The Transylvania Times -

Many Questions Posed At HCA Meeting – Brevard, NC


Last updated 2/17/2020 at 2:18pm

Editor’s Note: Last Thursday, The Transylvania Times published the first part of an article on a town hall meeting arranged by Gibbins Advisors, a health care consulting firm, in which the Transylvania County community expressed frustration with the quality of care at Transylvania Regional Hospital (TRH) under HCA’s ownership. The meeting was held at the Unitarian Universalists of Transylvania County. At the meeting, Ronald Winters, principal and cofounder of Gibbins Advisors, presented the firm’s role as the “independent monitor” that gathers feedback and reports it back to HCA. This second and final part includes questions and comments and Winters’ response.

Billing problems, reductions in staffing, volunteers and quality of service, and confusion over whether or not the Transitional Care Unit (TCU) was actually closed, were among the issues that surfaced throughout the meeting. Winters said there were some questions to which he did not have an answer and that some issues weren’t within his purview. Most of these speakers at the meeting did not identify themselves.

•“Shame on you HCA, because you’ve been charging for preventative care services when that’s covered and mandated by the Affordable Care Act, and you’ve been charging it as outpatient services, so I would like to know how you are compliant with the Affordable Care Act,” said a female speaker, who said she works for a primary care provider not associated with Mission. She said has to schedule testing, radiology and lab appointments, but that the “entire scheduling department at Transylvania Regional Hospital has been eliminated,” as well as bookkeeping.

She said it also took her five days to schedule an emergency radiology appointment.

“That’s a shame,” she said. “This is a hospital built by the community and for the community. If you want to be a community hospital, they (HCA) need to take consideration of the patients.”

She added that she just had a total knee replacement.

“I ended up at Transylvania Hospital, after the fact, because I wouldn’t have had the surgery done at Transylvania because the care unit shut down,” she said. “It’s a ghost town. It has no volunteers; they have asked the volunteers to basically stay home.

“There is nobody at the front desks, there is no one there to greet you and there is no security. It’s a good thing someone didn’t come in there with a gun because they would have had access to the entire place.”

•The second speaker said she was a heart surgery patient and had been “warned” by her own doctor about the new billing practices of HCA, but that she would have to sign something to agree to the billing practice.

“I didn’t sign anything and paid my copay,” she said.

After getting sick in December and later in January, she said she paid her copays at the doctor’s office.

“That should have been all I had to pay, but, suddenly, I am hundreds of dollars in debt to Mission Hospital because they suddenly changed their billing practice with no disclosure in any of those visits,” she said.

Her second experience came after a car accident in July 2019.

“I have Medicaid through my car insurance, and I’m a teacher, so I wanted to get all of this taken care of before I went back to school,” she said. “By August, I made sure it was all taken care of, but I started to get bills from Mission and threats that they were going to collection. I spent an hour and a half one afternoon with billing in tears, paid $100 because I didn’t want them to go to collection, and the next month I went through it all gain with a $600 bill, but I didn’t pay it that time.”

Her insurance company told her it obtained and cashed the check. She then talked to her car insurance company again and got proof that they had the check. A Mission billing person then told her to get a copy of the check and fax it to them.

“Who knows how many hours and tears I’ve put into this,” she said. “I just can’t talk on the telephone for hours during the day because I’m a teacher, but just recently with that doctor’s appointment that I had, the nurse practitioner said if you don’t get better give me a call. I didn’t get better. I needed another round of antibiotics.

“I called and spent an entire 35 minutes of my lunch break on the phone listening to the music because you can no longer can call a doctor’s office directly. I listened for my entire 35-minute lunch period. No one ever picked up, and I had to hang up the phone and go back to class. It was 24 hours before I could get my medication. I still can’t hear correctly out of one ear, nor can I afford to go back to the doctor to get that treated, because I’m hundreds of dollars in debt from the experience.”

•The third speaker said he was “getting the impression this meeting might be worthless” and suggested at some point Transylvania Regional Hospital will be closed.

•Brevard City Councilwoman Maureen Copelof also spoke during the meeting. In addressing the confusion on whether the TCU was closed, the quality of care and staffing, and HCA’s “commitment” to not close facilities for 10 years, Copelof invited Winters to tour TRH with her.

“I would like to have you physically walk through the facility,” she said. “I would like to go over with you to the Transitional Care Unit that everyone is saying is closed. HCA is using a different term. They don’t say it’s closed; they say it’s been temporarily shut down, or something.”

Copelof said she doesn’t want to play with semantics.

“I sat there in good faith representing people in this community, and listened to them assure me that these services weren’t going to get closed, and they are being closed,” she said. “And I will meet anyone and go over to that hospital and walk though it because I don’t think you can get a good feel for what’s happening in our facility without physically going over there and seeing for yourself what has really happened. I really think we have some compliance issues that need to be brought up whatever that chain of command is, and it’s not just about taking notes. These are real compliance issues that are impacting our community, and I think you can really see the degree of frustration.”

Winters told Copelof he toured the hospital in November.

•Speaker five asked what the firm can offer in its role as an “independent monitor” to those who are concerned about the quality of care, staffing and keeping facilities open.

Winters said his firm’s role is to advise the “seller representative,” which is ANC Healthcare and, ultimately, Dogwood Health Trust, in enforcing HCA’s compliance with the 15 commitments required by the state’s attorney general, including keeping facilities open for 10 years.

“The information we get from meetings like this is the most useful thing we can get, and it causes us to follow up with HCA and view the facility ourselves,” he said. “But at the end of the day, I’m listening carefully to everything being said here, and we review the transcript. It’s possible that some of these things don’t fall within the compliance obligations.

“But I’m not going to sit here tonight and make the determination if it does or does not. We are listening very carefully. We will take it all in and decide if it gives rise to compliance issues and if more questions are required. This is an information gathering for us. We aren’t the party that solves these problems. The basis for this is to gather information and provide it to HCA.”

•Transylvania County Commissioner Paige Lemel also addressed the meeting.

She asked about the advisory boards referenced in Winters’ initial presentation. Winters said his firm is advising the advisory boards of each hospital. Each advisory board is comprised of eight members, including four members appointed by HCA, while the other four are appointed by the directors of the original hospital prior to the sale. These advisory boards are required to consent to any changes in the 15 commitments.

If HCA requests “relief” from any of the commitments, there needs to be consent of the advisory board.

“Does the local advisory board have the ability to override the 10-year commitment if someone wanted to buy the hospital or if HCA wanted sell it before that 10 years?” Lemel asked.

Winters answered, “The local advisory board, based on my understanding, in the event that HCA wants to sell or close a facility, in order to do that, they need to request a variance from the agreement rather than from the 15 points. If they make that request – (and) to my knowledge no such request is pending, and I asked the regional leadership today if any such request is pending, and they said no – they would have to go to the local advisory boards. The local advisory boards would have to provide a consent if it thought it was appropriate, with some determination standards, and they would also have to get the consent of the ‘independent monitor’ if they wanted to do that.”

Lemel said the county’s Public Health Department is “struggling in finalizing contracts for mammograms that fall within the state funding guidelines and that has caused the Public Health Department to go to other hospital systems to try to provide that service for its citizens.”

Additionally, she said, because the county has no birthing center, it’s been hard to get follow-up records on mothers of babies born in Buncombe County at Mission Health.

Another issue is problems getting records on communicable diseases.

“The (county) health director did want to communicate that she has a great working relationship with the staff there, but it’s just the time in providing information on communicable diseases, which as you can imagine is a very hot topic right now,” Lemel said.

•The seventh speaker asked if there were fines if HCA is not in compliance.

“I don’t know the answer to that,” Winters said. “I know that they are required to comply, but I don’t know what penalties there are for noncompliance.”

•The eighth speaker said he had been a patient in the North Tower (at Mission) “thanks to a good ER doctor in Transylvania and a trauma surgeon,” but that when he arrived at the North Tower, he was “appalled by the lack of nursing help.”

“The nurses were overworked, and there was no cleaning staff,” he said. “We did not have time or access to cleaning materials, so my projectile vomiting from major GI issues stayed on the bathroom floor for three days in the surgery ward.”

He said he could hear people in other sections yelling for help.

“It was pathetic,” he said.

•Speaker nine asked rhetorically that if the decision of closing a hospital is based on an advisory board made up of four people from HCA and four people from ANC Healthcare, “what do you think will happen?”

•Speaker 10 said he believed HCA “has a slow-motion train wreck going on here with billing.”

“I just happened to get involved a couple of weeks ago and found myself arguing with them over a $15 copay,” he said. “I find myself asking why are they spending all this money over a $15 copay, and then I got another bill in which they had billed for a day that didn’t even exist. So, there is double billing that might be going on here. There is the possibility that if they are billing their insurance companies that there is Medicaid fraud, so I’m really concerned where this is going.”

•Speaker 11 asked what the community could do to help the “independent monitor” perform its job.

Winters said the information gathered at the town hall meetings is helpful and will request more data and a follow up on enquiries.

“We are 101 days into this engagement,” he said. “We are just getting started familiarizing ourselves with everything.

At one point he said that “on the surface,” some of the statements and questions he was hearing did not convey compliance.

“But I don’t want to judge standing here,” Winters said. “I want to listen and consider there may be something I’m not catching. We want to think about it, read the transcript and think about it again. There is a pretty good chance a number of the issues are outside our purview. We give all of the information to HCA, so they can act on it, and the things within our purview we determine if action with our client is required.”

•If there is a requirement to keep the TCU open, and someone said it was closed though Winters was told it was open, how is compliance achieved, speaker 12 asked.

“Is it over the phone?” she asked. “Is it in person? Is it going down there and physically seeing that the criteria is being met?”

“There are number of ways to determine it,” Winters replied. “For example, I have been told that it is not closed. You say, ‘It’s closed.’ So, now we dig deeper. We ask more questions. We go see for ourselves. It could be a number of different things. There is no specified way of doing things. The information starts with the information. You assert that it’s closed. I’m not arguing that. We are going to ask for data. Now the question has been raised. Several people have said it’s closed. I’m hearing one thing, and someone else is saying another thing.”

•Speaker 13 asked “why it takes someone from this group to tell you it’s (TCU) closed,” and if he was checking with what he is told by HCA, himself.

Winters answered, “We are not onsite. That’s not how this works. I haven’t any data yet. I’ve been told by HCA it’s not closed. You say it’s closed. Fair enough. We go and investigate.”

•Sam Edney, a candidate for N.C. House District 113, asked about the size of Gibbins Advisors’ staff and if the information gathered at the town hall that falls within the firm’s purview will “go into some circular file and disappear forever, or will there be some transparency provided for all of these complaints that are coming from real people.”

Winters said the firm has 11 people, with four in particular working on this project.

“We are gathering all kinds of information,” Winters said. “We ask that you speak into the microphone because we are recording it. Then, we get a transcript, and we are also getting information by email. “We’ve got some phone calls. We are getting it on the Internet, on the website, and we are cataloging forward and turning it over to HCA because they are the entity that can do something about it.”

•Speaker 14 asked how to “compel” HCA to come forward and organize a town hall in which people can get answers other than “I don’t know, or, is HCA afraid to come forward?”

“I’m a retired superintendent at a state prison, where I was for 15 years, and when my boss called and let me know he was coming to inspect, I made sure I had extra staff, the place is going to be spotless and everything will be in order,” he said. “What I’m getting at is – do you announce or tell HCA that you are coming, or do you do surprise inspections?”

Winters said he does not speak for HCA.

“If you want HCA to do a town hall then I suggest you speak to HCA about that,” he said. “To the second part of your question, I have not done unannounced visits. We are not checking out the restroom floor for vomit or other things. We are checking to see if they are continuing those agreed services. That’s done best with data.”

•Speaker 15 said she is the practice manager with Blue Ridge Community Health Services.

“I think we all came here tonight expecting that we would be able to ask questions and get an answer, but it seems that’s not the case,” she said. “We have patients who visit the ER. Then, in their follow up with their family care physician within the five-to-seven days, we get no reports, and we have no idea why they were there. We have no idea what medicines were changed or given, what they were treated with, nothing. You call for medical records, forget it. It can take 10 to 20 days at minimum to get those reports. I have spent hours on the phone with Mission and Transylvania trying to get access to read only access. I just want to let everyone know we are not affiliated with Mission, or HCA, and we are taking new patients every day.”

•Speaker 16 said it was “cowardly” of HCA not to have a representative at the meeting to provide answers.

“As far as alternatives, maybe our county and city officials might help us, but our attorney general is running for re-election, and I do think that in some way there should be some kind of petition because the Asheville meeting has been exactly like this meeting, and I think that (Attorney General Josh Stein) needs to hear what the results of this has been with a whole lot of signatures on it,” he said.

•Speaker 17 rec-ommended an action plan that involves a forensic audit of the billing department, as well as examine the decrease in staffing. Winters said that billing issues would not fall within the firm’s purview.

•Speaker 18 said she believed the public was “being set up.”

“We are getting poor service, and we the consumers are ready to go to Pardee,” she said. “If we the consumers go to Pardee, then we leave our doctors without patients, we leave our hospital without the data that you are looking for and they will close the hospital. The other part of my statement is that I think it’s also important for us to understand what the penalties are of noncompliance, because HCA is a multibillion-dollar corp-oration. They are simply going to look at whether or not they can just pay the penalties.”

•Copelof asked that now that Winters has heard the concerns of the community, how will the community get feedback.

“How does this community find out where you are in the process?” she asked. “How do I as an elected official get feedback as to what your findings are are? Is there transparency?”

Winters answered, “How it looks back to you with transparency, I’m not sure I can answer that standing in front of you. I need to determine what’s permitted and not, but I do know we advise our client on enforcing compliance.”

•Speaker 19 identified himself as a retired employee of HCA who retired to Brevard in 2018.

“Folks, I’m going to be an unpopular person here tonight,” he said. “I hope you don’t have rocks in your pocket to throw at me.”

He said he was “mortified” by the “horror stories” he was hearing at the meeting.

“That is not the company that I worked for 10 years and that I love,” he said. “I know you don’t feel it, and I know you don’t believe it, but HCA is an incredible corporation.”

He said he was at the meeting because he, too, was having billing issues and wanted to speak with the available representatives after the meeting who were there to address them.

“(HCA) are going though some transitional stuff right now, but the plan and simple truth is, if Mission Health weren’t struggling in some sort of way and looking for suitors to be acquired, this never would have happened,” he said. “HCA’s long-term obligation here is to stabilize Mission and to stabilize Transylvania, making them permanently viable in this community.”

•Speaker 20 said that people have been “happy” with the medical care and practitioners, whom she said have been “demoralized by what they are seeing now.”

She said part of her job involves communicating with those in the medical field.

“They are afraid they are a part of the problem even though they are not a part of the problem, but they are powerless,” she said. “One practitioner told me that he had a monitor who went in to check that he didn’t spend more than 10 minutes with any one patient, and if he spent 12 minutes with that same patient, he was written up.

“So, there are two sides to this story. We are confused and unhappy as the patients, but so are the practitioners.”

•Speaker 21 said he worked for 15 years with the volunteers of the hospital foundation to help raise money. He worked at Ecusta, he said, and the employees donated money out of their salaries on a monthly basis.

“As far as I’m concerned, HCA could care less or they would be here tonight representing themselves instead of having people to represent them,” he said. “I think one thing we need to do is to have the whole county sign a petition against HCA. I think a petition will stand out.”

Speaker 22 was Gil Newbury.

“Can somebody tell me if it is really 2020, because these stories I’m hearing tonight sound like they are out of the Middle Ages,” he said.

As a multibillion-dollar corporation, HCA, he said, can buy out the competition and run the system into the ground and then abandon it.

“What do you expect when you put the words ‘for-profit’ and health care in the same sentence?” he said. “I have friends who are ex-pats who I used to work with who retired to Central America and they laugh at me. They don’t deal with this down there and their health care costs are one third ours.”

He said people are “always afraid of what they don’t know,” while there are presidential candidates “out there right now touting different ways of handling health care.”

“Pay attention,” he said. “Educate yourself and vote. Because if you don’t, you are going to keep getting what you always got.”

•Speaker 23 said hospitals shouldn’t be for profit.

“I worked for the VA for decades,” he said. “Can you imagine if the VA was for profit? Everyone here has anxiety that frankly people in other countries don’t have. They look with horror. They can’t even understand or comprehend that you could be medically bankrupt. That’s the number one cause of bankruptcy: medical illness. You can lose your home because you got sick, and then you have collection agencies coming after you when you were sick. I think that goes beyond the pale. It’s a real moral issue. So, HCA has a lot to account for.”

•Speaker 24 was Dr. Ruffin Benton, who said he was “embarrassed and ashamed” by what he’s heard in the meeting.

“I’m on the board and I will take these concerns to the board, and we will talk about how to deal with these issues,” he said.


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