Nashville, Tenn.-based HCA Healthcare is urging shareholders to reject a proposal to be voted upon in an April 23 shareholder election that would require the company to disclose the health consequences of its hospital acquisitions, including staffing levels, physician departures and patient satisfaction ratings, the Asheville Watchdog reported March 19.
The proposal, introduced by state Sen. Julie Mayfield, a Democrat, cites Asheville, N.C.-based Mission Hospital, which HCA acquired in 2019, as its primary example, but would cover all HCA acquisitions over the past 10 years. HCA operates 190 hospitals, up from 170 in 2016, meaning the proposal would require examinations of approximately 20 acquisitions.
Ms. Mayfield’s proposal alleges that since 2019, more than 200 physicians have left Mission, HCA raised prices by 10%, began charging patients surprise fees, and reduced staff per occupied bed at the flagship hospital from six full-time equivalents to 3.7, well below North Carolina’s state average of 5.1. Patient satisfaction ratings allegedly fell from four and five stars pre-sale to one in 2025.
Since 2019, Mission has received five immediate jeopardy citations linked to multiple patient deaths and two Emergency Medical Treatment and Labor Act violations, with a third EMTALA referral pending. The most recent IJ designation, issued in late January after CMS cited patient care and safety deficiencies that led to two patient deaths, was lifted in early March. A CMS spokesperson told Becker’s the agency will conduct an unannounced on-site revisit to confirm corrections have been made.
“In addition to the usual plan of correction required to address deficiencies following a survey, Memorial Mission Hospital has committed to a robust, enhanced plan to correct systematic and repeated patterns of quality concerns CMS has observed at this facility,” the spokesperson said.
In its proxy statement response, HCA’s board noted that Mission received the 2026 Healthgrades America’s 50 Best Hospitals Award, its 11th consecutive year of recognition, citing it as evidence of “consistent clinical excellence.”
HCA attempted to block the proposal from a shareholder vote, arguing to the Securities and Exchange Commission that Ms. Mayfield was “using public opposition to the company and her Mission Health-related activism in an attempt to bolster her political career, an interest not shared by other shareholders at large.” The SEC rejected that argument.
A prior version of the proposal appeared on last year’s ballot and was defeated, along with proposals that would have tied executive bonuses more closely to patient health and safety. In February, HCA reaffirmed in an SEC report that executive bonuses will continue to be weighted 80% on hitting profit targets and 20% on quality of care.
According to the report, that formula — 80% profit, 20% quality — has remained unchanged through five immediate jeopardy citations, two confirmed EMTALA violations, a third pending and the departure of more than 200 physicians.
This year’s proposal appeals more directly to shareholders’ financial interests, according to the Watchdog, arguing that HCA’s alleged mismanagement of Mission threatens its institutional value, corporate revenue and potential legal liability. The HCA board also unanimously recommended against a separate proposal that would give shareholders greater voice in bringing concerns to the board.
In response to a request for comment, HCA referred Becker’s to its 2026 proxy statement. The board wrote that it had “carefully reviewed Proposal 4 and, for the following reasons, have determined that adopting the proposal is not in the best interests of HCA Healthcare or our stockholders. The board unanimously recommends a vote ‘Against’ the proposal.”
Moreover, HCA said generating such a report would be infeasible and an impractical use of resources, as well as a distraction from its core mission of providing quality healthcare to local communities.
“The board is actively engaged, both as a whole and through its committees, in overseeing the company’s policies and procedures relating to the delivery of quality medical care to patients,” the statement said. “We believe it would be inappropriate to delegate these types of management and board oversight functions to stockholders.”
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