is, What are we doing now?

And what happens next? So I first came to this work in 2019 when I was on city council and I started to hear the horror stories. All the things that we were all hearing from friends and constituents about what was happening at the hospital and their concerns and experiences about what was happening at the hospital.

So when the independent monitor came for that first meeting in 2020, I organized our elected officials and to read a letter at that meeting that was for anybody who was there. It was very impactful, and it basically sent the message to H. C. A. We, the elected leaders of this community were inking it.

We ain't gonna take it anymore. And and we had one we demanded to meet with them. We had one meeting with them that was going to be the first of many to start addressing these problems. And then about two weeks later, Covid hit. So it all just stopped. I tried to pick it back up in 2022. We had a, again, elected officials here in Asheville and Buncombe County.

We had a meeting scheduled with Sam Hazen. Also scuttled because of COVID that time because I got it. I was, at that point it was suggested to me that I redirect and try to work with some of the local leadership here in Asheville. With HCA, and I will just say that proved pretty unfruitful pretty quickly.

The independent monitor meeting this past October really provided a new opportunity to reinvigorate the and to catalyze the community concerns about this. And thankfully, Bruce Kelly showed up and were offered to, to work on a physician letter that was prepared and read that night.

At that time it had about 40 some odd physician signatures. It now has over 170. And the nurses were also a strong voice that night and and I have been working with the physicians ever since. What we are dedicated to going forward, now and going forward, and what we have been working on for the last three months is creating a coalition of dedicated physicians, nurses, and others in our community who are committed to creating accountability and restoring what has been lost at Mission Hospital, what has been lost in our medical community, and what has been lost throughout.

Our region. That is what we were, that is what we are doing. And here are some of the things that, again, just in the last three months, we have we have been doing. So the first is the physician letter that I mentioned. We continue to get physician signatures on that letter. We are actually just starting to roll it out to the rest of the region.

If you are a physician, if you know of physicians who have not signed that letter please let Bruce Kelly know. He's the, the keeper of that letter. Also on the accountability piece, after that, after the independent monitors meeting in October, we all started getting flooded with stories.

Just as Mayor Copelof had stories coming in from her community, we started getting them here, and I am fortunate enough to be in a position to have very direct communication into DHHS and the Attorney General's office. And people were sending me stories that then with their perMission I'm sending directly onto the agencies.

And we know that some of those stories resulted in, or are part of the, what brought DHHS to town, what is the basis of probably some of these immediate jeopardies helped form the basis of the AG's lawsuit. That is work that we are committed to continuing to do. There are out on the table information sheets about how you can submit complaints and your own story to the regulatory agencies.

I have also put two stacks of my cards out there. If you don't want to go through the hassle of submitting to the agencies, send your story to me and I can guarantee you I can get it straight into the hands of the regulators who have who have responsibility here. Let's see. Third thing we have been a real resource for reporters, both locally and nationally on what is happening in the hospital.

We have pulled together a team of attorneys who are working on how we can bring pressure to bear through the asset purchase agreement, through certificate of need reform, through legislation through the agent, through the regulatory agencies. We're just looking at a whole host of avenues to try to bring additional legal pressure to bear in addition to the lawsuits that are already out there.

We also have open conversations with the Dogwood Health Trust. They play a unique role in our community with regard to HCA. And we are encouraging them to see their role a little more broadly. And we're hopeful that those conversations will bear fruit. We have met with the nurses and the nurses union.

We support what they're doing and we will be, we will continue to support them as they go into their contract negotiations with HCA this year. They are not a formally a part of our coalition for legal reasons, but we do communicate and stay in touch with them. And we are growing this coalition. So originally it's physicians.

We've now added the health equity coalition. We have added the faith community, and I just, I want to ask if there are members leaders in the faith community who are here tonight. If you would stand up, you all have really shown up in a big way for us recently, so thank you.

You just heard Karen talk about retired nurses. We, Karen is part of our coalition to pull those in. We are working with neighborhood organizations regional voices. Mayor Kopoloff brings just a wealth of contacts and experience on this from Transylvania County, and we're going to be pulling in similar similar efforts from other regions and we we are also so we're all, waiting on pins and needles about this, the letter from CMS about, officially noticing these immediate jeopardies.

We are we are prepared when that letter comes out to, to go through it. And more importantly, to really take a fine tooth comb to the corrective action plan that HCA will have to put together. And, our doctors, Karen, other folks who have been in the hospital will be taking a look at that and we will be sending comments to the, to DHHS I don't know, I don't know that any of us trust HCA.

to put together a plan that's really going to solve these problems especially in 23 days. And we also have adopted a set of principles and guidelines that drive our work and we don't have them for you tonight, but we can send them out to folks later who sign up. And that gets me to signing up.

We have the ability for you, if you would like to join our coalition, if you would like to stay engaged, stay in touch, learn what we're doing learn about opportunities that you have to communicate with elected officials, with regulators, all of that you have a couple ways you can do it.

And if I can ask John and Missy to stand up for a second. This is Missy Harris. This is John Nicolay. We have sign up sheets over here and a QR code, if you're QR code savvy it'll take you to a Google form. We will also have sign up sheets. I think, John, you're going to be at the door or outside the door.

Yeah. So please, if you want to stay in touch, do that. And we can send you more information and just keep you engaged. So again, we are building a broad based community coalition that will create accountability and work toward restoration Of what we lost and we invite you to join us in that effort.

Thank you.