4H0-004 mission - HCP-Hyperion System 9 Financial Management 4.1 Updated: 2024

The XP-1 offers several advantages over electric hypercars, thanks to its extremely quick filling time and 1,000-mile range, as yet unsurpassed by any electric vehicle. Adaptability to all weather conditions is another area where Hyperion's creation outperforms EVs: unlike an electric car's batteries, the XP-1's state-of-the-art supercapacitors are not negatively affected by extreme temperatures, which makes them more resilient to any kind of weather.

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These are just a few of the reasons why Hyperion CEO Angelo Kafantaris is adamant that hydrogen cars, not EVs, represent the future of mobility: the XP-1 is part of his attempt to sway public opinion and open minds towards alternative fuel sources.

The Children's Hunger Outreach Hunger Program serves hundreds of schools in the area to make sure tummies are full over the weekend.

North Carolina’s attorney general is suing HCA Healthcare, alleging the for-profit hospital chain has “degraded” the formerly nonprofit Mission Health.

Attorney general Josh Stein’s complaint, filed Thursday, accuses the country’s largest hospital chain of failing to provide the emergency and cancer care it had promised to keep intact. Its nearly 60 pages describe a catastrophic state of dysfunction at Mission’s flagship Asheville hospital. They contain stunning allegations of patients being treated in waiting areas within full view of other patients, nurses emptying trash bins and delivering food, and patients found dead in emergency room beds hours after they died.

“For-profit HCA has broken its promise to the people of western North Carolina and to my office,” Stein said in a statement. “Quality health care is too important — in some cases, a matter of life and death. But HCA apparently cares more about its profits than its patients.”

The lawsuit follows a STAT investigation into the problems that have erupted at Mission since HCA took over in early 2019. Ten current and former Mission doctors told STAT the conditions at Mission Hospital have become unsafe because so many workers left, either because they were fired or driven away by unsafe environments, tough working conditions, and low pay.

Stein says his office has fielded more than 500 complaints about Mission since HCA took over. His lawsuit claims Mission Hospital no longer meets the standards of a level II trauma center because it’s not providing the necessary emergency care. For example, best practices are for each nurse to be assigned four patients in the emergency room and two patients in the intensive care unit. The lawsuit says Mission Hospital regularly exceeds that.

With respect to cancer care, Stein notes that Mission does not employ any medical oncologists, whereas it employed five in 2021. The doctors left because they were burned out and did not have adequate staffing support, the suit said. One of those oncologists who spoke anonymously to STAT said, “I couldn’t in good faith take care of patients somewhere that I didn’t think was safe.”

Stein’s lawsuit, filed in Buncombe County Superior Court, asks the court to declare that HCA has breached its asset purchase agreement, issue a permanent injunction to restrain HCA from committing such breaches, and require HCA to provide emergency and cancer services at the level they were prior to 2019.

In an emailed comment, Mission spokesperson Nancy Lindell emphasized the fact that Stein is currently running for governor, leading with, “We are aware of the announcement Gubernatorial Candidate Stein made in Asheville today.” Lindell wrote that HCA is confident it continues to meet the obligations under the purchase agreement. She pointed out that the independent monitor appointed to oversee HCA’s compliance found no problems during its most exact review.

“Though there have been challenges, some of which we are continuing to address as we work to expand our capacity, we remain committed to serving our community,” Lindell said. “Despite the state not allowing important expansions at Mission Hospital, we will continue to fight for critical access to healthcare services for the people of Western North Carolina.”

Specifically, Stein says HCA breached a section in the purchase agreement that requires services continue to be delivered at Mission Hospital at the same level as prior to HCA’s takeover for 10 years. It includes an exception for things like “acts of nature, war, terrorist activities,” but none of those happened in this case. He sent formal notice of his finding to HCA on Oct. 31, threatening to sue if HCA did not correct the lapses.

HCA brushed off Stein’s letter at the time, writing through an attorney that Stein’s request for information was a “bald attempt to obtain pre-litigation discovery.”

Most of the complaint centers on what’s happening in Mission Hospital’s emergency department. It describes much of the waiting room being taken up by an “Internal Processing Area,” a series of bays separated by small dividers. This is where, according to the lawsuit, patients are triaged within full view of other patients in the waiting room. The bay is across from a row of chairs where patients receive intravenous treatments. These patients are not put on heart monitors or pulse oximeters, and the bays do not have basic sanitation procedures like sinks where clinicians can wash their hands. The bays and chairs are not sanitized between patients, and bodily fluids like feces and vomit are frequently seen on the floor, the lawsuit says.

Sometimes, only one nurse staffs the Internal Processing Area. if it’s full, the complaint says that means one nurse is responsible for 28 patients.

The lawsuit echoed issues raised in STAT’s reporting, including a lack of sterilized equipment, long wait times because of low staffing, and HCA’s struggle to retain qualified nurses. The complaint says about 60% of first-year nurses staffed in the Asheville emergency department left Mission this year. It notes that HCA has fired housekeepers, food service workers, and other support staff, so that nurses who are already overworked must mop, empty trash bins, and deliver food.

This understaffing puts patients’ safety at risk, the complaint says. It says patients have been found dead in emergency room beds hours after they passed. Others have gone hours without being seen by their assigned nurse.

Stein’s lawsuit says that when state health inspectors visited the emergency department last month, HCA encouraged nurses to pick up shifts “any day they wanted.” After the inspectors left, HCA again reduced staffing.

“HCA is actively choosing not to staff all the beds in the emergency department to boost profit,” the complaint says. “It is not the case that all of the beds in Mission’s emergency department are full. Rather, all of the beds that Mission chooses to staff are full.”

Stein’s lawsuit also contends that HCA’s transfer policy artificially inflates the number of patients entering its emergency department. Typically, when emergency patients are transferred to another hospital for admission, they’re admitted directly to an inpatient floor. HCA does not allow this common practice and instead requires patients transferred to Mission Hospital to present to its emergency department.

Scott Joslin, a physician who formerly led the team of hospitalists at Mission Hospital, told STAT that policy not only adds to the backlog, it results in critically ill patients getting sent back to the waiting room, where their conditions deteriorate. One patient went into respiratory failure and another in life-threatening ketoacidosis stopped receiving insulin.

The complaint also accuses HCA of impeding local governments’ ability to provide ground and air ambulance services. That’s because when ambulances show up at Mission Hospital, they’re forced to wait to offload their patients because no providers can care for them. In 2023, for example, a patient with a brain bleed was transported to Mission’s emergency department by ambulance and waited 80 minutes for a bed. A patient with a broken neck had to wait over 2 hours. A patient with stroke symptoms had to wait almost 3.

Almost daily, the lawsuit says Buncombe County, which includes Asheville, finds itself with no ambulances available out of its fleet of more than 12 because they’re waiting at Mission Hospital.

With respect to cancer care, the lawsuit says the number of fully-staffed oncology beds at Mission Hospital has dropped from 44 at the time HCA took over to 24 today. It says HCA does not maintain an adequate supply of key chemotherapy drugs or reagents necessary for lab tests because it uses a “just in time” supply chain model. Even though HCA’s current vendors can’t provide sufficient supply to meet demand, HCA is reluctant to order from anyone other than its current vendor, Parallon, a company it owns, the lawsuit says. That inadequate supply means cancer patients had had to miss chemotherapy treatments, presenting significant risks to their health.

Stein’s lawsuit notes that the region’s largest outside practice stopped providing inpatient chemotherapy to certain patients because of unsafe conditions. He said those patients must now regularly travel hours away for care. He also said that the hospital only employs one chemotherapy-trained pharmacist.

Like many of the doctors and others critical of HCA, Stein’s lawsuit at several points praised the medical providers who continue to treat patients at Mission Hospital.

“These dedicated and hardworking health care providers must find ways to care for their patients without adequate support and resources, and sometimes in unsanitary or even unsafe conditions,” the lawsuit said.

Hannah Drummond, a nurse who works in Mission Hospital’s emergency department, spoke at a press conference Stein hosted on Thursday to announce the lawsuit. Just this week, she said she worked a shift where each nurse had more than 10 patients.

“The conditions that Hospital Corporation of America have allowed to persist at Mission are shameful and unsafe,” Drummond said.

Dive Brief:

• North Carolina Attorney General Josh Stein is suing HCA Healthcare over allegations that the for-profit operator downgraded services at Mission Health’s flagship hospital after acquiring the five-hospital system in 2019.
• The suit filed Thursday alleges that HCA “significantly degraded” emergency department and oncology services at Mission Hospital post-acquisition — violating HCA’s purchase agreement not to close service lines at Mission facilities for at least ten years following the deal’s close.
• A spokesperson for HCA said the health system intends to “defend the lawsuit vigorously” and that HCA has met or exceeded the terms of its purchase agreement.

Dive Insight:

Thursday’s lawsuit comes after the North Carolina Department of Justice received more than 500 complaints about care at HCA facilities across the state, according to a statement from Stein’s office.

In late October, Stein’s office issued formal notice of his intent to sue barring compliance with the 2019 purchase agreement. Stein sent the notice to Dogwood Health Trust, the nonprofit tasked with overseeing proceeds of the $1.5 billion 2019 sale and ensuring compliance with the purchase agreement.

The notice triggered a 40-day clock for HCA to remedy the complaints of reduced access to medical services.

HCA’s legal team hit back in November, denying allegations of wrongdoing. In a letter to North Carolina regulators, HCA said its more than $12.4 million in capital investments allocated to the Mission Cancer Center since 2019 proves its dedication to oncology services.

“As the [attorney general’s office] is aware, the [asset purchase agreement] requires that the Independent Monitor annually confirm that Mission is operating in compliance with its terms, and the Independent Monitor has done so every single year since 2019,” the law firm representing HCA wrote in the letter dated Nov. 7. 

Still, Stein filed the lawsuit, citing evidence from doctors, nurses and ambulatory service providers that conditions at Mission Health’s flagship facility have deteriorated since the acquisition.

The complaint, which was filed in North Carolina’s Buncombe County Superior Court, spans nearly 60 pages. It alleges severe shortcomings at the Western North Carolina facility, ranging from lengthy wait times, to bed shortages, to patients being treated in public areas within view of other patients.

In the most extreme instances, "patients have been found dead in emergency department beds many hours after they passed,” the lawsuit said.

The lawsuit also accuses HCA of under-staffing Mission’s emergency department. At times, one emergency department nurse was responsible for overseeing 28 patients, the complaint alleges.

“Responsibility for this downward spiral rests entirely with HCA,” the lawsuit states.

The complaint asks the court to declare HCA in breach of its agreement and to issue a permanent injunction restraining the system from committing additional breaches in the future.

Stein also called for HCA to return emergency, trauma and oncology services at Mission to the hospital's previous levels of quality.

The union representing Mission nurses applauded the lawsuit, telling Healthcare Dive over email that they had filed hundreds of complaints with HCA and with state and federal regulators documenting unsafe staffing and unsafe working conditions affecting patient care since the acquisition.

In a statement released Thursday, HCA once again stressed that an independent monitor hired by Dogwood Health Trust confirmed the operator’s compliance with its purchase agreement in its most exact review.

That review occurred in 2022.

By Ben Glickman

HCA Healthcare is being sued by North Carolina Attorney General Josh Stein for allegedly violating an agreement linked to its 2019 acquisition of Mission Health System.

Stein said in a statement that HCA had failed to provide "the quality, consistent emergency and cancer care for western North Carolinians it committed to deliver."

During the holidays, the Mission of Hope partners with Dollywood to deliver thousands of gifts to distressed communities and to children in need.