Lawsuit against Mission Health "could have an impact nationwide," says law professor
ASHEVILLE, N.C. (WLOS) — A class action lawsuit filed against Mission Health claims the hospital system has become a monopoly that's been overcharging patients for years.
The lawsuit was filed in August this year by six plaintiffs.
In a two part series, News 13 is investigating the details of the complaint, who's behind it and who could benefit from a possible settlement.
'COULD BE LANDMARK LITIGATION': NC TREASURER, PATIENT ADVOCATE WEIGH IN ON LAWSUIT VS. HCA
ONE PARENT'S STORY
When four-year-old Pheonix got sick in August, her mom knew something was seriously wrong.
"She wouldn't eat, she couldn't do anything," said Tiffany Grzankowski.
She tells us Pheonix's doctor was so concerned that they were sent to the Emergency Room at Mission Health.
Grzankowski tells us when they arrived, she felt like the hospital staff wasn't concerned about her daughter's condition.
"Everything was really looking not good with the labs and nobody could give us answers and it just seemed like nobody at the hospital really wanted to help," said Grzankowski.
Grzankowski says after bloodwork, they were sent home, with labs that showed a diagnosis of Hepatitis A.
But the next day, Pheonix was still suffering and returned to the ER. Tiffany says once again, they were sent home pretty quickly.
She says she later found out the diagnosis given at the hospital wasn't correct.
"Then they call from the health department and said no, they didn't test for Hepatitis A, they tested to see if she had the vaccine," Grzankowski said. "And that's kind of like, I think my heart just dropped, honestly."
So this whole time she was suffering, she was in clear pain, but there was no fluids, no nausea medicine, nothing at all was done.
She later learned from her doctor that Pheonix had mono.
"They need to do better, they need to do better," Grzankowski said. "It's not that I'm saying it's a horrible hospital and I don't want them here, I just want them to do better."
She tells News 13 she's aware of the recently filed lawsuit and thinks it's needed to bring change to Mission.
Weeks after the incident, Grzankowski tells she was finally able to sit down with Mission Health leaders.
“I feel the people with Mission were genuinely apologetic about what happened and took the feedback made to make some real changes," she said.
She said Mission plans to put new procedures in place so that what happened to her daughter doesn’t happen again.
THE LAWSUIT AND ITS SIGNIFICANCE
Tiffany's experience is echoed in the 87 page class action lawsuit filed against Mission Health.
The lawsuit was filed by two law firms, Wallace & Graham and Fairmark Partners LLP.
The defendants include HCA Healthcare, HCA Management Services, Mission Hospital and ANC Healthcare.
The six plaintiffs include Will Overfelt, Richard Nash, Jonathan Powell, William Davis, Katherine Button and Faith Cook.
Some of the plaintiffs say the quality of their healthcare has dropped because of Mission's sale to HCA. Others claim their health insurance premiums have risen because of the company's monopoly.
Overfelt is an Asheville resident who started a Facebook group for those concerned about the hospital.
In the lawsuit, he says he saw firsthand through his father's treatment in 2020 that the "quality of care was clearly worse after HCA bought mission".
Powell lives in Morganton and says his doctor left Mission because "HCA overwhelmed him with so many patients."
In the suit, Davis says HCA closed his doctor's office completely.
But besides complaints over how Mission cares for its patients, the class action lawsuit also claims that the hospital has been a growing monopoly for years, resulting in higher healthcare prices for everyone living in the mountains.
News 13 wanted to get some perspective on the lawsuit, its allegations and the likelihood that it will move forward in court.
Barak Richman specializes in anti trust healthcare law and is a law professor at Duke University.
He has also been followed Mission Health's story closely for years.
I'll tell you one thing that's immediately consequential about this lawsuit, the people of Western North Carolina now know or should know that they pay more than they should for healthcare, that's part of the complaint.
The lawsuit walks through Mission's past, back to 1995. That's when the hospital merged with the only other major hospital in Asheville at the time, St. Joseph's Hospital.
That move could have violated the anti-trust law, since it created a monopoly with no competition. But, North Carolina passed a special measure allowing the deal - what's called a Certificate of Public Advantage, or COPA.
The lawsuit claims the regulation was supposed to protect patients against higher healthcare costs, but in 2016, it expired.
"This, I think proves, definitely both the increase in prices and the subsequent sale to a for-profit entity that the COPA wasn't a good idea and my reaction was, I'm sad but I'm not surprised," said Richman.
The lawsuit claims that even under the COPA, Mission bought more hospitals and practices to "build an unprecedented empire" while hiding the growing cost to patients.
According to the lawsuit, a year later, secret negotiations began with HCA.
"I think the value of Mission to HCA increased dramatically after the COPA ended and that's just simple economics," said Richman.
Richman believes that's when the hospital's power and prices jumped dramatically.
"We have a monopoly that at least temporarily was blessed by the state but then we saw monopolistic, arguably illegal, conduct after the COPA ended," said Richman.
The lawsuit includes four counts: Violation of state antitrust law, attempted monopolization, restraint of trade, and injunctive, equitable, and declaratory relief.
We asked Richman what he thought the chances were that this lawsuit would move forward and be successful.
"I think it depends on what you mean by success," he replied. "I think that the likely course, the most likely course is that there will be some kind of settlement and the devil will be in the details."
Richman says Mission could be forced to follow different contract pricing practices, which could send a powerful signal to other hospital monopolies.
"What happens in Asheville really could have an impact nationwide," said Richman.
He goes on to say that any money in the settlement would, in a sense, be less important than any order for the hospital to change its practices.
"When these lawsuits get settled, there always is an injunctive element," Richman says. "It's not just that the hospital has to pay for the bad practices of the past, but they have to promise to stop doing things in the future and that could be really significant. The total dollar amount might be significant, but it's not really about compensating parties that overpaid, it's more about making sure this doesn't happen again," he said.
GROUP OF NC RESIDENTS FILES ANTITRUST LAWSUIT AGAINST HCA HEALTHCARE
MISSION'S RESPONSE
We asked Mission Health about what happened to Pheonix, but were told the hospital couldn't comment. A spokesperson for the hospital says she also can't comment on the pending lawsuit.
News 13 did receive this statement from Nancy Lindell, a spokesperson for Mission Health:
Mission Hospital cares for hundreds of our community members each day and our goal is for each and every person to receive compassionate, quality care. We encourage anyone who has a concern to call our patient experience number at 828-213-1210.
SIMILAR LAWSUIT
A similar lawsuit was filed against Sutter Health, the largest hospital in Northern California.
Before it went to trial, a settlement was reached, and the hospital had to pay $575 million dollars.
In addition, Sutter Health was ordered to change some of its practices, including increasing transparency, limiting out-of-network prices and to stop denying patients access to lower cost plans.
You can read the complete response from California's Attorney General on the settlement HERE.
WHAT'S NEXT?
The next step is for Mission to respond to the lawsuit through court. Then, a judge will decide whether the case will move forward.
Coming up tomorrow night, Sept. 16, News 13 continues to investigate the lawsuit, looking into the data about Mission's prices and News 13 does its own comparison of costs at local hospitals.