PART 2: Sub-Mission | State Sen. Julie Mayfield, Retired Dr. Bruce Kelly, Chaplain Missy Harris of Reclaim Healthcare WNC

In the second half of this two-part conversation, founders of the coalition Reclaim Healthcare WNC talk about their pressure campaign with HCA Healthcare to dramatically and demonstrably improve conditions for patients and staff at Mission Hospital. 

My guests are State Senator Julie Mayfield, retired physician Bruce Kelly and Missy Harris, who recently left Mission Hospital after five years there as a chaplain. 

They talk about the potential for competition with Mission in the regional healthcare marketplace. We get into any role Dogwood Health Trust could play, along with the efficacy of independent monitoring. We also talk with Mayfield about her conversations with some Mission board members responsible for approving the sale to HCA. Lastly, my guests talk about what they believe needs to happen to make things right with Mission Hospital, including potentiall selling the hospital back into nonprofit hands.

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Transcript

Matt Peiken: We started talking about Reclaim Healthcare and we got back into what's been happening with HCA, let's get back to Reclaim Healthcare.

Who is part of this coalition? Give me a sense of the people and industries involved. 

Julie Mayfield: Yeah, and let me answer, actually go back to another question that you asked, which was where did we come from? And it's all related. So this past fall, there were a number of things that, that happened. We started reading and hearing a lot about the diminishment of oncology services.

Things in the ER were just getting, disastrous. And the attorney general started paying attention. He, sent out some letters demanding information from HCA. We had physicians from Messino Cancer Center saying we're not going to be, we we're not sending our patients to mission some class of our patients to mission anymore.

So things were starting to build. The momentum and that's really when we came together. That's when I made that phone call to Bruce and said, look, five years ago we had a, an impactful statement by elected officials about what was happening this year. I think the most impactful [00:36:00] statement that we can make would be one from physicians.

And Bruce might regret that he picked up that phone, but he he worked with a handful of physicians to draft a letter that he can talk more about. That was a letter that again, was presented to the independent monitor at their meeting in October about just the vast diminishment and degradation of not only the quality of care, but the quality of our healthcare community in our region.

And that was the letter. That was the that was the catalyst for the group that has come together since, and we can talk more about that, but Bruce, I don't know if you want to talk about that. Yeah, let's 

Matt Peiken: talk a little bit about the letter, and now I know since the initial drafting you've had more signatories on it.

What was the general gist of this letter, and what did you hope to achieve by sending it to the independent monitor? 

Dr. Bruce Kelly: I think, as I said, I had a lot of catching up to do last fall and I think over, I don't know, a week or 10 days, I must have talked [00:37:00] to several dozen of my former colleagues who had been in the community, through the sale, and I just, I was just, frankly, stunned at what I was hearing.

I it took me a while to believe it, but eventually I did. And, as we have used the word degradation of this collegial and collaborative physician led community that we had all been a part of for decades, and it was just gone. Within years, they had erased our institutional memory and so fortunately was able to get, 40 physician signatures for that letter within two weeks that we read to the independent monitor.

And we spoke to the concerns that we had. Both about quality of care, but about the loss of the culture that really was the underpinning of what we were able to build. Because what HCA has brought is completely antithetical to the culture that really allows physicians to [00:38:00] be the best that they can be.

And it was just very clear that was gone. And so we felt a need to speak to that and since then have continued to reach out. And we're up to, as of yesterday, 254 signatures. About 30 of those are anonymous. Because of this intimidation and fear of retribution that is so widespread in the community.

Physicians are just many strong minded, strong willed physicians are afraid to speak out for fear of the harms that HCA could bring either to their programs or to their staff or to initiatives that they're supporting. To try to improve care and it's just, Missy used the word unconscionable and it is.

It's unconscionable. It's unethical. And it just flies in the face of everything that the best in healthcare should represent. 

Matt Peiken: So obviously, so doc, this letter from doctors was the rocket fuel, initially to launch this. [00:39:00] Who else is represented in this consortium? 

Julie Mayfield: After Bruce and after that initial group of physicians came together my next phone call was to Missy.

So Missy and I had connected a little over a year ago. I think it was last May. It was right after, right about the time you were leaving. That's right. And we did not know each other, but we were, we got connected and we spent probably an hour on the phone one day as I was driving home from Raleigh where she was pouring all of this out to me.

And at the time I didn't have anywhere for that to go, but with working with these physicians and getting the commitment that we are going to build something I reached back out to Missy and I said, I now have a place for your. Your energy and your anger and your passion to go.

And she immediately jumped in. And that, that then led to us reaching out to other to organizations that are already working on this issue. So the [00:40:00] health equity coalition is one that group actually came together during the sale of the hospital to advocate against the sale of the hospital.

Search up in Mitchell and Yancey counties, which came together when labor and delivery services were eliminated at Blue Ridge hospital. And that was under old mission. So that HCA doesn't get dinged with that that organization came together. And then we just, it really was just word of mouth.

Yeah. of people who brought different perspectives. So we have nurses, we have clergy, we have other elected officials. Mayor Maureen Koppel off in Brevard has been very outspoken about this. Mayor Patrick Taylor in Highlands, even though his hospital is a well functioning hospital and his constituents are happy with that hospital.

Many of his constituents end up coming here. To this hospital, and he is well aware of the problems and is very concerned about those. So we just kept [00:41:00] Expanding out. I mean y'all help me who are some of the other folks we have at the table 

Dr. Bruce Kelly: We have community representatives you know a number of leaders in the community So we've worked hard, to build a broad based coalition.

I think we have 23 members of reclaimed health care WNC community Right now, and we have a host of community supporters we have met with many organizations in town. We've talked to really countless individuals, and essentially no one is happy. Yeah, 

Julie Mayfield: and let me correct that. I just want to make, it's not a correction.

So when Bruce says we have 23 members, we have 23 members of what I would call our steering committee. And that group, from basically October. Until earlier this year, maybe March was meeting every week for about two and a half hours to, and that group again expanded over time to the 23. So that is the group.

Those are the leaders of the coalition. And then we have, [00:42:00] since we launched Missy can talk about the hundreds, literally hundreds of people who have signed up To, to become part of the work that we're doing. Yeah, I don't, I just don't want people to think that we're only 23 people.

No, it is vastly broader than that. 

Matt Peiken: Let me ask you. Whether there's hundreds or even thousands of people who are, Part of this and I want to just briefly run down what I've seen is your bullet point goals of Reclaim health care replace HCA with a non profit hospital system. That seems like a huge ask Okay, number one hold HCA accountable for harmful culture and practices doctor.

You were talking about the culture. That seems so Subjective, how can you hold somebody? Accountable for a culture, that, that can bubble up from within, that doesn't necessarily come from top down, that can be from the bottom up. The last, restore best in class healthcare throughout the mission system.

Laudable goal, everybody would like to see that. What do you think you can do as a coalition that hasn't [00:43:00] happened yet to make any of these things happen? 

Julie Mayfield: Oh, I think there's a lot. If you really look at it the only things that have happened to push HCA to do anything differently have been the Attorney General's lawsuit last December, the findings of immediate jeopardy and EMTALA violations and other instances of substandard care by CMS earlier this year. And then, most recently, a finding by the Dogwood Health Trust's independent monitor that they have that they are, they have violated some terms of the asset purchase agreement. There hasn't been any kind of coordinated effort to hold their feet to the fire, and our coalition is working, On a number of levels to to bring that pressure to bear the way that we think about it is, there's there is not one thing that is going to allow us to reach our goals.

It's going to be it's going to be multiple pressure points. I come out of the environmental world and what we say is that there's no [00:44:00] silver bullet for climate change. There's silver buckshot. And I think about that. I use that analogy in this case as well, there, there are already multiple pressure points on HCA and we are going to be creating more.

We are creating. 

Matt Peiken: Yeah. What I understand and tell me if I'm, my memory is off on this, but that mission is that second most profitable hospital in the HCA chain. They could look at all this pressure and say, you don't ultimately have any power to, the cynical view of this. They could say, look, we bought this, we're giving good health care, we've got these high scores, regardless of what you doctor have pointed out as the serious flaws in this system, but we've got these high scores, we're doing, we're giving great care, and, this deal is done and we're, they're not going to say we're making money hand over fist, but what's their incentive to surrender this hospital back into a non profit system?

Julie Mayfield: They don't [00:45:00] have it quite enough yet But we think they will. There will be a point, and we don't know where that is, that, that decision is only going to get made in their C suite. But there will be a point where the combination of these pressure points will and a lot of it has to be financial.

We're not naive about that. We're not going to win this fight by writing letters. That's not what's going to happen. But there will be a point where the public pressure, the media pressure, the legal pressure, the regulatory pressure, the legislative pressure, the financial pressure will come together and they will They I am convinced that they will leave 

Matt Peiken: one of the things that comes up occasionally I see that there's a proposal to have more hospital beds in the region and there's bids that go out to You know that different hospitals put in to have more beds 67 more beds here 23 more beds there and mission isn't winning those You know that there are other hospitals that are being able to add [00:46:00] beds and mission has fought that to me You Again, tell me if I'm naive in this.

Is there any competitor that could come in and offer an alternative to Mission that would steer people to seek their health care out through their system in this region and force their hand that way, or is that is Mission just such a huge monolithic force that no matter how Whether, oh, 63 more beds here, 27 more beds here, that's, doesn't matter to us.

It can competition, doctor, make a tangible difference in this region? 

Dr. Bruce Kelly: Yeah, I think without a question. And that's what you're seeing. Advent, has their beds up, in the northern part of the county. Novant has come in with applications for beds. Novant has been very present here for the past year, maybe two years.

Two, trying to fill gaps that have just developed because of what HCA has done. So I think without question, competition will help because [00:47:00] right now HCA, they're the only game in town but we do know, and we hear these stories all the time. More and more people are going to ADVENT or to Pardee if people have choices about going to other, medical centers that are hours away for elective care, they're doing so and so competition without question is one of those levers that, we are grateful, to see, you asked earlier about, the culture and just what role that plays, but right now there is a corporate driven culture that goes by a playbook.

That HCA uses to maximize their profits to the benefit of their shareholders and their executives in contrast to this collaborative collegial physician and nurse led culture That was all pulling together to provide the very best care possible for everybody in the western region And that is what we had for decades and that is now gone and we want that 

Matt Peiken: We 

Dr. Bruce Kelly: also want back the [00:48:00] trust and the pride that we had in mission.

Because it's gone. And it's gonna, it's not going to be easy to build that back. But we are determined to do everything we can to make that happen. 

Matt Peiken: You mentioned Novant and Advent. And I'm curious, have you had conversations as a collective or are you, Going to with either or both of them about becoming part of What your mission is with reclaim health care to try to pool their resources and their ability to?

Increase competition. Is there anything there? Are they aligned with your mission? Are they at are they? What's so allies are they allies of what you're trying to do or because of who they are do they have to keep a distance and Run their business is the way they're running them and if they can compete great But they don't want to get involved in this larger effort.

Where does that stand? 

Dr. Bruce Kelly: We you know, we're certainly having conversations with everyone and that would include, [00:49:00] those two those two non profit, systems. But I think, we're all on parallel paths with kind of a, a central, meeting point wherever that may be, and we don't know what that's going to look like.

But we all want safety, quality, a collaborative culture, and restore the trust that we had in what health care can be delivered at mission. 

Matt Peiken: You mentioned the independent monitor that Dogwood Health Trust is that has appointed as part of the agreement to be with the sale, is there any teeth to this monitor?

What are they monitoring? And if they have to report to dog, which was Dogwood, which was created because of the sale, is there a general conflict of interest there, just by the very nature of how this independent mon quote, independent monitor was appointed or no? Is there a real substantive independent monitoring happening, and if so, what are they looking at?

Julie Mayfield: Yeah I think there is a real independence there. There was a little, forming, storming, norming at the beginning of Dogwood Health Trust. [00:50:00] Some members of the mission board were put on the Dogwood Health Trust board. That Concerned a lot of people that there wouldn't be any kind of independence.

But we're not in that place anymore. And the Dogwood Health Trust Board is made up of great folks from all around the region. And they're not, these are not folks. Who were connected, who were on the board and were connected to the mission board when the sale happened, there are people like Jack Cecil, I would say, who's who personally and his family, have Deep routes with Mission Hospital but not involved around the sale.

So I do think Dogwood is an independent organization. Yes, they're funded with the proceeds of the sale, but that's what has to happen when a for profit buys a non profit. The proceeds of the non profit the the value of the non profit has to be used for non profit purposes. So that's, It's nothing nefarious there.

And I just 

Matt Peiken: want to put some context, Dogwood is far and away the most resourced non profit in [00:51:00] this region now. Far and away, there's more money with Dogwood than any other non profit here. I just wanted to give that context. 

Julie Mayfield: And I think it's even bigger than that. I believe they actually per capita might be the most well resourced foundation in the entire state.

Because again, they, because of the geographic. limitations on where they can spend their money. So it's, we have an incredible jewel in Dogwood Health Trust in terms of the resources that it can provide this region and that it is providing this region. So the foundation and the funding part is most of what Dogwood does, but they do have this obligation under the asset purchase agreement to monitor the, HCA's compliance with the asset purchase agreement.

And there are, there are real things there. As we mentioned earlier, the asset purchase agreement requires certain services to be provided at the various hospitals for certain periods of time. And that requires monitoring. And for [00:52:00] instance, that last December, that's when Josh Stein stepped in and said, you are no longer providing.

sufficient ER and oncology care to comply with the asset purchase agreement and the note the Just this week or last week I guess Dogwood Health Trust, their board, came out and said the same thing. We find that, we find, they have to say potential violations because that's the language in the agreement, but essentially, they have said we agree that, That HCA breached the agreement last year in terms of providing these services.

And then there were some other and that was a first, 

Matt Peiken: we have not heard that was a first. So what are the, that was huge, absolutely huge. What are the potential consequences of Dogwood saying that is, is that seems to be. Pretty big, I would think, but are there ultimately any consequences if HCA's board just decides to shut the curtains?

Julie Mayfield: So this gets [00:53:00] back to that agreement the asset purchase agreement and how incredibly lopsided it is and How missions staff lawyers and board allowed this agreement to get approved? I have no idea. It is incredibly it is so one sided in a normally in an agreement like this for failure to for failure to comply with the agreement, you would have penalties, you might have fines, you might have what are called liquidated damages, which is these are just these are damages that begin to accrue when there's a violation of the agreement and you don't have to go to court to get them.

You don't have to. They just happen. There would also be a lot, metrics about, Quality of care standards of care levels of staffing. There's dozens of things that you could have chosen They could have chosen and they didn't choose any of them So I think it just gets back to the point that this was very much an HCA driven agreement and the remedy that Dogwood Health Trust has if they find a breach of the agreement Is to try to bring HCA into compliance truly through [00:54:00] conversations.

Yeah, you can and possibly litigation if they cannot get to a place of agreement, Then dogwood has the option to file suit against HCA In the same way that the attorney general did last year 

Matt Peiken: and what's happening with that lawsuit that Josh Stein filed 

Julie Mayfield: So my understanding is that lawsuit is proceeding.

They are They are in discovery, which is they're sharing a lot of documents back and forth and that, that lawsuit will work itself out 

Matt Peiken: in years, it could take, it will take years, it 

Julie Mayfield: could take years, it could take months, likely HCA will file a motion to dismiss or a motion for summary judgment, which asks the judge to make a finding that, regardless of even assuming everything in the pleadings is true, that they still haven't violated the agreement.

So a judge will have an opportunity in a matter of months. It could be six, eight, ten months. 12 months, but over the course of the next year, we will hear from a judge that will [00:55:00] give us some sense of the judge's interpretation of the agreement. 

Matt Peiken: Let me ask you, and before we wrap here, Julie, you've been in this community a while you probably, tell me if I'm wrong on this, do you personally know any of the mission board members?

Anybody? You're nodding yes. That you know some of the people who were responsible for this sale. Have you? We've had off the mic, off the record, conversations with any of them, and if so, can you give us a sense of what those conversations have been like? 

Julie Mayfield: I have had conversations with some of those folks, and here's what I'll say, there is There's a thirst on the part of our community for change.

Those board members to renounce, repent disavow the decision that they made. My view is it is pointless to ask for that because we are not going to get it. That was a group of people who made a decision based on the information in front of them and [00:56:00] they made it. It was done. It's a done deal. We are where we are.

It doesn't serve anybody. It doesn't serve anybody for those folks to come forward and say we made a mistake. It 

Matt Peiken: does. That's wrong. I don't believe that's pointless. 

Julie Mayfield: But it doesn't. But it doesn't, again, it might make people in this community feel better. And I don't, I acknowledge that's important.

From my perspective, it doesn't move the ball forward in terms of fixing the care at the hospital in terms of getting HCA out the door. It doesn't move the ball forward that I'm trying to move forward. You don't think even in a lawsuit sense. But here's where I think they could, that group of people can be very helpful.

And this is what I have said to them. They are a unique group of people in our community. They did make this decision. They were in direct conversations with HCA leadership for months. About this, and I think the value that they can bring right now [00:57:00] is to acknowledge as some of them have publicly that things have not worked out the way that they expected that there has been damage to the health care community in our region to the hospital to quality of care and for them, if I could wish one thing, it would be for them to go to the HCA leadership and say, This ain't, this has not played out the way that we all thought.

And we need you to do better. And here are the ways in which we expect you to do better going forward. To 

Dr. Bruce Kelly: be clear. Just to add. Go ahead. Yeah, go ahead. I think it's also important to say that the board, we're not alone in buying what Ron Paulus was promoting. There were a lot of good people, including many physician leaders.

Who also thought that this was the right thing to do not just in our community, but in some of the surrounding communities and many of them have said this very thing that [00:58:00] they were sold a bill of goods They believed what Ron Paulus was telling them. And so even though the board is who made the decision They were not the only ones Who agreed that this was the right thing to do?

Matt Peiken: That's important context because I was just going to ask you, Julie, whether what you were hearing from the board members you think was honest, like we didn't know, like that they, I was just going to ask your interpretation of that. 

Julie Mayfield: Absolutely. I think they were told exactly what we were told, which is that there will be economic efficiencies and that things will not really change at the hospital.

And I don't think. I think if any of them could have envisioned what has happened to our hospital, I think if any of them had an inkling of it or any sense that this is where we were going, I would like to think that as leaders in our community, that they would not have made this decision. 

Matt Peiken: Yeah, Missy, are you still in touch with your colleagues there and [00:59:00] former colleagues and what's your sense of on the ground?

What? What's the tenor of working there and inside, is there any protestation happening from inside? The pressure that you're putting on through Reclaim Healthcare, is there a pressure campaign happening from inside? 

Missy Harris: Yes, there is. I am still in touch with not just my colleagues on the chaplain staff, but across the hospital, physicians, nurses, other support staff, and what we're hearing regularly and it's not.

Information that's just coming to me, but what we're hearing regularly is that the stories that came out in this report earlier in the year, situations and experiences are continuing to occur within the hospital system for staff and for patients that are reflective of this major report that we received earlier this year.

In fact, in response to when we launched a Reclaim Healthcare WNC Missions PR person responded they're just resharing old information [01:00:00] and on the surface, it may look like that's what we're doing, but underneath that, what is compelling us to continue to raise our voices and to continue to pull people into this conversation is the fact that we are still hearing stories day after day that reflect the kinds of circumstances that we're in.

HCA was cited for by the Centers for Medicare and Medicaid Services. And there are a couple of things that I just want to make sure that we include in this. One goes back to the conversation around other healthcare systems and whether they are able to purchase mission should that opportunity arise.

And I, you all can correct me if this isn't an accurate statement, but I understand what we're doing with Reclaim Healthcare, WNC, that. It reaches beyond what we're asking of HCA, that they either leave the community or that we hold them accountable in some way, that we see ourselves as [01:01:00] the eyes and ears of this wider community, that no matter who ends up owning this land.

mission health system that there is a community effort and group coming together to keep eyes and ears open to what's happening. Because no matter who owns the system, we are going to be holding them accountable to quality patient care metrics. And we're going to be continuing to Collect and encourage people to report to the regulatory agencies those stories that are counter to that Did you want to add anything to that 

Julie Mayfield: you're spot on?

Missy Harris: Nobody 

Julie Mayfield: gets a pass just because they're a non profit system. Yeah, whoever buys the system will know that they are coming into a The community of Asheville, which has very strong feelings about lots of things, including this. 

Matt Peiken: Is there anything we haven't talked about or talked about enough where we short skirted because we got onto another subject.

Do you think it's important to give more detail about or [01:02:00] context? 

Missy Harris: Yeah, I bet you're going there. I'm sure you go ahead. 

Dr. Bruce Kelly: We just want to be very clear as we have all along just how much respect and admiration and gratitude we have for the staff that are working there. Showing up every day and doing their best.

We just, we're just so grateful for them and we hope that everyone who listens to this or reads about it, when they go into that hospital, they express their thanks to whoever is taking care of them for doing the best that they can. With the resources that are available, and that there are still pockets of excellent care at Mission, thanks to the dedication of the staff who are showing up every single day doing their very best.

Great. 

Matt Peiken: Missy, you want to close? 

Missy Harris: Yeah, I have one, one last thing that, that I want to add, and it goes back to a question you that you raised. You asked earlier, what makes y'all think you're going to succeed at this? Because it is a daunting task. [01:03:00] HCA is this, he's a huge corporation with lots of resources and.

I am asked that question, yeah it seems impossible, but any social or cultural change in this world is often against huge odds. And any change any culture or social change that happens because people band together. Raise their voices and demand something better. A friend of many in this community, David Lamont just released his TEDx talk that was an editor's pick.

And in that, he speaks to this idea of a hero narrative versus a movement narrative. And when I listen to his TEDx talk, I, It was so encouraged because my experience in working with this group of people, this is not a hero narrative. There's not one of us that's flying in and suddenly making everything's better and then [01:04:00] sailing away.

This is a true community movement that is trying and working to build a broad base of support to Bring the people of this entire region together, because this is impacting not just folks here in Asheville, but all of Western North Carolina, and it's going to take all of us coming to the table, raising our voices, sharing our stories, and using all of that energy and social capital to move the needle in this, whether it's getting HCA out of the airwaves.

Western North Carolina or continuing to hold them accountable in whatever ways that we can with the power of community. And I'm deeply encouraged by that because that's exactly what is happening within this coalition. 

Matt Peiken: Thank all of you. I could talk to you about this for another hour, but I've kept you here long enough.

So thank you so much for being part of this conversation. Thank you. Thank you, Matt. Thank you.