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Macon residents unhappy with hospital transition

Ron Winters with Gibbins Advisors talks to Franklin residents about the firm’s role as an independent monitor of the Mission Health-HCA Healthcare sale. Jessi Stone photo Ron Winters with Gibbins Advisors talks to Franklin residents about the firm’s role as an independent monitor of the Mission Health-HCA Healthcare sale. Jessi Stone photo

The independent firm responsible for ensuring HCA Healthcare complies with the terms of its purchase agreement for Mission Health Systems held a public meeting in Franklin on Thursday, but residents were frustrated to learn there’s not much Gibbins Advisors can do about their complaints. 

“We can’t answer all your questions,” Tom Urban with Gibbins Advisors said before the meeting got started. However, he said Gibbins would be happy to pass along all feedback to HCA representatives when they meet with them soon.

Gibbins was contracted to be the watchdog, ensuring HCA meets all of the stipulations included in its purchase agreement to buy out nonprofit Mission Health Systems. HCA made 15 commitments in the purchase agreement, including retaining specified services and hospitals under Mission’s umbrella; to invest $232 million into capital improvements across the system; to set up a $25 million innovation investment fund; to invest in community health and wellbeing programs; to complete the Mission North Tower project in Asheville; to build a replacement hospital for Angel Medical Center in Franklin; to build a 120-bed behavioral health facility in Asheville; to adopt a new charity care policy that is an improvement over Mission’s policy and to submit annual reporting to the independent monitors through the advisory boards for each hospital. 

The room at the Robert C. Carpenter Community Center was packed with more than 50 people — most of them extremely frustrated with the way operations at Angel Medical Center have changed since HCA took over almost a year ago. Many people shared stories of improper billings or said they’d never received a bill before it was sent to collections. 

Others talked about incidents where it took more than 10 hours to get a transport from Angel Medical to Mission Hospital in Asheville for a service or procedure. Person after person described their experiences as “unacceptable” and “unconscionable.”

Brittney Lofthouse spoke about her experience after being involved in a car wreck when she was 34 weeks pregnant. Since Angel Medical Center closed its labor and delivery unit in 2017 before HCA bought Mission, Lofthouse had plans to deliver at Harris Regional Hospital in Sylva. The wreck caused her to go into early labor and she delivered her son at Harris before he had to be transported to the NICU at Mission in Asheville. 

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“I didn’t even get a chance to hold him before they took him to Mission and then Mission said they didn’t have a room for me and couldn’t even send an ambulance for me,” she said. “I had to be discharged six hours after a C-section just so my husband could take me to Mission so we could be with our son. Had I been able to deliver him here this wouldn’t have happened.”

Jennifer Turner-Lynn with REACH of Macon County said she never had an issue before HCA took over with getting a forensic nurse at Angel Medical to evaluate strangulation or rape victims, but now she said 99 percent of time one isn’t available and the nonprofit has to drive victims to Asheville for an exam.

“If Angel does the transport, the amount of time the victim must wait for an ambulance is unconscionable,” she said. “The last rape kit I did, I took them to Mission and we were there for 13 hours — this is just one of many examples.” 

Turner-Lynn said REACH had never had a problem with a rape victim being billed for the use of the emergency room and now victims are being billed for that at Mission. She said a client received a $1,000 bill from the ER and the only service she received was getting a rape kit performed.

Another incident involved a victim staying at the REACH shelter who had a stroke. Macon EMS took her to Angel and then she was transported to Mission. When she was released, she needed to stay with a family member to continue recovery. Turner-Lynn said usually the hospital is responsible for returning a patient to their county of origin, but that’s not what’s happening anymore. 

“Mission said we had to pay $300 to transport the victim back to Macon County. These are significant issues impacting rural residents — putting homeless and poor people in those positions to not get back to their county,” she said. “I’ve tried to reach out to resolve the issues but the ability to access someone is impossible. When services were local it was much easier.”

Franklin Mayor Bob Scott agreed there’s been a lack of communication and a major disconnect between the community and HCA. With the perception in the community being that the new Angel Medical Center will be a glorified transfer site to Mission Hospital in Asheville, residents want to hear what services will be provided from new owners HCA.

“As mayor, I haven’t been able to talk to any HCA folks — I would be happy to show them around and educate them about the community,” he said. “The other big question is what will happen to the old hospital?”

Macon County Commissioner Ronnie Beale said the county sees huge potential in the existing hospital and stakeholders have been having conversations about how it could continue to benefit the community when the new hospital is built on U.S. 441. 

“The county couldn’t buy it ourselves, but there’s so many options for that building — a VA hospital or behavioral health,” he said. “With state and local involvement I think it’s a viable building for the community. It would be a nice gesture for HCA to sell it to us — we’ll buy it for $1.”

Beale also said the county’s EMS services has seen an uptick in transports to Mission from Angel. EMS is averaging five to six trips per day to Asheville and Macon taxpayers are footing the bill because Medicaid reimbursement does not cover the actual cost of transport. With Macon County’s aging population, Beale said he’s concerned those costs will continue to rise. 

“We’re already a transition hospital. They (HCA) need to understand where our population is going. Health care is more and more important and the availability of health care. Getting from here to Asheville is a huge deal,” Beale said.

Ron Winters with Gibbins Advisors said many of the complaints didn’t fall within the Independent Monitor’s purview but that they would be able to pass along the information to HCA representatives. Winters advised local residents to reach out to the CEO of Angel Medical Karen Gorby with concerns. Gorby was present at the meeting but didn’t speak to any of the concerns of residents.

Several speakers said they had tried to reach out to Gorby, HCA and other leaders at Angel Medical with no luck. Pat Thomas said she had a friend experiencing abdominal pain and was diagnosed with appendicitis at Angel Medical. However, Angel didn’t have a surgeon available to do the routine laparoscopic surgery so he had to be taken to Mission. She said it took 11 hours for him to get to Mission and then the doctors there were also backed up and couldn’t get him into surgery until the next day. In the meantime, his appendix ruptured, which means the surgery was more invasive, his recovery time at the hospital was much longer and of course his medical bills will be more expensive. 

Thomas said she emailed HCA headquarters based in Tennessee and received a rapid response saying the complaint would be sent to the authorities at Angel Medical. She then received an email from Gorby stating that “those things happen” and that “sometimes we don’t have specialists at Angel.”

“So lots of luck contacting HCA. Karen Gorby is way over her head in my opinion,” she said. 

Gorby did respond to a few emailed questions from The Smoky Mountain News stating that she thinks the transition with Mission-HCA Healthcare has gone very well, but that there are always opportunities for improvement. 

“Being part of HCA Healthcare has provided Angel Medical Center with information to improve the care of our patients and has provided us with resources to improve the structure and operations of our hospital,” she said. “Additionally, HCA Healthcare construction has been instrumental in the planning and design of the new hospital to ensure the same level of services will be continued in a state-of-the-art facility.”

As for the concerns from community partners like REACH, Gorby said a meeting has already been scheduled with the nonprofit to develop a plan of action for the future. 

“In the past, the relationship with REACH has been very collaborative and when I am aware of patient concerns, I work to resolve them,” she said. 

If someone wishes to bring forward a concern, Gorby said they can call Angel and speak with her directly or ask for the quality manager. They can also reach out to her via email at This email address is being protected from spambots. You need JavaScript enabled to view it.. 

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