Written by Andrew R. Jones, Asheville Watchdog.
Dr. Michael Messino felt a gut punch when he read Asheville Watchdog’s report that the cancer group bearing his name would be halting acute leukemia chemotherapy at Mission hospital.
“I was pretty angry that it was going to happen,” the retired physician told The Watchdog in an exclusive interview recently, describing his reaction to the news that conditions at the hospital had prompted the move.
Messino’s former colleague, Dr. Martin Palmeri, a lead oncology doctor at Messino Cancer Centers and president of the North Carolina Oncology Association, wrote Mission on Sept. 20, notifying it of “system failures” that he said were risking patient harm and that the group had asked hospital leadership to fix for years.
Messino wrote his own letter and sent it to Buncombe County commissioners, Asheville City Council members, the state’s Department of Health and Human Services, North Carolina Gov. Roy Cooper, and Attorney General Josh Stein, prompting a meeting with the attorney general office’s general counsel days later.
“HCA and (its North Carolina Division President) Greg Lowe define success as ruthlessly running roughshod over anyone who gets in their way,” Messino wrote. “HCA has sold the people of Western North Carolina a lemon and now the Department of Justice is stepping in.
Doctors are stepping in, too.
Messino is one of now 123 local physicians who signed onto a letter condemning HCA’s profit-oriented management and saying it had “gutted the heart and soul of our community healthcare system” since it purchased the then non-profit Mission system in 2019 for $1.5 billion.
“HCA’s failures have had devastating repercussions on the patients of Western North Carolina,” Messino wrote in his own letter. “Medicine is about putting patients first and not dominating the marketplace.”
Messino Cancer Centers treats patients in Mission’s facilities through practice privileges, and its work there is separate from Mission Health SECU Cancer Center.
Responding to a series of questions about Messino Cancer Centers and Messino’s letter, HCA spokesperson Nancy Lindell referred to a July 19 letter Lowe sent to the attorney general’s office detailing the history of oncology services at Mission since 2019.
“As we addressed in our July 19 letter to the Attorney General’s office, Mission Health is committed to continuing to provide top-tier oncology services to the residents of Western North Carolina; and we are achieving that in addition to having more oncology providers on our medical staff than we did in January 2019,” Lindell said.
Reached for comment on Messino’s letter, Palmeri said, “Dr. Messino has been a pillar of oncology in the community. He supported oncology patients in Western North Carolina for 30 years. I think he’s a strong voice for cancer patients.”
Messino, 70, a medical oncologist and the founder of the Messino Cancer Centers, which was previously called Cancer Care of Western North Carolina, recognized the cancer center’s move as the end of an era. He started his practice more than 30 years ago.
“We were unique because most private practices don’t treat leukemia because it’s labor intensive, and you’ve got to have a lot of support,” he said.
Messino’s letter adds to a flurry of correspondence involving health care in Western North Carolina as HCA Healthcare is under investigation by the North Carolina attorney general’s office for violating commitments it made as part of the 2019 purchase, specifically related to its emergency department and oncology services.
The attorney general’s office has threatened legal action if HCA doesn’t fix the violations by Dec 10.
“The root cause for this decision is the inability of HCA to guarantee the support needed for these patients, such as specific laboratory services, pharmacy support and adequate nursing staffing with trained individuals familiar with the treatment for these patients,” Messino wrote of Messino Cancer Center’s decision to stop providing some acute leukemia therapies. “Now patients will need to travel long distances to receive their care for these treatments,” echoing a concern raised in Palmeri’s earlier letter.
The closest cities they can get this kind of care are in Charlotte, two hours from Asheville, and Durham, three and ½ hours away.
His letter made recommendations for how the hospital can improve — along with cost estimates — to help leukemia patients. He recommended:
- A chemotherapy trained pharmacist for an estimated $100,000 per year.
- Four additional oncology nurses for an estimated $400,000 a year.
- A dedicated care manager for an estimated $40,000 per year.
- Enhanced laboratory services for an estimated $500,000 per year.
And his final hiring recommendation: “Administrators who know how to deliver coordinated oncology care — priceless in this current environment.”
Despite its problems, Mission has excellent physicians, nurses, and staff, Messino said. “We want to support them and we want them to keep working because they are the ones that are holding things up,” he said. “And those are the people that are going to take care of us.”
Last week, more than 80 Mission doctors and healthcare workers signed their own letter rebutting the one signed by Messino and 122 other physicians. Messino told The Watchdog repeatedly he didn’t want those workers to feel as though they were under attack from doctors who had criticized HCA.
It’s the system and HCA’s takeover, he contends, that are putting patients at risk.
“I feel obligated to do something here”
In retirement Messino has become a kind of activist – writing letters, speaking at four public meetings this fall hosted by the independent monitor of the HCA/Mission sale, and meeting one-on-one with the attorney general’s office just hours after he sat down with The Watchdog, where, he said, he discussed emergency room and oncology issues that had been previously brought to the attorney general’s attention.
“I feel obligated to do something here,” he said. “I mean, Western North Carolina is my home.”
Mission, too, was Messino’s home before the HCA purchase, which physicians learned about six months before the finalized sale in 2019, he said.
That year, his whole group of physicians — then called Cancer Care of Western North Carolina — left Mission after contract negotiations fell through. The group then opened an independent practice and named it after Messino, a choice he said he initially opposed.
The cancer doctors didn’t leave Mission because HCA’s offer was bad, Messino said. His team had researched HCA when it found out about the impending sale, he said, and discovered that the company’s model frequently involved downsizing.
“They were going to take our employees,” Messino said. “The first thing (HCA) would have done was they’d have decimated the employees and we would have been stuck without enough people to do the work.”
HCA leaders didn’t think the oncologists would leave, Messino said, because the mass departure meant the physicians would need to find new offices in short order.
Within months, the group found offices and was up and running again by January 2020, transformed from CCWNC to Messino Cancer Centers.
Today it has locations in Asheville, Brevard, Franklin, Marion, Spruce Pine, and Sylva. The group is part of the American Oncology Network, which has $65 million in new capital from AEA Growth, a New York private equity fund.
Lindell did not respond to questions about whether HCA would have laid off cancer staff if Messino’s group had decided to renew its contract.
“In 2020, Messino joined AON, a private equity-backed company that recently went public, for their own financial reasons,” she said. “This and the other details that you’ve asked about are also covered in the numerous responses we’ve sent to the Attorney General in 2023.”
A plan doomed from the start
Nearly four years later, Messino remembers upheavals that came as Mission tried to recover from the loss of the 14 cancer doctors in his practice.
“The thing that we noticed (after departing) was that there was less staff,” Messino said. “There was less housekeeping staff, clearly. We had a really nice staff of nurses on the oncology floor and slowly they started to leave. You had all these people who had been in the system for years; they were leaving.”
HCA engineered a plan to mitigate the cancer physician losses. Messino attended a Mission medical staff meeting just after his group opened the doors of its independent practice. Lowe told gathered staff that Mission was going to hire 14 medical oncologists and “compete with that group that left us,” Messino said.
“I sat there and I mumbled under my breath, ‘It ain’t gonna happen,’” Messino said.
Lindell did not respond to questions about the details of the meeting.
According to a letter Lowe sent the attorney general’s office in May, Mission had hired six medical oncologists since 2020. According to another letter Lowe sent Oct. 4, the last of these and the last remaining medical oncologist on staff, Dr. Michael Burke, will leave Nov. 26, which Burke confirmed to The Watchdog in a recent interview.
Lindell would not say whether plans remain to build a large team of medical oncologists, whether the hospital had hired any medical oncologists recently or whether there would be any medical oncologists working after Dr. Burke’s departure.
Lowe’s plan upset some of the Messino group’s doctors, Messino said.
“Asheville Hematology and our group had always given care in that institution. And to think that you could just go out and pick up a bunch of oncologists was ludicrous,” Messino said.
That’s partly because “there’s not enough of us anymore,” he added, referring to a nationwide shortage of medical oncologists.
Messino said HCA’s own cancer institute, Sarah Cannon — which partners with Messino for exclusive patient trial privileges — has recommended to Mission administration multiple times that the hospital should work with Messino Cancer Centers.
That has never happened, Messino said.
Lindell, also a spokesperson for Sarah Cannon, did not answer questions about the recommendations.
From physician to patient
Last year, months before he retired, Messino became a patient at Mission.
A test revealed an abnormality in his abdomen, which he later learned was benign. Over three weeks he underwent an MRI, a CT scan, a cardiac catheterization, chest surgery and abdominal surgery, he said. Then, in September 2022, he was in a hospital bed.
The “horror stories” about staff shortages, he said, were true.
His wife was his daytime nurse, his daughter his nighttime one, he said.
Two weeks later, he was back at work.
“I had people I had to see,” he said. “I was getting my last four months done trying to see everybody I needed to see.”
On Dec. 30, 2022, he retired. He’s been spending time with his grandchildren, working on house repairs, honing his metalcraft hobby, canning tomatoes for sauces, working on a cookbook and advocating for improvements at Mission.
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email [email protected]. To show your support for this vital public service please visit avlwatchdog.org/donate.