Written by Andrew R. Jones and Barbara Durr, Asheville Watchdog.
A lawsuit filed in Buncombe County Superior Court alleges that gross medical and corporate negligence at Mission Hospital caused a 66-year-old Waynesville photographer’s wrongful death in August 2021.
The complaint, filed by Melanie Mace Griffin as the representative of her wife Cathryn Griffin’s estate, names as defendants Mission, corporate owner HCA Healthcare, three doctors, a nurse practitioner, and Asheville Pulmonary and Critical Care Associates, all of whom allegedly provided care to Griffin during her 22 days at the hospital.
According to the lawsuit, Griffin arrived Aug. 1, 2021, at Mission’s overstretched emergency department, where a catastrophic medical error led to a three-week succession of misdiagnoses, neglect, equipment failures, and treatment missteps that killed her.
Mission Health and HCA spokesperson Nancy Lindell acknowledged receipt of Asheville Watchdog’s requests for comment but did not provide answers to multiple questions.
The practice manager at Asheville Pulmonary Associates said it was policy not to comment on active lawsuits. Other named defendants did not respond individually.
Some defendants have requested the court give them until Feb. 20 to respond to the complaint, which does not include Griffin’s medical records. Those motions have been granted.
The complaint asks for $25,000 in compensatory medical expenses and describes “the amount in controversy” as more than $1 million. It argues that as a result of the “Defendants’ negligent, grossly negligent and reckless acts and omissions,” Griffin “suffered damages in the forms of medical expenses, as well as physical pain, injuries, loss of body parts, severe emotional suffering and distress, as well as other damages to be proven at trial, all in excess of the jurisdictional limit of $25,000.”
One of Mace Griffin’s attorneys, Hoyt E. Hart II, said he expects the total value of the case to be over $1 million.
North Carolina state law caps punitive damages at three times the amount of compensatory damages, or $250,000, whichever is greater. For medical liability, North Carolina limits non-economic damages to $500,000, but that limit does not apply to punitive damages.
The complaint was filed Dec. 19, five days after North Carolina Attorney General Josh Stein filed a lawsuit against HCA and Mission alleging they violated the asset purchase agreement — which includes 15 commitments to preserve services as they existed at the time of HCA’s $1.5 billion purchase of the hospital system in 2019 and to expand them — regarding cancer care and emergency services at the hospital.
The complaint incorporates several portions of Stein’s filing, without attribution, that accuse HCA of maximizing profits “at the expense of patient care, working conditions and responsible corporate behavior,” and specifically gutting staffing in such a way that puts patients in danger.
Complaint alleges negligence during 23-day hospitalization
Griffin, a photographer who taught at Western Carolina University, was admitted to the Mission emergency department after an episode of vomiting, according to the complaint. She was disabled, unable to speak and required a feeding tube, according to the complaint, which also stated she was “otherwise in reasonably good health for a sixty-six (66) year old disabled woman.”
Hart told The Watchdog that she was unable to walk but fully cognitive. He declined to provide additional detail about her disability.
“Our understanding is that she had normal blood pressure and renal function on arrival to Mission, but her O2 sat (oxygen saturation) was below normal due to her vomiting episodes,” Hart said in an email.
Mace Griffin would not answer questions, but emailed a statement that said, in part, that her experience with her wife at the hospital “will haunt me for the rest of my life.”
According to the complaint:
- On Aug. 1, Dr. Ann Ree Sumner Mitchell, an emergency medicine physician employed by Mission’s emergency department, “attempted to place a central line” – a tube used to give fluids or medications or do medical tests rapidly – “in Cathryn’s left femoral vein, puncturing Cathryn’s femoral artery.” Mace Griffin pointed out arterial bleeding, but Mitchell “took no action and allowed Cathryn to bleed internally without vascular intervention,” the complaint stated. The unattended bleeding eventually blocked blood flow to her lower left leg, leading to gangrene in her foot.
- Griffin was seen later that day by Dr. Luke Habegger of Asheville Pulmonary and Critical Care Associates, who “refused to admit Cathryn or to treat her for the punctured femoral artery,” the complaint stated. It stated Habegger suggested to Mace Griffin that Griffin be given morphine “to end her life” and refused to treat her further. (The complaint does not specify Griffin’s diagnosis or the reason Habegger allegedly suggested end-of-life care.)
- The next day, Madison Bryant, a nurse practitioner, and Dr. Gregg Stashenko of Asheville Pulmonary “incorrectly documented,” without having examined Griffin, that deep vein thrombosis – a blood clot – had restricted blood flow to her left leg, and “failed to call for a vascular surgery consult,” the complaint stated. Stashenko urged Mace Griffin to have Griffin transferred to hospice. “In lieu of examining Griffin,” the complaint stated, “defendant clinicians frequently took the shortcut of cutting and pasting prior exam notes.”
- By the end of Aug. 2, Griffin’s toes and foot turned blue from lack of circulation, a condition that was “visible and obvious to anyone who bothered to look,” the complaint stated. By Aug. 3, Griffin’s entire foot and ankle were purple.
- On Aug. 6, a kidney specialist inserted a vascular catheter in her left leg and “defendants attempted dialysis…This effort was predictably unsuccessful and demonstrates the lack of qualified personnel.” Ultimately continuous renal replacement therapy, a type of dialysis, was begun and continued throughout Griffin’s hospitalization. (The complaint does not explain why her kidneys were compromised.)
- Two days later, a vascular specialist assessed Griffin, finding “all left leg arteries” were completely blocked, and Griffin underwent surgery to repair “a bleeding hole in the femoral artery,” according to the complaint.
- Griffin had arrived at Mission with a gastronomy tube that allowed her to be fed through her stomach. But “nutrition was withheld without medical justification,” and the defendants neglected to order tube feeding for eight days, the complaint stated. On Aug. 9, Griffin was given food for the first time since Aug. 2.
- On Aug. 10, lab tests of her phlegm revealed bacterial growth “due to contaminated intubation equipment,” the complaint stated. Griffin, who had been on a ventilator, was weaned off the machine on Aug. 11 but had to be intubated again the next day after a chest X-ray showed pneumonia. Griffin was given the antibiotic Zosyn. (The complaint does not describe how long Griffin had been on a ventilator or why.)
- On Aug. 13, a specialist in oncology and hematology reviewed Griffin’s internal bleeding and low platelet count and suspected Zosyn as a cause. For the next nine days, Griffin received blood transfusions for her internal bleeding, but according to the complaint, “defendants never stopped the Zosyn.”
- The hospital did not employ dedicated dialysis nurses, relying instead on unqualified bedside nurses to manage dialysis equipment and treatment, the complaint stated. On the afternoon of Aug. 22, dialysis was stopped to change a filter, but the equipment was left unused until the night shift took over. “The night shift was unable to reassemble the machine and resume treatment,” the complaint stated. “Hours were wasted attempting to locate working dialysis equipment, unsuccessfully.”
- During the search for working dialysis equipment, a nurse initiated percussive bed therapy, which is a bed vibration usually employed to help clear airways, over Mace Griffin’s objections. The procedure “thrashed” Griffin until her airway was compromised and her oxygen saturation dropped below 80 percent, the complaint stated. The nurse attributed the reading to a faulty sensor and “then spent hours searching the hospital for a working” sensor, the complaint stated. “Each successive sensor gave the same reading and prompted the search to continue, all the while, no action was taken to correct the airway compromise.”
Griffin died of asphyxiation early Aug. 23 after gasping for air for several hours, the complaint stated.
“Defendants knew or should have known that failing to immediately correct the airway compromise would subject Cathryn to the risk of asphyxiation,” the complaint stated.
Griffin’s official death certificate lists “multi organ system failure,” as the immediate cause of death, with septic shock and “polymicrobial bacteremia and bacterial pneumonia” as contributing conditions. The National Institutes of Health states that asphyxiation is a major cause of multi-organ failure.
Mace Griffin told The Watchdog in her written statement that the hospital “played God and did not believe she had the right to live because she was disabled after they inflicted a fatal injury to her.”
Mace Griffin and Griffin were married 10 days before Griffin died, according to public records.
“The indignities, demoralizing, inhumane neglect, abuse and unfathomable pain she endured should be a warning to all of us,” Mace Griffin said in her statement.
Plaintiff’s attorney awaiting approval from judge
The lawsuit was filed by Hart, a Southern California-based attorney, and Katherine Langley of Burt Langley in Asheville.
Hart, whose license is in good standing in California, is awaiting a judge’s approval to represent Mace Griffin in the case because he is not licensed to practice in North Carolina.
As required by North Carolina law, Mace Griffin and her legal team stated in the complaint that an unidentified outside party had reviewed Cathryn’s medical records and is willing to testify as an expert witness. They declined to identify the person when asked by The Watchdog.
The complaint also incorporates language from a pending medical malpractice lawsuit filed by Ashley Smathers, the wife of Canton Mayor Zeb Smathers, against HCA in September 2022. That case, one of the highest-profile medical lawsuits against HCA in Western North Carolina in the past five years, alleges medical negligence during the birth of Smathers’ child in March 2020. The Smathers lawsuit alleged Ashley Smathers lost 10 liters of blood and her child suffered permanent brain damage. Mission has maintained that it provided appropriate care, according to the Asheville Citizen Times.
Griffin’s complaint also incorporates research by the Service Employees International Union, which represents some of HCA’s employees. That research stated that HCA’s executive compensation is tied to in-hospital mortality rates, stating HCA’s average Medicare hospice transfer rate was nearly 40 percent higher than the national average in 2021.
An HCA spokesperson told NBC News in June 2023 it strongly disagreed with the SEIU report, calling it inaccurate and misleading.
The complaint states that “HCA routinely engages in practices that maximize profits at the expense of patient safety, working conditions, and responsible corporate behavior,” echoing wording in Stein’s lawsuit. “HCA staffs its hospitals at very low levels, typically about 30% below the national average, according to analysis of Medicare cost report data. This trend of low staffing at HCA hospitals reflects an intentional corporate strategy that long predates the COVID pandemic. In particular, Medicare cost report data shows staffing levels routinely and precipitously drop after HCA acquires a hospital.”
Echoing the Smathers lawsuit, the complaint also stated that, “To the extent Defendants may try and claim that Mission Hospital experienced staffing shortages due to the COVID pandemic that impacted Plaintiffs’ care at issue, this is false.
“Any understaffing that may have existed at Mission Hospital was chronic, it predated both the COVID pandemic and CATHRYN’S encounter there, and was part of the intentional for-profit business decisions made by Defendants following HCA’s takeover Mission Health System and the monopoly power it represented in the area,” the complaint stated.
Mission has been under investigation by The Joint Commission, the nation’s largest hospital accreditation organization, and the North Carolina Department of Health and Human Services on behalf of the U.S. Centers for Medicare and Medicaid Services, according to The Watchdog’s reporting. Those investigations focused on emergency department and cancer care services.
Results from those investigations have yet to be made public, but The Watchdog has reported that the hospital made changes to its emergency department, including increasing nursing staff there while inspectors visited Mission. The hospital also offered emergency department physicians more hours and halted patient transfers from other area hospitals, all moves that would help the emergency department better serve patients.
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 him at [email protected]. Barbara Durr is a former correspondent for The Financial Times of London. Email her at [email protected]. To show your support for this vital public service please visit avlwatchdog.org/donate.