When asked recently if HCA Healthcare would be willing to sell Transylvania Regional Hospital (TRH) “back to the community,” the company’s CEO Sam Hazen said it was not an option, according to Brevard Mayor Maureen Copelof.

Hazen came to Brevard recently to meet with Copelof, Mark Weinstein – Brevard Music Center’s president – and local architect Parker Platt.

As previously reported, last year Weinstein and Platt resigned from the hospital’s board voicing concerns about TRH’s future.

In March Copelof sent a letter to Hazen documenting the community’s concerns about the hospital’s future and invited Hazen to the area.

Copelof is also the community liaison with the independent monitoring group charged with overseeing HCA/Mission’s compliance with the asset purchase agreement, which was signed in 2019 when HCA bought the Mission Health system, including TRH.

The local hospital had essentially been “owned” by the community since the early 1930s and was operated at different sites before opening at its current location in 1973, thanks in large part to community donations.

In 2012, TRH became a full member of Mission Health.

Since the for-profit HCA took over the nonprofit Mission, there have been some major changes to how health care is provided in the county.

As reported in March of last year, at least 15 health providers in the county either refused to sign new contracts with HCA/Mission Health or were terminated from their positions, with several going to Pardee or AdventHealth.

Copelof has been working with Weinstein and Platt on the issue.

“The three of us have been working together trying to figure out what can we do to try and improve the situation with health care here,” said Copelof. “We really wanted to talk to the top man in charge and make sure that he knew what the issues were; that the issues were not only known locally but that the head of the entire organization understands just how serious this lack of trust between the community and the hospital is right now.”

Also in attendance at the meeting were Michele Pilon, TRH’s CEO, and Greg Lowe, president of HCA Healthcare’s North Carolina division.

Copelof reiterated to Hazen a previous concern she has voiced – that she has been unsuccessful in the past 12 months to obtain the hospital’s metrics.

Due to contractual agreements, it is not possible to comparatively analyze trends in patient care and hospital performance, except anecdotally from community members.

The metrics, which compare, for example, how many surgeries were performed this year to how many were performed three years ago, are impossible for the public to obtain. Further, it is not possible for the public to know how many beds are, or are not, being occupied and for what purpose.

“The biggest problem we have right now is that the asset purchase agreement has no metrics in it,” said Copelof. “So trying to enforce, or even trying to show noncompliance with the agreement, is very difficult because it’s not quantified and we cannot get those metrics to try and determine what is really happening with health care.”

Hazen told Copelof she would be provided a “fact sheet.”

On April 28, Copelof also met with N.C. Attorney General Josh Stein to discuss some of the community’s dissatisfaction with TRH and the negative trend of rural health care in general within the region.

Copelof and Stein participated in a round table discussion which also included the mayors of Asheville and Franklin, doctors who have left the HCA system, nurses, a representative from Blue Cross Blue Shields and others. Frustrations focused on how the hospital merger’s proprietary contracts do not permit metrics to be provided to the public, and the increase in patient to nurse ratios and its impact on quality care.

“The elected officials,” said Copelof, “across the board talked about their frustrations with the fact that the community is very upset with what is happening with health care and we have very few tools and very little recourse to try and improve the situation.

“The fear really is that services will decline and, eventually, after the 10-year period the rural hospitals will really become emergency rooms with everything else transferred, and that’s what we want to prevent. I told the attorney general that I felt the system was broken, and there was a lack of trust between the hospital and the community. We need to fix this.”

This is not unique to TRH, said Copelof. “This is happening in all of the towns,” she said.

As a part of the purchase agreement, HCA is obligated for at least 10 years to continue four areas of service at TRH: emergency services, surgical services, acute medicine services and the Transitional Care Unit (skilled nursing facility). HCA Healthcare includes 182 hospitals and approximately 2,200 ambulatory sites of care in 20 states and the United Kingdom.

The company has 275,000 employees, which provides approximately 6% of all U.S. inpatient hospital services, according to its website.