John Snow dreads his daily trip to the post office these days. It’s just two blocks from his home outside Murphy, but the whole way there he wonders what will be waiting for him this time.

Once inside, he heads for the trash can and peers inside. And more often than not, he finds his own face staring back, perhaps flanked by a cartoonish cutout of Obama’s head, or alongside a drowning pink piggy bank, or — the worst yet — as an accompaniment to the menacing face of a child rapist behind prison bars.

Verbal sparring over key campaign issues in this fall’s state senate race was lively and pointed between N.C. Sen. Jim Davis, R-Franklin, and former Democratic state Sen. John Snow at an Aug. 9 forum the Macon County League of Women Voters hosted in Franklin.

State Sen. Jim Davis, R-Franklin, violated state ethics rules this month by using his government email address for personal, but political, purposes. Specifically, Davis used his General Assembly email account to send out a campaign announcement saying he would run for re-election.

The announcement touted Davis’ personal attributes and political accomplishments.  It included such language as, “Once he took office … Davis quickly established himself as a strong advocate for local government control.” And, that “his commitment to constituent service has become a hallmark of his service … ‘I did not go to Raleigh to make a career. I went to Raleigh to serve.’”

Davis’ legislative assistant sent the email out; Davis wrote the press release. State law dictates that elected officials cannot conduct “campaign from a legislative office, a member’s legislative office address, legislative email address, or legislative telephone number.”

Davis said he learned about the violation after being contacted by the Asheville Citizen-Times. The reporter asked if the senator was aware that it was illegal to use his General Assembly email for campaign purposes, Davis said. The senator said he called to check that fact, found it to be true, and self-reported his violation to senate leaders. He said there are and will be no repercussions.

“I was ignorant of the law, to tell the truth,” the freshman legislator said. “I did know of course that you couldn’t use your legislative email to raise money, that’s pretty obvious.”

In spite of Scott McLeod’s assertion that “it would be hard to argue otherwise” in his column (“Vote on NCAE dues a slap in the face to teachers,” The Smoky Mountain News, Jan 11 edition), I am going to give it a try.

I am not an apologist for the N.C. House of Representatives, but their leadership determines their agenda, not the governor. The legislature was called back into session to consider the veto override of S9, No Discriminatory Purpose in Death Penalty. The Senate overrode the veto in a 31-19 partisan vote. The House did not have the votes but instead referred it to the House Committee on Judiciary for future consideration.  

Speaker Thom Tillis has been very candid from the start in telling members that the governor’s vetoes could be considered at any time when the legislature is in session. Consequently, since they were in session they brought up the governor's veto of S727, “No Dues Checkoff for School Employees.” The Senate overrode the veto on July 13, 2011. The House overrode the veto in the early morning hours of Jan. 5. Two Democratic House members were absent due to illness and one Republican member is deployed in Afghanistan. The speaker had the votes to override two other vetoes but chose not to do so at that time.

There has been much misinformation put forward about S727. It is not an assault on teachers or education, merely an end to the practice of the state being the dues collection agency for the NCAE. The citizens of North Carolina should not be forced to bear the cost for collecting NCAE dues. That should be the responsibility of the NCAE. I am sure the teachers that choose to be NCAE members can find an alternative to the automatic dues checkoff, e.g., electronic funds transfer from their personal checking account.

Considering the NCAE is a thinly veiled lobbying group for Democrats, it should be no surprise that it does not have many sympathizers in the Republican ranks. More than 98 percent of the NCAE campaign donations go to Democrats.

During my 10 year service as a Macon County commissioner, I voted for every capital facilities improvement in Macon County Schools since 1997, investments of more than $50 million. For the first time in more than 35 years there will be no mobile classrooms at the start of the 2012-13 school year. That is a record I’m proud of and a testimony to the value Macon citizens place on their public schools. In spite of that record, the NCAE chose to spend thousands of dollars on mailers that contained misleading information and/or outright lies about my record. So, is the NCAE for education or is the NCAE for the Democrat Party? My personal experience makes me wonder.

I have met no person in the Legislature who is interested in an “orchestrated evisceration of the state’s public schools,” as was stated in the column. I have met many who are interested in improving public education so that students are better prepared to compete in a global economy. Our results are not adequate at this time and it will take more than money to improve them.

Your readers should be reminded that H200, the bipartisan budget passed for this biennium, cut K-12 education budget 0.5 percent more than the governor's recommended budget. Hardly the draconian cuts described by some. That does not include the $60 to $100 million the governor wanted to pass on to local governments for school bus purchases. Ask your county commissioners what they thought of that idea. The legislature worked diligently to craft a budget so that our state was fiscally sound. We have begun that journey but there is still much work to do.  

The present legislature inherited a $2.5 billion deficit, a $2.6 billion debt to the federal government for unemployment compensation, $7 billion in tax supported debt, a $2.8 billion underfunded state employee retirement system, a $40 million underfunded consolidated judicial retirement system, a $40 million underfunded National Guard retirement system, and a $32.8 billion unfunded liability for retiree health insurance benefits. The legislature would prefer to dedicate more to education programs that work and reward good teachers with merit pay, but those efforts will not reach full fruition until we have our fiscal house in order.

We do agree that teachers should not be held accountable for society’s ills. We cannot continue to dump our problems at the schoolhouse door and expect our teachers, our educational system, to make it all better. To use Mr. McLeod’s own words, “Student achievement still has ground to make up with counterparts around the nation. Many counties have put together quality programs that send students on to college prepared for what lies ahead, but others are lacking.”  

We need to invest in finding out what works and need to stop doing what clearly does not. As we move forward to provide our students with the very best we can offer, we must infuse integrity into our stewardship of funds for education so that those same students will not be shackled with state and nationally imposed debt they will not live long enough to repay. That, sir, is a burden they do not deserve and one against which I will continue to hold my guard.

(Sen. Davis, a Republican, lives in Franklin. His 50th District, after the recent redistricting, covers all of Haywood, Jackson, Swain, Macon, Clay, Cherokee and Graham counties. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..)

N.C. Senator Jim Davis spoke about the Eastern Band of Cherokee Indians’ contribution to Western North Carolina at a tribal council meeting in Cherokee last week.

Harrah’s Cherokee Casino and Resort contributes about $375 million to the economy in Western North Carolina, and it’s benefit “goes far beyond that,” said Davis, R-Franklin.

Council members inquired how much the state gave to the Eastern Band each year.

“Not enough,” responded Davis, who did not know an amount offhand.

The casino has been an economic engine for the area.

“Swain County for many, many years was the poorest county in the state,” said Bo Taylor, a tribal council representative from Big Cove. “We provide jobs in WNC.”

Harrah’s, which employs about 2,000 people, is the largest employer west of Asheville. It doles out more than $53 million in salary and wages each year.

Casino jobs account for 5 percent of all employment in Swain and Jackson counties, according to a June 2011 economic impact report by the Frank Hawkins Kenan Institute of Private Enterprise at the University of North Carolina in Chapel Hill.

Taylor added that money generated and wages paid from Cherokee businesses, including the casino, go back into the local economy, promoting further economic growth.

More than 80 percent of the wages and salaries paid out by the casino is fed into the local economy, according to the report.

During his visit, Davis praised the independence for the tribe and received a gavel with a beaded handle.

“I have great admiration for your tribe, for the sovereignty you have,” he said.

Many members of tribal council thanked Davis for supporting Cherokee and for being easily accessible.

“I want to thank you for stepping forward and supporting the Eastern Band,” said Councilwoman Tommye Saunooke. “There’s not many legislators that would do that.”

Sen. Jim Davis, R-Macon County, doesn’t mince words: he knows perfectly well that his budding state political career is being jeopardized by his own party’s redistricting proposals.

“But it follows the state constitution, and I’m in favor of that,” Davis said. “The districts are clean, and they are fair, and I think following the law is a lot more important than catering to my political career.”

Davis, a Franklin orthodontist and longtime Macon County commissioner, beat incumbent Sen. John Snow, D-Cherokee County, during last year’s election in a Republican scrum that saw conservatives wrest control of the General Assembly. The victory won the GOP the right to reconfigure the state’s political landscape for the next decade.

But in recompiling state House and Senate districts to comply with population changes as recorded in the 2010 U.S. census, the GOP sure didn’t do party-member Davis any favors. The 50th Senate District has been redrawn minus Republican stronghold Transylvania County, and including all of Democratic-heavy Haywood County.

Davis knows that he could be fighting for his state political life.

The race last year was close: Davis trumped Snow by just more than 200 votes.

Not too fast, boys

“The 50th could be vulnerable to a Democratic challenger, but it’s far from a sure thing,” said North Carolina political expert Chris Cooper, a political science professor at Western Carolina University.

With the reconfiguring, Gov. Beverly Perdue still would have won the district 50-46 percent, Cooper pointed out. On the other hand, Republican U.S. Sen. Elizabeth Dole would have won 49-47 percent over challenger Kay Hagen, a Democrat who went on to win the Senate seat, and Elaine Marshall, a Democrat, and Republican Sen. Richard Burr, would have ended in a dead heat, he said. Despite all of those relatively close races, however, Sen. John McCain, a Republican presidential candidate, would have won soundly, 57-44 percent.

“It’s an interesting one for political prognosticators,” Cooper said. “We talk a lot about ‘incumbency advantage,’ the name recognition and benefits that come from being an incumbent, but with two potential challengers who have been in office before, it’s tough to know exactly how it will play out.”

Careful what you wish for

Janie Benson, chairman of the Haywood County Democratic Party, is excited about the prospects for her party.

“We feel like we do have two strong candidates,” she said.

Republicans, on the other hand, are left in the awkward position of supporting their party’s proposed redistricting plan even while acknowledging Davis has been left vulnerable.

“It’s going to make it very rough on Jim,” said Ralph Slaughter, chairman of the Jackson County Republican Party. “It really hurt to lose Transylvania. But, it’s logical, and it equalizes the counties (population numbers).”

Slaughter said the Republican Party would need to get conservative voters “revitalized” in Haywood County, and that the GOP has its work cut out for it to hold on to the 50th.

Ironically, Haywood County’s Republican Party openly lobbied for the county to be returned to one district. Haywood currently is a split county in both the Senate and the House, and is represented by two different legislators.

County Republicans, apparently with some success, argued that two House and two Senate districts are confusing to voters and have diluted the county’s legislative influence. Local Democrats fought the change they now are embracing joyfully, maintaining only a few weeks ago that Haywood County residents were well served by having two senators and two representatives.

Davis said the Haywood County precincts he currently represents are solidly Republican, but that he’s now picking up strong Democratic-dominated precincts, based on party registrations.

But, he said, it’s impossible to argue with the geographic logic of having the 50th Senate District made up of the state’s seven westernmost counties, as it once was.

For his part, former Sen. Joe Sam Queen, a Democrat from Haywood County, doesn’t believe that GOP redistricting leaders were trying to develop a perfectly balanced and fair political scenario in this part of the state. He thinks they simply ran out of North Carolina counties while trying to juggle things elsewhere in favor of Republicans.

“They didn’t have a lot of options at this end of the state,” Queen said. “You can’t get behind John.”

Cherokee County is the state’s westernmost county, bordered by Tennessee and Georgia.

Elsewhere, the GOP’s proposed redistricting does appear to favor the party’s chances of retaining House and Senate seats. Transylvania County would shift from the 50th to the 48th District, further locking down the Republican’s hold through Sen. Tom Apodaca, R-Henderson County, the rules committee chairman in the Senate.

Also shifting in a dominoes-like manner? Polk County would move from the 48th to the 47th District, and more of the 48th District’s precincts in Buncombe County would shift to the 49th District. Senate Minority Leader Martin Nesbitt, a Democrat, represents the 49th.

“Six incumbent Democrats were placed in districts with other incumbent Democrats, compared to three Republicans who were doubled up,” Cooper said. “There is also some evidence that Democratic voters were ‘packed’ into districts, increasing the chances that the Republicans hold onto more seats or expand their lead.  

“We can’t forget, however, that the Democrats would do the same thing — and did do the same thing 10 years earlier. It is one reason these districts are so difficult to analyze — we tend to compare them to the existing districts that were drawn by Democrats.”

Angel Medical Center in Franklin, one of the last, small independent hospitals in the state, is now part of Mission Health System in Asheville.

After months of negotiations, Angel last week came under Mission’s management umbrella — likely a temporary arrangement on the road to full merger. The move does not come as a surprise. Angel has had a close partnership with Mission for years.

Angel CEO Tim Hubbs equated the deal signed last week to getting engaged after years of dating.

“I would call it the engagement period. I think in short order we might say ‘Let’s go ahead and get married’ but we haven’t set that date yet,” Hubbs said.

Hubbs would not say what would trigger an acquisition by Mission, only that it would be based on certain outcomes being realized over an undisclosed length of time.

While the deal falls short of a full merger for now, most of the benefits of affiliation will be realized right away, Hubbs said.

The move will be financially advantageous for Angel. The hospital can get bulk rates on medical supplies, push for higher reimbursement from insurance companies and get better deals on equipment or contracts thanks to the buying power and leverage that comes with being part of a larger institution like Mission.

Mission already came to Angel’s aid on the monetary front two years ago, when the hospital was about to see its interest rate on some $14 million in debt jump substantially. The debt dates back to renovations and expansions over the years, Hubbs said.

SEE ALSO: The passing of an era? Residents in Macon County say goodbye to independent hospital 

Faced with pressure from the national credit crisis, the bond holders reassessed Angel’s risk level and planned to adjust the interest rate accordingly. Mission stepped in a guaranteed the debt, akin to co-signing for a loan, and allowed Angel to keep its interest rates reasonable, Hubbs said.

Tapping new capital is not a reason for the affiliation, Hubbs said, although at some point that may be a possibility.  

Small hospital challenges

A very costly undertaking for hospitals, and one that has driven other small, independent hospitals around the state to affiliate, is the transition to electronic medical records. The cost of computers and software to go from paper charts to integrated electronic patient records is astronomical, according to Janet Moore, the marketing director of Mission Hospital.

Moore said small rural hospitals have it tough these days. They usually have a high percentage of patients on Medicare and Medicaid, which pay less than private health insurance plans. There’s also a higher percentage of people who can’t pay and have to be written off.

“It leaves them in a real bind,” Moore said.

Mission can provide expertise in the increasingly complex world of hospital management. Picking the right medical code in the maze of billing bureaucracy can make a substantial difference on how much insurance companies or Medicare reimburses for a particular service.

Mission also has experts that can help Angel with best practices, from preventing falls to reducing infections among hospitalized patients, Moore said. It is not just a matter of patient safety, but Medicare and Medicaid won’t pay for infections or injuries picked up during a hospital stay.

“The federal government has said, ‘We are not paying for that anymore.’ They say, ‘That happens in your hospital you eat the cost,’” Moore said.

Another benefit: Angel can now lean on Mission’s reputation when recruiting doctors to locate in Franklin.

“I do think if you are recruiting a physician and you can be part of Mission’s system, it does feel differently for them than just a solo hospital,” Hubbs said.

That’s what inspired Transylvania County Hospital in Brevard to sign a management contract with Mission recently as well.

“What they are looking at is how do they continue to attract specialists and doctors to come there and live and work,” Moore said.

A few doctors affiliated with Mission already hold satellite office hours in Franklin, providing access to specialties otherwise not available in the community.

“We have been able to bring specialists and subspecialists to enhance what the community already has,” Moore said.

Despite fears to the contrary, Mission does not plan to siphon care out of Franklin and send patients to its flagship in Asheville.

“We’re looking forward to working more closely with Angel’s leaders, physicians and staff to help ensure the continued delivery of quality care close to home by this outstanding community hospital,” said Ron Paulus, CEO of Mission Health System.

The hospitals in Spruce Pine and McDowell County both saw both their revenue and the number of doctors practicing in their communities increase substantially following their mergers with Mission.

Angel has long partnered with Mission, both formally and informally. Angel serves as a western base for Mission’s emergency medical helicopter. The two recently embarked on a joint spine center.

Last year, Angel’s board made public that it was pursuing a formal affiliation with Mission. The terms of the contract signed by Angel’s board of directors last week are not being made public. Both institutions are private and not required to disclose details of the deal.

Hubbs would only say that the contract is long-term, longer than just a few years. The financial terms are private as well, such as the management fee Mission may be getting or benefits Angel expects in return.  

Mission facing challenges

The deal comes amidst debate over Mission’s presence in the region. Detractors claim competition from Mission amounts to a monopoly and should be reined in. Supporters counter that Mission is merely trying to provide the region with access to the best health care possible.

State regulators are reviewing Mission’s anti-trust regulations to determine whether they should be tightened or loosened. Meanwhile, a bill has been introduced by Sen. Jim Davis, R-Franklin, that would bar Mission from expanding pending a state-commissioned study. If it passed before Angel inked a deal with Mission, it could have derailed it, but not now.

“There is nothing in the bill that would create an unwind situation,” Hubbs said.

The bill could still hurt Angel from realizing the full benefits of the affiliation. It aims to limit how many doctors Mission can employ, for example, undermining its ability to recruit new doctors to Franklin.

The loss of autonomy, whether perceived or actual, is a likely side-effect of a merger. Two other hospitals that have merged with Mission — namely McDowell County Hospital and Blue Ridge Regional Hospital in Spruce Pine — have preserved a balance of power, however.

The local hospitals kept their own board of directors, although some board members are now appointed by Mission. The local hospital board has hiring and firing authority over the CEO, but the CEO also reports directly to Mission. In essence, the CEO has two bosses. And if he got conflicting orders?

“That has never happened,” Moore said.

Moore said Mission has never expected the CEO to make decisions that benefit Mission to the detriment of the local hospital, thus it’s never been an issue.

That’s what Angel is counting on as well.

“The focus of this agreement is to maintain, enhance and increase access to health services here locally, while maintaining local input,” Hubbs said.

A state bill aimed at ensuring a balance of power between Mission Health System and smaller hospitals has placed lawmakers in the middle of a healthcare turf war.

As Mission steps up efforts to acquire smaller hospitals and doctors’ practices around the region, some fear the Asheville-based health system will siphon healthcare dollars away from local communities and limit the scope of medical care patients can get closer to home.

Meanwhile, patients don’t want business motives to drive the healthcare they receive. The medical community universally asserts that isn’t the case, even as hospitals jockey over market share and fiercely guard their territory from encroaching competition.

But Sen. Jim Davis, R-Franklin, who introduced the bill, isn’t so sure.

SEE ALSO: Angel close to merger with Mission if state bill stays at bay

“Health care is a business, it is a huge business, and for Mission it is close to a billion dollar a year business,” said Davis, an orthodontist in private practice who represents the six westernmost counties in the General Assembly. “Just like any other business we have to guard against monopolies.”

If Mission’s dominance is allowed to expand unchecked, with more and more doctors and rural hospitals coming under its umbrella, Davis fears everything except routine medical procedures and basic care would be funneled to the flagship in Asheville.

“None of these hospitals in the western part of the state want to be an emergency care center and just shove everything to Asheville,” Davis said. “Local hospitals want to maintain care in the local communities.”

Mission leaders maintain they do not want to suck up business from smaller county hospitals — and if they tried, patients wouldn’t stand for it.

“The data has been very consistent that people prefer their local hospital for routine hospitalization,” said Janet Moore, communications director at Mission.

Mission plays a life or death role for patients across Western North Carolina as the only hospital in the state’s 17 westernmost counties where highly advanced medical care is provided.

It’s not in anybody’s interest to see that function undermined, Moore said. On that point, Davis agrees.

“It is essential that Mission hospital remain strong in the western part of the state,” Davis said.

Yet Moore said the freshman senator’s bill would hamstring Mission: it would bar Mission from affiliations or joint ventures with other hospitals and doctors’ practices until the end of the year, or until a study is completed.

“This bill says Mission has to compete with a different set of rules than everybody else,” said Moore. “We are a little perplexed by the bill. What problem is this legislation supposed to fix?”

Mission is already subject to anti-trust regulations, imposed when it merged with St. Joseph’s Hospital. The state dictates how much it can charge for procedures, sets a profit ceiling and limits how many doctors the hospital can employ.

“We basically operate under a microscope,” Moore said.

Davis questions whether the rules go far enough, however.

“I have heard of quite a few physicians that are concerned about the lack of competition in the medical field,” Davis said.

Davis’ bill would commission a study to determine if those concerns are warranted.

“I have no evidence Mission has done anything wrong,” Davis said. “The whole purpose of my bill is to start a conversation.”

Mission’s frontline

Doctors in the region are divided on whether Mission is predatory in its business practices.

“There always will be a lot of paranoia in healthcare that the big, 800-pound gorilla is going to come in and steal your patients,” said Dr. David Mulholland, a family doctor in Waynesville who is affiliated with Mission.

But, that’s not the case, he said.

“They have plenty of patients. They don’t need any more patients,” Mulholland said.

What Mission does need, however, is referrals for highly specialized care not available at local hospitals — such as neonatal intensive care, open-heart surgery or repairing aortic aneurysms. Mission needs enough volume to cover the cost of highly specialized doctors and equipment. It counts on smaller hospitals to send patients needing advanced medical care its way, Moore said.

But when the hospitals in Haywood, Jackson and Swain counties partnered up last year with Carolina’s Health System headquartered in Charlotte, Mission began fearing those patients could be sent out of the region to Charlotte.

“Hospitals have very small profit margins. If even a small percentage of that business was siphoned off to Atlanta or Charlotte, it would be a big thing. It would hurt access for everyone in Western North Carolina,” Mulholland said.

Mission had hoped the MedWest group of hospitals in Haywood, Jackson and Swain would partner with it. But when they chose Carolinas instead, Mission reacted.

Mission began actively recruiting doctors in Haywood to join its staff. It also set up an outpatient clinic practically next door to Haywood’s hospital staffed by rotating doctors from Asheville.

Critics fear such a toehold could allow Mission to steer patients to Asheville for services. But it could be Mission is merely protecting its interests.

“Would they have had an interest in Haywood County if it was still just Haywood Regional Medical Center? They probably would have said ‘No, it is a stable situation. We get the tertiary referrals and that’s what we need and that’s what we want,’” Mulholland said. But “hospital administrators know the history of what happens when other competing large health care systems come into your area.”

Perhaps the paranoia cuts both ways, however.

MedWest CEO Mike Poore said his hospitals are not sending patients to Charlotte rather than Mission.

“Our referral patterns have not changed at all,” Poore said. “Patients do not have to worry that if a physician is employed by whatever institution that healthcare decisions are made based on anything other than providing the best care.”

When Poore’s own son needed neurosurgery recently, he sent him to Mission, not Charlotte.

“The neurosurgeons at Mission are excellent,” Poore said. “There is no reason for anyone to go beyond there for tertiary care.”

Poore said there are a lot of fears, but they are nothing more than that.

“We are working very hard to work together,” Poore said.

Dr. Stephen Wall, a pediatrician in Haywood County, said Haywood is a great hospital with great doctors, as is Mission.

“I wish we could all work together regionally,” Wall said. “I wish we could do this without always feeling like we are cutting each other’s throats.”

While MedWest frets that Mission is trying to steals its local health care dollars, and Mission frets that MedWest will send patients to Charlotte instead of Asheville, competing hospitals are nothing new in major metropolitan areas.

“It is not uncommon to have surgery center, hospital, surgery center, hospital — all within a stretch of a quarter mile,” said Dr. Chuck Trentham, an anesthesiologist at Angel Medical Center in Franklin. “We just aren’t used to the big business of medicine.”

Trentham said both sides are off in their portrayal of Mission — as a predatory hospital on one hand, or a purely benevolent institution on the other.

“I don’t think they are as bad as they are portrayed, or as good as they portray themselves,” Trentham said.

Angel CEO Tim Hubbs said he does not resent doctors affiliated with Mission providing services in their territory.

“If I didn’t have them coming a couple days a week I may not have an oncologist. For us it is not competition, it is providing a benefit to our community,” Hubbs said.

Wall said the outpatient clinic being run by Asheville doctors could be driven more by doctors’ interests than Mission’s.

“There are probably too many doctors in Asheville,” Wall said. “It is a great area and doctors want to live there, so there is competition for a shrinking healthcare dollar.”

In Franklin, doctors are used to competition from neighboring counties. Several Sylva-based practices have satellite offices in Franklin, holding office hours there one or two days a week, and sending business out of the county to Harris hospital run by MedWest in Sylva.

“The same way Mission is encroaching on MedWest, MedWest is encroaching on us,” Trentham said.

Who’s for it?

While battle lines are being drawn over the bill, exactly how it came to be isn’t completely clear. Davis wouldn’t name names when asked who approached him about the bill or who helped write it.

“I have talked to a lot of people about this bill,” Davis said. “There were hospitals and physicians groups and individuals that encouraged me to file this bill.”

It’s no secret that Park Ridge Hospital in Hendersonville supports the bill, and many believe it was the instigator. Park Ridge has reportedly brought two lobbyists on board to advocate for the bill in Raleigh.

For now, it remains the lone hospital that has gone public in support of the bill.

Park Ridge is part of the Adventist Health System, with 43 hospitals in 12 states. While Davis is a Seventh-Day Adventist, he said he did not introduce the bill to help Park Ridge because of that shared connection.

Davis said there are a “plethora” of theories about motives behind the bill. But he said his primary concern is that “health consumers’ interests are protected.”

Despite tension between Mission and Haywood, MedWest is not for the bill.

“We just don’t feel like we have any standing to support that bill,” said MedWest CEO Mike Poore. “We don’t see legislation as how you deal with competition. We believe in providing good quality health care, strong access and a great patient experience as how we compete, and that legislation is not needed.”

Some in the medical community have accused MedWest of advocating for the legislation, however.

“There has been a lot of goings on behind the scenes and behind closed doors,” Moore said.

Dr. Peter Goodfield, an Asheville cardiologist, claims the legislation was “promulgated by Park Ridge Hospital and MedWest.”

Park Ridge in Henderson and MedWest-Haywood are the region’s biggest and likely strongest hospitals after Mission. Yet their close proximity to Asheville makes it easy, too easy, for patients to defect — and thus have the most to lose should Mission launch an all-out affront.

While MedWest’s official position is against the bill, individual doctors in Haywood County are supporting it.

Three former chiefs of staff of MedWest-Haywood have gone on record supporting the legislation and accusing Mission of predatory practices. They wrote to the state as part of the public comment period on the COPA.

“Taking patients from the local hospital and medical community undermines the strong rural hospital system we are trying to build,” Dr. Shannon Hunter, an ear, nose and throat specialist in Haywood, wrote.

Dr. Al Mina, a general surgeon in Haywood County, believes Mission’s “aggressive expansion” into surrounding counties should be halted while the issue is studied.

“I have seen them duplicate services here in an attempt to weaken the local hospitals and siphon care that can very easily be performed here to Asheville,” Mina wrote.

Dr. Charles Thomas, an oncologist with 21st Century Oncology in Haywood County, has been at war with Mission hospital for more than 15 years.

Mission has attempted to block 21st Century Oncology from opening new cancer treatment centers in the region, from Franklin to Murphy to Marion. Mission challenged state permits for the competing cancer services and filed lawsuits to the same end.

“Throughout these many battles Mission’s ‘mission’ was to prevent competition,” Thomas wrote in his public comments to the state. “Mission will continue to do everything in its power to dictate healthcare delivery in Western North Carolina – even if it means cancer patients have to travel hours to receive necessary care.”

Recruiting doctors

In an effort to temper Mission’s dominance in the region, Davis’ bill aims to cap the number of doctors on Mission’s payroll.

Mission can’t employ more than 20 percent of the doctors in Buncombe County under its current anti-trust regulations. It is approaching that cap now.

Mission asked the state to increase the limit, which may have backfired by opening the door to the current debate. Davis’ bill would immediately stop Mission from employing more doctors during a study period, and would cap the number of doctors Mission can employ to 10 percent for the 18-county region. (The 20 percent cap now applies only to Buncombe.)

It’s not surprising that Mission wants to employ more doctors. It’s a national trend, driven by today’s generation of doctors who find the hassle of running their own office — the stress of being an entrepreneur on top of practicing medicine — isn’t worth the freedom.

It’s also financially attractive. Doctors are increasingly being squeezed by rising overhead and lower reimbursements from Medicare and Medicaid patients. As a result, doctors are gravitating toward a new model of being employed directly by hospitals. The hospitals keep the revenue generated from the patients, while providing a steady salary to the doctors.

But allowing Mission to employ more and more doctors will give them a lock on health care, Davis said.

“Where do you think the physicians are going to refer their patients if they are employed by Mission?” Davis said.

If Angel Medical in Franklin merges with Mission, Davis questioned whether doctors would start referring patients to Mission instead of the much closer hospital in Sylva.

But Mulholland in Waynesville said he does not steer them toward Asheville over Haywood.

“I let them decide where they want to go,” Mulholland said.

“I have no reason to stop using the local specialists. I still talk to and use our local physicians and trust them.”

Mission employs 150 physicians out of 700 who have privileges to treat patients at the hospital. Other hospitals employ a greater percentage of their doctors than Mission does. Angel employs 15 of the 40 doctors on its active staff while MedWest employs 75 doctors out of 230 — both more than one-third.

The majority employed by Mission are specialists. If they had to operate as a private practice, they wouldn’t be here, Moore said.

“There isn’t the volume of work here, for them to maintain their own practice would be financially very difficult,” Moore said.

Specialists employed by the hospital include several children’s specialists, like pediatric cancer and surgery.

“Without those specialists here these families and their children would be driving anywhere from two to four to six hours to get care,” Moore said.

Rural hospitals that have affiliated with Mission in recent years were partly drawn by having a heavy-weight in their corner to help recruit doctors.

Once affiliated with Mission, Angel Medical may be able to attract doctors to Franklin that it couldn’t on its own.

“We have the resources to pay the competitive salaries,” Moore said.

Mission is better equipped to help set up their offices, to buy them the equipment and technology they need, and offer them a larger network of doctors to be a part of, Moore said.

However, Davis has heard that some physicians felt forced to give up their private practices and become employees Mission. State regulators who crafted Mission’s anti-trust regulations obviously thought a cap was necessary, but didn’t foresee 15 years ago that it would be necessary beyond Asheville’s borders.

“There is a reason that was there: to protect physicians’ practices and to protect patients,” Davis said.

But according to Dr. Peter Goodfield with Asheville Cardiology Associates, tightening the cap for Mission when the national trend is moving the opposite direction is ridiculous.

“There are going to be virtually no physicians remaining in private practice. None of us can survive,” Goodfield wrote in public comments submitted to the state.

Mission monopoly?

Mission has already folded three smaller hospitals into its umbrella — those in Marion, Spruce Pine and Brevard. The hospital in Franklin is headed that way.

Mission is also close to a deal to build a $45 million outpatient center in conjunction with Pardee Hospital in Henderson County, seen as a threat to Park Ridge, which is also based in Henderson County.

Mission is not taking advantage of its dominance when it comes to pricing, Moore said. Its is the third lowest hospital in the state for costs, even though Mission has the highest percentage of patients in the state on Medicare and Medicaid — nearly 70 percent — who pay less than other patients.

While Davis talks about Mission’s unfair advantage, Moore said the bill actually stacks the deck against Mission.

Mission’s neighbors include Park Ridge in Hendersonville, run by Adventist Health System, with hospitals in 12 states, and Carolinas Health System in Haywood County, which has 29 hospitals under its umbrella.

“And they are claiming that we are a monopoly?” Moore said. “We don’t mind competing on cost and quality. We just want there to be a level playing field.”

Angel is a stand alone hospital, an increasingly rare status for small hospitals. It can’t continue that way indefinitely and has brokered a deal to merge with Mission in coming months. The bill would delay or even derail it.

Angel might then have to turn to MedWest for a partnership, which already has hospitals in Haywood, Jackson and Swain.

“That’s a de facto monopoly right there,” said Dr. Chuck Trentham, an anesthesiologist at Angel.

But given its market share of only 60 percent in Haywood and 57 percent in Jackson, it doesn’t come close to the definition of a monopoly, MedWest CEO Mike Poore said.

“The contrast to that is Mission’s market share in Buncombe and Madison is north of 94 percent,” Poore said.

What is COPA?

While a bill circulates in Raleigh to limit the dominance of Mission Health System, a state regulatory process is already under way to examine just that issue, independent from the legislation.

Mission is governed by anti-trust regulations dating to its merger with St. Joseph’s 15 years ago. The regulations are up for review, prompting a flurry of debate in the medical community about whether Mission’s ambitions should be curbed or it should be given the freedom it needs to serve as the region’s healthcare leader.

The players

Mission Health System: Memorial Mission merged with St. Joseph’s hospital 15 years ago to form a single, large hospital serving the Asheville area. It has three smaller hospitals under its wing, with plans to add a fourth.

Park Ridge Hospital: Based in Hendersonville and perhaps Mission’s fiercest competitor, Park Ridge is part of Adventist Health System with 43 hospitals in 12 states.

MedWest-Haywood, MedWest-Harris, MedWest-Swain: The hospitals in Haywood, Jackson and Swain counties recently united forming the new entity MedWest and adopting new names in the process. They are 18 months in to a three-year management contract with Carolinas HealthCare System.

Carolinas HealthCare System: As the state’s largest hospital network, the Charlotte-based system has 33 hospitals under its umbrella.

Angel Medical Center: A small standalone hospital in Franklin, Macon County. Angel plan to affiliate with Mission.

A hard-hitting campaign, coupled with a surging Republican tide helped Jim Davis claim the state’s 50th District Senate seat on Tuesday.

Davis, a Macon County resident, beat incumbent state Sen. John Snow, a Cherokee County Democrat. If unofficial election night results stand, then Davis helped give Republicans control of the state Senate for the first time in more than a century . Republicans also took control of the N.C. House.

Davis late Tuesday night described himself as excited, elated and exhausted. The Franklin orthodontist said he intends to continue his dental practice.

Davis will now also resign his seat as a Macon County commissioner, with two years left to his term. He said his understanding is that the county’s Republican Executive Committee, via a subcommittee, will select his replacement.

Davis ran on an economic platform that promises a new policy of frugality. He blamed out-of-control taxing and spending by Democrats for North Carolina’s economic problems. He also said the state has created a climate that is unfavorable for businesses, squelching job creation.

Jim Blaine, head of North Carolina’s Senate Republican Caucus, told The Smoky Mountain News two weeks ago that he believed mountain voters would help overturn Democratic control of the state because of a desire to receive a more equitable distribution of tax dollars when compared with amounts received in the eastern portion of the state.

Snow is a retired District Court judge and prosecutor who had served three terms in the state Senate.

50th Senate District

Jim Davis (R)    30,838

John Snow (D)    30,634