A Mission Hospital pharmacist who supervised a team that tracked medication histories and prevented errors is suing the hospital, its corporate owner, and her boss after she was fired for posting a comment on social media criticizing what she described as inadequate staffing in her department.

The lawsuit, filed in Buncombe County Superior Court on Dec. 13, alleges that Mission prevented medication reconciliation supervisor Andrea Leone from making hires that would have kept her team fully staffed and then tried to silence her. 

“Defendants’ primary purpose was to squelch Leone’s voice by firing her, and thereby hide and conceal from the public the dangerous and unsafe conditions that HCA’s cost-cutting practices and patient-to-staff ratios are creating,” the complaint states. 

Medication reconciliation is a subgroup of pharmacy employees whose job is to ensure patients get the right medications as they are admitted and discharged from the hospital and as their care evolves.

Asheville Watchdog sought comment from Mission Health spokesperson Nancy Lindell but did not receive a response.

Mission maintained in its firing of Leone that she violated a leadership code of conduct and shared proprietary information about staffing levels and ratios, according to the lawsuit and the termination documents it cited. 

Instead, the lawsuit states, she had the right and responsibility to warn her managers and the public about unsafe staffing levels in her department.

In May, Leone commented on LinkedIn, responding to an article posted there regarding how Mission’s loss of medical staff since HCA Healthcare bought the Mission Health system in 2019 for $1.5 billion had contributed to a spike in profits.

“I’m a pharmacist supervisor at Mission, responsible for transitions in care (primarily med histories on admission, barriers to access, safety on continued meds, and reconciliation at discharge),” Leone said in her May 15 comment on the career networking site. “The [full time employee] battle is real here. … We are constantly ‘in the red’ despite having as many as 90 open shifts not covered last schedule period. Fortunately for patients, staff picks up many extra shift [sic]. Unfortunately, positions have been ‘cut’ bc we are considered overstaffed. Surge pay incentives pick up shifts, but not influence overall FTEs [fulltime employees]. It’s an unsafe practice leading to burnout.”

Two days after Leone’s social media post, an HCA employee in Nashville took a screenshot of it and forwarded it to administrators in Asheville, according to the lawsuit. On May 23, Leone received a termination notice signed by her direct supervisor, Christine Dresback.

Dresback wrote in the notice that, “Sharing such information, staffing ratios and expressing concern for patient safety and staff burnout, violates the Leadership Responsibilities of the HCA Code of Conduct specific to supervisors,’’ according to the lawsuit.

The notice described its expectations for leaders’ conduct: “While all HCA Healthcare colleagues are obligated to follow our Code [of Conduct], we expect our leaders to set the example, to be in every respect a model. We expect everyone in the organization with supervisory responsibility to exercise that responsibility in a manner that is kind, sensitive, thoughtful and respectful.”

Boxes checked on the termination notice, which is attached to the lawsuit, show Leone was fired for  “Conduct/Behavior” and for “Policy Violation.”

 “Andrea Leone was terminated because she stood up against HCA’s cost-cutting practices, practices which jeopardize consumer health and safety by reducing hospital staff to unsafe levels,” Leone’s attorney Jake Snider told The Watchdog on Monday. 

“Leone’s termination serves two primary purposes for HCA. The first is that it acts to halt Leone herself from continuing to be able to complain and publicly share about HCA’s cost cutting practices of reducing staff to patient ratios to dangerous levels. The second purpose is to send a chilling message to other HCA employees. That message is to the effect of ‘Keep your mouth shut, or your livelihood could be put on the chopping block, just like Leone, who we’ve made an example of.’’’

Leone’s lawsuit arrives in the last weeks of a tumultuous year for Mission and HCA. In February, the U.S. Centers for Medicare & Medicaid Services (CMS) cited the hospital for violating federal standards of care. An investigation by the North Carolina Department of Health and Human Services and CMS resulted in an immediate jeopardy finding for Mission, the most severe sanction a healthcare facility can face. A 384-page CMS report showed four people died between 2022-2023 because of the hospital‘s failures in medical care and leadership. The deaths came during a five-month period in which the hospital had more than 450 nursing vacancies, a Watchdog investigation found in May.

In December 2023, North Carolina Attorney General Josh Stein sued HCA and Mission Health, alleging that they violated commitments made in the asset purchase agreement regarding cancer care and emergency services at Mission Hospital, with emphasis on staffing deficits. 

Pharmacy team faced short staffing, suit alleges

Leone was supposed to supervise a team of 18 people, according to the lawsuit: 10 technicians, three pharmacists, two residents and three interns. But for an extended period during Leone’s career at Mission, which started in October 2021, many of those positions were not filled.

“In 2022 and 2023 several employees under Leone either quit, were terminated or were moved out of her sub-department, resulting in her sub-department being understaffed,” the lawsuit said. “For an extended time, the department was staffed at only 60%.”

The entire pharmacy began to see reduced staffing levels and “was struggling to provide adequate medication monitoring to Mission patients,” the lawsuit said.

This endangered some patients, according to the lawsuit, which cited a 2022 incident in which a patient “coded.” The lawsuit alleges the patient stopped breathing and his “medication cart was not fully and properly stocked with the patient’s required prescription drugs — a responsibility of the understaffed pharmacy department (albeit a part of the department that Leone was not in charge of).”

In late 2023, the hospital froze hiring, according to the lawsuit, leading to a situation in which “there were not enough pharmacists to properly and safely monitor the drugs being prescribed and administered to patients at Mission Hospital.” 

Leone tried to communicate the severity of these issues to Mission leadership, but she was prevented from hiring staff, according to the lawsuit.

Following these alleged struggles, Leone commented on LinkedIn.

The lawsuit also argues that Leone’s termination was not justified because it was not specific enough. Though Mission’s termination letter says Leone was fired because the hospital’s “Expectation is that any social media postings by team members would avoid voicing any particulars around staffing ratios and proprietary information related to how staffing and productivity is measured,” it does not describe how staffing ratios are proprietary, according to the lawsuit.

Leone argued against her termination in handwritten notes, stating she had repeatedly tried to raise staffing concerns through “appropriate avenues,” but her “requests [had] been disregarded or not communicated leaving me with little option than to publical[ly] state my concerns. I feel this is nothing but retaliation.”

She wrote a multi-section rebuttal, refused to sign the termination paperwork, and attached hospital policies she argued were being misinterpreted. 

“I disagree that I do not uphold the code of conduct,” Leone wrote. “The information divulged was not proprietary but common knowledge within the department. I understand the avenue in which it was posted was a public forum but came from near 3 years of frustration from continuing to express concerns that were not addressed/acted on.”  

Leone now works as a part-time pharmacist at a CVS. Though she praised HCA for hiring her in 2021, she told The Watchdog in an exclusive interview that the hospital didn’t follow through with maintaining a functional medication reconciliation program. 

“HCA, you know, they did something good by layering on a supervisor to this program,” she said. “But when it came down to it, they couldn’t fully support their own good ideas because of their inherent lean towards profit over quality.” 

Physicians across the hospital have said the same, pointing to Mission’s staffing and program cutbacks to boost profit margins following the sale to HCA.

“What we should be wary of is — providers and people in the community in general — is that Mission is a monopoly here,” Leone said in the interview. “There’s not much choice if you’re very sick. And HCA has said publicly that they’re built to be bigger, so they’re going to continue to cannibalize these health systems that are in points of struggle for profit.”

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 during this crisis 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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