ASHEVILLE — Letters supporting the proposed Mission Health sale to HCA Healthcare outnumber opposition to it by a more than 6-to-1 ratio, with many arguing the deal offers long-term benefits and protections for residents of Western North Carolina, records provided to the Citizen Times show.

The deal has received broad-based support in letters sent to North Carolina Attorney General Josh Stein's office, most of which have come since Mission and HCA signed a sale agreement in August. Stein and the state's Justice Department are evaluating the transaction to determine if the proposed $1.5 billion sale price is appropriate and whether the deal offers enough protections to Mission's five rural hospitals, among other concerns.

State law grants Stein the option to sue to block transactions in which a nonprofit entity is being sold to a for-profit company, as is the case in the Mission-HCA deal.

RELATED:

► WNC residents want more protections for rural hospitals in Mission-HCA deal

► Mission Health agrees to $1.5 billion sale to HCA Healthcare

►OPINION: Racial disparities in health are real. The Dogwood Board should reflect that

Roughly 70 percent of the 94 provided letters — the vast majority of which are penned by regional nonprofit and municipal leaders — are supportive of the transaction. Many also champion the creation of Dogwood Health Trust, a successor foundation that proposes to make annual grants that could total $50 million or more to address the core social determinants of health in the region.

"Dogwood Health Trust could be transformational for our community," Asheville Mayor Esther Manheimer wrote in an Oct. 30 letter of support. "Targeting all its resources, strategically and thoughtfully, to address the social determinants of health, it has the potential to be a change-maker for Asheville, Buncombe County and Western North Carolina."

Stein's office said this month it has received about 180 constituent emails and letters referencing the deal.

Story continues below

Of the provided letters, 17 express concern about the transaction, about HCA, a Nashville-based for-profit hospital conglomerate, as well as its anticipated impact on Mission's five smaller hospitals in Brevard, Franklin, Highlands, Marion and Spruce Pine. Ten letters to Stein's office oppose the deal.

They include people like Biltmore Lake resident and attorney Andrew D. Atherton, who wrote about his "grave concerns" in an Oct. 19 letter to Stein. Atherton said he questions the accuracy of information provided by Mission and its administration, citing a negative experience involving his daughter.

"I certainly hope that your office is taking a deep dive into the finances and how Mission has treated residents of WNC," Atherton said. "I do not think that the sale proposed has anything to do with helping WNC but padding the pockets of those in power at Mission Hospital."

A compilation of letters provided by Stein's office is posted below.

Stein's office has up to 60 days to file a lawsuit once it has gathered all of the applicable information it needs to review the transaction. Laura Brewer, the department's communications director, said Thursday that Mission and HCA are "continuing progress on providing our office with the information we need."

The 60-day clock has not yet begun, Brewer said.

Stein told the Citizen Times this month the department continues to ask questions related to the deal, and declined to say when the process might end.

"So many people's futures are at stake," Stein said previously. "We want to do everything in our power to make sure that the people of Western North Carolina get the quality of health care that they deserve."

For

Much of the support for the deal touts the benefit of Dogwood as well as HCA's proposed facilities investments such as building a new, 120-bed hospital in Asheville to treat people with behavioral health issues. Those are just two of the major takeaways supporters say will benefit the region when the seven-hospital system joins HCA.

Most letters were submitted to Stein in mid-to-late October following a Sept. 30 private forum hosted by Mission at the U.S. Cellular Center in downtown Asheville. Mission and HCA provided documentation of the deal to the state Justice Department heads earlier that month.

Rowena Buffett Timms, Mission's senior vice president for government and community relations, said hospital leadership asked community leaders to write letters in support of Dogwood, and by extension, the deal. Timms said Mission felt "very comfortable" doing so because of its "deep relationships with these community leaders," and because of how Dogwood grant funding will address regional drivers of health.

She called Mission a respected organization facing "organized and often inaccurate opposition and publicity," but noted it was imperative letters of support be sent only if community leaders were "comfortable and agreeable with doing so."

"Given that specific direction from the Attorney General’s office, we adopted that means as the most appropriate way for community members to engage, have their voice heard, and speak personally as to the impact the pending transaction – or lack of it – may have on their community and/or organization," she said.

Quite a bit of support provided to Stein's office comes from established community and hospital leaders.

In an Oct. 16 letter, Pat Smith, former president of the Community Foundation of Western North Carolina, writes with support of the creation of Dogwood, singling out its inclusion of Asheville-based attorney Wyatt Stevens as a bright spot on its board.

Story continues below

"The Dogwood Health Trust, if managed with humility, integrity, open dialogue with the community and transparency, can make an unprecedented difference across our mountains," Smith said. "In most cases, the trust will not need to reinvent the wheel. There are many excellent programs and willing partners across our region to help 'address the social determinants of health.'"

Dr. John A McCoy, former chairman of the Highlands-Cashiers Hospital board who retired in 2017, offered his "unreserved support" of the sale in an Oct. 23 letter. McCoy cited the behavioral health hospital and Dogwood as benefits as well as a $15 million investment into a Highlands legacy foundation and the creation of a $50 million innovation fund.

"I believe (Dr. Paulus) and his team have a genuine concern for our community and would do nothing to negatively impact its health and well-being," McCoy said.

A number of high-ranking Mission employees are among those to offer letters of support. They include Karen Gorby, president and chief nursing officer at Angel Medical Center; Marc. B. Westle, Mission's senior vice president of administration; and Dr. Jacqueline Medland, president and chief nursing officer at Highlands-Cashiers Hospital.

Marion Mayor Stephen R. Little, a former McDowell Hospital board member, did not mince words in his letter.

"Please do not be swayed on this highly critical issue by cynical, suspicious or whining comments from people whose vision and perspective may be limited or motivated by other reasons," Little said.

Franklin resident Linda Straufe, who identifies herself as a Mission employee, offered a different perspective in her Oct. 11 letter. She asked Stein to approve the sale because the hospital system is "not taking any action to improve anything or hire anyone until the sale is complete."

Straufe called the work environment "controlled chaos," and asked the AG to push the deal through.

"The facility I work at is in desperate need of attention but we are unable to get the basic help/attention we need," she said. "The employee morale is at an all-time low, people are leaving for other jobs, even if they have to work in another state."

Against

Opposition and concern also are represented in letters to Stein's office with the most prominent gripe related to the racial and gender composition of the Dogwood board.

The board has drawn heat in recent weeks after Asheville Buncombe County NAACP President Carmen Ramos-Kennedy called for some of board members to step aside to create a body more broadly representative of the region. At the time of her critique, eight of its nine members were white and seven of nine were men.

Stein also expressed some concern in December about the board and whether it's truly representative of WNC.

Dogwood's board added two new members earlier in December: Vivian Bolanos, a banker from Henderson County, and Jacquelyn "Jackie" Shropshire Simms, a retired hearing educator and administrator from Buncombe County.

"It takes many perspectives to find the solutions to embedded societal challenges," Ramos-Kennedy said in Sept. 25 letter in conjunction with nine organizations including the ACLU Western North Carolina Chapter and Carolina Jews for Justice/West. "While many may see points of division in the region, we believe that DHT has a unique opportunity to transcend separations of geography, population density, race, ethnicity, and gender."

But Buffett Timms pushed back on the notion Dogwood board should reconsider its nominating process.

"We appreciate that 'some' will request things that they perceive to be in their interests, whether appropriate or not," she said. Buffett Timms added the Dogwood board has adopted a "deliberate, best-practice process" for selecting additional directors.

The board has made an "intentional pledge" to serve the 18-county WNC region, she said.

Other feedback on the deal is varied. Candler resident Marshall Brown asked Stein to deny the "takeover" of Mission by HCA given the region's limited competition from other hospitals.

"Allowing this takeover is not going to resolve this," Brown said.

In an Oct. 12 letter, Asheville resident Steve Legeay suggested Stein do "all in your power to oppose" the deal.

"I do not believe this sale will operate to the benefit of the people of Western North Carolina," Legeay said. "It will substitute profit maximization for HCA shareholders for community direction and operation. Control will effectively pass from our region to a removed set of corporate directors."

Arguably the strongest letter of concern comes from a group representing four regional health organizations: Bakersville Community Health Center, Blue Ridge Community Health Services, High Country Community Health Center and Western NC Community Health Services. They argue proceeds from the deal will not be allocated "equitably," but in a manner "that furthers the interests of HCA, Mission and Mission's partners."

Among several issues outlined in a six-page letter, the organizations take issue with Mission's links to Appalachian Mountain Community Health Centers, or AMCHC, a Federally Qualified Health Center network that operates in Buncombe, Jackson, Graham and Cherokee counties. It notes the signed agreement between Mission and HCA references Dogwood and Mission's intent to maintain or establish relationship with FQHCs — which, they argue, may inequitably favor AMCHC.

Story continues below

"We suspect that such language was included to preserve Mission's longstanding support of AMCHC, rather than to reflect a commitment to supporting our network of safety net providers," they said.

Black Mountain resident Jim Hillegas, however, says in an Oct. 23 letter that the best course of action would be to hold off on the deal. He argues that the U.S. will have a "Medicare for All"-type health care system in the coming years, and that such a system would allow Mission to "operate efficiently and serve all the community needs without the hitches and challenges of the current insurance-based environment."

"I see every good reason for delaying this merger which has community downsides and may be needless in a few short years due to the reasonable revamping of our health care system," Hillegas said.

Want to comment?

The state Justice Department still is accepting public comment on the proposed sale of Mission Health to HCA Healthcare by telephone at 1-877-5NOSCAM or through an online form at ncdoj.gov/complaint.



