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An excerpt from oncologist Martin Palmeri\u2019s August 2024 deposition that was included in a recent court filing by North Carolina Attorney General Jeff Jackson in the state\u2019s lawsuit against HCA.<\/p>\nThe cancer patients on floor K9 were among the sickest at Mission Hospital, in need of close monitoring.<\/p>\n
Dr. Martin Palmeri, an oncologist at Messino Cancer Centers, already had grave concerns about the quality of care under HCA Healthcare\u2019s ownership when he received a call about a patient.<\/p>\n
The nurse wanted to check on the patient\u2019s kidney function but when Palmeri opened their chart he noticed a potentially life-threatening development: a neutropenic fever had been documented two hours earlier.<\/p>\n
\u201cThat would be considered an oncologic emergency,\u201d Palmeri testified in an August 2024 deposition. \u201cAnd I was like\u2026\u2019Why didn\u2019t you call me about it?\u2019\u201d<\/p>\n
\u201cAnd she was like, \u2018What\u2019s a neutropenic fever?\u2019\u201d<\/p>\n
Palmeri said he explained and the nurse responded, \u201cI didn\u2019t know that\u2026 I\u2019m just a traveler.\u2019\u201d<\/p>\n
Palmeri said he offered to educate the nurse about the condition but she responded, \u201c\u2018No, I\u2019m not going to be here in a couple of days.\u2019\u201d<\/p>\n
Excerpts from Palmeri\u2019s deposition were included in a recent court filing by North Carolina Attorney General Jeff Jackson in a lawsuit against HCA alleging the company broke its commitments to continue oncology and other services at Mission after it purchased the hospital system in 2019.<\/p>\n
HCA has not responded to the filing, and neither its lawyers nor hospital spokeswoman Nancy Lindell replied to a request for comment from Asheville Watchdog.<\/p>\n
The case centers on a provision of the asset purchase agreement (APA) that detailed the terms of the $1.5 billion sale of the nonprofit Mission Health system. The APA states HCA \u201cshall not discontinue the provision\u201d of services including behavioral health, cardiology, emergency and trauma, obstetrics, surgery, oncology and pediatrics at Mission for 10 years.<\/p>\n
An excerpt from oncologist Martin Palmeri\u2019s August 2024 deposition that was included in a recent court filing by North Carolina Attorney General Jeff Jackson in the state\u2019s lawsuit against HCA.<\/p>\n
HCA has denied that it violated the agreement and argued that it never promised to provide quality health care<\/a>. Its lawyers wrote in a court filing that the APA was \u201csilent as to the quantity or quality of services required.\u201d<\/p>\n HCA also has argued in court that the words \u201cshall not discontinue\u201d mean the company is merely obligated to provide \u201cthe facilities and ancillary staff necessary for providers who choose to use the hospital to care for their patients.\u201d<\/p>\n By that interpretation,\u201call it must do is keep its hospital doors unlocked and offer ancillary staff \u2014 whether or not Mission actually provides care to patients,\u201d the attorney general\u2019s office wrote in an Oct. 27 brief.<\/p>\n HCA clearly breached the APA\u2019s requirement for oncology services, Jackson\u2019s brief states. By the end of 2023, \u201cHCA had zero medical oncologists on staff at Mission to supervise initial chemotherapy treatments and provide inpatient complex hematology services.\u201d\u00a0<\/p>\n Hospital care compromised patients, Palmeri testifies<\/strong><\/p>\n Oncologists became increasingly concerned about the care their patients were receiving and tried to work within internal channels at Mission, Palmeri testified in his deposition.<\/p>\n They filed \u201cvigilance reports\u201d about patient incidents with the hospital\u2019s quality improvement committee to \u201ctry to find some methodology to make sure it doesn\u2019t happen again,\u201d Palmeri said.\u00a0<\/p>\n \u201cFor the first couple of years we were filing many, many reports, and we just weren\u2019t getting feedback on those,\u201d he said. \u201cWe were finding that there were lots of examples of missed care that was compromising our patients.\u201d<\/p>\n In 2022, oncologists at Mission took a vote of no confidence<\/a> in the hospital\u2019s management. \u201cWe felt that HCA\u2019s leadership was not capable of competently running K9, and that led to the vote,\u201d Palmeri said in his deposition.<\/p>\n Patients on the floor had complex needs and cancers such as acute leukemia and lymphomas.\u00a0<\/p>\n \u201cThese are very, very sick people,\u201d Palmeri said. \u201cThey often require very skilled nurses, very attentive nurses.\u201d<\/p>\n Oncology nursing guidelines called for three to four patients per nurse, but nurses at Mission were each caring for six to seven patients, he said.<\/p>\n \u201cWe were finding that the nurses not necessarily do things wrong, but the nurses were definitely missing things,\u201d Palmeri said. \u201cThe fact the nursing ratios were too high, a lot of the nurses began to quit\u2026They were refilling the ranks with nurses that didn\u2019t have any experience in oncology.\u201d<\/p>\n Palmeri testified that nurses \u201cwere not checking temperature in the time frames that they\u2019re supposed to check.\u201d<\/p>\n Exodus of oncologists<\/strong><\/p>\n Cancer patients undergoing treatments such as chemotherapy often have neutropenia, low levels of a type of white blood cell that make them susceptible to infection.<\/p>\n \u201cA patient who is considered neutropenic, if they spike a low-grade temperature of 100.4, they can go from being alive and well to dead in three hours,\u201d Palmeri said.\u00a0<\/p>\n In September 2023, oncologists at Messino said they would no longer treat acute hematology cancer patients<\/a> at the hospital due to \u201congoing system failures,\u201d Palmeri wrote in a letter announcing the decision.\u00a0<\/p>\n \u201cThere had been an ongoing discussion, probably going back nine months from when that letter was written, talking about, is the hospital still a safe place to deliver complex hematologic care?\u201d Palmeri said in his deposition. \u201cThis had been brought up on numerous occasions in the months preceding the actual announcement.\u201d<\/p>\n Messino once provided the oncologists at Mission under a professional agreement, but it ended in 2019 after the sale. Some Messino doctors continued to provide acute hematology care until the September 2023 announcement.<\/p>\n HCA started its own practice, Mission Medical Oncology, when Messino\u2019s 2019 agreement ended and planned to hire 13 doctors plus nurses and support staff, according to the attorney general\u2019s brief last month.<\/p>\n While HCA \u201csuccessfully hired five well trained oncologists,\u201d the medical director of the practice from 2020 to 2023 stated it was \u201cunable to retain these oncologists due to unresolved practice issues at Mission Hospital,\u201d according to the brief.<\/p>\n In 2021, the Mission oncologists began leaving and by November 2023, there were none.<\/a><\/p>\n \u201cThis discontinuance of services constitutes a breach\u201d of the purchase agreement, the attorney general brief states.<\/p>\n Lindell, the Mission spokeswoman, did not respond to questions about whether Mission had replaced the oncologists, how many it currently had or whether the hospital was providing complex hematology care.<\/p>\n Consulting a dictionary<\/strong><\/p>\n The lawsuit, filed in December 2023<\/a> by Jackson\u2019s predecessor and now-Gov. Josh Stein, followed an attorney general investigation and numerous complaints from medical staff, patients and elected officials about a decline in care after the sale. The lawsuit seeks to require HCA to restore emergency and trauma care and oncology services to pre-sale levels.<\/p>\n The case could hinge on the meaning of three words in the purchase agreement: \u201cshall not discontinue.\u201d<\/p>\n HCA previously sought a partial summary judgment, a legal ruling by a judge without a trial, \u201con the proper textual construction of\u201d the phrase, according to an April court order.<\/p>\n Both sides consulted Merriam-Webster. HCA relied on \u201cseveral dictionary definitions\u201d of discontinue to support its position and said that \u201cthe Attorney General is attempting to add quality and volume metrics that were not negotiated,\u201d the order states.<\/p>\n It said the attorney general focused on the definition \u201cto break the continuity of\u201d and argued \u201cthat even a gap or temporary break in a service constitutes a discontinuation of that service for the patient impacted.\u201d<\/p>\n Julianna Theall Earp, Special Superior Court Judge for complex business cases, ruled April 16 that not only was the phrase \u201cshall not continue\u201d ambiguous but \u201calso that the word \u2018services\u2019 lacks clarity.\u201d<\/p>\n \u201cFor example, does a discontinuation of chemotherapy under \u2018oncology services\u2019 mean a cessation of all types of chemotherapy, or is it enough to stop providing one type of chemotherapy?\u201d the judge wrote. \u201cDoes it mean that the service stops for all current and prospective patients, or is it enough for a single patient to experience a discontinuation of treatment?<\/p>\n \u201cAdditional evidence is needed,\u201d the judge wrote, \u201cto determine the parties\u2019 intent.\u201d<\/p>\n Attorney general: No support for HCA\u2019s \u2018litigation theory\u2019\u00a0<\/strong><\/p>\n Additional evidence is now in, the attorney general\u2019s office wrote in its brief, and it shows \u201cthat the parties always understood [the APA] as a commitment to continuously provide the services available at Mission at the time of the sale.\u201d<\/p>\n Among the evidence the attorney general cited:<\/p>\n HCA\u2019s internal documents reflected similar language, the\u00a0 attorney general contends. Included with the court filing are HCA spreadsheets circulated among senior leadership, such as one in August 2019 titled, \u201cNC Division Post-Close Commitment Checklist,\u201d that includes a requirement to \u201ccontinue services currently provided at Mission\u2019s primary Asheville hospital .. . for 10 years.\u201d<\/p>\n On internal HCA audit forms, signed every year after the sale, Mission\u2019s CEO attested that the services under the APA were \u201ccontinuously offered.\u201d<\/p>\n \u201cCollectively, there is now uncontroverted material evidence\u201d that all parties understood the APA required HCA to continuously provide \u201cservices that were available at Mission at the time of the transaction,\u201d the attorney general\u2019s brief states. \u201cIn contrast, the evidence offers no support for HCA\u2019s litigation theory\u201d that the agreement was \u201cnothing more than a promise to keep Mission\u2019s facilities open and provide ancillary staff to physicians who may wish to provide services.\u201d<\/p>\n The expectation from the sale of Mission, the attorney general contends, was not just that HCA would continue its level of care but build on it.<\/p>\n \u201cIdeally, HCA would do more than just maintain services \u2013 it would expand them beyond pre-sale Mission\u2019s capacity. But if not, the people of western North Carolina would at least be able to count on a continuation of the status quo: the provision of high-quality emergency and trauma and oncology services as available at the time of sale.\u201d<\/p>\n Asheville Watchdog welcomes thoughtful reader comments about this story, which has been republished on our Facebook page<\/a>. Please submit your comments there.\u00a0<\/p>\n Asheville Watchdog<\/a> is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Sally Kestin is a Pulitzer Prize-winning investigative reporter. Email skestin@avlwatchdog.org. The Watchdog\u2019s reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org\/support-our-publication\/<\/a>.<\/p>\n \n\tRelated<\/p>\n","protected":false},"excerpt":{"rendered":"The cancer patients on floor K9 were among the sickest at Mission Hospital, in need of close monitoring.…\n","protected":false},"author":3,"featured_media":382614,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[210,1141,1142,63681,67,132,68],"class_list":{"0":"post-382613","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-health","9":"tag-health-care","10":"tag-healthcare","11":"tag-mission-hospital","12":"tag-united-states","13":"tag-unitedstates","14":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/115558491903374477","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/382613","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=382613"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/382613\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/382614"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=382613"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=382613"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=382613"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"\"](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/11\/MCC_Martin-Palmeri-min.jpg\")
\u201cWe felt that HCA\u2019s leadership was not capable of competently running K9, and that led to the vote,\u201d oncologist Martin Palmeri said in his deposition, explaining why oncologists at Mission took a vote of no confidence in the hospital\u2019s management in 2022. \/\/ Credit: Messino Cancer Centers<\/p>\n![\"\"](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/11\/Image-13.png\")
Messino Cancer Centers once provided the oncologists at Mission under a professional agreement, but it ended in 2019 after the sale. Some Messino doctors continued to provide acute hematology care until the September 2023 announcement. \/\/ Watchdog file photo by Starr Sariego<\/p>\n![\"\"](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/11\/Image-10.png\")
In December 2023, then-North Carolina Attorney General Josh Stein announced that his office was suing HCA Healthcare, alleging the company broke its commitments to continue oncology and other services at Mission after it purchased the hospital system in 2019. \/\/ Watchdog file photo by Andrew R. Jones<\/p>\n\n