Written by Andrew R. Jones, Asheville Watchdog.
Dogwood Health Trust has announced the appointment of the new independent monitor responsible for ensuring HCA Healthcare lives up to the commitments it made when it purchased Mission Hospital for $1.5 billion in 2019.
Affiliated Monitors, Inc. (AMI) will replace former monitor Gibbins Advisors, Dogwood announced in a recent news release.
AMI will be responsible for ensuring HCA complies with the Mission asset purchase agreement (APA) and 15 conditions reviewed and approved by North Carolina Attorney General Josh Stein in 2019. They include restrictions on closing or selling facilities, commitments to continue to provide certain services, and the continuance of Mission Hospital’s charity care policy. Separately, HCA made certain capital expenditure commitments at the time of the sale.
AMI’s work for Dogwood, will focus on four primary responsibilities:
- Evaluation of HCA’s own annual compliance report
- Community engagement and education
- Engagement with the attorney general’s office
- Continuous compliance evaluation
Dogwood spokesperson Erica Allsion said community meetings with AMI are expected to begin this spring.
“(Meetings) will be held throughout the region including in Transylvania, Buncombe, McDowell, Yancey counties, and the Highlands and Cashiers area. Community members are welcome and encouraged to attend these meetings,” Allison said.
She did not answer questions about whether those meetings would be open-mic sessions where members of the public could talk to the monitor about their concerns in front of the whole room, like they did in the 2022 and 2023 Gibbins meetings.
Dogwood would not share information about how much it paid Gibbins or how much it will pay AMI. It also would not provide AMI’s proposal, which was one of 10, Allison said.
“Out of respect for privacy and fairness to all concerned, Dogwood does not share sensitive information about contracts and amounts paid to our subcontractors and vendors,” Allison told Asheville Watchdog. “We take our role in stewarding the resources of Dogwood Health Trust very seriously and conducted a thorough process to ensure fair market value.”
AMI has handled numerous federal, state, and private enforcement actions, tracking compliance with government regulations and industry practices in public utilities, financial services, insurance, manufacturing, healthcare, construction, transportation, retail and commerce, according to its website. Based in Boston, it has offices in several cities including Los Angeles and Washington, D.C.
Dogwood, created from the proceeds of the Mission sale, monitors and enforces HCA’s compliance through the independent monitor. If the independent monitor found any noncompliance, it would be required to inform Dogwood, which could then begin a dispute resolution process with HCA.
Gibbins’ most recent compliance report to Dogwood, filed last year, found no compliance violations at Asheville’s Mission. But in mid-December, North Carolina Attorney General Josh Stein filed a lawsuit against HCA and Missionon behalf of Dogwood, contending that they were not living up to two of 15 commitments in the APA, specifically not keeping oncology and emergency care services at Asheville’s hospital at the levels it committed to at the time of the sale.
HCA countered in February that it never committed to providing quality health care and that the APA is “silent as to the quantity or quality of services required” at Mission.
“AMI was selected as the Independent Monitor after a thorough and thoughtful RFP process,” Dogwood CEO Dr. Susan Mims said in the release. “Their focused experience in monitoring was a distinguishing characteristic that helped inform our selection. In fact, monitoring is their only business.”
The release also included a statement from Stein who said he appreciated Dogwood’s efforts to conduct a thorough search for a new independent monitor.
“I’m hopeful that the new independent monitor will provide effective oversight of HCA Mission’s healthcare commitments to the people of western North Carolina,” Stein said.
Mission Health spokesperson Nancy Lindell said the six-hospital system looked forward to working with AMI.
“We are working to develop a full understanding of the issues that Dogwood, HCA, the North Carolina Attorney General’s Office and the communities served by each of the hospitals have been facing,” AMI president Vin DiCianni said. “It will take the dedicated efforts of all parties to make the objectives of the Asset Purchase Agreement successful. We look forward to working with the parties, stakeholders and community.”
Gibbins curated a public website during its time in western North Carolina, putting documents, meeting transcripts, explanation and an archive of helpful information related to compliance.
That website is currently down.
“The independent monitor website will be transitioned over to AMI and that will be updated soon,” Allison said. “Once these resources are available, they will be posted on Dogwood’s website. AMI will also be setting up a hotline for community concerns and we expect to see that operational this spring.”
Shortly before Dogwood put out the call for a new independent monitor, the U.S. Centers for Medicare & Medicaid Services found that Mission was in immediate jeopardy, the most severe sanction a hospital can face, and had racked up numerous deficiencies and violations of federal standards for hospital care, including a violation of the Emergency Medical Treatment & Labor Act (EMTALA).
Those deficiencies contributed to the deaths of four patients between April 2022 and November 2023 and endangered several others, investigators from the North Carolina Department of Health and Human Services found during an onsite visit in November.
While the federal government lifted the immediate jeopardy status, Mission faces a June 5 deadline to fix the deficiencies or face losing federal funding, which would threaten its financial viability.
Earlier this year, Dogwood announced it was expanding the scope of work for the independent monitor, saying Stein’s lawsuit prompted more community engagement than originally envisioned. Dogwood solicited bids and Gibbins, the independent monitor since HCA’s purchase, declined to submit one.
Asked in February why Gibbins didn’t reapply for the position, co-founder and Managing Director Ronald Winters told The Watchdog it was a “good time to pass the baton to someone new.”
The next APA compliance reports are scheduled to be completed this spring.
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email [email protected]. The Watchdog’s reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/donate.