REPLY TO:
LLOGAN R. WALTERS
JOSH STEIN
ASSISTANT ATTORNEY
ATTORNEY GENERAL
GENERAL
LWALTERS@NCDOJ.GOV
September 29, 2023
Greg Lowe
President, North Carolina Division, HCA Health Care,
509 Biltmore Avenue
Asheville, NC 28801
Greg.Lowe@hcahealthcare.com
Dear Mr. Lowe,
As you are aware, for several months now, our office has been investigating concerns that
HCA is failing to provide oncology services in western North Carolina, in violation of the
Purchase Agreement that HCA signed with the Attorney General. Two recent public reports
exacerbate our concerns and require an urgent response from you.
First, we have learned that Messino Cancer Group has determined that it can no longer
safely provide inpatient complex hematology treatment at Mission Hospital to adults with
leukemia or lymphoma. Our understanding is that Messino Cancer Group reached this
conclusion because HCA failed to provide adequate staffing and resources to support acute
hematology chemotherapy treatment. As a result, western North Carolinians with one of the most
severe forms of cancer must now travel to Charlotte, the Research Triangle Park area, or out of
state to receive lifesaving treatment.
Second, our office recently learned that GenesisCare, another practice group whose
doctors contracted with Mission Hospital for certain oncology services, has declared bankruptcy.
Our office has already noted that Mission Hospital itself employs a single medical oncologist.
The loss of GenesisCare’s oncologists leaves Mission Hospital’s oncology practice further
understaffed.
The people of western North Carolina deserve access to high quality cancer care in their
own community, not several hours away from their families and support systems. That is why
the Attorney General conditioned his approval of HCA’s acquisition of Mission Health System
on HCA’s commitment to continue providing oncology services in the area. Forcing the most
acute cancer patients to travel hundreds of miles to receive care is plainly inconsistent with that
commitment.
WWW.NCDOJ.GOV 114 W. EDENTON STREET, RALEIGH, NC 27603 919.716.6400
P. O. BOX 629, RALEIGH, NC 27602-0629
To help us understand the impact of these developments on HCA’s provision of cancer
services in western North Carolina, please advise us at your earliest convenience, of the
following:
(1) Whether and how HCA has addressed the care delivery issues that led Messino
Cancer Center to determine that it could not safely provide inpatient complex
hematology treatment at Mission Hospital;
(2) What discussions, if any, HCA has had with Messino Cancer Center about the
possibility of Messino Cancer Center continuing leukemia and lymphoma treatment
at Mission Hospital;
(3) How many patients received inpatient complex hematology treatment at Mission
Hospital per year for each year since 2019;
(4) How many Mission Hospital patients were transferred to a non-Mission facility for
inpatient hematology treatment prior to September 20, 2023.
(5) Whether HCA has any plans to provide inpatient hematology treatment at Mission
Hospital if Messino Cancer Center continues to determine it cannot safely do so;
(6) Any information about the anticipated effect of GenesisCare’s bankruptcy on
oncology services at Mission Hospital and how HCA plans to ameliorate any negative
effects on oncology services.
In the immediate term, our office will continue to investigate HCA’s compliance with the
Purchase Agreement and is considering all options at its disposal to protect patients’ access to
critical care.
Sincerely,
Llogan R. Walters
Assistant General Counsel
cc: Jason Ehrlinspiel, Senior Litigation Counsel, HCA Healthcare, Inc.
Lori Kroll, Vice President for Government Relations – North Carolina Division, HCA
Healthcare, Inc.
Rachel Ryan, General Counsel, Dogwood Health Trust
Ronald Winters, Principal, Gibbins Advisors, LLC
Sarah G. Boyce, General Counsel and Deputy Attorney General
Jasmine McGhee, Senior Deputy Attorney General
South A. Moore, Assistant General Counsel
