North Carolina’s new Attorney General, Jeff Jackson, said Thursday he will continue the legal battle against HCA Healthcare that his predecessor, now-Gov. Josh Stein, started in December 2023.

Stein’s lawsuit, filed on behalf of Dogwood Health Trust, alleges HCA failed to maintain then-current levels of emergency services and oncology services as it promised when it bought the nonprofit Mission Health system in 2019 for $1.5 billion. 

The lawsuit alleges that Nashville-based HCA has mismanaged Mission, endangering patients and prompting an exodus of doctors and nurses, and has shuttered or reduced some services in violation of the 2019 Asset Purchase Agreement approved by then-Attorney General Stein.

“I have heard that some of their [HCA’s] attorneys were hoping that a new attorney general would drop that case,” Jackson said at a press conference in Canton. “Well, I am the new attorney general, and we’re not going to drop that case because they broke the agreement that they made with the state to provide a certain level of service, specifically with respect to emergency, trauma and oncology.”

The lawsuit was later updated to include evidence revealed after an investigation found Mission Hospital in Asheville, the flagship facility in the six regional hospitals purchased by HCA, violated federal standards of care. The lawsuit contends the finding of immediate jeopardy — the most severe sanction a hospital can face — leveled by the U.S. Centers for Medicare & Medicaid Services (CMS) in February 2024 was evidence that HCA violated the purchase agreement.

The CMS investigation revealed that four Mission patients died in two years related to those violations of care and leadership mismanagement.

Lawyers for HCA, the largest hospital system in America, countered that it never promised to provide quality healthcare at Mission.

“I believe there’s strong evidence that they have not kept up their end of that agreement,” Jackson said Thursday. “So, we’re going to keep going with that case until we get a fair outcome.”

Stein’s name is still on the lawsuit, but it’s now in Jackon’s office’s hands, according to the governor’s office.

“Attorney General Jackson automatically became the plaintiff in that lawsuit upon taking office and is now overseeing the case,” spokesperson Olivia Weidie said in a statement to Asheville Watchdog. “Governor Stein is confident Attorney General Jackson will continue to ensure the people of western North Carolina receive the health care HCA promised. The Governor remains committed to expanding access to affordable, high-quality health care for every North Carolinian, including in western North Carolina.”

The case is ongoing in North Carolina Business Court, where there have been more than 140 related filings in the past year. Most recently, on Dec. 6, Judge Julianna Theall Earp filed an opinion dismissing HCA’s counterclaims against Stein. 

Stein’s lawsuit is not the only legal issue facing Nashville-based HCA in western North Carolina. Buncombe County, the cities of Asheville and Brevard, and Madison County are suing HCA in a separate antitrust lawsuit in federal court.

Jackson, 42, a Democrat, is a former U.S. congressman and state senator. He beat Republican Dan Bishop for the state’s top law enforcement job on Nov. 6. 

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 arjones@avlwatchdog.org. The Watchdog’s local reporting is made possible by donations from the community.  To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.

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