My Aunt Mary Ann lived in Madison County, and suffered with congestive heart failure. A lung cancer survivor, the aggressive treatment that cured her cancer left her with a damaged heart. She was nevertheless always pleasant and upbeat. An avid crafter, she quilted security blankets for sick children, knitted caps for premature babies, and loved her weekly sewing circle at the Beech Glen Community Center (Their group won a 1st place prize one year at the Asheville Quilt Show!). Mary Ann had an enormously generous heart, but keeping it beating required complicated medical tests, monitoring, and an occasional rush to the ER when things got out of balance.
When Mission Health announced they were going to be acquired by for-profit HCA, I thought of people like my aunt. Mission operates five rural hospitals. Would a for-profit hospital system have the same commitment to keeping rural hospitals open that our local, non-profit system had? Rural hospitals struggle to provide healthcare to a population that is disproportionately uninsured. If they couldn’t generate a profit, what would happened to the people they served?
A group in Yancey County called SEARCH had similar concerns. They came together after the Labor and Delivery Department closed at Blue Ridge Regional Hospital in Spruce Pine and were already organized when the Mission-HCA acquisition was announced. They viscerally understood what it means to live in rural North Carolina and lose access to healthcare services.
SEARCH closely examined the Mission-HCA sales agreement. When a non-profit is sold to a for-profit entity, the proceeds of the sale remain with a non-profit, in this case, the newly formed Dogwood Foundation. Dogwood would ensure that HCA complied with the provisions of the sale agreement and would establish a process to use the income generated from the proceeds of the sale, $1.5 billion, to address underlying causes of illness, otherwise known as social determinants of health, throughout the region.
SEARCH members had serious concerns that the HCA-Mission sales agreement did not adequately protect Mission’s rural hospitals. Their concerns seemed justified when members of the Dogwood Foundation Board were announced. Although the initial appointees to the board were an impressive group of community-minded civic leaders, they were almost entirely from Buncombe County and nearly all had been former Mission Health board members. To the SEARCH folks in Yancey County, that was a cause for alarm. Without representation from communities served by Mission’s rural hospitals, they felt those hospitals were more vulnerable to closure.
Others in the community had additional concerns. While talented business and legal minds would be necessary to ensure compliance with the sales agreement, many community members were concerned that the Dogwood Board lacked the diversity to adequately reflect the entire region. After all, women and minorities were seriously underrepresented on the board.
The Health Equity Coalition was born of these concerns. Together with REACH, HEC organized town halls, wrote letters-to-the-editor, called their local officials, and got online to make sure Josh Stein knew about their issues. As the Attorney General, he had to approve the sale.
Their advocacy worked! Attorney General Josh Stein took the public input he received seriously, and tasked his staff to address each issue. HCA, Mission Health, and the Dogwood Foundation came to the table, open and willing to negotiate a better deal. As a result, protection for our rural hospitals was extended from five years to ten years. HCA also committed to building a new Angel Medical Center in Franklin, and a much-needed, 120-bed outpatient behavioral health facility in Asheville.
And I’m relieved to say the updated agreement addresses my own concerns about the services people like my Aunt Mary Ann depend on. Providing additional oversight by an independent monitor and the Attorney General makes it more likely rural hospitals will remain open.
Furthermore, the Dogwood Foundation is committed to an open and inclusive process around their grant making. There will be a national search for an executive director, better ethnic, gender and rural representation on the board, and public meetings across the region to gather input about how it can fulfill its mission to improve health.
The revised sales agreement demonstrates how good things happen when public officials listen to their constituents and stakeholders are willing to work together for a common goal. I am so proud to live in a region united in our quest for a vibrant and healthy Western North Carolina.
This is how good governance works.
Sen. Terry Van Duyn (D – Buncombe) is a member of the NC Senate representing District 49.