How can $1.5 billion transform the health and wellness of Western North Carolina communities for decades to come? That’s the question Dogwood Health Trust’s Board of Directors is currently asking itself since the new foundation was tasked with spending the proceeds from Mission Health’s sale to HCA Healthcare last year. 

After a months’ long battle, Mission Health hospitals and its affiliates will be back in Blue Cross Blue Shield’s network as of Dec. 15.

2003

Carrie Blackburn Brown, who eventually founded Kory Wawanaca Children’s Home, graduated from Appalachian State University with degrees in dance and Spanish and a general desire to spend a few months abroad volunteering.

That last full day in Tacachia, I didn’t have energy for much besides sinking into my wooden chair while waiting for the onslaught of elementary-aged kids to join us for pre-dinner playtime.

Shane Claiborne was a couple minutes late for his interview with The Smoky Mountain News, but for good reason. Claiborne and his entourage of Philadelphia friends-turned-family had encountered some crawfish that needed catching, and the job required a couple of extra minutes to splash in the creek. 

Angel Medical Center in Franklin officially came under the umbrella of Mission Hospital System this week, a move Angel leaders say will help improve health care for patients and the hospital’s bottom line.

I followed the Janet Moore controversy from the beginning to its conclusion, which was all of three days. The former vice president of marketing for Mission Hospital made a mistake — a mistake that became very public — and paid a high price by losing a job she had held since 1991.

What seems obvious is that Moore was a casualty in a war that involves politics and medical market share, and that the war is far from over. She got caught in the crossfire.

This controversy, however, is also about cultural understanding and the words we use and knowing that what is acceptable in one conversation may be totally out of line in another place at another time. Moore crossed a line, and it cost her a career. In many instances, however, that line is not so clearly marked.

Wrangling over market share

For those who don’t know what I’m talking about, here’s a short version. An audio recording of Moore speaking at a medical marketing conference earlier this year became fodder in the raging debate among healthcare institutions in Western North Carolina about Mission’s operating agreement with the state.

An excerpt from her comments at that conference was played at a public hearing on Thursday, Oct. 20. She countered that her comments about Mission’s market share were taken out of context. So Park Ridge Hospital officials, who released the earlier, edited version, put her entire conference presentation up on a website. She resigned on Friday, Oct. 21. The Asheville Citizen-Times reported the story on Saturday, Oct. 22.

Here’s what led to Moore’s resignation. At that conference, she told an anecdote about visiting a woman way up in a holler in Haywood County. Here’s how an article by Jon Ostendorff and John Boyle of the Asheville Citizen-Times on Oct. 22 described what she told that audience:

In the recording from the Society for Healthcare Strategy and Marketing Development conference in September, Moore told an anecdote about taking her elderly parents to a remote part of Haywood County.

Moore said they encountered a woman at her trailer “that had in front of it some used appliances and old cars, which is not an unusual sight in our part of the country.”

Moore’s father wanted to know what some pens were in the backyard. At this point, Moore mimicked the woman living there with her “best Haywood County accent,” saying the pens held fighting roosters and curly horned sheep.

“My father said, ‘Lady, what do you do with these things?’ And she said, ‘I sell them on the Internet,’” Moore said. “True story. So here you have this woman in a holler in Haywood County — clearly not investing in dental care, I can tell you — and she is doing e-business. With illegal animals, I might add.”

In the audio recording (which can be found at www.wncchoice.com/, go down to picture of Janet Moore and then click on “full presentation” button, and then go about 7 minutes and 20 seconds into the audio to get to the controversial part), Moore’s portrayal of the Haywood County’s accent and her reference to “not investing in dental” care are in poor taste. The ACT story quoted both the chairman of the Haywood County commissioners and the head of the Tourism Development Authority criticizing Moore’s use of stereotypes to describe county residents.

Moore made a mistake. In the audio, she follows up her negative comments by saying that you can’t stereotype rural mountain people, that these folks way back up in the woods are Internet savvy.

Unfortunately, in this case it became clear very quickly that the end did not justify the means.

It is what it is

But what about the comments? Anyone completely outraged about the description? Where do we draw the line when talking about groups of people?

First, of course, is the fact that Moore was in a position where she is paid to say the right things. If you’re a spokesperson or marketing person, a slip of the tongue can be expensive for the company you represent.

In my private life, seldom does a day go by that I don’t hear similar derogatory comments — jokes, by another name — about Yankees and Floridians, or the “left-coasters” in California. As a Southerner who has done a bit of traveling, I’m used to snide or trying-to-be-funny insults coming my way (still happens everyday in television and in movies) about being from the South and living in the Appalachians.

Is it OK for someone here to talk about rude, sarcastic New Yorkers with Yankee accents but not hillbillies with bad teeth and a mountain twang? I guess it’s all about context and timing. Moore’s remarks became a firebomb in the political battle about Mission’s market share. At a different meeting in a less contentious situation, they might have been shrugged off as just being in poor taste.

(Scott McLeod can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..)

The medical community in Western North Carolina is embroiled in a debate over Mission Hospital — should its influence and reach be reined in or given the freedom it needs to serves as the region’s health care leader?

A state committee is examining whether Mission needs more checks on its health care monopoly, and will hold a public hearing on the issue at 6 p.m. Thursday, Oct. 20, at the WNC Agricultural Center in Asheville.

Physicians in surrounding counties fear encroachment by Mission could siphon patients away from their local hospitals to Asheville, despite the same quality of care and caliber of physicians serving in their community closer to home.

“You have to have a certain volume of business to be viable,” said David Markoff, an ophthalmologist in Haywood County. “At some point, you reach this tipping point where you can’t keep quality health care locally because the physicians aren’t busy enough.”

Mission has made overtures to buy physician practices in Haywood County and has set up an outpatient clinic for doctors from Asheville to hold office hours in Haywood on select days. If successful, this could result in patients being sent to Mission for procedures and take business away from MedWest-Haywood.

Janet Moore, vice president of communications for Mission, said Mission is trying to fill in gaps of medical specialties that aren’t accessible now, citing a doctor shortage in America that could grow more acute for the region.

Yet that doesn’t explain why Mission is courting local doctors to join its payroll, nor accounts for all the doctors, including general orthopedists, coming over the county line to set up shop in Haywood.

Graham Fields, a spokesperson for Park Ridge Hospital, said Mission’s maneuvers could ultimately undermine patient choice by squelching the free market.

“Missions’ success is inversely proportional to small hospital’s success. As Haywood gets better at keeping patients at home, Mission loses business and has to get more aggressive,” said Fields.

Mission currently attracts about 32 percent of Haywood County’s impatient market share.

Mission sees itself unfairly placed in the crosshairs, however.

“Rather than stepping back with the patient at the center saying what’s right for the region, we have a lot of politicking, frankly,” Moore said.

Mission, however, isn’t the only one playing offense. Carolina’s HealthCare System has brought four hospitals in the region — including Haywood, Jackson and Swain — under its management umbrella. It is based out of Charlotte and dwarfs Mission.

“Carolinas has a footprint that reaches from Murphy to Manteo,” Moore said.

Mission seems to be concerned that Carolinas could funnel specialty care away from it. It is a troubling prospect as Mission’s thin margins grow even thinner. More patients lack insurance and are being written off as charity cases, while Medicaid and Medicare continue to reduce their level of reimbursements to hospitals.

“What you have is a pie that isn’t getting any bigger,” Moore said. “Nobody can afford to lose market share. Everybody wants to stay where they are or get better.”

Markoff said Asheville has attracted lots of doctors since it is such a desirable place to live.

“Asheville has too many physicians for the patients in Buncombe County. They have to pull patients in from surrounding counties to keep their physicians happy,” Markoff said.

Mission is governed by anti-trust regulations dating back to its merger with St. Joseph’s 15 years ago.

“We are the most regulated hospital in the state of North Carolina and in the United States. We live under a microscope and have for 15 years,” Moore said.

Mission sent out a mass email to employees and community members encouraging them to come out and voice support for Mission.

“If you are an employee who is planning on attending and would like a boxed dinner, please click below,” the email read.