Could hospital mergers lead to more medical malpractice?
We like to think that healthcare providers place their primary focus on their patients’ health. However, the truth is that American health care is also business. Accordingly, the people working in it keep an eye to their bottom line. The problem is that the bottom line of health care isn’t just about money; it’s also about people’s lives. When providers focus too much on the money, they can place lives at risk.
This is part of the argument raised by a recent lawsuit. In North Carolina, residents sued HCA Healthcare for creating a monopoly they argue has led to higher costs and lower quality.
An antitrust case with healthcare consequences
The North Carolina lawsuit is technically directed against HCA’s anti-competitive business practices. Still, it could have serious implications for medical malpractice cases in North Carolina and elsewhere.
As Fierce Healthcare notes in its reporting, HCA runs a staggering 90 percent of all inpatient hospital care in western North Carolina. This market share resulted from a 1995 merger that saw Mission Health unit combine with St. Joseph’s Hospital. That meant Mission Health no longer had true competition. HCA gained its market share when it bought Mission Health in 2019.
One might expect the state would have blocked Mission Health’s merger with St. Joseph’s. Instead, they permitted it because Mission Health had agreed to state oversight. However, the state later removed the oversight restrictions. When it did, it also got rid of Mission Health’s antitrust immunities.
Accordingly, North Carolina residents have sued HCA for its purchase of Mission Health and its use of anti-competitive tactics. These include forcing providers to accept gag clauses and insurance companies to accept “all-or-none” arrangements. Effectively, anyone who wants to work in health care in western North Carolina has to play by HCA’s rules. At the same time, HCA has refused to provide mandatory pricing transparency.
Still, residents may be less concerned by those actions than by their consequences. As several lawmakers noted in an open letter to the Citizen Times, HCA’s actions have real consequences for the quality of the region’s health care:
- Fewer conditions covered
- No pre-approval for patient care, meaning more patients find themselves saddled with unexpected medical debt
- Numerous staffing cuts, accompanied by numerous departures from deeply dissatisfied nurses and doctors
- Increased patient safety risks, including at least one death
Obviously, it’s this last point that stands out as a safety concern. However, it’s worth remembering that health concerns don’t live in a vacuum. People who worry that they cannot afford medical procedures may choose not to get the treatment they need. Even delaying certain treatments can cause real problems.
When could such anti-competitive tactics lead to malpractice?
We don’t typically hear complaints about questionable business practices and think they could lead to medical malpractice. However, in this case, that’s a real consideration.
Healthcare providers owe their patients a certain standard or duty of care. When providers fail to uphold that duty and their failures lead to real harm, that’s medical malpractice. While it’s easiest to imagine malpractice resulting from missed diagnoses or surgical errors, you could potentially see harm result from an understaffed hospital’s inability to treat a patient in time.
The lawsuit against HCA originated in North Carolina. Still, the issues it raises are as pertinent to Florida residents as they are to anyone anywhere. Standards of care apply at multiple levels, and hospital chains that don’t meet those standards could open themselves up to multiple malpractice claims.