HCA profit-driven goals come at Asheville community health care
Dr. Virgil Thrash
My first memories of medical care and doctors were at the age of 5 when my tonsils were removed in 1950 by our family GP Dr. Eugene Herman in LaGrange, Georgia, a small textile town of 25,000.
Dr. Herman was a bit scary. The nurses in our small hospital were nice, and the ice cream for my sore throat was plentiful. In my early teens, Dr. Charles Cowart, a local surgeon and family friend, though always busy, was never too busy not to ask about my fox terrier, Butch. Those early memories made deep impressions on me about what medical care should look like. It should be patient-centered, and personal.
I decided at 15 that I would become a doctor. Four years of college at Emory, four years at the Medical College of Georgia, a year of a rotating internship at Parkland Memorial Hospital in Dallas, two years as a flight surgeon in the Air Force, and three years of Internal Medicine residency back at Parkland followed.
During Christmas 1975 my wife Nancy and I traveled to Asheville at the invitation of Dr. Lucian Rice and Dr. Ted Hill. I remember making hospital rounds with Lucian and meeting many friendly, knowledgeable physicians and nurses at both St. Joseph’s and Memorial Mission Hospitals. Several of these doctors reminded me of Dr. Herman and Dr. Cowart. Nancy and I fell in love with Asheville, the mountains, and the medical community here. When Lucian and Ted asked me to join their practice at Biltmore Medical Associates I accepted.
I began my medical practice here in July 1976. My first three years with the group were in a rented space at Mission’s old clinic building. In 1979 we built Biltmore Medical’s present Asheland Avenue office. Primarily because of the outstanding reputations of Lucian and Ted my practice grew rapidly. I became very active with the Buncombe County Medical Society. I volunteered to be a member of the teaching staff for the new MAHEC Family Medicine Residency Program and served on a host of committees at both hospitals. My hospitalized patients were evenly distributed between St. Joseph and Mission, I’d round at both each morning before going to the office. Outstanding care was facilitated by the growing network of superb surgical and non-surgical specialists amassing in Asheville. The nursing and paramedical care of these patients were exceptional.
I strongly supported Mission’s purchase of St. Joseph in 1998, believing the consolidation would further facilitate patient care in Western North Carolina. This proved to be true thanks to coordinated administrative, nursing, paramedical, and physician involvement.
I retired from Biltmore Medical in 2018 after 42 years of practice. At that time, purchase negotiations were almost complete between HCA Healthcare and Mission Health. Our treasured nonprofit community system was now a large corporate for-profit one.
I remain in close contact with many of my previous patients. Over the past two years I am hearing more complaints from these friends regarding their experiences at Mission. There is still very often excellent nursing, physician and support staff care. However, these reports suggest that the reduction of the nursing and paramedical staff is making it difficult to consistently receive the patient-centered care that was impressed upon me as a child, and that I committed to providing throughout my career. It appears that the necessity for HCA to declare a profit at Mission is coming at the expense of the type of care all of us in Western North Carolina had come to expect.
All health care systems are challenged by their cost for indigent care, increasing diagnostic and therapeutic expenses, and staffing needs for those requiring high intensity care. Both not-for-profit and for-profit systems face these same problems.
Perhaps St. Joseph and Mission should have remained independent hospitals. Perhaps Mission should never have sold to HCA. Perhaps Mission should be re-purchased by a not-for-profit health system. These questions and more are being addressed by WNC’s medical and civic leadership.
Asheville’s medical facility landscape is changing. We are seeing more services offered by Advent, Novant, and UNC Health systems. While these changes are certainly welcomed, Mission needs to remain the tertiary and quaternary health care center which it was becoming when I began practice here in 1976. The people of WNC deserve no less.
Dr. W. Virgil Thrash, MD, joined Biltmore Medical Associates in 1976 where he practiced internal medicine for 43 years , retiring in 2019. He and his wife Nancy continue to live in north Asheville.
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