Buncombe County asks for $3 million in damages, seeks to join AG's lawsuit against Mission

ASHEVILLE — Buncombe County is seeking to intervene in Attorney General Josh Stein's lawsuit against HCA and is asking for $3 million in damages — the amount the county claims HCA's Mission Hospital has cost taxpayers for the "extensive" time county emergency services personnel have to wait with ambulance patients before the hospital accepts them.

The county filed a Motion to Intervene in Stein's lawsuit, as well as a proposed Intervenor Complaint, on April 3 in Buncombe County Superior Court, according to a news release from the county.

The proposed complaint states that following the company's purchase of nonprofit Mission hospital system for $1.5 billion in 2019, HCA has allowed the Emergency Room Department at Mission to "deteriorate dramatically" and has "disregarded their statutory, contractual, and common-law obligations."

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Central to the county's motion are EMS wait times at the hospital. The county says the hospital "far exceeds" the national standard for the time it takes 90% of patient transfers from EMS to the ER. Called "90th percentile times," Mission's doubled between the first quarter of 2020 and the third quarter of 2023, from about 16 minutes to more than 32 minutes, the county said in the release. The national standard reported by the National Emergency Medical Services Information System is 20 minutes.

The county also said EMS wait times increased from 9:41 minutes in the first quarter of 2020 to 17:41 minutes in the third quarter of 2023, "despite numerous requests and demands from County staff and management to expedite care in the ER."

"... during relevant times, Defendants intentionally understaffed the Mission ER so that Buncombe County’s EMS crews often experienced excessive wait times to transfer patients to the Mission ER, requiring EMS personnel to attend to emergency room patients long after arriving at the Mission ER,” the complaint said. 

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As a result of Mission “parking” ER patients with Buncombe County EMS — frequently called "wall times" since paramedics have to stand waiting with the patient against the hallway wall leading to the emergency rooms — the county claims HCA has cost taxpayers $3 million since the beginning of 2020, which the county is now seeking in damages.

Though the wait times decreased when HCA took preliminary action to address the problem, the complaint states Mission continued to avoid responsibility to patients at the expense of the county until Stein filed the lawsuit in December and until the U.S. Centers for Medicare and Medicaid Services issued a notice of "immediate jeopardy."

"The County maintains that only after such action by the Attorney General and CMS did Mission begin to take action to adequately staff its ER rather than deliberately relying on the County’s EMS to treat Mission’s ER patients," the release said. "However, at any time Mission may choose to revert to previous practices, which both endanger patient safety in emergency situations and run up costs incurred by the County."

The county's complaint will be assigned to the North Carolina Business Court, which is hearing Stein's suit. Stein, who is the Democratic nominee for governor, first sued HCA Dec. 14, alleging that the Nashville-based company did not provide the level of emergency and cancer care at Mission it agreed to when it bought the hospital system in 2019.

This story will be updated.

Ryley Ober is the Public Safety Reporter for Asheville Citizen Times, part of the USA Today Network. Email her at rober@gannett.com and follow her on Twitter @ryleyober